bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Pavement Albedo on Radiative Forcing and Building Energy Demand: Comparative Analysis of Urban Neighborhoods
Authors: Xu Xin , Gregory Jeremy , Kirchain Randolph
Published: September 2018

Albedo is the measure of the ratio of solar radiation reflected by the Earth’s surface. High-albedo reflective surfaces absorb less energy and reflect more shortwave radiation. The change in radiative energy balance at the top-of-atmosphere (TOA), which is called radiative forcing (RF), reduces nearby air temperatures and influences the surrounding building energy demand (BED). The impact of reflective surfaces on RF and BED has been investigated separately by researchers through modeling and observational studies, however, no one has compared RF and BED impacts under the same context and the net effect of these two phenomena remains unclear. This paper presents a comprehensive approach to assess the net impacts of pavement albedo modification strategies in selected urban neighborhoods. We apply an adapted analytical model for RF and a hybrid model framework combining two different models for BED to estimate the impacts of increasing pavement albedo from 0.1 to 0.3 for different urban neighborhoods in Boston and Phoenix. The impact of several context-specific factors, including location, urban morphology, shadings etc., are taken into account in the models. Comparative analysis reveals that the net impact of changing pavement albedo can vary from one neighborhood to another. In Phoenix downtown, reflective pavements create net global warming potential burdens, while increasing pavement albedo results in potential savings in the Boston downtown area. This work provides insights into pavement albedo impacts at urban scale and supports more informed decisions on pavement designs that save energy and counteract some of the effects of global warming.
Assessment of Resource Allocation and Tradeoff Analysis Approaches in Transportation Asset Management
Authors: Bryce James , Rada Gonzalo , Van Hecke Samuel , Zissman Joseph
Published: September 2018

Transportation asset management (TAM) practices continue to grow and to develop as transportation agencies seek to make more objective and defensible decisions, as well as responding to recent legislation. One primary goal of TAM is to provide a structure in which decisions on how to distribute resources across many disparate assets can be made using a systematic process. Resource allocation is analogous to multi-objective optimization, and thus presents the complication that many potential optimal solutions (i.e., a Pareto set) can be found. To solve the multi-objective resource allocation problem, many approaches have been recommended, such as the use of utility theory and weighting functions to express preferences that result in a single solution being selected. This paper discusses those recommendations, as well as describing the current state of the resource allocation process in an effort to identify gaps in practice and, in turn, to provide recommendations for addressing those gaps. First, the process of cross-asset resource allocation is deconstructed to highlight the key steps. Then, current practices identified from the literature, as well as from interviews with five State agencies are discussed. Finally, a set of recommendations for improving resource allocation and the supporting processes within resource allocation are presented.
Bioconversion of Scotch broom into a high-quality organic fertiliser: Vermicomposting as a sustainable option
Authors: Domínguez Jorge , Gómez-Brandón María , Martínez-Cordeiro Hugo , Lores Marta
Published: September 2018

Wild Scotch broom ( Cytisus scoparius (L.) Link) shrubs are widely distributed throughout the world and, in some countries, are considered to be a threat to other plant species. The use of plant biomass from Scotch broom as a fertiliser seems to be the optimum solution for its disposal because it contains considerable amounts of macronutrients. However, its direct application to soils may cause phytotoxicity due to the release of polyphenols, which could negatively affect crop growth. This study evaluated the efficiency of vermicomposting in processing this leguminous plant on an industrial scale. Vermicomposting substantially reduced the biomass of Scotch broom (by 84%), mainly as a result of the loss of volatile solids. Simultaneously, the initial population of earthworms ( Eisenia andrei) increased remarkably throughout the process, offering the possibility of obtaining earthworm protein for animal feed. A nutrient-rich and stabilised peat-like material without polyphenol-associated phytotoxicity was obtained after 42 days of vermicomposting. Lower values of microbial biomass and activity, indicative of stabilised materials, were recorded at the end of the trial. These findings suggest that vermicomposting is an environmentally sound management system for Scotch broom and could easily be scaled up for industrial application.
Effect of Annotation Preferences of the EFL Students’ on Their Level of Vocabulary Recall and Retention
Authors: Gürkan Serkan
Published: September 2018

The contemporary era brings technology into every part of our lives. As a result of technological improvements, education process has been affected and the use of technological devices is inevitable. Teaching language has also been affected by this movement. Thus, Mobile-Assisted Language Learning has gained importance through the recent years. Within light of these, the aim of this study is to understand the effect of annotation use on vocabulary recall and retention levels of English as a foreign language students. A software called Vocastyle was developed for this study. It included annotations that helped students to learn and remember new vocabulary items. The participants of the study were 122 students of a state elementary school in which multimedia learning is benefited at a major city of Turkey. In order to understand whether the use of annotations caused any difference between students’ level of vocabulary recall and retention, the pre-, post-, and delayed posttests were applied. Quantitative data analyses were done via descriptive statistics, chi-square, multivariate analysis of variance, and Kruskal–Wallis and Mann–Whitney U tests. The results implied that learners who used multimedia annotations recalled and retained better than the learners who used paper-based annotations and who received no treatment at all.
Social media engagement in the digital age: Accountability or threats
Authors: Wu Yanfang
Published: September 2018

An online survey of newspaper journalists (N = 1,063) shows engagement is a mediator between social media instructions in newsrooms and perceptions or attitude toward social media. The more journalists are engaged with Twitter, the more they believe social media is accountable and social media is less threatening to journalists, journalism and their news organizations. However, social media accountability is not significantly associated with social media as threats.
Calculation Efficiencies for Mean Numerosity
Authors: Solomon Joshua A. , Morgan Michael J.
Published: September 2018

Relative numerosity is traditionally studied using texture pairs. Observers must decide which member of each pair has the greater total number of texture elements. In the present experiment, textures were segregated into nonoverlapping “sectors” containing between zero and four elements, and our observers were asked to select the texture containing the greater average number of texture elements (per sector). If observers were more sensitive to total numerosity than average numerosity, their performance (quantified by the just-noticeable Weber fraction) should have been better when the two textures occupied the same number of sectors than when they occupied unequal numbers of sectors. However, we recorded Weber fractions between 11% and 13% for all observers in all conditions. This performance was comparable with an otherwise-ideal observer whose decisions were based on between three and five sectors in each texture. We conjecture that traditional numerosity discriminations are based on similarly small numbers of element clusters.
Abrupt mortality of marine invertebrates at the Younger Dryas-Holocene transition in a shallow inlet of the Goldthwait Sea
Authors: Bourgeois-Roy Andréanne , Crites Hugo , Bernatchez Pascal , Lacelle Denis , Martel André
Published: September 2018

The late Pleistocene–early Holocene transition period was characterized by rapid environmental change. Here, we investigate the impact of these changes on the marine invertebrates living in a shallow inlet of the post-glacial Goldthwait Sea. The site is located near Baie-Comeau (QC, Canada), where a number of remarkably well-preserved shell deposits are found along the Rivière aux Anglais Valley on the north shore of the St. Lawrence maritime estuary. Seven phyla of marine invertebrates with a minimum of 25 species or taxa were inventoried in a shell deposit, dominated by a community of Hiatella arctica with Mytilus edulis and barnacles composing the subcommunity. The majority of taxa identified in the shell deposit are boreal and sub-Arctic species; however, temperate species that exist today in the St. Lawrence maritime estuary have not been found. Based on marine invertebrate diversity and δ18O(CaCO3) of Mytilus edulis, the water in the shallow inlet of the Goldthwait Sea must have been cold and saline. The range of AMS 14C ages from 15 Mytilus edulis, constrained to 10,900 and 10,690 cal. yr BP, and exceptional state of preservation of adult and juvenile molluscan specimens suggest the abrupt mortality of entire invertebrate communities due to changing hydrodynamic conditions that included the combined effect of freshwater discharge from the receding Laurentide Ice Sheet and rapid isostatic uplift.
Comparative seismic fragility estimates of steel moment frame buildings with or without superelastic viscous dampers
Authors: Silwal Baikuntha , Huang Qindan , Ozbulut Osman E , Dyanati Mojtaba
Published: September 2018

Superelastic viscous damper is a passive hybrid control device that combines shape memory alloy cables and a viscoelastic damper to mitigate dynamic response of structures subjected to multi-level seismic hazards. In the hybrid device, shape memory alloy cables that exhibit a nonlinear but elastic response are used mainly as re-centering unit, while the viscoelastic damper composed of high-damped butyl rubber compounds is employed to augment the equivalent viscous damping provided by the device. This study evaluates the effectiveness of superelastic viscous dampers in mitigating seismic response of steel frame structures through a probabilistic framework. First, a nine-story steel frame building is designed and modeled with and without superelastic viscous dampers, and extensive nonlinear response-history analyses are conducted. Then, probabilistic demand models are developed for selected engineering demand parameters. To quantitatively compare the performance of the designed buildings, seismic fragility curves and mean annual frequency of exceeding different performance levels are developed. In particular, the structural performance is evaluated using both peak inter-story drift and residual drift responses. Results indicate that superelastic viscous dampers can significantly improve structural performance; thus, it has the potential to lower the post-earthquake losses, as the better structural performance leads to less loss in relocation, rental, and economic loss.
Enhancing Clinical Learning Through an Innovative Instructor Application for ECMO Patient Simulators
Authors: Alsalemi Abdullah , Disi Mohammed Al , Alhomsi Yahya , Bensaali Fayçal , Amira Abbes , Alinier Guillaume
Published: September 2018

Background.Simulation-based learning (SBL) employs the synergy between technology and people to immerse learners in highly-realistic situations in order to achieve quality clinical education. Due to the ever-increasing popularity of extracorporeal membrane oxygenation (ECMO) SBL, there is a pressing need for a proper technological infrastructure that enables high-fidelity simulation to better train ECMO specialists to deal with related emergencies. In this article, we tackle the control aspect of the infrastructure by presenting and evaluating an innovative cloud-based instructor, simulator controller, and simulation operations specialist application that enables real-time remote control of full-scale immersive ECMO simulation experiences for ECMO specialists as well as creating custom simulation scenarios for standardized training of individual healthcare professionals or clinical teams.

Aim. This article evaluates the intuitiveness, responsiveness, and convenience of the ECMO instructor application as a viable ECMO simulator control interface.

Method. A questionnaire-based usability study was conducted following institutional ethical approval. Nineteen ECMO practitioners were given a live demonstration of the instructor application in the context of an ECMO simulator demonstration during which they also had the opportunity to interact with it. Participants then filled in a questionnaire to evaluate the ECMO instructor application as per intuitiveness, responsiveness, and convenience.

Results. The collected feedback data confirmed that the presented application has an intuitive, responsive, and convenient ECMO simulator control interface.

Conclusion. The present study provided evidence signifying that the ECMO instructor application is a viable ECMO simulator control interface. Next steps will comprise a pilot study evaluating the educational efficacy of the instructor application in the clinical context with further technical enhancements as per participants’ feedback.
Orthotropic Liver Transplantation for Acute Intrahepatic Cholestasis in Sickle Cell Disease: Clinical and Histopathologic Features of a Rare Case
Authors: Kwun Lui Shu , Krasinskas Alyssa , Shah Rushikesh , Tracht Jessica M.
Published: September 2018

Sickle cell disease has a wide range of hepatic manifestations, with acute intrahepatic cholestasis being one of the rarest and most fatal, often resulting in acute fulminant hepatic failure. Liver transplantation is an emerging but rarely utilized treatment for hepatic failure in the setting of sickle cell disease. Few such cases have been reported in the literature, with little emphasis on histopathologic correlation. We report a case of acute intrahepatic cholestasis in a patient with sickle cell disease who underwent orthotropic liver transplantation and describe novel correlating histopathologic features. The patient is a 29-year-old man who presented with hyperbilirubinemia, acute kidney injury, and coagulopathy. He was diagnosed clinically with acute intrahepatic cholestasis and received an orthotropic liver transplant. The explanted liver demonstrated marked sinusoidal expansion by sickled erythrocytes, hyperplastic Kupffer cells, and extramedullary hematopoiesis. There was extensive sinusoidal and centrizonal fibrosis with occlusion of central veins reminiscent of chronic sinusoidal obstructive syndrome, a previously undescribed pattern of injury. This case represents one of the few reported cases of sickle cell intrahepatic cholestasis treated by transplantation and demonstrates the rarely reported histopathologic features and gives insight to a potentially new mechanism of injury in these patients. Familiarity with the morphologic features of sickle cell hepatopathy and its clinical manifestations is important as transplantation in sickle cell–related liver injury increases in frequency.
A Coordinated Analysis of Variance in Affect in Daily Life
Authors: Scott Stacey B. , Sliwinski Martin J. , Zawadzki Matthew , Stawski Robert S. , Kim Jinhyuk , Marcusson-Clavertz David , Lanza Stephanie T. , Conroy David E. , Buxton Orfeu , Almeida David M. , Smyth Joshua M.
Published: September 2018

Despite widespread interest in variance in affect, basic questions remain pertaining to the relative proportions of between-person and within-person variance, the contribution of days and moments, and the reliability of these estimates. We addressed these questions by decomposing negative affect and positive affect variance across three levels (person, day, moment), and calculating reliability using a coordinated analysis of seven daily diary, ecological momentary assessment (EMA), and diary-EMA hybrid studies (across studies age = 18-84 years, total Npersons = 2,103, total Nobservations = 45,065). Across studies, within-person variance was sizeable (negative affect: 45% to 66%, positive affect: 25% to 74%); in EMA more within-person variance was attributable to momentary rather than daily level. Reliability was adequate to high at all levels of analysis (within-person: .73-.91; between-person: .96-1.00) despite different items and designs. We discuss the implications of these results for the design of future intensive studies of affect variance.
Room 329: Silencing the Voices in the Cleveland School of the Arts
Authors: Weems Mary E.
Published: September 2018

Rm. 329 chronicles an unexpected experience during a playwriting residency at a Cleveland, Ohio arts school. It’s an exemplar of what’s possible when student activists organize to protest against institutional racism and for education as the practice of freedom.
Stability and visual outcomes yielded by three intraocular trifocal lenses with same optical zone design but differing material or toricity
Authors: Poyales Francisco , Garzón Nuria , Pizarro Daniel , Cobreces Santiago , Hernández Adolfo
Published: September 2018

Purpose:

To compare rotational stability, centration and visual outcomes provided by three trifocal lens models that have the same optical zone design but different material, composition, and/or toricity.

Methods:

The study included 78 patients with symmetric bilateral intraocular lens implantation. The lenses under evaluation were trifocal intraocular lenses made of hydrophilic acrylic material: a spherical lens 26% hydrophilic acrylic (POD FineVision), a similar lens but having a toric design (POD Toric FineVision), and a trifocal lens 25% hydrophilic acrylic material (FineVision/MicroF). Moreover, the lenses share the same optical zone design. The lenses’ rotational stability and centration were measured by means of the PIOLET software, which relies on recording and image processing techniques to determine lens rotation and centration based on slit-lamp images. We also assessed patients’ visual quality by means of 25, 40, and 80 cm VA tests.

Results:

The best centration results were achieved with the POD Toric FineVision model, although the differences were not statistically significant. As for lens rotation, it was below 5° in all cases under study. Regarding VA, all subjects attained at least 0.3 logMAR for far distance uncorrected VA, at 80 cm VA was about 0.2 logMAR, at 40 cm it was above 0.15 logMAR, and at 25 cm it was about 0.3 logMAR for both lens types.

Conclusion:

All three intraocular lens models yield excellent visual results at far, near as well as intermediate distances. The POD FineVision and POD Toric FineVision models, with double C-loop design, yielded the best results centration-wise and rotation-wise. Differences had no clinical relevance.
Acoustic performance of brick masonry walls: Construction defects and influence of installations
Authors: Labres Henrique , de Oliveira Maria Fernanda , Pacheco Fernanda , Patrício Jorge , Tutikian Bernardo
Published: September 2018

Construction defects, even visually untraceable, can forfeit the acoustic performance of systems. The execution of the systems is a parameter that is hard to control. This article aims to evaluate construction defects. Wall system samples of real proportions were made with induced defects. In comparison with the reference, reductions of 1 dB were found for the samples with defective gaps above the wall and 2 dB for the trials with no vertical filling. Regarding the samples with installations, this reduction reached 1 and 3 dB for samples with installation of electrical junction boxes at the same face and two on each face, respectively.
Effects of a Combined Semantic Feature Analysis and Multimodal Treatment for Primary Progressive Aphasia: Pilot Study
Authors: Rebstock Alicia M. , Wallace Sarah E.
Published: September 2018

Primary progressive aphasia (PPA) is a neurodegenerative condition characterized by language and cognitive decline. Word-retrieval deficits are the most common PPA symptom and contribute to impaired spoken expression. Intense semantic interventions show promise for improving word retrieval in people with PPA. In addition, people with PPA may learn to use alternative communication modalities when they are unable to retrieve a word. However, executive function impairments can cause people to struggle to switch among modalities to repair communication breakdowns.This study examined the effects of a combined semantic feature analysis and multimodal communication program (SFA+MCP) on word-retrieval accuracy, switching among modalities, and overall communicative effectiveness in a person with PPA. An adult female with PPA completed SFA+MCP. Baseline, probe, intervention, and postintervention sessions were completed to measure word-retrieval accuracy and switching between communication modalities. A postintervention listener task was completed to measure communicative effectiveness. Changes in word-retrieval accuracy and switching were minimal. However, the listeners’ identification of the participant’s communication attempts was more accurate following treatment, suggesting increased overall communicative effectiveness. Further investigations of SFA+MCP, specifically relative to timing, intensity, and appropriate modifications for people with cognitive impairments associated with PPA are warranted.
Decreased Expression of ZWINT is Associated With Poor Prognosis in Patients With HCC After Surgery
Authors: Yang Xiao-Yu , Wu Bin , Ma Sen-Lin , Yin Lei , Wu Meng-Chao , Li Ai-Jun
Published: September 2018

Background:

ZW10 interactor was recently reported to correlate with human cancers. However, the prognostic value of ZW10 interactor in hepatocellular carcinoma was not reported.

Methods:

The expression level of ZW10 interactor was evaluated by Western blot and immunohistochemistry using tissue microarray. In the present study, we used 5 pairs of hepatocellular carcinoma and peritumoral frozen tissues for Western blot, and 70 paired paraffin-embedded hepatocellular carcinoma and peritumoral tissues as expression pattern cohort (cohort 1), and 280 paraffin-embedded hepatocellular carcinoma tissues were used as prognostic cohort (cohort 2). The integral optic density representing the expression level of ZW10 interactor in each tissue sample, was calculated using Image-Pro Plus. The integral optic density was added to the X-tile software for calculating the outcome-based cut point. Kaplan-Meier and Cox regression were used to evaluate the prognostic values.

Results:

The expression level ZW10 interactor was decreased in hepatocellular carcinoma tissues in 85.7% (60/70) of the cases compared to the corresponding peritumoral tissues evaluated by immunohistochemistry. Similar result was obtained by Western blot analysis using frozen tissue. Expression of ZW10 interactor was closely correlated with age ( P = .0001) and liver cirrhosis in cohort 1 and tumor node metastasis ( P = .018), tumor size ( P = .005), and vascular invasion ( P = .022) in cohort 2 based on χ2 analyses. Survival analyses indicated that patients with hepatocellular carcinoma having low ZW10 interactor expression had a shorter overall survival time and time to recurrence compared to cases with high ZW10 interactor expression in the prognostic cohort ( P < .0001 for both overall survival and time to recurrence ). Univariate and multivariate Cox analyses indicated that ZW10 interactor was an independent prognostic factor for overall survival ( P = .033).

Conclusions:

The present study clearly showed that ZW10 interactor was frequently decreased in hepatocellular carcinoma compared to nontumoral liver tissues, and ZW10 interactor could serve as a potential prognostic marker in patients with hepatocellular carcinoma after surgery.
A plane strain testing apparatus characterized by flexible loading and noncontact deformation measurement and its application to the study of shear band failure of sand
Authors: Tang Hongxiang , Du Tao , Zhang Lijuan , Shao Longtan
Published: September 2018

A new type of plane strain apparatus is developed to study the mechanical properties and shear band failure of soil, which possesses the advantages of flexible loading for lateral confining pressure and noncontact measurement and high measurement accuracy for surface deformation. In addition, the whole deformation procedure of the specimen can be recorded with images, which can be used to describe the development of strain localization and the shear band. It can be seen that the deformation process has three obvious stages, that is, the hardening stage, the softening stage, and the residual stage. The measured inclination angles of shear bands decrease as confining pressure or the mean size increases. In addition, it can be observed that the sand presents continuing growth of the unrecoverable plastic deformation inside the shear band and exhibits almost elastic deformation outside. From the detection results for local points in the specimen, the stress–strain relationships are different for different parts, and the sand sample behaves like an uneven structure instead of an even element, which means that the usual method of measuring the stress–strain relationship of the soil sample is only a macroscopic approximation.
OneShot-M: A New Device for Close Laparoscopy Pneumoperitoneum
Authors: Cassata Giovanni , Palumbo Vincenzo , Cicero Luca , De Luca Antonino , Damiano Giuseppe , Fazzotta Salvatore , Buscemi Salvatore , Lo Monte Attilio Ignazio
Published: September 2018

Introduction. The induction of pneumoperitoneum is the first and most critical phase of laparoscopy, due to the significant risk of serious vascular and visceral complications. The closed technique for the creation of pneumoperitoneum could lead to several surgical complications. The present study aimed to overcome the complications associated with the insertion of Veress needle, improving its use, and facilitating the rapid creation of pneumoperitoneum. Methods. Thirty large white female pigs were enrolled in our study. A common plunger was modified in order to allow the passage of a 15-cm long Veress needle. This method was applied to 26 laparoscopic procedures (26 pigs) of several specialist branches. Results. OneShot-M close laparoscopy pneumoperitoneum creation device allowed us to obtain pneumoperitoneum quickly in all attempts, without any intraoperative and postoperative complications related to the use of the Veress needle. Conclusion. The use of the proposed device showed an induction time as quick as the standard laparoscopic closed abdominal entry. The patented device is cheap and allows a safe abdominal entry. In addition, abdominal entry is much faster than the classic open technique.
A novel analytical model for straightening process of rectangle-section metal bars considering asymmetrical hardening features
Authors: Zhang Yongquan , Lu Hong , Zhang Xinbao , Fan Wei , Ling He , Wei Qinyu , Ma Mingtian
Published: September 2018

The applied straightening moment and the springback after unloading with respect to the straightening process of rectangle-section metal bars have a direct influence on the straightening accuracy and efficiency. In this article, an asymmetrical hardening material model is first proposed to describe the stress–strain curves considering the asymmetrical features of yield stress and plastic hardening stage in tension and compression, and it is also compared with the traditional linear hardening material model. To accurately evaluate the elasto-plastic bending deformation and the springback in the straightening process, an analytical model for the loading and unloading moments is then established. The strain and stress distributions in elastic and plastic regions during the straightening process are also discussed in this article. Finally, the straightening experiments of rectangle-section metal bars under different heat-treated conditions are conducted on the ROSE-JZ50 straightening machine with displacement sensors, force sensors and strain gauges to validate the proposed analytical straightening model.
Solving the nuclear dilemma: Is a world state necessary?
Authors: Craig Campbell
Published: September 2018

The unique dangers raised by the possibility of nuclear warfare have long prompted intensive debates about what political action is needed to avoid it. While most scholars contend that it is possible to prevent a nuclear war without fundamental political change, others argue that a substantial solution to the problem demands the abolition of the existing interstate system. Two such ‘radical’ positions are the ‘Weberian’ school, which insists that an authoritative world state is necessary, and Daniel Deudney’s alternative, a liberal order based upon republican traditions of mutual restraint, internal power balancing and powerful arms control institutions. In this essay, I argue, using both historical and theoretical analysis, that the regime Deudney envisions would amount to the establishment of a Pax Americana. This would be rejected by illiberal nuclear powers and therefore fail to solve the nuclear problem.
Twitter Analysis of #OpenAPS DIY Artificial Pancreas Technology Use Suggests Improved A1C and Quality of Life
Authors: Litchman Michelle L. , Lewis Dana , Kelly Lesly A. , Gee Perry M.
Published: September 2018

Background:

Patient-driven innovation in diabetes management has resulted in a group of people with type 1 diabetes who choose to build and share knowledge around a do-it-yourself (DIY) open source artificial pancreas systems (OpenAPS). The purpose of this study was to examine Twitter data to understand how patients, caregivers, and care partners perceive OpenAPS, the personal and emotional ramifications of using OpenAPS, and the influence of OpenAPS on daily life.

Methods:

Qualitative netnography was used to analyze #OpenAPS on Twitter over a two-year period.

Results:

There were 328 patients, caregivers, and care partners who generated 3347 tweets. One overarching theme, OpenAPS changes lives, and five subthemes emerged from the data: (1) OpenAPS use suggests self-reported A1C and glucose variability improvement, (2) OpenAPS improves sense of diabetes burden and quality of life, (3) OpenAPS is perceived as safe, (4) patient/caregiver–provider interaction related to OpenAPS, and (5) technology adaptation for user needs.

Conclusions:

As users of a patient-driven technology, OpenAPS users are self-reporting improved A1C, day-to-day glucose levels, and quality of life. Safety features important to individuals with diabetes are perceived to be embedded into OpenAPS technology. Twitter analysis provides insight on a patient population driving an innovative solution to improve their quality of diabetes care.
Development and Implementation of a Subcutaneous Insulin Clinical Decision Support Tool for Hospitalized Patients
Authors: Mathioudakis Nestoras , Jeun Rebecca , Godwin Gerald , Perschke Annette , Yalamanchi Swaytha , Everett Estelle , Greene Peter , Knight Amy , Yuan Christina , Hill Golden Sherita
Published: September 2018

Background:

Insulin is one of the highest risk medications used in hospitalized patients. Multiple complex factors must be considered in determining a safe and effective insulin regimen. We sought to develop a computerized clinical decision support (CDS) tool to assist hospital-based clinicians in insulin management.

Methods:

Adapting existing clinical practice guidelines for inpatient glucose management, a design team selected, configured, and implemented a CDS tool to guide subcutaneous insulin dosing in non–critically ill hospitalized patients at two academic medical centers that use the EpicCare® electronic medical record (EMR). The Agency for Healthcare Research and Quality (AHRQ) best practices in CDS design and implementation were followed.

Results:

A CDS tool was developed in the form of an EpicCare SmartForm, which generates an insulin regimen by integrating information about the patient’s body weight, diabetes type, home and hospital insulin requirements, and nutritional status. Total daily recommended insulin doses are distributed into respective basal and nutritional doses with a tailored correctional insulin scale. Preimplementation, several approaches were used to communicate this new tool to clinicians, including emails, lectures, and videos. Postimplementation, a support team was available to address user technical issues. Feedback from stakeholders has been used to continuously refine the tool. Inclusion of the programming in the EMR vendor’s community library has allowed dissemination of the tool outside our institution.

Conclusions:

We have developed an EMR-based tool to guide SQ insulin dosing in non–critically ill hospitalized patients. Further studies are needed to evaluate adoption and clinical effectiveness of this intervention.
Influence of Color in a Lactation Room on Users’ Affective Impressions and Preferences
Authors: López-Tarruella Juan , Llinares Millán Carmen , Serra Lluch Juan , Iñarra Abad Susana , Wijk Helle
Published: September 2018

Objective:

The present study aims to examine the influence of environmental color hue in a lactation room at a health center on users’ affective response and preference.

Background:

Hospital design plays an important role in the emotional experience of patients. In this regard, many studies have attempted to find relationships between design variables and healthcare facilities users’ response. Color has been frequently examined because it is always present in the environment and can be easily changed. However, most of the studies dealing with color–emotion relationships acquire users’ affective response by questionnaires developed by experts which could lead to inaccurate results since nonexperts may misunderstand concepts set by experts and use nonimmersive images to simulate the environments to assess.

Methods:

To overcome these limitations, a Kansei Engineering–based approach was proposed. In the first phase, users’ specific affective factors for lactation rooms were determined using Semantic Differential. In the second phase, the influence of nine different color hues on users’ affective factors was obtained. An immersive display system was used to visualize the room altering hues in an isolated and controlled way.

Results:

(1) Six user’s affective factors connected to the lactation rooms were discovered: safety, elegance, coziness, spaciousness, simplicity, and luminosity, of which coziness has the most impact on the assessment of the room. (2) Warm colors like orange and yellow tend to score highly for coziness which puts them in leading positions when users’ assess lactation rooms.

Conclusions:

Results provide recommendations for designers and show the advantages of using semantic differential and immersive displays to analyze user’s affective response to environments.
A Retrospective Analysis of Prolonged Empiric Antibiotic Therapy for Pneumonia Among Adult Neurocritical Care Patients
Authors: Patzke Ciera L. , Armahizer Michael J. , Badjatia Neeraj , Motta Melissa
Published: September 2018

Background and Purpose:

Current literature reports that half of critically ill patients are continued on broad-spectrum antibiotics beyond 72 hours despite no confirmed infection. The purpose of this retrospective study was to identify the incidence of and risk factors for prolonged empiric antimicrobial therapy (PEAT) in adult neurocritical care (NCC) patients treated for pneumonia, hypothesizing that NCC patients will have a higher incidence of PEAT.

Methods:

This is a retrospective chart review of adult NCC patients treated for pneumonia. Antibiotic therapy was classified as restrictive, definitive, or PEAT based on culture results and timing of discontinuation or de-escalation.

Results:

A total of 95 patients (median age: 57 years; 28.4% female; admission diagnosis: 73.7% cerebrovascular, 10.5% neuromuscular, and 15.8% seizure-related) were included in this study. Overall, 59% of antibiotic regimens were considered PEAT, with vancomycin and piperacillin/tazobactam being most commonly prescribed. Median duration of therapy was 6.8 days, with shorter duration in patients with negative culture results compared to those with positive culture results (6.1 days [interquartile range, IQR 4.0-8.3] vs 7.2 days [IQR 5.8-10.3], P < .05). On multivariable analysis, elevated baseline white blood cell count, meeting Centers for Disease Control criteria for pneumonia, and negative bacterial culture were significantly associated with PEAT.

Conclusion:

The incidence of prolonged empiric antibiotic use was high in the NCC population. Patients are at particular risk for PEAT if they have negative cultures. All but one patient did not meet criteria for central fever, highlighting the challenges in identifying fever etiology in the NCC population.
Chronic pain: a consequence of dysregulated protective action
Authors: Hill Patrick
Published: September 2018

Introduction:

Pain is considered to be one of a number of idiosyncratic, context-dependent ‘protective actions’ projected into the conscious domain by the central nervous system (CNS), as a result of a series of complex interactions in response to perceived threat. A model is described which proposes chronic pain and a variety of long-term, systemic functional neurological conditions to be a consequence of significant dysregulation of these protection systems.

The Model:

Previous research has demonstrated that a cognitive–behavioural model, first described in 1995 by Surawy et al., for chronic fatigue has been successful in predicting the transition from acute to chronic states in a number of conditions. This model includes predisposing, precipitating and perpetuating biopsychosocial factors. This article discusses the potential role of these factors in affecting descending inhibition in the CNS, significantly altering its ability to modulate the threat detection system. The development of ‘central sensitisation’ is considered in this context.

Conclusion:

This model proposes that chronic pain, chronic fatigue and other so-called functional neurological phenomena can, perhaps, be more helpfully seen as the actions of a dysregulated neurological protection system, rather than symptoms of an untreatable and deteriorating medical condition. Recommendations are made for the development of appropriate therapeutic interventions indicated by this model.
Using Social Network Analysis in the Classroom: An Experiential Activity and Tool to Enhance a Sense of Community
Authors: Dunn Mary B.
Published: September 2018

This article presents an experiential exercise where students learn the basics of social network analysis, relate social networks to social capital, and analyze their own networks in the classroom. Instructors of all types of courses at both the undergraduate and graduate levels can use this activity to teach students about social networks and build a greater sense of community in the classroom. This article provides instructions for collecting students’ social network data, teaching students about social networks as the basis for social capital, guiding students through basic social network analyses, and facilitating a discussion about ways to increase social capital for individuals and collectives. While engaging in this activity, students have opportunities to interact with other students and build high-quality relationships. In doing so, this exercise can facilitate a greater sense of community in the classroom, enrich the social capital for the collective, and promote students’ learning.
Maximizing Benefit and Minimizing Risk in Medical Imaging Use: An Educational Primer for Health Care Professions Students
Authors: Armao Diane , Hartman Terry S , Shea Christopher M , Katz Laurence , Thurnes Tracey , Smith J Keith
Published: September 2018

“I am not young enough to know everything.” Oscar Wilde

Background:

There is insufficient knowledge among providers and patients/caregivers of ionizing radiation exposure from medical imaging examinations. This study used a brief, interactive educational intervention targeting the topics of best imaging practices and radiation safety early in health professions students’ training. The authors hypothesized that public health, medical, and physician assistant students who receive early education for imaging appropriateness and radiation safety will undergo a change in attitude and have increased awareness and knowledge of these topics.

Materials and methods:

The authors conducted a 1.5-hour interactive educational intervention focusing on medical imaging utilization and radiation safety. Students were presented with a pre/postquestionnaire and data were analyzed using t tests and multivariate analysis of variance.

Results:

A total of 301 students were enrolled in the study. There was 58% ( P < .01) and 85% ( P < .01) improvement in attitude and knowledge regarding appropriateness of imaging, respectively. The authors also found an 8% increase ( P < .01) in students who thought informed consent should be obtained prior to pediatric computed tomographic imaging. Physical assistant students were more likely than medical students to prefer obtaining informed consent at baseline ( P = .03).

Conclusions:

A brief educational session provided to health professions students early in their education showed an increased awareness and knowledge of the utility, limitations, and risks associated with medical imaging. Incorporation of a best imagining practice educational session early during medical education may promote more thoughtful imaging decisions for future medical providers.
Single-cell heterogeneity in Sézary syndrome
Authors: Buus Terkild Brink , Willerslev-Olsen Andreas , Fredholm Simon , Blümel Edda , Nastasi Claudia , Gluud Maria , Hu Tengpeng , Lindahl Lise M. , Iversen Lars , Fogh Hanne , Gniadecki Robert , Litvinov Ivan V. , Persson Jenny L. , Bonefeld Charlotte Menné , Geisler Carsten , Christensen Jan Pravsgaard , Krejsgaard Thorbjørn , Litman Thomas , Woetmann Anders , Ødum Niels
Published: September 2018

Key Points

Individual patients with Sézary syndrome contain several distinct malignant subpopulations and show marked single-cell heterogeneity. Malignant subpopulations exhibit differences in their sensitivity to treatment warranting precision therapy.
Patient Factors Associated With Delays in Obtaining Cancer Care in Botswana
Authors: Bhatia Rohini K. , Rayne Sarah , Rate William , Bakwenabatsile Lame , Monare Barati , Anakwenze Chidinma , Dhillon Preet , Narasimhamurthy Mohan , Dryden-Peterson Scott , Grover Surbhi
Published: September 2018

Purpose

Delays in diagnosis and treatment of cancers can lead to poor survival. These delays represent a multifaceted problem attributable to patient, provider, and systemic factors. We aim to quantify intervals from symptom onset to treatment start among patients with cancer in Botswana and to understand potential risk factors for delay.

Patients and Methods

From December 2015 to January 2017, we surveyed patients seen in an oncology clinic in Botswana. We calculated proportions of patients who experienced delays in appraisal (between detecting symptoms and perceiving a reason to discuss them with provider, defined as > 1 month), help seeking (between discussing symptoms and first consultation with provider, defined as > 1 month), diagnosis (between first consultation and receiving a diagnosis, defined as > 3 months), and treatment (between diagnosis and starting treatment, defined as > 3 months).

Results

Among 214 patients with cancer who completed the survey, median age at diagnosis was 46 years, and the most common cancer was cancer of the cervix (42.2%). Eighty-one percent of patients were women, 60.7% were HIV infected, and 56.6% presented with advanced cancer (stage III or IV). Twenty-six percent of patients experienced delays in appraisal, 35.5% experienced delays help seeking, 63.1% experienced delays in diagnosis, and 50.4% experienced delays in treatment. Patient income, education, and age were not associated with delays. In univariable analysis, patients living with larger families were less likely to experience a help-seeking delay (odds ratio [OR], 0.31; P = .03), women and patients with perceived very serious symptoms were less likely to experience an appraisal delay (OR, 0.45; P = .032 and OR, 0.14; P = .02, respectively).

Conclusion

Nearly all patients surveyed experienced a delay in obtaining cancer care. In a setting where care is provided without charge, cancer type and male sex were more important predictors of delays than socioeconomic factors.
Violence Work
Authors: Seigel Micol
Published: September 2018

In Violence Work Micol Seigel offers a new theorization of the quintessential incarnation of state power: the police. Foregrounding the interdependence of policing, the state, and global capital, Seigel redefines policing as “violence work,” showing how it is shaped by its role of channeling state violence. She traces this dynamic by examining the formation, demise, and aftermath of the U.S. State Department's Office of Public Safety (OPS), which between 1962 and 1974 specialized in training police forces internationally. Officially a civilian agency, the OPS grew and operated in military and counterinsurgency realms in ways that transgressed the borders that are meant to contain the police within civilian, public, and local spheres. Tracing the career paths of OPS agents after their agency closed, Seigel shows how police practices writ large are rooted in violence—especially against people of color, the poor, and working people—and how understanding police as a civilian, public, and local institution legitimizes state violence while preserving the myth of state benevolence.
Regulation of energy metabolism during early mammalian development: TEAD4 controls mitochondrial transcription
Authors: Kumar Ram P. , Ray Soma , Home Pratik , Saha Biswarup , Bhattacharya Bhaswati , Wilkins Heather M. , Chavan Hemantkumar , Ganguly Avishek , Milano-Foster Jessica , Paul Arindam , Krishnamurthy Partha , Swerdlow Russell H. , Paul Soumen
Published: September 2018

Early mammalian development is critically dependent on the establishment of oxidative energy metabolism within the trophectoderm (TE) lineage. Unlike inner cell mass (ICM), TE cells enhance ATP production via mitochondrial oxidative phosphorylation (OXPHOS) and this metabolic preference is essential for blastocyst maturation. However, molecular mechanisms that regulate establishment of oxidative energy metabolism in TE cells are incompletely understood. Here, we show that conserved transcription factor TEAD4, which is essential for pre-implantation mammalian development, regulates this process by promoting mitochondrial transcription. In the developing TE and TE-derived trophoblast stem cells (TSCs), TEAD4 localizes to mitochondria, binds to mitochondrial DNA (mtDNA) and facilitates mtDNA transcription by recruiting mitochondrial RNA Polymerase (POLRMT). Loss of TEAD4 impairs recruitment of POLRMT, resulting in reduced expression of mtDNA-encoded electron transport chain components, thereby inhibiting oxidative energy metabolism. Our studies identify a novel TEAD4-dependent molecular mechanism that regulates energy metabolism in the TE lineage to ensure mammalian development.