bluuebunny/crossref_metadata_2025 huggingface dataset:
Coiled Tubing Drilling: Case Study, New Zealand
Authors: Kariminejad Soheil , Lundin Henrik , Horvath Lucas , Sweet Steven
Published: March 2018

While the oil and gas market continues to fluctuate, operators are forced to reduce drilling costs and increase efficiency to remain profitable; therefore, the focus on well reentry, sidetracks, and multilaterals from existing wellbores is growing in popularity, particularly within Australasia. Coiled tubing drilling (CTD) technology has been explored in New Zealand; however, successfully executed operations have so far been limited. After evaluating economic benefits and finding a suitable candidate trial well, a Canadian-based operator attempted a CTD operation in New Zealand that was technically successful.

This case history outlines the two-phase project and discusses well intervention to isolate existing perforations and the sidetrack from the primary motherbore to drill to the base of the new reservoir. The objectives were to convert the suspended well from an oil producer to a water injector, enhance oil recovery within the field, and prolong oil production by reviving an underused asset. This paper discusses the engineering and technology used as well as regulatory obstacles and challenges encountered that were overcome to reach the operator’s objective.

A 2 7/8-in. coiled tubing (CT) string was used for both phases of the operation, spanning intervention and drilling to perform all scheduled operations as efficiently as possible. The resulting completion, post-sidetrack, was to incorporate the CT workstring with approximately 100 m of a perforated 2 7/8-in. jointed pipe to maintain openhole stability across the injection zone.
Redefining Pressure Deployment
Authors: Shampine Rod , Zsolt Liam , Higgins Stephen , Aftab Saif , Flander Mattias , Bronga Jaime , Mielke Rob
Published: March 2018

As coiled tubing (CT) has matured as a service, the complexity and length of toolstrings has increased. Today, even with a 100-ton crane, operators are often required to make multiple runs rather than employ a single toolstring. In environments where lifting heights are more limited, such as mast-based CT units (CTUs), this can lead to many runs and inefficient operations. Historically, deploying tools in sections hung off in a blowout preventer (BOP) has been used to address this. However, this solution has typically been avoided because of the complexity and hazard of the operation. The groundwork for improving this operation was laid out by Thomeer and Eslinger in their 1992 paper, Safe Deployment of Specialized Coiled-Tubing Tools in Live Wells (SPE-24621MS presented at the SPE Annual Technical Conference and Exhibition). The present work was done to improve the safety and efficiency of the entire bar deployment operation. It was first used in Alaska to deploy 560 feet of perforating guns where it replaced 26 runs with 3 logging runs and 3 perforating runs, saving 5.8 CTU days.
New Initiation System Delivers Improved Perforating Safety and Reliability While Maximizing Efficiency
Authors: Aboelnaga S. , Austin D. , Garcia-Osuna F. , Goodman K. , Fayard A. J. , Bouloudene S. , Mohamed Yasser
Published: March 2018

In the perforating industry, operators, service companies, and manufacturers are constantly looking to improve shaped-charge performance and product quality and reliability while ensuring the highest levels of safety. More recently, there has been a heightened urgency to deliver improved operational efficiency considering recent industry downturns and the need to become more cost efficient. A new wireline perforating initiation system has been developed that addresses current industry challenges by improving reliability and efficiency while also improving the overall safety of wireline perforating operations.

The development of a new initiation system for the conventional perforating market has built upon existing technologies previously developed for the unconventional market. The initiator system follows the guidelines of API RP67, fourth edition (in review at the time of publication), and has undergone detailed testing and validation before introduction to the field. The design has been qualified as an APIRP67 Group 2 initiator, which allows use without requiring radio silence in the conventional exclusion area. Field testing has demonstrated that the simplification of the preparation and arming process significantly improves operational efficiency and reduces the risk of human error. Additionally, by eliminating parts and simplifying maintenance, system reliability and usability is further improved. Selective guns are much simpler to prepare and arm, making the utilization of such gunstrings more appealing in areas where, in the past, they may not have been viable due to the additional complexity and/or associated arming time.

This new gun system is currently being deployed in several areas around the world and has shown that it can deliver step-change improvements in reliability and efficiency with improved operational safety when working with explosives in wireline operations. This will have a significant impact on perforating operations, improving the safety of the field workforce while simultaneously improving operational efficiency.
Utilizing Ultrasonic Imaging Technology to Evaluate a Lateral Entry Module
Authors: Solberg Marianne , Sullivan Michael , Drake Steve G. , Rommetveit Tarjei , Troup Duncan , Johns Joel
Published: March 2018

As a result of improved drilling and completion techniques, an increasing number of wells worldwide utilize multilateral systems to minimize the number of surface penetrations required to maximize reservoir contact. However, these systems increase the complexity, which in turn introduces new failure modes and challenges related to inspection of erroneous completions. The scanning range and measurement capabilities utilizing ultrasound imaging techniques provide a new solution for well diagnosis of multi-lateral completions.

Several attempts to enter the upper lateral of a multi-lateral well operated by a major oil company in Alaska, USA had been unsuccessful. Different technologies were attempted to diagnose the problem but no conclusive results were obtained. In May 2017, an ultrasonic imaging technique based on medical ultrasound imaging was used to inspect the Lateral Entry Modules (LEMs). This paper presents the data collected by an ultrasound downhole scanner demonstrating a novel method for diagnosing multi-lateral wells.

The ultrasound downhole scanner utilizes established technology applied in medical ultrasound imaging (e.g. Angelsen 2000) to obtain images and measurements of downhole completion components. A 288 element, 3.3MHz circumferential ultrasound transducer array combined with electronic beamforming allows the flexibility to optimize image quality for different tubing sizes with no moving parts. The transducer operates in pulse-echo mode. Logging is performed dynamically with images obtained real-time. In 2011, the scanner was used to measure damages in sand screens (Hyde-Barber et al.) and has since 2009 been used to image and measure downhole completion components worldwide.

The possibly defective LEM was investigated by the scanner. A reference scan of a fully functional LEM in the same well was also made and the results from the two compared. The ultrasound data, visualized both as 2D grey-scale images and 3D-rendered images, clearly show that the upper LEM assembly was not properly aligned with the window of the lateral. Thus, explaining the past unsuccessful attempts to enter the completion. Measurements were made directly on the ultrasound images to document the findings. The results from the survey helped the customer to understand the situation of their well and gave information which was valuable for the decision making process.
Electric Line Deployed Orientated Suction Cleanout Device Enables Gas Lift Valve Retrieval from Debris Blocked Side Pocket Mandrel in a Highly Deviated Well
Authors: Murchie Stuart , Gjertsen John , Grødem Magne , Sætrevik Martin Severin , Osaland Espen , Sørensen Peter Lykke , Hansen Steen Korsgaard
Published: March 2018

The client had a leaking gas lift valve (GLV), which needed to be replaced to restore the integrity of the well. The side pocket mandrel (SPM), was located at a high angle part of the well, positioned on the low side and sand debris had accumulated in and around the GLV, impairing its retrieval. Tests carried out on surface to attempt to latch a GLV through the sand proved ineffective, even with jarring.

To further optimise production, SPMs are being installed at increasing well depths, enabling deeper gas injection into the tubing. Placing SPMs into the high angle section of deviated wells inherently increases the risk of them retaining debris, as was the case in this well. A novel solution, to remove the accumulated sand debris from the SPM was proposed, utilising an orientation sub, run in conjunction with an electric line deployed tractor-suction tool configuration, incorporating a bespoke side facing inlet nozzle.

Tests on the designed solution were conducted in the engineering facility, recreating the deviation, orientation and debris expected and evaluating the nozzle alignment and cleanout capability for the expected debris type. These tests proved to be highly successful, giving the customer the confidence to perform the job. The deviation also necessitated electric line tractor deployment of a modified retrieval device. Following a drift and plug setting run, the well tractor and suction tool assembly was deployed and two litres of sand was collected from within the SPM. The subsequent run to pull the faulty GLV was successful, as was the deployment of a replacement GLV.

The operation proved this to be an excellent and highly effective example of a rapidly designed and tested, bespoke, electric line deployed SPM cleanout solution.
Área de Proteção Ambiental (APA) da Barra Grande em Icapuí-CE: Caminhos para a Sustentabilidade
Authors: De Andrade Meireles Antonio Jeovah , Arimatea da Silva José , Souza Wallason Farias de
Published: March 2018

O estuário Barra Grande, localizado no litoral de Icapuí, extremo Leste do Ceará, é composto por sistemas ambientais de extrema importância socioeconômica para o litoral cearense. Está inserido na diversidade de componentes geoambientais e ecológicos da planície costeira, tendo o ecossistema manguezal como síntese das conexões entre os componentes tipicamente costeiros (planície de maré, laguna, dunas, falésias e praias), com os marinhos (delta de maré e bancos de algas). O objetivo da pesquisa foi realizar zoneamento ambiental da Área de Proteção Ambiental (APA) da Barra Grande, envolvendo os sistemas ambientais adjacentes para aprimorar os instrumentos de gestão. A gestão foi proposta através de zoneamento ambiental a partir de diagnóstico e mapas temáticos. Foi possível constatar os impactos ambientais (principalmente os relacionados com a carcinicultura e indústria salineira), para a formulação das zonas de diversidade de usos, de conservação e de preservação. Como resultado, foi realizado diagnóstico geoambiental e proposta de zoneamento.
Identifying explosive behavioral trace in the CNX Nifty Index: a quantum finance approach
Authors: Ghosh Bikramaditya , Kozarević Emira
Published: March 2018

The financial markets are found to be finite Hilbert space, inside which the stocks are displaying their wave-particle duality. The Reynolds number, an age old fluid mechanics theory, has been redefined in investment finance domain to identify possible explosive moments in the stock exchange. CNX Nifty Index, a known index on the National Stock Exchange of India Ltd., has been put to the test under this situation. The Reynolds number (its financial version) has been predicted, as well as connected with plausible behavioral rationale. While predicting, both econometric and machine-learning approaches have been put into use. The primary objective of this paper is to set up an efficient econophysics’ proxy for stock exchange explosion. The secondary objective of the paper is to predict the Reynolds number for the future. Last but not least, this paper aims to trace back the behavioral links as well.
The role of adaptation in mobile technology innovation for the water, sanitation and hygiene sector
Authors: Murthy Sharmila L. , Shemie Daniel , Bichai Françoise
Published: March 2018

While the growing availability of mobile phones has commanded the attention of the development community, an estimated 844 million people continue to lack access to basic drinking water and 2.3 billion to adequate sanitation. Development has now begun of mobile applications to improve access to water, sanitation and hygiene services (mWASH). To understand the barriers to innovation, nine mWASH applications were studied using the Framework for Analyzing a Multi-level Innovation System (FAMIS), a conceptual model. Applying FAMIS to a technology aids in understanding when and why it succeeds or fails, and how key stakeholders and institutions can be targeted for intervention. The analysis highlights ways to overcome barriers to innovation and suggests that the technology is less important than the way in which it is implemented.
Vacuum sewerage systems – a solution for fast growing cities in developing countries?
Authors: Mohr Marius , Beckett Marc , Schließmann Ursula , Erlbeck Ruth , Trosse Ralph
Published: March 2018

Developed more than a century ago, the potential of vacuum sewerage systems remains underexploited. At the same time, the rapid urbanization in Asia brings about major challenges for municipal utilities. In this context, the GIZ (Deutsche Gesellschaft fuer Internationale Zusammenarbeit) project ‘Integrated Resource Management in Asian Cities: the Urban Nexus’ gives technical advice to stakeholders in the partner cities. Fraunhofer IGB, having operated a vacuum sewer system for more than ten years in the context of a research project, carried out a survey regarding current experiences with vacuum sewer systems and the transferability to countries of the Global South. In an environment with existing infrastructure, it is often not economically reasonable to install an additional sewer system. Nevertheless, with aging infrastructure and an increasing importance of circular economy concepts including water reuse, nutrient recovery and biogas generation, vacuum sewers can pose a viable alternative for refurbishments or new developments in semi-decentralized sanitation approaches involving local treatment and resource recovery.
Health Care Cost Analyses for Exploring Cost Savings Opportunities in Older Patients: Longitudinal Retrospective Study (Preprint)
Authors: Agboola Stephen , Simons Mariana , Golas Sara , op den Buijs Jorn , Felsted Jennifer , Fischer Nils , Schertzer Linda , Orenstein Allison , Jethwani Kamal , Kvedar Joseph
Published: March 2018

BACKGROUND

Half of Medicare reimbursement goes toward caring for the top 5% of the most expensive patients. However, little is known about these patients prior to reaching the top or how their costs change annually. To address these gaps, we analyzed patient flow and associated health care cost trends over 5 years.

OBJECTIVE

To evaluate the cost of health care utilization in older patients by analyzing changes in their long-term expenditures.

METHODS

This was a retrospective, longitudinal, multicenter study to evaluate health care costs of 2643 older patients from 2011 to 2015. All patients had at least one episode of home health care during the study period and used a personal emergency response service (PERS) at home for any length of time during the observation period. We segmented all patients into top (5%), middle (6%-50%), and bottom (51%-100%) segments by their annual expenditures and built cost pyramids based thereon. The longitudinal health care expenditure trends of the complete study population and each segment were assessed by linear regression models. Patient flows throughout the segments of the cost acuity pyramids from year to year were modeled by Markov chains.

RESULTS

Total health care costs of the study population nearly doubled from US $17.7M in 2011 to US $33.0M in 2015 with an expected annual cost increase of US $3.6M (P=.003). This growth was primarily driven by a significantly higher cost increases in the middle segment (US $2.3M, P=.003). The expected annual cost increases in the top and bottom segments were US $1.2M (P=.008) and US $0.1M (P=.004), respectively. Patient and cost flow analyses showed that 18% of patients moved up the cost acuity pyramid yearly, and their costs increased by 672%. This was in contrast to 22% of patients that moved down with a cost decrease of 86%. The remaining 60% of patients stayed in the same segment from year to year, though their costs also increased by 18%.

CONCLUSIONS

Although many health care organizations target intensive and costly interventions to their most expensive patients, this analysis unveiled potential cost savings opportunities by managing the patients in the lower cost segments that are at risk of moving up the cost acuity pyramid. To achieve this, data analytics integrating longitudinal data from electronic health records and home monitoring devices may help health care organizations optimize resources by enabling clinicians to proactively manage patients in their home or community environments beyond institutional settings and 30- and 60-day telehealth services.
See It – Do It – Learn It: Learning Interprofessional Collaboration in the Clinical Context
Authors: Grymonpre Ruby , Van Ineveld Cornelia (Kristel) , Nelson Michelle , Jensen Fiona , De Jaeger Amy , Sullivan Theresa , Weinberg Leah , Swinamer Jenneth , Booth Ann
Published: March 2018

Background: The primary goal of the Interprofessional Education in Geriatric Care (IEGC) project was to design, deliver, and evaluate interprofessional (IP) clinical placements for pre-licensure learners in geriatric day hospitals.Methods: Project evaluation was guided by the modified Kirkpatrick's Model of Educational Outcomes. Using a controlled before-after design, the Attitudes Toward Health Care Teams Scale (ATHCTS), Team Skills Scale (TSS), and Knowledge Questionnaire were administered to intervention and control learners pre-, post-, and 6 months post clinical placements. Quantitative data were analyzed using descriptive and multivariate statistics. Qualitative data collected through journals and questionnaires were analyzed using content analysis.Findings: Eleven IP clinical placements occurred at 3 test sites involving 32 intervention and 11 control learner participants. There was no significant change, over time, in the ATHCTS quality of care and physician centrality scores for the combined group (i.e., intervention and control) and between intervention and control groups. Time effects were noted in the quality of care scores for the intervention group after controlling for prior IPE (p = .031). The Knowledge scores were higher for the intervention group compared with controls over time (p = .004). Both intervention and control groups demonstrated significant improvements in their TSS scores over time (p = .000), although there was no significant difference in the magnitude of the change between groups (p = .112). Themes observed through qualitative analysis of learners' journals and post-program reflective questionnaires supported the quantitative findings.Conclusions: The IEGC experience was valuable to senior pre-licensure learners in helping them understand collaborative patient-centred practice and team skills. Future research should strive for larger sample sizes through multi-site projects to allow for comparisons within and between clinical sites.
A Qualitative Study of Workplace Factors Influencing Expertise in the Delivery of Children’s Education and Mental Health Services
Authors: King Gillian , Specht Jacqueline , Bartlett Doreen , Servais Michelle , Petersen Patricia , Brown Heather , Young Gabrielle , Stewart Shannon
Published: March 2018

Background: Interest in professional expertise is growing. Interactional and developmental perspectives are being adopted to understand the nature of expertise and the environmental factors that influence its development. This article provides qualitative information about the workplace factors and experiences considered important by individuals providing education or mental health services to children, with one group working within an interprofessional team approach (service providers) and the other working in a discipline-specific manner (teachers).Methods and Findings: Two focus groups were held: one involving 5 elementary or secondary school teachers and principals, and one involving 9 therapists who provide specialized children’s mental health services. Information arising in these group sessions was used to develop themes reflecting key elements discussed; the themes were then contrasted to infer differences between the two groups. The findings point to the importance of establishing a collaborative, learning-oriented workplace culture, including opportunities for varied work experiences, peer interaction and dialogue, and feedback.Conclusions: Implications include adopting relationship-oriented and collaborative service delivery models and ensuring that workplace settings encourage natural learning opportunities involving interaction, dialogue, and feedback, as well as meaningful professional development experiences of value to participants.
A Novel Approach to Interprofessional Education: Interprofessional Day, the Four-Year Experience at the Medical University of South Carolina
Authors: Hall Philip D. , Zoller James S. , West Valerie T. , Lancaster Carol J. , Blue Amy V.
Published: March 2018

Background: In order to introduce students to different disciplines and promote interprofessional teamwork, the Medical University of South Carolina developed an innovative educational program, Interprofessional (IP) Day, for all first- and second-year health professions students. The IP Day Committee, composed of representatives from each of the six colleges (pharmacy, nursing, medicine, graduate studies, health professions, and dental medicine), coordinates the day's activities. The morning session (for second-year students only) and the afternoon session (for first-year students only) each begin with a large group meeting where an invited speaker details the concept and implementation of interprofessional teamwork. Following the speaker, students divide into small discussion groups containing at least one student from each of the six colleges and led by a faculty member and student facilitators. The first-year session introduces the role of each discipline (e.g., occupational therapy, nursing). The second-year session promotes teamwork among the professions via a case discussion.Methods and Findings: We assessed the students' satisfaction with the program and measured their attitudes toward interprofessional collaboration using both quantitative and qualitative methods. Results from a formative evaluation of the IP Day suggest improved knowledge about other healthcare professions after participating in interprofessional day, particularly for first-year students.Conclusions: IP Day lays the groundwork for our students' successful interprofessional collaborative experience at MUSC, a paramount university goal.
Survey of Interprofessional Collaboration Learning Needs and Training Interest in Health Professionals, Teachers, and Students: An Exploratory Study
Authors: Baerg Krista , Lake Deborah , Paslawski Teresa
Published: March 2018

AbstractBackground: Researchers and trainers from many professions and settings have emphasized the importance of explicit training in interprofessional collaboration (IPC), but interest in and best practice for training for IPC remains unknown.Methods and Findings: A 33-item Internet-based survey was completed by 486 practicing professionals and students from the sectors of health and education. The survey assessed experiences and knowledge of IPC as well as interest in and barriers to further training in IPC. Overall, there was agreement among respondents regarding the importance of IPC. Satisfaction with IPC was associated with higher self-ratings of knowledge and skills related to IPC. Interest in further IPC training was high, especially for one- or two-day workshops or web-based modules. Qualitative analysis of responses to an open-ended question about IPC skills and knowledge revealed seven networks of common themes that can serve as a framework for training and theory development.Conclusions: IPC training should provide knowledge about IPC models and research, leadership styles, team stages, and conflict management, while also ensuring that training applies to the workplace or practicum placement. Efforts should be made to promote awareness of the need for training in areas where trainees already feel competent.
The RIPPER Experience: A 3 Year Evaluation of an Australian Interprofessional Rural Health Education Pilot
Authors: Woodroffe Jessica , Spencer Judy , Rooney Kim , Le Quynh , Allen Penny
Published: March 2018

AbstractBackground: The Rural Interprofessional Program Educational Retreat (RIPPER) uses interprofessional learning and educational strategies to prepare final year Tasmanian nursing, medical, and pharmacy students for effective healthcare delivery. RIPPER provided students (n = 90) with the opportunity to learn about working in an interdisciplinary team using authentic and relevant situational learning. RIPPER allowed students to work and learn interprofessionally in small teams and to apply their different professional skills and knowledge to a variety of rural healthcare situations.Methods and Findings: This article reports on three years of results from the program’s evaluation which used a pre-post test mixed method design. The findings show a significant and positive shift in students’ attitudes and understanding of interprofessional learning and practice following their participation in RIPPER. The evaluation findings suggest the need for sustainable interprofessional rural health education that is embedded in undergraduate curricula.Conclusion: The evaluation of RIPPER suggests that exposure of healthcare students to interprofessional education can positively affect their perceptions of collaboration, patient care, and teamwork. The evaluation also points to the rural context as an ideal place to showcase elements of effective interprofessional practice.
Bridging the Location Gap: How Can Pharmacists and Physicians Collaborate for Delivering Patient Care? (BRIDGE Study Phase I)
Authors: Dow Elizabeth Nicole , Hager Keri , Cernohous Tim
Published: March 2018

Background: Research has shown that collaboration between physicians and pharmacists improves health outcomes and prevents adverse drug events. Pharmacists providing medication therapy management (MTM) services in local stand-alone MTM clinics have experienced significant difficulty collaborating with physicians. However, MTM pharmacists who practice in the same facility with the physician self-rate their practices as highly collaborative. The purpose of this study is to determine if collaboration varies based on MTM practice location.Methods: A convenience sample of 15 physicians who had received documentation of patient care from both an internal and external MTM pharmacist was surveyed to assess pharmacist-physician collaboration. Each physician was asked to complete the same survey for both an internal and an external MTM pharmacist, and to provide background and demographic information.Results: Eleven surveys were returned by physicians for a 73% response rate (11/15). Four surveys were completed in their entirety. Seven surveys were returned with only the internal MTM pharmacist portion completed. The total score for external MTM pharmacists ranged from 52 to 87 with a mean score of 73.25 and standard deviation (SD) of 15.28. The total score for internal MTM pharmacists ranged from 74 to 98 with a mean score of 87.90 and SD of 9.12. Total mean scores resulting from summing items for the three domains of trustworthiness, role specification, and relationship initiation were higher for internal MTM pharmacists versus external MTM pharmacists (p = .03).Conclusion: Based on our results, it appears the level of collaboration between physicians and MTM pharmacists tends to be higher when they practice in the same facility.
Confident, Credible but Lonely – Outcomes Following Postgraduate Interprofessional Education in Rehabilitation
Authors: Grainger Rebecca , Boland Pauline , Levack William
Published: March 2018

Background: Interprofessional education aims to enhance health service delivery. This study examined whether health professionals changed their clinical practice after completing a postgraduate interprofessional qualification in rehabilitation. Methods & Findings: All graduates of postgraduate qualifications in rehabilitation at University of Otago were invited to complete a questionnaire. Thirteen participants were purposively selected for further in-depth interviews. Questionnaire data were summarized using descriptive statistics. Qualitative responses from questionnaires and interview transcripts were explored using thematic analysis. The survey response rate was 24% (77/315 students). Postgraduate study was reported to have had a positive impact on professional attitudes and commitment to learning (81%), to enhance interdisciplinary collaboration (79%), and to promote change in service delivery (40%). Themes identified from questionnaire responses were: 1) increased confidence, 2) enhanced credibility, and 3) widened view of rehabilitation. Analysis of the interviews identified three contrasting themes: 1) isolation hampers momentum, 2) managers and clinical leaders do not value postgraduate qualifications, 3) implementing change required postgraduate study plus persistence. Conclusions: Educators and employers of health professionals should be aware of the benefits of postgraduate interprofessional education for health professionals and healthcare delivery. Employers should recognize and value these benefits and support health professionals to apply new skills in their clinical practice.
Sixteen Months “From Square One”: The Process of Forming an Interprofessional Clinical Teaching Team
Authors: McKinlay Eileen M. , Gallagher Peter A , Gray Lesley A , Wilson Christine L , Pullon Susan R
Published: March 2018

Background: Descriptions of interprofessional education (IPE) programs and teacher competencies exist, but limited research has been undertaken about the process of IPE teaching team formation. This research project examined how pedagogically naïve clinicians of different disciplines initially formed an IPE teaching team.Methods and Findings: A case study approach was undertaken with data collected over the first sixteen months of an IPE program. Data included: audio recordings, transcripts, and field notes from nine individual teacher interviews, two teaching team focus groups, five student focus groups, and eight summary reports. Data analysis using a grounded theory constant comparison approach revealed themes relating to the formation, development, and evolving sophistication of the teaching team from functioning, to co-ordinating, to co-operating, and finally to collaborating. These stages were influenced by four external factors: remote rural context, Hauora Māori principles, personal attributes, and teacher development.Conclusions: Formation of interprofessional clinical teaching teams requires educational preparation, time learning to work with each other, and trust development, with a number of local contextual factors influencing this process. Teaching team formation paralleled Wegner’s Community of Practice model where shared vision supported the adoption of an increasingly complex IPE pedagogy.
Interprofessional Collaboration in Addressing Diet as a Common Risk Factor: A Qualitative Study
Authors: Ong Hwee Hsia , Wan Chi Ching Joan Wan Joan , Gao Xiaoli
Published: March 2018

Background: Unhealthy diet is a common risk factor threatening dental and general health. Conflicting dietary advice persists among different healthcare professions, despite some shared goals, causing mystification to patients and the public. This qualitative study aimed to understand the perspectives of dentists, physicians, and dietitians in targeting unhealthy diet as a common risk factor, their experiences and barriers in addressing conflicting dietary advice, and possible ways for improving cross-professional coordination.Methods and Findings: A purposive sample of 40 dentists, physicians, and dieticians was recruited from different service sectors and joined in semi-structured interviews, which were subjected to thematic content analysis. Participants supported the common risk factor approach and suggested improving cross-professional cooperation by maximizing potentials of multidisciplinary care, engaging auxiliary/allied staff, refining electronic systems, and incorporating cutting-edge communication technologies. Inconsistent dietary advice stemmed from different treatment focuses and lack of mutual understanding and well-followed guidelines. Inconsistencies can be resolved by striking a balance for the patient’s best interest, well-informing patients, respecting patients’ autonomy, acquiring cross-professional knowledge, and conforming to shared guidelines.Conclusions: Views solicited from three healthcare professions endorsed the importance of cross-professional partnership in preventing/managing dietrelated health problems. Educators, professional bodies, and administrators share the responsibility to dispel conflicting health messages and promote better practice in dietary counselling.
The Primacy of Fair Presentation: Evidence from PCAOB Standards, Federal Legislation, and the Courts
Authors: DeFond Mark L. , Lennox Clive S. , Zhang Jieying
Published: March 2018

SYNOPSIS

Palmrose and Kinney (2018; hereafter PK) claim that technical compliance with GAAP is sufficient to justify an unqualified audit opinion. We disagree. PK's view ignores “fair presentation,” a concept equivalent to “faithful representation.” Their “technical compliance” view portrays GAAP as a set of black and white rules and auditing as a box-checking exercise, contradicting guidance from the SEC, FASB, IASB, PCAOB, and the courts. We show that the compliance mindset advocated by PK is responsible for many audit failures, including Enron, WorldCom, and Lehman Brothers. PK's view has long been used by auditing firms and their expert witnesses in (unsuccessful) attempts to avoid legal liability. Unfortunately, it is also a view that has greatly damaged the credibility of the auditing profession.
ntPET: A New Application of PET Imaging for Characterizing the Kinetics of Endogenous Neurotransmitter Release
Authors: Morris Evan D. , Yoder Karmen K. , Wang Chunzhi , Normandin Marc D. , Zheng Qi-Huang , Mock Bruce , Raymond F. Muzic , Froehlich Janice C.
Published: March 2018

We present a new application of positron emission tomography (“ntPET” or “neurotransmitter PET”) designed to recover temporal patterns of neurotransmitter release from dynamic data. Our approach employs an enhanced tracer kinetic model that describes uptake of a labeled dopamine D2/D3 receptor ligand in the presence of a time-varying rise and fall in endogenous dopamine. Data must be acquired during both baseline and stimulus (transient dopamine release) conditions. Data from a reference region in both conditions are used as an input function, which alleviates the need for any arterial blood sampling. We use simulation studies to demonstrate the ability of the method to recover the temporal characteristics of an increase in dopamine concentration that might be expected following a drug treatment. The accuracy and precision of the method—as well as its potential for false-positive responses due to noise or changes in blood flow—were examined. Finally, we applied the ntPET method to small-animal imaging data in order to produce the first noninvasive assay of the time-varying release of dopamine in the rat striatum following alcohol.
MIPortal: A High Capacity Server for Molecular Imaging Research
Authors: Pivovarov Misha , Bhandary Gokul , Mahmood Umar , Zahlmann Gudrun , Naraghi Mohammad , Weissleder Ralph
Published: March 2018

The introduction of novel molecular tools in research and clinical medicine has created a need for more refined information management systems. This article describes the design and implementation of such a new information platform: the Molecular Imaging Portal (MIPortal). The platform was created to organize, archive, and rapidly retrieve large datasets using Web-based browsers as access points. The system has been implemented in a heterogeneous, academic research environment serving Macintosh, Unix, and Microsoft Windows clients and has been shown to be extraordinarily robust and versatile. In addition, it has served as a useful tool for clinical trials and collaborative multi-institutional small-animal imaging research.
Permeation Peptide Conjugates for In Vivo Molecular Imaging Applications
Authors: Bullok Kristin E. , Gammon Seth T. , Violini Stefania , Prantner Andrew M. , Villalobos Victor M. , Sharma Vijay , Piwnica-Worms David
Published: March 2018

Rapid and efficient delivery of imaging probes to the cell interior using permeation peptides has enabled novel applications in molecular imaging. Membrane permeant peptides based on the HIV-1 Tat basic domain sequence, GRKKRRQRRR, labeled with fluorophores and fluorescent proteins for optical imaging or with appropriate peptide-based motifs or macrocycles to chelate metals, such as technetium for nuclear scintigraphy and gadolinium for magnetic resonance imaging, have been synthesized. In addition, iron oxide complexes have been functionalized with the Tat basic domain peptides for magnetic resonance imaging applications. Herein we review current applications of permeation peptides in molecular imaging and factors influencing permeation peptide internalization. These diagnostic agents show concentrative cell accumulation and rapid kinetics and display cytosolic and focal nuclear accumulation in human cells. Combining methods, dual-labeled permeation peptides incorporating fluorescein maleimide and chelated technetium have allowed for both qualitative and quantitative analysis of cellular uptake. Imaging studies in mice following intravenous administration of prototypic diagnostic permeation peptides show rapid whole-body distribution allowing for various molecular imaging applications. Strategies to develop permeation peptides into molecular imaging probes have included incorporation of targeting motifs such as molecular beacons or protease cleavable domains that enable selective retention, activatable fluorescence, or targeted transduction. These novel permeation peptide conjugates maintain rapid translocation across cell membranes into intracellular compartments and have the potential for targeted in vivo applications in molecular imaging and combination therapy.
High-throughput Identification of Phage-derived Imaging Agents
Authors: Kelly Kimberly A. , Clemons Paul A. , Yu Amy M. , Weissleder Ralph
Published: March 2018

The use of phage-displayed peptide libraries is a powerful method for selecting peptides with desired binding properties. However, the validation and prioritization of “hits” obtained from this screening approach remains challenging. Here, we describe the development and testing of a new analysis method to identify and display hits from phage-display experiments and high-throughput enzyme-linked immunosorbent assay screens. We test the method using a phage screen against activated macrophages to develop imaging agents with higher specificity for active disease processes. The new methodology should be useful in identifying phage hits and is extendable to other library screening methods such as small-molecule and nanoparticle libraries.
Imaging Molecular Expression on Vascular Endothelial Cells by In Vivo Immunofluorescence Microscopy
Authors: Runnels Judith M. , Zamiri Parisa , Spencer Joel A. , Veilleux Isreal , Wei Xunbin , Bogdanov Alexei , Lin Charles P.
Published: March 2018

Molecular expression on the vascular endothelium is critical in regulating the interaction of circulating cells with the blood vessel wall. Leukocytes as well as circulating cancer cells gain entry into tissue by interacting with adhesion molecules on the endothelial cells (EC). Molecular targets on the EC are increasingly being explored for tissue-specific delivery of therapeutic and imaging agents. Here we use in vivo immunofluorescence microscopy to visualize the endothelial molecular expression in the vasculature of live animals. High-resolution images are obtained by optical sectioning through the intact skin using in vivo confocal and multiphoton microscopy after in situ labeling of EC surface markers with fluorescent antibodies. Other vascular beds such as the bone marrow and ocular blood vessels can be imaged with little or no tissue manipulation. Live imaging is particularly useful for following the dynamic expression of inducible molecules such as E-selectin during an inflammatory response.
A Tumor-Targeted Nanodelivery System to Improve Early MRI Detection of Cancer
Authors: Pirollo Kathleen F. , Dagata John , Wang Paul , Freedman Matthew , Vladar Andras , Fricke Stanley , Ileva Lilia , Zhou Qi , Chang Esther H.
Published: March 2018

The development of improvements in magnetic resonance imaging (MRI) that would enhance sensitivity, leading to earlier detection of cancer and visualization of metastatic disease, is an area of intense exploration. We have devised a tumor-targeting, liposomal nanodelivery platform for use in gene medicine. This systemically administered nanocomplex has been shown to specifically and efficiently deliver both genes and oligonucleotides to primary and metastatic tumor cells, resulting in significant tumor growth inhibition and even tumor regression. Here we examine the effect on MRI of incorporating conventional MRI contrast agent Magnevist® into our anti-transferrin receptor single-chain antibody (TfRscFv) liposomal complex. Both in vitro and in an in vivo orthotopic mouse model of pancreatic cancer, we show increased resolution and image intensity with the complexed Magnevist®. Using advanced microscopy techniques (scanning electron microscopy and scanning probe microscopy), we also established that the Magnevist® is in fact encapsulated by the liposome in the complex and that the complex still retains its nanodimensional size. These results demonstrate that this TfRscFv-liposome-Magnevist® nanocomplex has the potential to become a useful tool in early cancer detection.
Assessment of Cardiovascular Apoptosis in the Isolated Rat Heart by Magnetic Resonance Molecular Imaging
Authors: Hiller Karl-Heinz , Waller Christiane , Nahrendorf Matthias , Bauer Wolfgang R. , Jakob Peter M.
Published: March 2018

Apoptosis, an active process of cell self-destruction, is associated with myocardial ischemia. The redistribution of phosphatidylserine (PS) from the inner to the outer leaflet of the cell membrane is an early event in apoptosis. Annexin V, a protein with high specificity and tight binding to PS, was used to identify and localize apoptosis in the ischemic heart. Fluorescein-labeled annexin V has been used routinely for the assessment of apoptosis in vitro. For the detection of apoptosis in vivo, positron emission tomography and single-photon emission computed tomography have been shown to be suitable tools. In view of the relatively low spatial resolution of nuclear imaging techniques, we developed a high-resolution contrast-enhanced magnetic resonance imaging (MRI) method that allows rapid and noninvasive monitoring of apoptosis in intact organs. Instead of employing superparamagnetic iron oxide particles linked to annexin V, a new T1 contrast agent was used. To this effect, annexin V was linked to gadolinium diethylenetriamine pentaacetate (Gd-DTPA)-coated liposomes. The left coronary artery of perfused isolated rat hearts was ligated for 30 min followed by reperfusion. T1 and T2* images were acquired by using an 11.7-T magnet before and after intracoronary injection of Gd-DTP-labeled annexin V to visualize apoptotic cells. A significant increase in signal intensity was visible in those regions containing cardiomyocytes in the early stage of apoptosis. Because labeling of early apoptotic cell death in intact organs by histological and immunohistochemical methods remains challenging, the use of Gd-DTPA-labeled annexin V in MRI is clearly an improvement in rapid targeting of apoptotic cells in the ischemic and reperfused myocardium.
“Clickable” Nanoparticles for Targeted Imaging
Authors: Sun Eric Yi , Josephson Lee , Weissleder Ralph
Published: March 2018

Nanomaterials functionalized with targeting ligands are increasingly recognized as useful materials for molecular imaging and drug delivery. Here we describe the development and validation of azide–alkyne reactions (“click chemistry”) for the rapid, site-specific modification of nanoparticles with small molecules. The facile preparation of stable nanoparticles bearing azido or alkyne groups capable of reaction with their corresponding counterpart functionalized small molecules is demonstrated. The Cu(I)-catalyzed cycloaddition of azides and alkynes is shown to be a highly efficient and selective method for point functionalization of magnetic nanoparticles. Derivatized nanoparticles bearing biotin, fluorochrome, or steroid moieties are stable for several months. Nanoparticle click chemistry will be useful for other nanomaterials, design of novel sensors, and drug delivery vehicles.
Ultrasound Radiation Force Modulates Ligand Availability on Targeted Contrast Agents
Authors: Borden Mark A. , Sarantos Melissa R. , Stieger Susanne M. , Simon Scott I. , Ferrara Katherine W. , Dayton Paul A.
Published: March 2018

Radiation force produced by low-amplitude ultrasound at clinically relevant frequencies remotely translates freely flowing microbubble ultrasound contrast agents over distances up to centimeters from the luminal space to the vessel wall in order to enhance ligand-receptor contact in targeting applications. The question arises as to how the microbubble shell might be designed at the molecular level to fully take advantage of such physical forces in targeted adhesion for molecular imaging and controlled therapeutic release. Herein, we report on a novel surface architecture in which the tethered ligand is buried in a polymeric overbrush. Our results, with biotin-avidin as the model ligand-receptor pair, show that the overbrush conceals the ligand, thereby reducing immune cell binding and increasing circulation persistence. Targeted adhesion is achieved through application of ultrasound radiation force to instantly reveal the ligand within a well-defined focal zone and simultaneously bind the ligand and receptor. Our data illustrate how the adhesive properties of the contrast agent surface can be reversibly changed, from stealth to sticky, through the physical effects of ultrasound. This technique can be combined with any ligand-receptor pair to optimize targeted adhesion for ultrasonic molecular imaging.
Reduction of Image Artifacts in Mice by Bladder Flushing with a Novel Double-Lumen Urethral Catheter
Authors: Haney Chad R. , Parasca Adrian D. , Ichikawa Kazuhiro , Williams Benjamin B. , Elas Martyna , Pelizzari Charles A. , Halpern Howard J.
Published: March 2018

In electron paramagnetic resonance imaging (EPRI), the accumulation of contrast agent in the bladder can create a very large source of signal, often far greater than that of the organ of interest. Mouse model images have become increasingly important in preclinical testing. To minimize bladder accumulation on mouse images, we developed a novel, minimally invasive, MRI/EPRI-friendly procedure for flushing a female mouse bladder. It is also applicable to other imaging techniques, for example, PET, SPECT, etc., where contrast agent accumulation in the bladder is also undesirable. A double-lumen urethral catheter was developed, using a standard IV catheter with a silicone tube extension, having a polyethylene tube threaded into the IV catheter. Flushing of the bladder provides a substantial reduction in artifacts, as shown in images of tumors in mice.