Search

Extracorporeal membrane oxygenation (ECMO) and extracorporeal life support (ECLS) devices are well-established adjunctive treatment measures for patients with heart failure. ECMO can serve as a bridge to transplant in a chronic setting or as a salvage therapy for patients who are unable to be weaned from bypass following cardiac surgery. However, the role of ECMO as a bridge to definitive therapy in a setting of acute heart failure is less established. Similarly, the treatment of patients using combined ECMO and ECLS devices has been, at times, shown to show some benefit; however, these benefits have not been widely studied. In this study, we present the case of a patient who was diagnosed with severe acute onset heart failure secondary to torrential mitral regurgitation following COVID-19 pneumonia. The patient was emergently placed on venoarterial (VA) ECMO with an indwelling centrifugal pump device in the left ventricle. This combination of ECMO and ECLS served as a bridge to open mitral valve replacement 6 days after presentation. Following successful mitral valve replacement, the patient had persistent right ventricular failure, and therefore, a decision was made to incorporate venovenous (VV) ECMO into the VA ECMO circuit. This technique resulted in a VV-VA or VPa-VA configuration, as oxygenated blood was being returned to the pulmonary artery as well as the descending aorta. VA ECMO was discontinued after 4 days of therapy, and the patient was extubated 3 days later. VV ECMO was weaned over the following week, and the patient was decannulated after a total 23 days of ECMO. The patient was then transitioned to inpatient rehabilitation and ultimately discharged home after 18 days. At the 6-month follow-up, the patient was doing well, and objective cardiopulmonary testing revealed normal function. This case is an excellent demonstration of how advanced ECMO and ECLS devices can be used in unique ways through multiple configurations to rescue and optimize patients in the perioperative period.

Cold mix asphalt produced using conventional emulsion and limestone filler has three main disadvantages, namely low early strength due to high amount of water within the mix, long curing time ranging from 2-24 months and high air voids content. In this study, the effect of a novel technology for producing high-quality cold mix asphalt using modified bitumen emulsion has been investigated in terms of indirect tensile stiffness modulus. the effect of a novel technology for homogenizing a bitumen emulsion on its viscosity, particle size and particle size distribution has been investigated. Ultrasound technology has been used to reduce the viscosity and the size of the bitumen droplets. Different samples of cationic bitumen emulsion (C50B4) have been prepared with different treatment durations (0, 5, 7, 10, 12.5, 15, 30, 45 and 60) min. The results have shown a reduction in the viscosity of the bitumen emulsion at treatment times from 5-15 min. The viscosity has been decreased by 28% after 10 min treatment for the emulsion compared to the untreated sample. This reduction indicated a uniform droplet size distribution. In addition, the particle size measurements revealed that the 7 min treatment showed a significant reduction in the D50, which was 84.5%, D10, was 85.89%, and D90 was 90.28% compared to the untreated bitumen emulsion. The results reported contains a comparison between the viscosity of the emulsions, and the indirect tensile stiffness modulus of a control conventional cold mix asphalt and the new high quality cold mix asphalt with low viscosity. Interestingly, the reduction of the 28% in the viscosity of the new emulsion causes an improvement of the indirect tensile stiffness modulus to 216%, which indicates an outstanding achievement.

Most stars generate winds and move through the interstellar medium that surrounds them. This movement creates a cocoon formed by the deflection of these winds that envelops and protects the stars. We call these “cocoons” astrospheres. The Sun has its own cocoon, the heliosphere. The heliosphere is an immense shield that protects the Solar System from harsh, galactic radiation. The radiation that enters the heliosphere affects life on Earth as well as human space exploration. Galactic cosmic rays are the dominant source of radiation and principal hazard affecting space missions within our Solar System. Current global heliosphere models do not successfully predict the radiation environment at all locations or under different solar conditions. To understand the heliosphere’s shielding properties, we need to understand its structure and large-scale dynamics. A fortunate confluence of missions has provided the scientific community with a treasury of heliospheric data. However, fundamental features remain unknown. The vision of the Solar wind with Hydrogen Ion charge Exchange and Large-Scale Dynamics (SHIELD) DRIVE Science Center is to understand the nature and structure of the heliosphere. Through four integrated research thrusts leading to the global model, SHIELD will: 1) determine the global nature of the heliosphere; 2) determine how pickup ions evolve from “cradle to grave” and affect heliospheric processes; 3) establish how the heliosphere interacts with and influences the Local Interstellar Medium (LISM); and 4) establish how cosmic rays are filtered by and transported through the heliosphere. The key deliverable is a comprehensive, self-consistent, global model of the heliosphere that explains data from all relevant in situ and remote observations and predicts the radiation environment. SHIELD will develop a “digital twin” of the heliosphere capable of: (a) predicting how changing solar and LISM conditions affect life on Earth, (b) understanding the radiation environment to support long-duration space travel, and (c) contributing toward finding life elsewhere in the Galaxy. SHIELD also will train the next-generation of heliophysicists, a diverse community fluent in team science and skilled working in highly transdisciplinary collaborative environments.

This paper examines the geometry of interstellar magnetic field lines close to the boundary of the heliosphere in the direction of the unperturbed local interstellar magnetic field, where the field lines are spread apart by the heliopause (HP). Such field parting establishes a region of weaker magnetic field of about 300 au in size in the northern hemisphere that acts as a giant magnetic trap affecting the propagation of galactic cosmic rays (GCRs). The choice of an analytic model of the magnetic field in the very local interstellar medium allows us to qualitatively study the resulting magnetic field draping pattern while avoiding unphysical dissipation across the HP-impeding numerical magnetohydrodynamic (MHD) models. We investigate GCR transport in the region exterior to the heliosphere, including the magnetic trap, subject to guiding center drifts, pitch angle scattering, and perpendicular diffusion. The transport coefficients were derived from Voyager 1 observations of magnetic turbulence in the VLISM. Our results predict a ring current of energetic ions drifting around the interior of the magnetic trap. It is also demonstrated that GCRs cross the HP for the first time preferentially through a crescent-shaped region between the magnetic trap and the upwind direction. The paper includes results of MHD modeling of the heliosphere that provide the coordinates of the center of the magnetic trap in ecliptic coordinates. In addition to the heliosphere, we examine several extreme field draping configurations that could describe the astrospheres of other stars.

We present the broader impacts effort of the NASA SHIELD DRIVE Science Center, summarizing both phase I and now phase II efforts. The purpose of the broadening impact efforts are to address the overall lack of diversity in the space physics workforce through intentional programming intended to increase inclusiveness and explicit support for emerging and early career researchers. Specific efforts include an online repository of testimonials of diverse early career researchers, SHIELD webinars highlighting the human side of eminent scientists, support for REU students at different institutions, and a yearly heliophysics summer school. We also discuss efforts to support heliophysics scientists through community building events and ongoing training. The SHIELD Drive Science Center’s overall broadening impact goal is to train and mentor the next-generation of team-based heliophysicists while accelerating knowledge integration, transfer, and communication across traditional boundaries.

Given the growing importance of system dynamics (SD) in solving increasingly complex and dynamic problems in any country, we believe SD education will become an imperative leverage point in helping us deal with our uncertain future. This study tries to understand the causal relationships in proliferating SD education by a system dynamics group modelling approach in China. Based on a questionnaire survey and a group model building (GMB) workshop, we aim to explore the interactions of feedback loops in the constructed causal loop diagram (CLD). This uncovers insights into what constitutes the growth of SD education in China and helps to guide the design and implementation of policies to achieve this growth. We conclude that it is important and relevant to find ways to improve, including the construction of an SD teaching platform to integrate normative resources, providing opportunities for teacher training, enhancing the availability and accessibility of SD education, and building networks with international partners. The results of our study may set the foundation for further research to extend the generalizability of our insights and methodological approaches to other countries.

Ecological poverty alleviation (EPA) is a syngenetic approach to tackling challenges in alleviating extreme poverty and ecological protection. Such an approach is crucial to help countries facing these two challenges to accelerate their progression towards meeting the United Nations Sustainable Development Goals in 2030. Prior research on EPA was focusing on understanding EPA from a national perspective and limited consideration was given to regional pertinence. This study uses systems thinking to construct causal loop diagrams (CLDs) and analyzes the mechanisms of EPA in Lanping County, Yunnan Province based on qualitative material. It reveals that the dynamics mechanism of EPA in Lanping County consists of seven reinforcing feedback loops and ten balancing feedback loops. Results indicate that external support, funding resources, employment, and endogenous-driven industrial development are the key drivers to successful EPA. Policies should be taken to avoid the risk of returning to poverty caused by the withdrawal of external support. This study proposes an effective tool with system foresight for exploring the mechanism of EPA and provides reference suggestions for poverty alleviation and development worldwide.

Abstract Background Measurement of health utilities is required for economic evaluations. Few studies have evaluated health utilities for rare conditions; even fewer have incorporated disutility that may be experienced by caregivers. This study aimed to (1) estimate health utilities for three rare conditions currently recommended for newborn screening at the state or federal level, and (2) estimate the disutility, or spillover, experienced by parents of patients diagnosed with a rare, heritable disorder. Methods A stated-preference survey using a time trade-off approach elicited health utilities for Krabbe disease, phenylketonuria, and Pompe disease at varying stages (mild, moderate, severe) and onset of disease symptoms (infancy, childhood, and adulthood). We recruited respondents from a nationally representative community sample (n = 862). Respondents valued disease specific health states in three consecutive question frames: (1) adult health state (> = 18 years of age), (2) child health state (

Abstract Throughout history, humans have settled in areas of high biodiversity. Today these areas are home to our biggest urban centers with biodiversity at increasing risk from escalating cumulative threats. Identifying the management strategies to conserve species within such regions, and ensuring effective governance to oversee their implementation, presents enormous challenges. Using a novel Priority Threat Management (PTM) approach that calculates the cost‐effectiveness of conservation action and co‐governance, we discover that the 102 species at risk of local extinction within Canada's most diverse, heavily urbanized coastal region, the Fraser River estuary, require urgent investment in management strategies costing an estimated CAD$381 M over 25 years. Our study also suggests that co‐governance underpins conservation success in urban areas, by increasing the feasibility of management strategies. This study underscores that biodiversity conservation in heavily urbanized areas is not a lost cause but does require strategic planning, attention to governance, and large‐scale investment.

At the 2007 International System Dynamics Society Conference, Professor Jay Forrester posed a challenge: “We need books addressed to the public that are understandable, relevant, important and dramatic”. We need to overcome the “constraints of academe” that inhibit path-breaking work. We need to address “the big issues”. We need to march “upward from the present aimless plateau and start climbing the mountains ahead”. This was a message that was intended to inspire and empower, not to criticize. Responding to Professor Forrester’s challenge, this paper first describes the work of three inspiring role models, Dennis Meadows, Junko Edahiro and John Sterman. They have demonstrated how books can have an impact on people’s lives, how “big issues” can be addressed, how the constraints of academe can be overcome and how mountains can be scaled. Second, it offers grounds for optimism about the future of system dynamics modeling in Asia, gained from my sojourn at the National University of Singapore. Third, it describes three “mountains ahead” to be scaled and highlights the work of individuals who have already begun the journey.

My plan is to examine Nietzsche's view of (what is I think) the most characteristically Kantian kind of argument, what's now often called 'transcendental argument'. I understand this as an argument in which a concept or principle or value is justified as a 'condition of the possibility' of something indisputable (or indispensable). I will look at Nietzsche's critique of this pattern of argument in Kant, but also at the ways he still uses such arguments himself, in all three of the sectors of Kant's critique: theoretical, practical, aesthetic.

Abstract This Critical Synthesis Package contains: (1) a Critical Analysis of the psychometric properties and the application to health science education of the short version of the Experiences of Teaching and Learning Questionnaire (ETLQ), and (2) a copy of the short version of the ETLQ and scoring instructions developed by Noel Entwistle, PhD. The short version of the ETLQ is a self-report instrument consisting of 49 items divided into five sections. The Approaches to Learning, and the Experiences of Teaching and Learning sections each contain 15 items. The Approaches to Learning section assesses use of a deep approach, a surface approach, monitoring studying and organized studying; while the Experiences of Teaching and Learning assesses six aspects of the experience of a particular course unit. The remaining sections are Demands Made by the Course Unit (10 items), What you Learned from this Course Unit (8 items), and How well You Have Done in the Course Unit (1 item). A five-point Likert scale is utilized for the first four sections, while a nine-point scale is used for the final section. The short version of this survey presented here demonstrates satisfactory internal consistency and satisfactory construct validity according to exploratory factor analyses of the first two sections of the questionnaire. Evidence has also been obtained of an association between students' perceptions of a course or program and their approaches to studying. The short version of the ETLQ can be recommended for use in health sciences education, provided that it is revalidated for use in each new context. An adaptation of the ETLQ can be recommended for evaluating entire programs of study.

In the vast majority of cystic fibrosis (CF) patients, deletion of residue F508 from CFTR is the cause of disease. F508 resides in the first nucleotide binding domain (NBD1) and its absence leads to CFTR misfolding and degradation. We show here that the primary folding defect arises during synthesis, as soon as NBD1 is translated. Introduction of either the I539T or G550E suppressor mutation in NBD1 partially rescues ΔF508 CFTR to the cell surface, but only I539T repaired ΔF508 NBD1. We demonstrated rescue of folding and stability of NBD1 from full-length ΔF508 CFTR expressed in cells to isolated purified domain. The co-translational rescue of ΔF508 NBD1 misfolding in CFTR by I539T advocates this domain as the most important drug target for cystic fibrosis.

We describe a healthy 40-year old professional hockey player with an asymptomatic sternal non-union following aortic root surgery. The purpose of this case report is to make orthopedic surgeons aware of the possibility of this complication following sternotomy, and to discuss the considerations involved in return to play in contact sports. We will discuss our work-up, evaluation, and management of a sternal non-union in a professional athlete. Patient’s consent has been obtained.