Search

This article presents the results of a 2016 classroom research study assessing the impact of open pedagogy on student skills mastery in English 101, a first-year undergraduate composition course at a two-year community college in North America. Ninety-two students in five sections used the same free OER course materials, but two sections were given traditional assignments (i.e. formal essays and grammar exercises) and the other three sections were given "open" assignments that involved designing and remixing open resources. Assignment results and other course metrics used to investigate the impact on student skills mastery yielded no statistically significant differences in performance between the student groups, which suggests that there may be no harm in shifting away from the traditional "disposable" assignment.

Cleft Lip/Palate (CLP) is a congenital orofacial anomaly appearing in approximately one in 700 births worldwide. While in high-income countries CLP is normally addressed surgically during infancy, in developing countries CLP is often left unoperated, potentially impacting multiple dimensions of life quality. Previous research has frequently compared CLP outcomes to those of the general population. But because local environmental and genetic factors both contribute to the risk of CLP and also may influence life outcomes, such studies may present a downward bias in estimates of both CLP status and restorative surgery. Working with the non- profit organization Operation Smile, this research uses quasi-experimental causal methods on a novel data set of 1,118 Indian children to study the impact of CLP status and CLP correction on the physical, psychological, and social well-being of Indian teenagers. Our results indicate that adolescents with median-level CLP severity show statistically significant losses in indices of speech quality (-1.55), academic and cognitive ability (-0.43), physical well-being (-0.35), psychological well-being (-0.23), and social inclusion (-0.35). We find that CLP surgery improves speech if carried out at an early age, and that it significantly restores social inclusion.

BackgroundThe Warkentin 4-T scoring system for determining the pretest probability of heparin-induced thrombocytopenia (HIT) has been shown to be inaccurate in the ICU and does not take into account body mass index (BMI).MethodsProspectively collected data on patients in the surgical and cardiac ICU between January 2007 and February 2016 who were presumed to have HIT by clinical suspicion were reviewed. Patients were categorized into 3 BMI groups and assigned scores: Normal weight, overweight, and obese. Multivariate analyses were used to identify independent predictors of HIT.ResultsA total of 523 patients met inclusion criteria. Multivariate analysis showed that only BMI, Timing, and oTher variables were independently associated with HIT. This new 3-T model was better than a five-component model consisting of the entire 4-T scoring system plus BMI (AUC = 0.791).ConclusionsIncorporating patient 'T'hickness into a pretest probability model along with platelet 'T'iming and the exclusion of o'T'her causes of thrombocytopenia yields a simplified "3-T" scoring system that has increased predictive accuracy in the ICU.

PURPOSE Recent literature suggests an increasing use of systemic treatment in patients with advanced cancer near the end of life (EOL), partially driven by the increasing adoption of immune checkpoint inhibitors (ICIs). While studies have identified this trend, additional variables associated with ICI use at EOL are limited. Our aim was to characterize a population of patients who received a dose of ICI in the last 30 days of life. METHODS We performed a manual retrospective chart review of patients $ 18 years who died within 30 days of receiving a dose of ICI. Metrics such as Eastern Cooperative Oncology Group performance status (ECOG PS), number of ICI doses, need for hospitalization, and numerous other variables were evaluated. RESULTS Over a 4-year time period, 97 patients received an ICI at EOL. For 40% of patients, the ICI given in the 30 days before death was their only dose. Over 50% of patients had an ECOG PS of $ 2, including 17% of patients with an ECOG PS of 3. Over 60% were hospitalized, 65% visited the emergency department, 20% required intensive care unit admission, and 25% died in the hospital. CONCLUSION Our study contributes to the ongoing literature regarding the risks and benefits of ICI use in patients with advanced cancer near the EOL. While accurate predictions regarding the EOL are challenging, oncologists may routinely use clinical factors such as ECOG PS along with patient preferences to guide recommendations and shared decision making. Ultimately, further follow-up studies to better characterize and prognosticate this population of patients are needed. [ABSTRACT FROM AUTHOR]

TABLE OF CONTENTS INTRODUCTION I. BROADCAST REGULATION AND THE FIRST AMENDMENT II. THE CASE FOR ELIMINATING THE CABLE/BROADCAST DISTINCTION A. EXPLICATING THE CABLE/BROADCAST REGULATORY DISTINCTION B. CABLE AS A PERVASIVE [...]

Combining statistical information across studies (i.e., meta-analysis) is a standard research tool in applied psychology. The most common meta-analytic approach in applied psychology, the fixed effects approach, assumes that individual studies are homogeneous and are sampled from the same population. This model assumes that sampling error alone explains the majority of observed differences in study effect sizes and its use has lead some to challenge the notion of situational specificity in favor of validity generalization. We critique the fixed effects methodology and propose an advancement - the random effects model (RE) which provides estimates of how between-study differences influence the relationships under study. RE models assume that studies are heterogeneous since they are often conducted by different investigators under different settings. Parameter estimates of both models are compared and evidence in favor of the random effects approach is presented. We argue against use of the fixed effects model because it may lead to misleading conclusions about situational specificity. (Reprinted by permission of the publisher.)

Gastric pneumatosis, the presence of air within the stomach wall, is a very rare occurrence with poor outcomes. One of the most common mechanisms for gastric pneumatosis is gastric ischaemia, also a rare entity. Although patients with gastric ischaemia may require surgical intervention, they can often be treated with conservative measures such as a proton pump inhibitor, broad-spectrum antibiotics, nasogastric tube decompression, fluid resuscitation and total parenteral nutrition. We report a rare case of gastric ischaemia and pneumatosis following therapeutic left gastric artery argon plasma coagulation that was treated with conservative measures. [ABSTRACT FROM AUTHOR]

Sodium glucose cotransporter-2 (SGLT2) inhibitors are glucose-lowering drugs with proven efficacy in treating type 2 diabetes mellitus, and more recently, have been shown to improve heart failure outcomes in patients without diabetes. A rare complication of SGLT2 inhibitor use is the development of euglycaemic diabetic ketoacidosis (EDKA), characterised by euglycaemia (blood glucose level <250 mg/dL), metabolic acidosis (arterial pH <7.3 and serum bicarbonate <18 mEq/L), and ketonaemia. Given patients with EDKA do not present with the typical manifestations of diabetic ketoacidosis, including marked hyperglycaemia and dehydration, the diagnosis of EDKA may be missed and initiation of treatment delayed. We present the case of a man with recent SGLT2 inhibitor use and multiple other risk factors who developed EDKA. [ABSTRACT FROM AUTHOR]

Background: Historically, liver allografts with >30% macrosteatosis (MaS) on donor biopsy have been associated with early allograft dysfunction and worse graft survival; however, successful outcomes have been reported in small cohorts. This study proposes an elevated MaS threshold for organ utilization without detriment to graft survival. Methods: The UNOS Standard Transplant Analysis and Research database was evaluated for transplants between 2006–2015. Graft survival up to 1-year was evaluated by Kaplan-Meier (KM) survival analyses, and by univariate and multivariable logistic regression analyses, including donor and recipient characteristics. Odds ratios (OR) with 95% confidence intervals (CI) for risk of graft loss are reported. Results: Thirty-day risk of graft loss was increased with MaS as low as 10–19% (OR [95% CI] 1.301 [1.055–1.605], p<0.0001) and peaked with MaS 50–59% (2.921 [1.672–5.103]). At 1-year, risk of graft loss remained elevated with MaS 40–49% (1.465 [1.002–2.142]) and MaS 50–59% (1.978 [1.281–3.056], p = 0.0224). Multivariable models were created for Lower and Higher MELD recipients and MaS cutoffs were established. In Lower MELD recipients, organs with ≥50% MaS had increased risk of graft loss at 30 days (2.451 [1.541–3.897], p = 0.0008) and 1-year post-transplant (1.720 [1.224–2.418], p = 0.0125). Higher MELD recipients had increased risk of graft loss at 30 days with allografts showing MaS ≥40% (4.204 [1.440–5.076], p = 0.0016). At 1-year the risk remained increased, but MaS was not significant predictor of graft loss.048 [1.131–3.710], p = 0.0616). In both MELD cohorts, organs with MaS levels below threshold had similar survival to those transplanted without a donor biopsy. Conclusions: In conjunction with recipient selection, organs with MaS up to 50% may be safely used without detriment to outcomes. [ABSTRACT FROM AUTHOR]

This article presents the results of a 2016 classroom research study assessing the impact of open pedagogy on student skills mastery in English 101, a first-year undergraduate composition course at a two-year community college in North America. Ninety-two students in five sections used the same free OER course materials, but two sections were given traditional assignments (i.e. formal essays and grammar exercises) and the other three sections were given "open" assignments that involved designing and remixing open resources. Assignment results and other course metrics used to investigate the impact on student skills mastery yielded no statistically significant differences in performance between the student groups, which suggests that there may be no harm in shifting away from the traditional "disposable" assignment. [ABSTRACT FROM AUTHOR]

We sought to identify a simple bedside method to predict successful extubation outcomes that might be used during rounds. We hypothesized that a direct 2-minute unassisted breathing evaluation (DTUBE) could replace a longer spontaneous breathing trial (SBT). Data were prospectively collected on all patients endotracheally intubated for >48 hours nearing extubation in a tertiary center's mixed trauma/surgical intensive care unit from August 2012 to August 2013. The SBT was performed for at least 30 minutes at 40 per cent FiO2, PEEP 5, and PS 8. DTUBE was performed by physically disconnecting the intubated patient from the ventilator circuit for a 2-minute period of direct observation on room air. Successful extubation was defined freedom from ventilator for greater than 72 hours. Both SBT and DTUBE were performed 128 times, resulting in 90 extubations. The DTUBE correctly predicted success in 75/79 (94.9%) extubations versus 82/89 (92.1%) via SBT. No adverse effects were directly attributed to the DTUBE. The DTUBE is a rapid method of evaluating patients for extubation with prediction accuracy similar to the SBT. [ABSTRACT FROM AUTHOR]

Recently, there has been a strong push toward automation and the use of real-time models in the drilling industry. However, it has been recognized that these new methods require a dramatic improvement in the quality of sensor data gathered at the rig. In this paper, we investigate how accurate measurement of drillpipe torque and tension at the surface can be used to diagnose downhole conditions. A surface-based torque-and-tension sub (TTS) was used to perform measurements while drilling several horizontal wells in the Dilly Creek area of the Horn River Basin, which is onshore in Canada. A filtered version of surface torque was used to calculate a stick/slip metric, which was compared to stick/slip measurements acquired with a downhole tool. The results show that there is reasonable correlation between surface and downhole metrics, but the correlation is highly dependent on torque filter start and stop frequencies. A comparison is also performed between the hookload measured with a deadline sensor and the tension measurement from the surface sub. The results show a systematic discrepancy of approximately 5% that is likely caused by sheave friction. A commercial torque-and-drag (T&D) software package is used to show that values for casing friction factor (FF) may be underestimated if sheave friction is present but ignored in the analysis. The results from this study show that an advanced measurement sub placed below the topdrive can provide valuable information regarding drilling performance. Specifically, the torque signal can be used to estimate the level of downhole stick/slip, which alleviates the need for an expensive downhole-dynamics tool. Also, the tension signal can be used to obtain accurate measurements of wellbore FF, which can be compared with theoretical values obtained with T&D analysis. With an appropriate-software implementation, these measurements can be performed in real time, which would enable rig crews to react quickly whenever excessive stick/slip or wellbore drag is encountered during drilling operations. [ABSTRACT FROM AUTHOR]

Pleural effusions occur frequently in mechanically ventilated patients, but no consensus exists regarding the clinical benefit of effusion drainage. We sought to determine the impact of thoracentesis on gas exchange in patients with differing severities of acute lung injury (ALI). A retrospective analysis was conducted on therapeutic thoracenteses performed on intubated patients in an adult surgical intensive care unit of a tertiary center. Effusions judged by ultrasound to be 400 mL or larger were drained. Subjects were divided into groups based on their initial P:F ratios: normal >300, ALI 200 to 300, and acute respiratory distress syndrome (ARDS) <200. Baseline characteristics, physiologic variables, arterial blood gases, and ventilator settings before and after the intervention were analyzed. The primary end point was the change in measures of oxygenation. Significant improvements in P:F ratios (mean ± SD) were seen only in patients with ARDS (50.4 ± 38.5, P = 0.001) and ALI (90.6 ± 161.7, P = 0.022). Statistically significant improvement was observed in the pO2 (31.1, P = 0.005) and O2 saturation (4.1, P < 0.001) of the ARDS group. The volume of effusion removed did not correlate with changes in individual patient's oxygenation. These data support the role of therapeutic thoracentesis for intubated patients with abnormal P:F ratios. [ABSTRACT FROM AUTHOR]

Background Although it is assumed that obese patients are naturally protected against anterior abdominal stab wounds, the relationship has never been formally studied. We sought to examine the impact of body mass index (BMI) on severity of sustained injury, need for operation, and patient outcomes. Materials and methods We conducted a review of all patients presenting with abdominal stab wounds at an urban level I trauma center from January 2000-December 2012. Patients were divided into groups based on their BMI (<18.5, 18.5-29.9, 30-35, and >35). Data abstracted included baseline demographics, physiologic data, and characterization of whether the stab wound had violated the peritoneum, caused intra-abdominal injury, or required an operation that was therapeutic. The one-sided Cochran-Armitage trend test was used for significance testing of the protective effect. Results Of 281 patients with abdominal stab wounds, 249 had complete data for evaluation. Chest and abdomen abbreviated injury scale trends decreased with increasing BMI, as did overall injury severity score, the percent of patients severely injured (injury severity score ≥25), and length of intensive care unit stay. Rates of peritoneal violation (100%, 84%, 77%, and 74%; P = 0.077), visceral injury (83%, 56%, 50%, and 30%; P = 0.022), and injury requiring a therapeutic operation (67%, 45%, 40%, and 20%; P = 0.034) all decreased with increasing BMI. Patients in the thinnest group required an operation three times more often than those in the most obese. Conclusions Increased BMI protects patients with abdominal stab wounds and is associated with lower incidence of severe injury and need for operation. Heavier patients may be more suitable to observation and serial examinations, whereas very thin patients are more likely to require an operation and be critically injured. [ABSTRACT FROM AUTHOR]

The rodent septohippocampal system contains "theta cells," which burst rhythmically at 4-12Hz, but the functional significance of this rhythm remains poorly understood (Buzsaki, 2006). Theta rhythm commonly modulates the spike trains of spatially tuned neurons such as place (O'Keefe and Dostrovsky, 1971 ), head direction (Tsanov et al., 20lla), grid (Hafting et al., 2005), and border cells ( avelli et al., 2008; Sols tad et al., 2008). An "oscillatory interference" theory has hypothesized that some of these spatially tuned neurons may derive their positional firing from phase interference among theta oscillations with frequencies that are modulated by the speed and direction of translational movements (Burgess et al., 2005, 2007). This theory is supported by studies reporting modulation of theta frequency by movement speed (Rivas et al.,l996; Geisler et al., 2007; Jeewajee et al., 2008a), but modulation of theta frequency by movement direction has never been observed. Here we recorded theta cells from hippocampus, medial septum, and anterior thalamus of freely behaving rats. Theta cell burst frequencies varied as the cosine of the rat's movement direction, and this directional tuning was influenced by landmark cues, in agreement with predictions of the oscillatory interference theory. Computer simulations and mathematical analysis demonstrated how a postsynaptic neuron can detect location-dependent synchrony among inputs from such theta cells, and thereby mimic the spatial tuning properties of place, grid, or border cells. These results suggest that theta cells may serve a high-level computational function by encoding a basis set of oscillatory signals that interfere with one another to synthesize spatial memory representations. [ABSTRACT FROM AUTHOR]

The article discusses the economic growth in Toledo, Ohio and northwest Ohio from 1860 to 1900. The author noted that the Toledo's economic development indicated the impact of state events, policies, town sites, internal improvements, industrialization and urbanization on the economy in 19th century. The author also highlighted the concept of system of cities, that is, a network of cities that comprised a sub-regional hub, smaller economic centers and surrounding agricultural land.