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Most research on governments' use of social media focuses on the national or federal level. We therefore know little about the way local authorities harness social media platforms to communicate with their constituencies. This paper studies the role structural and political variables played in Chilean mayors' political communication strategies during 2020–2021, a period of municipal elections marked by lockdowns due to the COVID-19 pandemic. We evaluate whether the volume and characteristics of mayors' social media posts are related to political factors (partisanship; alignment or not with the governing block; years in office), socioeconomic characteristics (poverty rate; age profile; health infrastructure; etc.); and the incidence of COVID-19 cases and deaths at the municipal level. We found that mayors' social media communication strategies depend on the functions that different municipalities perform in the territory, and that socioeconomic variables differentiate these activities. More specifically, we found that mayors of poorer communities made more extensive use of social media during lockdown periods than did mayors of more affluent municipalities. [ABSTRACT FROM AUTHOR]

Despite the high prevalence, treatment challenges, and significant impact of eyelid retraction on vision and quality of life among patients with thyroid eye disease, the effects of teprotumumab on eyelid retraction are not fully understood. This study evaluated change in upper eyelid position after teprotumumab. A retrospective study of all patients who completed eight teprotumumab infusions at one institution from January 1 2020 to December 31 2022. Primary outcome was change in upper eyelid position immediately after treatment and at most recent follow-up compared to pre-treatment. Among 234 eyes of 118 patients, average margin reflex distance-1 (MRD1) pre-treatment was 5.25 mm (range 0–10.0, SD 1.75), 4.66 mm (1.0–9.0, SD 1.32) immediately post-treatment (p < 0.001), and 4.50 mm (0–10.0, SD 1.52) at most recent follow-up (mean follow-up duration 10.60 months). In total, 136 (58.12%) eyes of 88 patients had MRD1 reduction immediately post-treatment, averaging 1.49 mm (0.5–5.0 mm, SD 0.97). Every 1-mm increase in pre-treatment MRD1 increased the odds of MRD1 reduction by 15.03% (CI 10.52–19.72, p < 0.001) and increased the reduction amount by 0.48 mm (CI 0.39–0.57, p < 0.001). Of 154 eyes of 78 patients with most recent follow-up, 107 (69.48%) eyes had stable or further improved retraction at most recent follow-up compared to immediately post-treatment. This study found a modest but significant reduction in MRD1 in approximately 60% of eyes, independent of proptosis change, which was sustained by most patients over longer-term follow-up. Higher pre-treatment MRD1 corresponded with greater improvement. These results suggest an overall mild benefit of teprotumumab for upper eyelid retraction. [ABSTRACT FROM AUTHOR]

Disseminated intravascular coagulation (DIC) is characterized by abnormal activation of the coagulation cascade, which leads to simultaneous hypercoagulation and excessive bleeding. While it typically occurs in systemic diseases, such as infection, inflammation, obstetric complications, and malignancy, it can rarely manifest postoperatively. This case report describes a patient who presented with prolonged, refractory bleeding after ectropion repair via a lateral tarsal strip procedure. Due to the inability to control the patient’s bleeding with conservative measures followed by surgical exploration and electrocautery, the patient underwent a hematologic work-up. Laboratory studies were consistent with DIC, attributed to his large burden of endovascular stents. He was treated with anticoagulation using apixaban in addition to tranexamic acid to achieve lasting hemostasis. This case highlights the importance of thorough preoperative assessments, even for minor surgical procedures, and systemic workup for atypical postoperative bleeding. [ABSTRACT FROM AUTHOR]

AbstractPurposeMethods and MaterialsResultsConclusionsPhysician educators are often expected to direct educational programs and assume roles that conform to field norms for career advancement but that may not afford meaningful work for educators. The purpose of this study was to describe and analyse the perspectives and actions taken by physician educators in response to tension between feeling compelled to direct an educational program and doing educationally meaningful work.We used data from a longitudinal study and focused on three participants who, over the course of the five-year study, offered significant insights into how physician educators act in ways that run counter to expectations for career advancement. Our narrative analysis entailed organizing data from interview transcripts into time-ordered displays, weaving data into counternarratives that were edited by participants, and using the theory of faculty agency (and its key constructs, strategic perspectives and strategic action) to thread the stories together.In each counternarrative, the participant deliberated their sense of being a physician educator (strategic perspectives) and when expectations became untenable, they did what they needed to do to engage in meaningful work (strategic action) rather than comply with expectations for career advancement in academic medicine. For one participant, faculty agency meant leaving academic medicine; for another, it meant reducing clinical time so that unpaid time could be devoted to education; and for another, it meant opting not do direct a reputable education program.Faculty agency is a useful theoretical lens for conceptualizing how physician educators navigate their careers in academic medicine. Counternarratives that illuminate faculty agency offer stories that describe alternate career paths and portend a different future for physician educators. [ABSTRACT FROM AUTHOR]

This study compares response time and accuracy in a binary data labeling task on two platforms: a desktop computer and a mobile phone. Three methods were used on the computer: a keyboard, a mouse, and a mouse with perceptual variability that was designed to combat vigilance decrement. Three additional methods were used on the mobile phone: a tap, a swipe touch-gesture, and a tap with perceptual variability. Results of the study show that the fastest was the keyboard, which may explain its popularity in labeling tasks. The second fastest was the tap interface, suggesting the unexploited potential of mobile devices for "labeling while waiting for the bus." In terms of accuracy, we found clear evidence for a speed–accuracy tradeoff, and the advantage of the perceptual variability methods to be more accurate than the matching methods without perceptual variability. The results suggest that different user input methods should be employed depending on whether response time or accuracy is more valued. [ABSTRACT FROM AUTHOR]

To describe herpetic ocular infections following SARS-CoV-2 vaccinations. A retrospective study of herpetic ocular infections after BNT162b2mRNA vaccination and a literature review. A cohort of five patients: three varicella zoster virus (VZV) and two herpes simplex virus (HSV) cases, as well as 19 literature cases: 9 cases of VZV and 10 cases of HSV post BNT162b2mRNA, AZD1222, mRNA-1273, and CoronaVac vaccinations. All cases presented within 28 days post vaccination. Most VZV and HSV cases (15/19) reported in the literature presented post first vaccine dose, while in our cohort 2 VZV cases presented post second dose and both HSV cases and one VZV case post third dose. The most common presentations were HZO with ocular involvement and HSV keratitis. All eyes had complete resolution; however, one had retinal detachment and three corneal scars. Herpetic ocular infections may develop shortly after SARS-CoV-2 vaccinations. Overall, the outcome is good. [ABSTRACT FROM AUTHOR]

In 2006, Brazil's domestic violence legislation came into force and, among other innovations, established specialised courts to deal with criminal offences committed against women in the domestic context. This legislation has been referred to by United Nations (UN) entities as a global model, particularly for the creation of such courts, which are structured to work within a multidisciplinary approach and in tandem with a network of services to support and protect victims against further violence. More recently, though, UN Women has acknowledged some limitations in their workings, particularly linked to the lack of coordination between agencies and of trained personnel. This article is aimed at supporting and illustrating such concerns. It draws on a larger empirical study to showcase how victims' experiences of secondary victimisation are linked to judges' focus on the criminal aspects of the Maria da Penha Law and to their lack of expertise in gender issues. [ABSTRACT FROM AUTHOR]

Our cross-sectional study seeks to understand how COVID-19 stigma, race/ethnicity [Asian, Black, Hispanic/Latinx, white] and residency [New York City (NYC) resident vs. non-NYC resident] associated with depression. Our sample includes 568 participants: 260 (45.77%) were NYC residents and 308 (54.3%) were non-NYC residents. A series of multiple linear regression were run to examine the relationship between race/ethnicity, COVID-19 stigma, and depressive symptoms. Irrespective of residency, older age and ever being diagnosed with COVID-19 were negatively associated with depressive symptoms. Stigma and thinking less of oneself significantly associates with depressive symptoms across residency. Our study expects to benefit mental health care providers and public health professionals in designing best practices to mitigate stigma in ongoing or future pandemics. [ABSTRACT FROM AUTHOR]

The 'encounter conception' of restorative justice is definitively the most widespread of all, and practices that involve an encounter may well deserve to be called 'fully restorative'. That said, an encounter between an individual, identifiable 'victim' and an equally individual, identifiable 'offender' is not always possible (or desirable). Indeed, an encounter conception of restorative justice is problematic for a variety of reasons, including for attaching people to distinct labels – those of 'offender' and 'victim' – when only a few have the 'paradoxical privilege' to be recognised as victims. This article is aimed at promoting an exercise of thinking beyond an encounter conception of restorative justice. We would like to argue that such an exercise facilitates the processes of us rethinking the current language of restorative justice (still too restricted compared to the current criminal justice system). It also helps us to acknowledge the movement's wide-ranging agendas or directions (and to position ourselves within them). [ABSTRACT FROM AUTHOR]

To provide an updated comparison of the risk and cost of stroke/systemic embolism (SE) and major bleeding between direct oral anticoagulants (DOAC: apixaban, rivaroxaban, dabigatran) and warfarin among non-valvular atrial fibrillation (NVAF) patients. Adults (≥65 years) initiating warfarin or DOACs between 1 January 2013 and 31 December 2014 were selected from the Medicare database and propensity scores matched 1:1 to balance baseline characteristics. Cox proportional hazards models were used to estimate the risks of stroke/SE and major bleeding of each DOAC vs. warfarin. Two-part models were used to compare the stroke/SE- and major bleeding-related medical costs in each matched cohort. Of the 264,479 eligible patients, 38,740 apixaban-warfarin pairs, 76,677 rivaroxaban-warfarin pairs, and 20,955 dabigatran-warfarin pairs were matched. Apixaban (Hazard Ratio [HR] = 0.46; 95% Confidence Interval [CI] 0.38–0.56) and rivaroxaban (HR = 0.71; 95% CI 0.63–0.80) were associated with a significantly lower risk of stroke/SE compared to warfarin. Apixaban (HR = 0.57; 95% CI 0.51–0.63) and dabigatran (HR = 0.80; 95% CI 0.70–0.90) were associated with a significantly lower risk of major bleeding; rivaroxaban (HR = 1.14; 95% CI 1.07–1.21) was associated with a significantly higher risk of major bleeding compared to warfarin. Compared to warfarin, apixaban and rivaroxaban had significantly lower stroke/SE-related medical costs; and apixaban and dabigatran had significantly lower major bleeding-related medical costs. This real-world analysis showed DOACs to be associated with a lower risk of stroke/SE and major bleeding, and lower medical costs compared to warfarin. Among them, only apixaban appears to be associated with a significantly lower risk of all three outcomes collectively: stroke/SE, major bleeding, and lower related medical costs compared to warfarin. [ABSTRACT FROM AUTHOR]

This study evaluated the risk of hospitalization among nonvalvular atrial fibrillation (NVAF) patients with an outpatient COVID-19 diagnosis who discontinued vs continued apixaban treatment. Adult patients with NVAF with an apixaban prescription prior to an outpatient COVID-19 diagnosis were identified from Optum Clinformatics claims database (1 April 2020–31 March 2021). Continuers were those who continued apixaban as of the index date (date of initial outpatient COVID-19 diagnosis) and discontinuers were those who had the last day of apixaban supply on or before index. Patients were followed from COVID-19 diagnosis to change of continuation/discontinuation status, switch, death, end of continuous coverage or study end, whichever occurred first. Inverse probability treatment weighting (IPTW) was performed to balance cohorts. Cox proportional hazard models were used to compare the risk of all-cause hospitalization and hospitalization for ischemic stroke (IS), venous thromboembolism (VTE), myocardial infarction (MI), bleeding and mortality. A total of 7869 apixaban patients with COVID-19 were included: 6676 continuers (84.8%) and 1193 discontinuers (15.2%). Compared with continuers, discontinuers had a higher risk of all-cause hospitalization (hazard ratio [HR]: 1.23; 95% confidence interval [CI]: 1.08–1.40), IS (HR: 2.00; 95% CI: 1.03–3.87), VTE (HR: 2.37; 95% CI: 1.06–5.27) and mortality (HR: 2.28; 95% CI: 1.85–2.80). There were no significant differences in the risk of MI (HR: 1.01; 95% CI: 0.54–1.90) or bleeding-related hospitalization (HR: 1.13; 95% CI: 0.73–1.76). NVAF patients with COVID-19 who discontinued apixaban had a higher risk of hospitalization and thrombotic events vs those who continued apixaban, with no significant difference in bleeding-related hospitalization. [ABSTRACT FROM AUTHOR]

The article focuses on superior vena cava syndrome (SVCS) in lung cancer, examining its prevalence, associated outcomes, and potential racial disparities using the National Inpatient Sample (NIS) database. While SVCS predominantly arises from lung cancer, the study highlights significant racial differences in its occurrence and underscores the need for further investigation into underlying factors contributing to this disparity.

How do political candidates combine social media campaign tools with on-the-ground political campaigns to pursue segmented electoral strategies? We argue that online campaigns can reproduce and reinforce segmented electoral appeals. Furthermore, our study suggests that electoral segmentation remains a broader phenomenon that includes social media as but one of many instruments by which to appeal to voters. To test our argument, we analyze the case of the 2017 legislative elections in Chile. We combine an analysis of Facebook and online electoral campaign data from 80 congressional campaigns that competed in three districts with ethnographic sources (i.e., campaigns observed on the ground and in-depth interviews with candidates). The results of this novel study suggest that intensive online campaigning mirrors offline segmentation. [ABSTRACT FROM AUTHOR]

This paper considers how representations of the Holocaust – what is labeled Holocaust institutionalization – have been critiqued and even condemned in literary texts. Rather than exploring the Holocaust, and the corollaries of memory, identity, Second Generation inherited trauma, and other concerns, this body of literature considers the integrity, decency and purpose of Holocaust projects. Mainly it looks at the way aspects of Holocaust institutionalization are morally suspect, exploitive and counter to meaningful engagement with Holocaust history in the writings of Mordecai Richler. Then, as a counterpoint it examines Hope by Shalom Auslander and Nathan Englander's 2012 short story, 'What We Talk About When We Talk About Anne Frank,' which traffic in moral inquiries into assumptions about Holocaust institutionalization. [ABSTRACT FROM AUTHOR]

Elizabeth Parang reviews Transfer Student Success: Academic Library Outreach and Engagement; Stephanie Rosenblatt reviews The One-Shot Library Instruction Survival Guide, Third Edition. [ABSTRACT FROM AUTHOR]

In the love letters of 14 couples every couple communicated about issues of death and grief, which suggests that death and grief may often have a place in the development of couple relationships. For some, writing about the possible death of self or other seemed connected to the emotional intensity and importance of their mutual love. For some the shared intimacy made the lover a key person with whom to share information, feelings and thought about recent deaths. For some, communications about death and grief seemed steps toward shared approaches to meaning making and expressing feelings regarding death and grief. [ABSTRACT FROM AUTHOR]

This pooled claims database study evaluated the risk of recurrent Venous Thromboembolism (VTE) and major bleeding (MB) among patients with VTE and active cancer prescribed apixaban, low-molecular weight heparin (LMWH), or warfarin stratified by high-risk subgroups. Patients diagnosed with VTE in the setting of active cancer who initiated apixaban, LMWH, or warfarin were identified using four US commercial claims databases from 01SEP2014 to the end of the study period (MarketScan: 01MAR2014-30JUNE2017; Optum and Humana: 01MAR2014-31DEC2017; PharMetrics: 01MAR2014-31MAR2018). Stabilized inverse probability treatment weighting (IPTW) was used to balance treatment cohorts. Cox proportional hazard models were used to evaluate the risk of recurrent VTE and MB for each subgroup stratification: VTE risk level based on cancer types, metastatic diagnosis, cancer treatment, chemotherapy, gastrointestinal cancer, and index VTE event type (PE vs. DVT). Statistical significance (p <.10) of the interaction between treatment effects and subgroups was evaluated. Eligible subjects included 3393 apixaban, 6108 LMWH, and 4585 warfarin patients. After IPTW, all patient characteristics were balanced. Analyses stratified by the VTE risk level, metastatic diagnosis, cancer treatment, chemotherapy, gastrointestinal cancer and index VTE event type showed generally consistent results according to the respective subgroup (most of the p values for interaction >0.10). Two significant interactions were observed between apixaban vs. LMWH and VTE risk level (interaction p =.051) and metastatic diagnosis (interaction p <.001) for recurrent VTE; one significant interactions were observed between apixaban vs. LMWH and cancer treatment for MB (interaction p =.074). Additionally, for warfarin vs. LMWH, two significant interactions were observed between treatment and VTE risk level (interaction p =.005) and metastatic diagnosis (interaction p =.002) for recurrent VTE. Across these high-risk subgroups of VTE cancer patients, treatment outcomes associated with apixaban were generally positive compared to LMWH and warfarin. [ABSTRACT FROM AUTHOR]

There are many ways of understanding what it is for an argument to be valid. Although we usually identify the concept of validity with (classical first-order) logical validity and, in turn, we typically take this to capture the notion of necessary preservation of truth in virtue of logical form, this is just one way in which validity can be explained. A different understanding of the notion of validity that has received some attention recently is based on the idea that an argument is valid just in case accepting its premises is incoherent with rejecting its conclusion. The main claim of the paper will be that, under this understanding of the notion of validity, the usual reasons to privilege a treatment of validities over a treatment of invalidities loose much of their force. Validity and invalidity are on a par, which means that there are no strong reasons to treat validities primitively and to define invalidities in terms of them. [ABSTRACT FROM AUTHOR]

The best upfront therapy for patients with non-gastric extranodal marginal zone lymphoma (EMZL) remains unclear. Notably, 5 (29.4%) patients remain alive and without lymphoma relapse, with 4 (23.6%) for more than 10 years; 5 (29.4%) patients remain alive for more than 6 years after relapse within the first 3 years of diagnosis, and all 7 deaths were non-lymphoma related (Table 1). Two patients pursued with surveillance (1 asymptomatic patient and another patient with liver failure secondary to primary sclerosing cholangitis). Progression-free survival (A), overall survival (B), cumulative incidence of relapse accounting for 5 non-lymphoma death as competing risk (C), and time-to-events by patient (D) in 17 patients treated with 90Y-ibritumomab. [Extracted from the article]

To evaluate utilization of anticoagulants (ACs) and the predictors of treatment of patients with a diagnosis of atrial fibrillation (AF) during a hospital stay in the USA. Patients (≥18 years of age) who had a primary or secondary discharge diagnosis code of AF during a hospitalization (without a diagnosis of venous thromboembolism) were identified from the Premier Hospital database (1 January 2016–30 September 2017). AC treatments were examined during hospitalizations to assign AF patients into 3 study cohorts: those who received an oral AC (OAC), those who received parenteral AC only, and those who did not receive AC therapy. Multivariable logistic regression analyses were carried out to evaluate potential predictors of receiving parenteral AC only vs. OAC therapy, no AC therapy vs. OAC therapy, as well as the specific OAC drug choices. Of the patients hospitalized with an AF diagnosis (n = 482,729; mean age: 74.7 years; 46.8% female; 82.9% White; 79.4% with Medicare), 42.6% received OAC therapy (most commonly, warfarin or apixaban), 35.3% parenteral AC only, and 22.2% no AC therapy. A key predictor of not receiving OAC therapy was having an AF diagnosis in the second position (applicable to 87.4% of study population). Greater comorbidity level and prior baseline bleeding were strong predictors of receiving parenteral AC only or not receiving any AC therapy vs. receiving OAC therapy. Predictors of receiving warfarin vs. apixaban included higher stroke risk and prior baseline bleeding. OAC utilization may have been underestimated since outpatient OAC utilization was not included in the analysis. A substantial portion of hospitalized AF patients did not receive any AC therapy, particularly those patients with an AF diagnosis in the second position on hospital records. The predictors of inpatient AC treatment that were identified may be helpful in the clinical decision-making process for patients who are hospitalized with AF. [ABSTRACT FROM AUTHOR]

Objectives: To compare the risks of 1-month all-cause, major bleeding (MB)-related and stroke-related readmissions and the associated hospital resource use and costs among patients previously hospitalized for nonvalvular atrial fibrillation (NVAF) and treated with warfarin, rivaroxaban, and dabigatran vs apixaban. Methods: Adult patients hospitalized with NVAF (any discharge diagnosis position) who received apixaban, warfarin, rivaroxaban, or dabigatran during hospitalization were identified from the Premier database (1 January 2013-30 June 2017) and grouped into respective cohorts. Propensity score matching was used to generate cohorts with similar characteristics. In regression analyses the risk of readmissions that occurred within 1month of discharge were evaluated and the associated length of stay (LOS) and costs compared. R Result: NVAF patients treated with warfarin vs apixaban had significantly greater risk of all-cause (odds ratio [OR] = 1.05; confidence interval [CI] = 1.02–1.08; p < .001), MB-related (OR: 1.28; CI: 1.16–1.42; p < .001), and stroke-related (OR: 1.33; CI: 1.11–1.58; p = .002) readmissions; for all readmission categories, average LOS was significantly longer and costs significantly higher for warfarin treated patients. NVAF patients treated with rivaroxaban versus apixaban had significantly greater risk of all-cause (OR: 1.06; CI: 1.02–1.09; p = .001) and MB-related (OR = 1.62; CI = 1.44–1.83; p < .001) readmissions, but not stroke-related readmission; for MB-related readmissions average LOS and costs were higher for rivaroxaban treated patients. Significant differences in risks of all-cause, MB-related, and stroke-related readmissions were not observed between the apixaban and dabigatran cohorts. Conclusion: In this retrospective real-world analysis of NVAF patients, apixaban treatment was associated with better clinical outcomes than warfarin or rivaroxaban and lower hospital resource burden. [ABSTRACT FROM AUTHOR]

Objectives: The conditioned-medium derived from corneal mesenchymal stromal cells (cMSCs) has been shown to have wound healing and immunomodulatory effects in corneal injury models. Here, the therapeutic effects of lyophilized cMSC conditioned-medium were compared with fresh conditioned-medium. Methods: The epithelial wound healing effects of fresh and lyophilized cMSC conditioned-medium were compared with conditioned-medium from non-MSC cells (corneal epithelial cells) using scratch assay. To evaluate the anti-inflammatory effects of fresh and lyophilized cMSC conditioned-media, macrophages were stimulated by a Toll-Like Receptor (TLR) ligand followed by treatment with the conditioned-media and measuring the expression of inflammatory genes. In vivo wound healing effects of fresh and lyophilized cMSC conditioned-media were assessed in a murine model of cornea epithelial injury. Results: Both fresh and lyophilized cMSCs-derived conditioned-medium induced significantly faster closure of in vitro epithelial wounds compared to conditioned-medium from non-MSC cells (P <.0001). Treating stimulated macrophages with fresh or lyophilized cMSCs-derived conditioned-media significantly decreased the expression of inflammatory genes compared to control (P <.0001). Murine corneal epithelial wounds were healed by 87.6 ± 2.7% and 86.2 ± 4.6% following treatment with fresh and lyophilized cMSC conditioned-media, respectively, while the control was healed by 64.7 ± 16.8% (P <.05). Conclusion: Lyophilized cMSC-derived conditioned-medium is as effective as fresh conditioned-medium in promoting wound healing and modulating inflammation. The results of this study support the application of lyophilized cMSCs-derived conditioned-medium, which allows for more extended storage, as a promising non-invasive option in the treatment of corneal wounds. [ABSTRACT FROM AUTHOR]

Quantization for probability distributions refers broadly to estimating a given probability measure by a discrete probability measure supported by a finite number of points. We consider general geometric approaches to quantization using stationary processes arising in dynamical systems, followed by a discussion of the special cases of stationary processes: random processes and Diophantine processes. We are interested in how close stationary process can be to giving optimal n-means and nth optimal mean distortion errors. We also consider different ways of measuring the degree of approximation by quantization, and their advantages and disadvantages in these different contexts. [ABSTRACT FROM AUTHOR]

Corneal opacity is a leading cause of reversible blindness worldwide. An electronic corneal prosthesis, or intraocular projector, could potentially restore high-quality vision without need for corneal clarity. Four intraocular projection systems were constructed from commercially available electronic components and encased in biocompatible plastic housing. They were tested for optical properties, biocompatibility, heat dissipation, waterproofing, and accelerated wear. A surgical implantation technique was developed. Intraocular projectors were produced of a size that can fit within the eye. Their optics produce better than 20/200 equivalent visual acuity. MTT assay demonstrated no cytotoxicity of devices in vitro. Temperature testing demonstrated less than 2°C increase in temperature after 1 h. Three devices lasted over 12 weeks under accelerated wear conditions. Implantation surgery was demonstrated via corneal trephination insertion in a cadaver eye. This is the first study to demonstrate and characterize fully functional intraocular projection systems. This technology has the potential to be an important new tool in the treatment of intractable corneal blindness. [ABSTRACT FROM AUTHOR]

Tool use has been documented across a diverse array of animals; however, this behavior has received little attention in reptiles. Recently, researchers reported observations of two crocodilian species apparently using sticks as lures to aid in the capture of nesting birds, but the evidence for the behavior was anecdotal and correlative. To explore the behavior in a more controlled situation we designed an experiment to explicitly test the ability of crocodilians to tailor stick-displaying behaviors to specific environmental contexts using four captive pond-dwelling American alligator (Alligator mississippiensis) populations, two of which reside near bird rookeries and two of which do not. During bird nesting season we added sticks to each pond and observed the frequency with which each population exhibited stick-displaying behaviors. We found that in most comparisons the frequency of stick-displaying behavior did not differ between rookery and no-rookery sites, while in one comparison the alligators at a no-rookery site actually displayed the behavior more frequently than a paired rookery site. Our results do not generally support the hypothesis that crocodilians tailor stick-displaying behaviors to specific environmental contexts, therefore the hypothesis that crocodilians are true tool users is also called into question. Furthermore, our results suggest that experiments on captive populations are not the ideal way to study stick-displaying behavior because of issues like unrealistic alligator densities and food provisioning. [ABSTRACT FROM AUTHOR]

Every healer works within a culture of healing. Healing cultures may work well when "clients" understand and accept their place in the healing culture. But a healing culture can create challenges for clients whose cultural background is remote from it. This paper explores how the culture of grief counseling and grief therapy may create difficulties for clients who are cultural outsiders. The paper offers advice to culturally other clients, to help them and all readers to understand the culture of grief professionals and to help to overcome, where possible, problems cultural outsiders may encounter when seeking help from grief professionals. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the validity of diagnosis codes for identifying obesity and morbid obesity among newly treated nonvalvular atrial fibrillation (NVAF) patients.Methods: An integrated electronic medical record (EMR) and claims database (1 January 2013-31 March 2018) was used. Adult patients with ≥1 claim for an oral anticoagulant (OAC) from 1 January 2014-30 September 2017 were identified (index date). Patients were required to have ≥1 atrial fibrillation diagnosis, no OAC use or valvular disease during the 12 months before index date, ≥12 months of continuous enrollment before and ≥6 months after index date, and ≥1 BMI measurement 6 months before or after index date. Patients with BMI ≥30 kg/m2 and BMI ≥40 kg/m2 were classified as obese and morbidly obese, respectively. Sensitivity, specificity and positive predictive value (PPV) were calculated to assess the validity of diagnosis codes for obesity and morbid obesity.Results: A total of 7501 patients met all selection criteria. Forty-six percent of patients had BMI ≥ 30 kg/m2, of whom about one-quarter had a BMI ≥ 40 kg/m2. Twenty-five percent and 10% of patients had a diagnosis code for obesity or morbid obesity, respectively. Sensitivity, specificity and PPV for obesity diagnosis codes were 48.67% (95% CI: 47.00%-50.35%), 95.24% (94.54%-95.88%) and 89.78% (88.32%-91.12%), respectively, and 62.75% (59.30%-66.11%), 96.46% (95.99%-96.89%) and 67.93% (64.43%-71.29%) for morbid obesity diagnosis codes, respectively.Conclusion: Among newly treated NVAF patients, obesity diagnosis codes had high PPV, high specificity and modest sensitivity. Morbid obesity diagnosis codes also had high specificity, but modest PPV and sensitivity. These findings have implications for case selection and control for obesity as a confounder in studies using a claims database. [ABSTRACT FROM AUTHOR]

Pulmonary alveolar proteinosis is an uncommon cause of insidious onset shortness of breath and hypoxemia. It is caused by an accumulation of surfactant within the alveoli. Left untreated, it can be fatal. Standard-of-care treatment is whole-lung lavage; however, in severe cases, the associated hypoxemia can be profound and single-lung ventilation would not be tolerated, potentially preventing a lifesaving treatment. Single cases using veno-venous extracorporeal membrane oxygenation to perform whole-lung lavage have been reported. Here we describe three patients with severe pulmonary alveolar proteinosis who were successfully treated with whole-lung lavage using veno-venous extracorporeal membrane oxygenation for oxygenation support. [ABSTRACT FROM AUTHOR]

Objective: To compare safety, effectiveness, and healthcare costs of major bleeding (MB), clinically relevant non-major (CRNM) bleeding, recurrent venous thromboembolism (VTE), and all-cause hospitalization among elderly Medicare VTE patients prescribed warfarin vs apixaban.Methods: Using 100% Medicare data, elderly patients prescribed apixaban or warfarin within 30 days after a VTE encounter were identified. Patients had continuous health plan enrollment and no parenteral or oral anticoagulant use ≤6 months preceding the VTE encounter. Cohorts were balanced using 1:1 propensity score matching (PSM). Cox proportional hazard models were used to assess the risk of MB, CRNM bleeding, recurrent VTE, and all-cause hospitalization. Generalized linear and two-part models were used to estimate MB-, recurrent VTE-, and all-cause related costs (per patient per month [PPPM]).Results: In the pre-matched cohort, 25,284 (66.9%) patients were prescribed warfarin and 12,515 (33.1%) apixaban. After 1:1 PSM, 11,363 matched pairs of apixaban-warfarin patients were included for a mean follow-up of 4.0 and 4.4 months, respectively. Matched cohorts had a mean age of 78 years and mean Charlson Comorbidity Index score of 2.9. Warfarin was associated with a higher risk of MB (hazard ratio [HR] = 1.31; 95% confidence interval [CI] = 1.10-1.57) and CRNM bleeding (HR = 1.31; 95% CI = 1.19-1.43) vs apixaban. The risks of recurrent VTE (HR = 0.96; 95% CI = 0.70-1.33) and all-cause hospitalization (HR = 1.05; 95% CI = 0.99-1.12) were similar among warfarin and apixaban patients. Warfarin patients had higher MB-related ($147 vs $75; p = .003) and all-cause costs PPPM ($3,267 vs $3,033; p < .001), but similar recurrent VTE-related medical costs PPPM ($30 vs $36; p = .516) vs apixaban patients.Conclusions: Warfarin was associated with significantly higher risk of MB and CRNM bleeding as well as higher MB-related and all-cause costs vs apixaban patients. Recurrent VTE risk and costs were similar among warfarin and apixaban patients. [ABSTRACT FROM AUTHOR]

Objective: To compare the risk of hospitalization and costs associated with major bleeding (MB) or stroke/systemic embolism (SE) among elderly patients with nonvalvular atrial fibrillation (NVAF) who initiated apixaban then switched to another oral anticoagulant (OAC) vs. those who continued with apixaban treatment. Methods: NVAF patients (≥65 years) initiating apixaban were identified from the Humana database (1 January 2013-30 September 2017) and grouped into switcher and continuer cohorts. For switchers, the earliest switch from apixaban to another OAC was defined as the index event/date. A random date during apixaban treatment was selected as the index date for continuers. Patients were followed from index date to health plan disenrollment or 31 December 2017, whichever was earlier. Multivariable regression analyses were used to examine the association of switchers vs. continuers with risk of MB-related or stroke/SE-related hospitalization and healthcare costs during follow-up. Results: Of 7858 elderly NVAF patients included in the study, 14% (N = 1110; mean age: 78 years) were switchers; 86% (N = 6748; mean age: 79 years) were continuers. Apixaban switchers vs. continuers had significantly greater risk of MB-related hospitalization (hazard ratio [HR]: 2.00; 95% CI: 1.52-2.64; p < .001) during follow-up; risk of stroke/SE hospitalization did not differ significantly (HR: 1.36, 95% CI: 0.89-2.06, p = .154). MB- and stroke/SE-related medical costs were higher for switchers vs. continuers, although total all-cause healthcare costs were similar. Conclusion: Elderly patients with NVAF in the US who continued with apixaban treatment had a lower risk of MB-related hospitalization and lower MB- and stroke/SE-related medical costs compared to patients who switched to another OAC. [ABSTRACT FROM AUTHOR]

People grieving a death may grieve not only the loss of the person who died but also relationship systems lost because of the death. Relationship systems can be defined as what goes on between or among people. In helping bereaved people who talk about systemic loss it is important to acknowledge and speak to that aspect of their loss and, if appropriate, to support them in finding ways to move forward in addressing their systemic losses. Failure to acknowledge and stay with a bereaved person's words about systemic loss and instead to slide into talking about, for example, grief feelings could be taken as a lack of death competence and an empathic failure. The paper provides illustrations regarding systemic losses in the area of roles, including losses in the areas of collaboration in defining realities, memory-sharing, and mutual knowing and being known. [ABSTRACT FROM AUTHOR]

Blepharoptosis or ptosis is a common and potentially debilitating clinical problem. Long-term surgical treatment for ptosis caused by progressive myopathies can be challenging due to potential recurrence and complications associated with facial muscle weakness. When surgical treatment is no longer effective, an eyelid crutch can be used as an alternative intervention. This report demonstrates how 3D printing was used to rapidly design, prototype, and manufacture new custom-fit eyelid crutches at a low cost. [ABSTRACT FROM AUTHOR]

Creativity is a critical part of counseling work. Counseling educators are consistently seeking new ways to cultivate counselors' in training (CIT) creative capacity and self-reflection in the classroom. This article is a pilot study of photovoice, a qualitative research methodology, as a pedagogical tool. Participants (n = 7) were master's degree students enrolled in a section of Counseling Techniques. As part of the course, students were asked to take a photo that represented each week's material and to participate in class discussions about those photos. Results indicate that participants found the assignment enjoyable and helpful. Additionally, the article includes a discussion of the considerations for using photovoice in the classroom as well as areas for further research. [ABSTRACT FROM AUTHOR]

Purpose: To describe the demographics and clinical characteristics of patients with herpetic anterior uveitis (HAU), and compare characteristics by pathogen, recurrence, and association to iris atrophy.Methods: Multicenter, retrospective study of AU patients diagnosed clinically and by polymerase chain reaction (PCR).Results: The study included 112 eyes in 109 patients: 54 (48.2%) HSV, 34 (30.4%) VZV, 2 (1.8%) CMV, and 22 (19.6%) unspecified diagnosis. HSV eyes, compared to VZV, had a higher recurrence rate, corneal involvement, KPs, iris atrophy, elevated IOP and posterior synechia (p < 0.05). VZV patients had more frequent immunomodulatory treatments and history of systemic herpetic disease (p < 0.05). Fifty-nine (52.7%) eyes had recurrent disease. Iris atrophy was associated with a higher prevalence of posterior synechia, dilated distorted pupil, and high IOP (p < 0.05).Conclusion: Different HAU-causing Herpesviridae produce common clinical findings; therefore, PCR should be used more often to confirm specific diagnosis. Iris atrophy was associated with more severe disease. [ABSTRACT FROM AUTHOR]

In order to improve their service level many automated storage/retrieval systems (AS/RS) have adopted a dual command policy. In a dual command policy both storage and retrieval of pallets are done within one roundtrip of the crane. The expected travel time for a dual command policy is composed of two one-way travel time elements used for storage and retrieval, and an interleaving time element used for moving from a storage location to a retrieval location. In this study we apply the nearest-neighbour policy to a class-based warehouse in order to decrease the interleaving time. We develop the methodology for determining the interleaving time for both square and rectangular (time-wise) warehouses. We show that using the nearest-neighbour policy in a class-based environment can decrease the interleaving time, resulting in a significant increase in the total throughput. [ABSTRACT FROM AUTHOR]

A solution procedure is provided for solving the joint replenishment problem using a basic cycle approach. The solution procedure is very simple, and involves comparing possible values between the `minimum' and `maximum' cycle times. Extensive simulation demonstrates that this solution procedure is superior to previously known algorithms for solving this problem. [ABSTRACT FROM AUTHOR]

The use of containers as basic handling units in warehousing systems is continuously expanding. A systematic procedure is proposed for finding the best container size for such systems. An approximating approach is developed which is valid under specific conditions. When these conditions do not hold, a simulation model is applied, yielding a minimum-cost container size that satisfies prescribed requirements. [ABSTRACT FROM AUTHOR]

A heuristic algorithm for solving the quadratic assignment formulation to the plant layout problem is presented. The algorithm involves deriving an initial assignment of departments to sites (a construction phase) and then, possibly, improving the solution through exchange between pairs of departments. A 'classical' numerical example is used to demonstrate the effectiveness, costwise and in terms of computational effort, of the algorithm. Finally, a set of examples previously used by various authors is assembled and solved in the Appendix. Results are compared to optimal solution values and to the average solution of another known heuristic. These examples could serve as a sample set for testing the effectiveness of other approaches to this problem. [ABSTRACT FROM AUTHOR]

In this study we examine the elements that affect the required capacity of a warehouse in a stochastic environment. The required capacity is measured in terms of its deviation from the nominal capacity requirement (NCR). A simulation model was developed to measure the relationship between warehouse capacity and the various pertinent parameters. From a set of simulated experiments, it is seen that the deviation in the required capacity is mainly affected by the number of items stored, the ordering quantity and the average issues of items per day. [ABSTRACT FROM AUTHOR]

Discusses the single period plant layout problem in facilities design. Use of the robustness approach in dealing with the problem; Characteristics and effectiveness of the robustness approach.

In this study, models for obtaining economic order quantities (EOQ) are considered which take into account the effects of advertising, price elasticity and economies of scale, and the possibility of some ordered items being defective. An earlier model by Subramanyam and Kumaraswamy (1981) is shown to be restrictive in its treatment of the effects of defective items. To correctly model these effects, three different scenarios for dealing with defective items are considered and the resulting EOQ models presented. Special cases are also considered. It is shown that the earlier model can lead to incorrect economic order quantities in these scenarios. [ABSTRACT FROM AUTHOR]

Compares two policies for the joint replenishment problem with a general ordering cost function in inventory management. Use of dynamic programming approach to solve the fixed-cycle policy; Comparison of the effectiveness of the two policies; Applications of the basic-cycle approach.

This paper deals with the problem of finding the order quantities, or cycle times, for the case of a multi-item inventory system with joint replenishment costs. The ordering cost is composed of a fixed cost independent of the number of items ordered and additional ordering costs dependent on the specific items ordered. Different solution procedures suggested for solving this problem are presented. A simulation program is developed comparing the effectiveness of these algorithms. One hundred and thirty two different settings, each consisting of one thousand examples, are analysed. Based on the simulation, two approaches are recommended for solving this problem. [ABSTRACT FROM AUTHOR]

Presents a procedure for solving warehouse design problem with storage policy considerations. Types of cost that are considered; Size of the warehouse; Internal layout of the warehouse.

Micro-productivity measurement models have been proposed for calculating, partial (single factor) or aggregate (total factor), productivity indexes in industrial environments. In this paper, the models are extended to cover project productivity measurement, by considering project duration as a distinct input factor in addition to the other physical inputs. The duration effect if measured by comparing the future value, at completion, of all invested inputs.

In this paper a problem of multi-item production on a single facility is being dealt with. The facility is an electrochemical machining (ECM) system and the products are impact sockets of various sizes for power wrenches. Sequencing production lots in a certain order minimizes set-up time for each new production lot. However, as demand differs from item to item, it is not essential to produce each item in every production cycle. A grouping procedure of the various items is adopted. A modified version of the Page and Paul algorithm is then applied to insure production cycle times which are multiples of the shortest production cycle time. Application of a sequencing policy based on this modified algorithm led to considerable savings. [ABSTRACT FROM AUTHOR]

Two basic approaches, the Lagrangian method and the fixed cycle method, have been suggested for solving the problem of multi-item inventory systems with budgetary constraints. The two solution procedures are compared. A simple algorithm is developed to test which solution procedure would result in a lower cost. [ABSTRACT FROM AUTHOR]

This paper presents a combined quantitative and qualitative (subjective) approach to the plant layout problem. The two objectives, which may be conflicting, are minimizing the material handling cost and maximizing a closeness rating measure. A heuristic algorithm is developed which results in a discrete efficient frontier set, including only 'efficient layouts'. By specifying the different weights, or range of weights, for these goals, the 'best' solution (layout) is generated. [ABSTRACT FROM AUTHOR]

The initial management of patients presenting with acute pulmonary embolism (PE) is individualized based on hemodynamic status and other prognostic factors. Patients at low risk of adverse outcomes are treated conservatively with anticoagulation, whereas high-risk and selected intermediate-risk patients should be considered for advanced interventions. Seeking to better understand local practice patterns, we retrospectively reviewed 196 cases of acute PE diagnosed in the emergency department of Baylor University Medical Center over a 12-month period. Given the available data, we classified 86 cases as low risk, 101 as intermediate risk, and 9 as high risk for early mortality. Four patients with high-risk PE and 11 patients with intermediate-risk PE were treated with thrombolytic therapy. Central embolus location, right ventricular dilation on computed tomography, and right ventricular strain on electrocardiogram were associated with the use of thrombolytic therapy in the intermediate-risk group. In total, 9 patients died and 11 suffered major bleeding. Patients with acute PE are a remarkably heterogeneous group with wide variations in workup, treatment, and outcomes. [ABSTRACT FROM AUTHOR]

Objective: To report new cases of orbital inflammatory syndrome (OIS) post group A streptococcal (GAS) infection and review the literature.Methods: A retrospective case series of patients with OIS post GAS infection seen in our clinic (from January 2015 to December 2016) and review of additional patients from the literature.Results: A total of nine patients with OIS post GAS infection were included in the study (four patients seen in our clinic and five from previous literature); seven females and two males, three children (under the age of 16), and six adults. Eight patients (89%) presented with a single rectus muscle (5 medial, 3 lateral) myositis, and one (11%) presented with posterior scleritis and diffuse OIS.Conclusions: Although there are very few reports on OIS post GAS infection, it may be more common than previously thought and should be considered in the differential diagnosis of patients with orbital inflammation. [ABSTRACT FROM AUTHOR]