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An unexpected academic department closure can be deeply unsettling to many stakeholders. Department closure is typically intended to be a cost-saving measure; however, department closure can be a difficult, time-consuming process with unexpected consequences. This study takes a hermeneutical phenomenological approach to explore the impact of the closure of an academic department. Participants were enrolled in one of the department's academic programs at the time of the closure announcement and during data collection. Results indicated that participants sanctified the department, a process in which persons instill an object or aspect of their lives with spiritual significance (Pargament et al., 2005). The closure prompted participants to experience a cosmology episode in which a sudden shift in worldview occurred, and participants indicated being in the sense-losing stage where meaning had not yet been made. The findings of this study can serve as a model for leadership at all levels who are considering program closures, with particular attention on how to assist students.

IntroductionFirearms and motor vehicle collisions (MVC) are leading causes of mortality in children. We hypothesized that firearm injuries would have a higher mortality than MVCs in children and a higher level of resource utilization METHODS: Trauma patients

Thyroid storm is a rare, life-threatening endocrine emergency with a high mortality rate of up to 30%. We present a unique management challenge of a critically ill patient who developed thyroid storm in the setting of a duodenal perforation from amphetamine-associated non-occlusive mesenteric ischaemia. The diagnosis of 'thyroid storm' was made based on clinical criteria and a Burch-Wartofsky score of 100. During emergent exploratory laparotomy, a 1 cm duodenal perforation with surrounding friable tissue was found and repaired. Intraoperatively, a nasogastric tube was guided distal to the area of perforation to allow for enteric administration of medications, which was critical in the setting of thyroid storm. Therapeutic plasma exchange achieved biochemical control of our patient's thyroid storm but ultimately did not prevent in-hospital mortality.

Stroke identification is a key step in acute ischemic stroke management. Our objectives were to prospectively examine the agreement between prehospital and hospital Modified National Institutes of Health Stroke Scale (mNIHSS) assessments as well as assess the prehospital performance characteristics of the mNIHSS for identification of large vessel occlusion strokes. Method: In this prospective cohort study conducted over a 20-month period (11/2016-6/2018), we trained 40 prehospital providers (paramedics) in Emergency Neurological Life Support (ENLS) curriculum and in mNIHSS. English-speaking patients aged 18 and above transported for an acute neurological deficit were included. Using unique identifiers, we linked the prehospital assessment records to the hospital record. We calculated the agreement between prehospital and hospital mNIHSS scores using the Bland-Altman analysis and the sensitivity and specificity of the prehospital mNIHSS. Results: Of the 31 patients, the mean difference (prehospital mNIHSS-hospital mNIHSS) was 2.4, 95% limits of agreement (-5.2 to 10.0); 10 patients (32%) met our a priori imaging definition of large vessel occlusion and the sensitivity of mNIHSS ≥ 8 was 6/10 or 0.60 (95% CI: 0.26-0.88) and the specificity was 13/21 or 0.62 (95% CI: 0.38-0.82), respectively. Conclusions: We were able to train prehospital providers to use the prehospital mNIHSS. Prehospital and hospital mNIHSS had a reasonable level of agreement and and the scale was able to predict large vessel occlusions with moderate sensitivity.

Introduction: In March 2020, shelter-in-place orders were enacted to attenuate the spread of coronavirus 2019 (COVID-19). Emergency departments (EDs) experienced unexpected and dramatic decreases in patient volume, raising concerns about exacerbating health disparities.Methods: We queried our electronic health record to describe the overall change in visits to a two-ED healthcare system in Northern California from March–June 2020 compared to 2019. We compared weekly absolute numbers and proportional change in visits focusing on race/ethnicity, insurance, household income, and acuity. We calculated the z-score to identify whether there was a statistically significant difference in proportions between 2020 and 2019.Results: Overall ED volume declined 28% during the study period. The nadir of volume was 52% of 2019 levels and occurred five weeks after a shelter-in-place order was enacted. Patient demographics also shifted. By week 4 (April 5), the proportion of Hispanic patients decreased by 3.3 percentage points (pp) (P = 0.0053) compared to a 6.2 pp increase in White patients (P = 0.000005). The proportion of patients with commercial insurance increased by 11.6 pp, while Medicaid visits decreased by 9.5 pp (P < 0.00001) at the initiation of shelter-in-place orders. For patients from neighborhoods 400% FPL the week of the shelter-in-place order. Overall, 2020 evidenced a consistently elevated proportion of high-acuity Emergency Severity Index (ESI) level 1 patients compared to 2019. Increased acuity was also demonstrated by an increase in the admission rate, with a 10.8 pp increase from 2019. Although there was an increased proportion of high-acuity patients, the overall census was decreased.Conclusion: Our results demonstrate changing ED utilization patterns circa the shelter-in-place orders. Those from historically vulnerable populations such as Hispanics, those from lower socioeconomic areas, and Medicaid users presented at disproportionately lower rates and numbers than other groups. As the pandemic continues, hospitals should use operations data to monitor utilization patterns by demographic, in addition to clinical indicators. Messaging about availability of emergency care and other services should include vulnerable populations to avoid exacerbating healthcare disparities.

Introduction: Hallway beds in the emergency department (ED) produce lower patient satisfaction and inferior care. We sought to determine whether socioeconomic factors influence which visits are assigned to hallway beds, independent of clinical characteristics at triage.Methods: We studied 332,919 visits, across 189,326 patients, to two academic EDs from 2013-2016. We estimated a logistic model of hallway bed assignment, conditioning on payor, demographics, triage acuity, chief complaint, patient visit frequency, and ED volume. Because payor is not generally known at the time of triage, we interpreted it as a proxy for other observable characteristics that may influence bed assignment. We estimated a Cox proportional hazards model of hallway bed assignment on length of stay.Results: Median patient age was 53. 54.0% of visits were by women. 42.1% of visits were paid primarily by private payors, 37.1% by Medicare, and 20.7% by Medicaid. A total of 16.2% of visits were assigned to hallway beds. Hallway bed assignment was more likely for frequent ED visitors, for lower acuity presentations, and for psychiatric, substance use, and musculoskeletal chief complaints, which were more common among visits paid primarily by Medicaid. In a logistic model controlling for these factors, as well as for other patient demographics and for the volume of recent ED arrivals, Medicaid status was nevertheless associated with 22% greater odds of assignment to a hallway bed (odds ratio 1.22, [95% confidence interval, CI, 1.18-1.26]), compared to private insurance. Visits assigned to hallway beds had longer lengths of stay than roomed visits of comparable acuity (hazard ratio for departure 0.91 [95% CI, 0.90-0.92]).Conclusion: We find evidence of social determinants of hallway bed use, likely involving epidemiologic, clinical, and operational factors. Even after accounting for different distributions of chief complaints and for more frequent ED use by the Medicaid population, as well as for other visit characteristics known at the time of triage, visits paid primarily by Medicaid retain a disproportionate association with hallway bed assignment. Further research is needed to eliminate potential bias in the use of hallway beds.

In understanding how active and blended learning approaches with learning technologies engagement in undergraduate education, current research models tend to undermine the effect of learners' variations, particularly regarding their styles and approaches to learning, on intention and use of learning technologies. This study contributes to further examine a working model for learning outcomes in higher education with the Unified Theory of Acceptance and Use of Technology (UTAUT) on SRS adoption attitude, and the Study Process Questionnaire (SPQ) on students' approach to learning. Adopting a cross-section observational design, the current study featured an online survey incorporating items UTAUT and SPQ. The survey was administered to 1627 undergraduate students at a large comprehensive university in Hong Kong. Relationships between SRS adoption attitude, learning approaches, and learning outcomes in higher-order thinking & learning and collaborative learning were analyzed with a structural equation model (SEM). A total of 3 latent factors, including four factors from UTAUT in Performance Expectancy, Effort Expectancy, and Deep Learning Approach from the SPQ, were identified in the structural model on students' intention to adopt SRS in classes. Current results suggested that a model of active learning outcomes comprising both UTAUT constructs and deep learning approach. Model presented in the present study supported the UTAUT in predicting both behavioral intention and in adopting SRS in large classes of undergraduate education. Specifically, positive attitudes towards SRS use measured with the UTAUT, via a learning approach towards deep learning, accounted for variation on high-impact learning including higher-order thinking and collaborative learning. Results demonstrated that the process of technology adoption should be conceptualized in conjunction with learners' diversity for explaining variation in adoption of technologies in the higher education context.

The H1 subtype of influenza A viruses (IAVs) has been circulating in swine since the 1918 human influenza pandemic. Over time, and aided by further introductions from nonswine hosts, swine H1 viruses have diversified into three genetic lineages. Due to limited global data, these H1 lineages were named based on colloquial context, leading to a proliferation of inconsistent regional naming conventions. In this study, we propose rigorous phylogenetic criteria to establish a globally consistent nomenclature of swine H1 virus hemagglutinin (HA) evolution. These criteria applied to a data set of 7,070 H1 HA sequences led to 28 distinct clades as the basis for the nomenclature. We developed and implemented a web-accessible annotation tool that can assign these biologically informative categories to new sequence data. The annotation tool assigned the combined data set of 7,070 H1 sequences to the correct clade more than 99% of the time. Our analyses indicated that 87% of the swine H1 viruses from 2010 to the present had HAs that belonged to 7 contemporary cocirculating clades. Our nomenclature and web-accessible classification tool provide an accurate method for researchers, diagnosticians, and health officials to assign clade designations to HA sequences. The tool can be updated readily to track evolving nomenclature as new clades emerge, ensuring continued relevance. A common global nomenclature facilitates comparisons of IAVs infecting humans and pigs, within and between regions, and can provide insight into the diversity of swine H1 influenza virus and its impact on vaccine strain selection, diagnostic reagents, and test performance, thereby simplifying communication of such data. IMPORTANCE A fundamental goal in the biological sciences is the definition of groups of organisms based on evolutionary history and the naming of those groups. For influenza A viruses (IAVs) in swine, understanding the hemagglutinin (HA) genetic lineage of a circulating strain aids in vaccine antigen selection and allows for inferences about vaccine efficacy. Previous reporting of H1 virus HA in swine relied on colloquial names, frequently with incriminating and stigmatizing geographic toponyms, making comparisons between studies challenging. To overcome this, we developed an adaptable nomenclature using measurable criteria for historical and contemporary evolutionary patterns of H1 global swine IAVs. We also developed a web-accessible tool that classifies viruses according to this nomenclature. This classification system will aid agricultural production and pandemic preparedness through the identification of important changes in swine IAVs and provides terminology enabling discussion of swine IAVs in a common context among animal and human health initiatives.

BackgroundMost human microbiota studies focus on bacteria inhabiting body surfaces, but these surfaces also are home to large populations of viruses. Many are bacteriophages, and their role in driving bacterial diversity is difficult to decipher without the use of in vitro ecosystems that can reproduce human microbial communities.ResultsWe used chemostat culture systems known to harbor diverse fecal bacteria to decipher whether these cultures also are home to phage communities. We found that there are vast viral communities inhabiting these ecosystems, with estimated concentrations similar to those found in human feces. The viral communities are composed entirely of bacteriophages and likely contain both temperate and lytic phages based on their similarities to other known phages. We examined the cultured phage communities at five separate time points over 24 days and found that they were highly individual-specific, suggesting that much of the subject-specificity found in human viromes also is captured by this culture-based system. A high proportion of the community membership is conserved over time, but the cultured communities maintain more similarity with other intra-subject cultures than they do to human feces. In four of the five subjects, estimated viral diversity between fecal and cultured communities was highly similar.ConclusionsBecause the diversity of phages in these cultured fecal communities have similarities to those found in humans, we believe these communities can serve as valuable ecosystems to help uncover the role of phages in human microbial communities.

BackgroundA nutrient-wide approach may be useful to comprehensively test and validate associations between nutrients (derived from foods and supplements) and blood pressure (BP) in an unbiased manner.Methods and resultsData from 4680 participants aged 40 to 59 years in the cross-sectional International Study of Macro/Micronutrients and Blood Pressure (INTERMAP) were stratified randomly into training and testing sets. US National Health and Nutrition Examination Survey (NHANES) four cross-sectional cohorts (1999-2000, 2001-2002, 2003-2004, 2005-2006) were used for external validation. We performed multiple linear regression analyses associating each of 82 nutrients and 3 urine electrolytes with systolic and diastolic BP in the INTERMAP training set. Significant findings were validated in the INTERMAP testing set and further in the NHANES cohorts (false discovery rate

The total ion current generated by a vacuum arc plasma source was measured. The discharge system investigated allowed ion collection from the arc plasma streaming through a hemispherical mesh anode with geometric transparency of 72 percent. A range of different cathode materials was investigated, and the arc current was varied over the range 50-500 A. We find that the normalized ion current (Iion/Iarc) depends on the cathode material, with values in the range from 5 percent to 19 percent and generally greater for elements of low cohesive energy. The application of a strong axial magnetic field in the cathode and arc region leads to increased normalized ion current, but only by virtue of enhanced ion charge states formed in a strong magnetic field.

The ion flux from vacuum arc cathode spots was measured in two vacuum arc systems. The first was a vacuum arc ion source which was modified allowing us to collect ions from arc plasma streaming through an anode mesh. The second discharge system essentially consisted of a cathode placed near the center of a spherically shaped mesh anode. In both systems, the ion current streaming through the mesh was measured by a biased collector. The mesh anodes had geometric transmittances of 60% and 72%, respectively, which were taken into account as correction factors. The ion current from different cathode materials was measured for 50-500 A of arc current. The ion current normalized by the arc current was found to depend on the cathode material, with values in the range from 5% to 19%. The normalized ion current is generally greater for elements of low cohesive energy. The ion erosion rates were determined from values of ion current and ion charge states, which were previously measured in the same ion source. The absolute ion erosion rates range from 16-173 mu g/C.

Micro-patterning for cell culturing is a critical technique for today s bioengineering that has gained increasing attention in recent years. Micro-patterning can be achieved by chemical or physical means. One important way of modifying the interaction between living cells and surfaces of materials conventionally used in biomedical applications is by means of thin coatings: of particular interest to this work is diamondlike carbon films (DLC). Rather than a single material, DLC is best described as a class of materials, typically formed by carbon atoms or carbon and hydrogen atoms in a random network with no long-range order. The properties of these materials cover a broad range of values, and are primarily determined by their chemical composition and bonding configuration. Biocompatibility of DLC has been demonstrated in a series of publications 1-4. DLC can be alloyed with other elements, such as refractory metals, Si, N, F and others. Adding these elements modifies both bulk and surface properties. Bulk properties, such as electrical properties or intrinsic stresses, have a great effect on the performance of the coated part under different operating conditions e.g., external load, temperature and so forth. On the other hand, surface properties determine the interaction between the film and its environment, which is critical, for instance, for cell culturing. An interesting application of DLC in micro-patterning has been recently proposed for the selective growth of neurons 5. Preferential attachment on DLC coated glass slides was demonstrated, as shown in Figure 1. However, cell growth takes place not directly over the deposited DLC, but on a layer of collagen, which lies between the modified surface and the cells. Therefore in order to understand the observation of preferential growth on DLC coated surfaces, it is important to understand the interaction between DLC and the collagen molecules .In this article we discuss the deposition processes of the different types of DLC films on a variety of substrates, and some basic properties of such films. The effect of adding different alloying elements (N, Si, Ti) to the DLC on cell growth is discussed. In this article we also discuss our experiments to test the hypothesis proposed in our earlier publication 5 that the selectivity in cell growth is actually due to differentiation in the collagen films prepared on the treated and untreated surfaces. Atomic force microscopy (AFM) and electron microscopy are used to characterize the collagen morphology on surfaces coated with the different types of DLC and surfaces without any DLC. References: 1. Ohl, A and Shroder, K, Surface and Coatings Technology 116-119, 820-830 (1999). 2. Lettington, A H, Phil. Trans. R. Soc. London Ser. A, 342 287-296 (1993). 3. Dowling, DP et al. Diamond and Related Materials 6, 390-393 (1997). 4. Hauert, R Diamond and Related Materials 12 583-589 (2003) 5. Brown, I G et al. Plasma Phys. Control. Fusion 45 547-554 (2003).

A vacuum arc ion source was modified allowing us to collect ions from arc plasma streaming through an anode mesh. The mesh had a geometric transmittance of 60 percent, which was taken into account as a correction factor. The ion current from twenty-two cathode materials was measured at an arc current of 100 A. The ion current normalized by the arc current was found to depend on the cathode material, with valuesin the range from 5 percent to 11 percent. The normalized ion current is generally greater for light elements than for heavy elements. The ion erosion rates were determined from values of ion currentand ion charge states, which were previously measured in the same experimental system. The ion erosion rates range from 12-94 mu g/C.