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Introduction: Team-based learning and Problem-Based Learning can be integrated for in person and online psychology or behavioral health related courses in higher education. Statement of the Problem: Historically, team-based learning and problem-based learning have been considered separate (and seemingly competing) activities and not often conducted concurrently during a course. Literature Review: A review of the literature on team-based learning, however, has uncovered some cases where team-based learning and problem-based learning were integrated together in a course. Teaching Implications: The purpose of this article is to present a case example in which team-based learning and problem-based learning were integrated together in two master's level sex therapy courses: one in the U.S. and one in Austria. The article describes how this integration was achieved through outlining the activities of the class and the possible benefits seen based on self-report. Conclusion: Integrating team-based learning and problem-based learning was an effective method for teaching two master's level sex therapy courses and may have relevant application to psychology classes and/or treatment-oriented topics in behavioral health.

Research on translingual repertoires has highlighted the diverse semiotic resources that individuals access in communication, but little research has considered how spatial factors permit or limit access to these resources. Furthermore, as translingual studies have predominantly focused on interactional analysis, there is a paucity of studies on how social networks shape the repertoires of users. To fill this gap, we examine the communicative practices of an international spouse temporarily living in the United States. Through interview data and mobility maps, we analyze the participant's subject positioning and its relation to his use of spatial resources in different spaces. Despite the participant's low English proficiency, he engaged in conversations in many spaces through strategic employment of semiotic resources, including multiple languages and material objects. He also adopted certain positionings that afforded him more opportunities to interact. Thus, we argue that the usefulness of semiotic resources is tied to the spaces in which they are employed and that access to these resources is shaped by subject positioning.

Sociolinguists have recently employed the notion of spatiotemporal scales to explain the changing social status of linguistic codes across social and geopolitical domains. Scales enable us to address the portability of semiotic resources in migration with great insight. In addition, unlike romanticized orientations to globalization and transnational relations, this model enables us to address the role of power in shaping the uptake of resources in shifting social contexts. Sociolinguists in this tradition show how the resources that enjoy power and prestige in certain local contexts receive lower status as migrants move to other social contexts, especially in Western urban communities. Despite the usefulness of this orientation, the sociolinguistics of scale suffers from certain limitations. It presents a highly stratified vision of social spaces, ignoring the possibility for renegotiating status differences and hierarchies. It assumes a normative orientation to languages, unable to accommodate the possibility that new language norms and practices might emerge, leading to new orders of indexicality. For these reasons, it is also insensitive to agency in mobility, unable to theorize how migrants may renegotiate norms in elite and privileged contexts. I present interview data from African skilled migrants in the UK, USA, and Australia to demonstrate their attitudes toward renegotiating the valuation and status of their own varieties of English in transnational contexts. Their narratives suggest how migrants negotiate spatiotemporal scales to their advantage, redefine the translocal space, and reconstruct new orders of indexicality in intercultural communication. Though I lack interactional data to examine uptake, the interview data helps develop a more complex use of scalar metaphors to address the dynamics of agency and inequality in intercultural communication in translocal spaces. (Contains 3 notes.)

Thorough understanding of surgical indications and type of revision shoulder arthroplasty (SA) performed aids policy making decisions, resource allocation, and research into cost and utilization. The purpose of this study was to determine indications for and the type of revision SA performed in the United States. Healthcare Cost and Utilization Project National Inpatient Sample database was used to analyze clinical, demographic, and economic data from 61,615 revision SA procedures performed from 2012 to 2018. The prevalence of revision procedures was calculated for population subgroups in the United States that were stratified according to age, sex, diagnosis, primary payer class, and type of hospital using the most recent year of data. The indication for revision and average length of stay after revision surgery were also determined for each type of revision arthroplasty procedure. Linear regression was used to estimate procedures through 2030, using incidence values from 2012 to 2018. Annual volume of revision SA in the United States increased by 153% from 5650 procedures in 2012 to 14,300 procedures in 2018. Linear regression predicted a continued increase in this annual volume, increasing to 37,329 revision SA procedures by 2030. The most common SA procedure performed in the revision setting was reverse shoulder arthroplasty and the most common indications for revision were for instability (25%) and infection (21%). Revision SA procedures were most commonly performed in patients aged 60-70 years, with a mean age of 66.6 years and with Medicare insurance (66%). The mean length of hospital stay for revision SA was 3.1 days. Annual volume of revision SA increased by 153% from 2012 to 2018 in the United States with a continued predicted increase through 2030. Instability and infection are the most common indications for surgery. Reverse shoulder arthroplasty was the most commonly performed surgery in the revision setting. [ABSTRACT FROM AUTHOR]

This study focuses on the ways youth in the Sri Lankan Tamil diaspora in Canada, Britain, and the United States construct their ethnic identity when proficiency in their heritage language is limited. Though these youth claim only rudimentary proficiency in Tamil and identify English as their dominant language, they are nonetheless able to claim ethnic identity through strategic language practices. Different from Rampton's theorization of crossing, such acts involve self-styling. While crossing is transgressive, self-styling is affirmative. While crossing is ludic, self-styling is invested. Furthermore, while crossing has been studied mostly in terms of the tokens produced, this study illustrates the way receptive proficiency and nonverbal participatory practices can help style one's own. The study illustrates certain new configurations of language and ethnicity in diaspora life. (Contains 3 footnotes.)

Background: Current American College of Cardiology/American Heart Association guidelines recommend using the 10-year atherosclerotic cardiovascular disease (ASCVD) risk to guide statin therapy for primary prevention. Real-world data on adherence and consequences of nonadherence to the guidelines in primary are limited. We investigated the guideline-directed statin intensity (GDSI) and associated outcomes in a large health care system, stratified by ASCVD risk.Methods: Statin prescription in patients without coronary artery disease, peripheral vascular disease, or ischemic stroke were evaluated within a large health care network (2013-2017) using electronic medical health records. Patient categories constructed by the 10-year ASCVD risk were borderline (5%-7.4%), intermediate (7.5%-19.9%), or high (≥20%). The GDSI (before time of first event) was defined as none or any intensity for borderline, and at least moderate for intermediate and high-risk groups. Mean (±SD) time to start/change to GDSI from first interaction in health care and incident rates (per 1000 person-years) for each outcome were calculated. Cox regression models were used to calculate hazard ratios for incident ASCVD and mortality across risk categories stratified by statin utilization.Results: Among 282 298 patients (mean age ≈50 years), 29 134 (10.3%), 63 299 (22.4%), and 26 687 (9.5%) were categorized as borderline, intermediate, and high risk, respectively. Among intermediate and high-risk categories, 27 358 (43%) and 8300 (31%) patients did not receive any statin, respectively. Only 17 519 (65.6%) high-risk patients who were prescribed a statin received GDSI. The mean time to GDSI was ≈2 years among the intermediate and high-risk groups. At a median follow-up of 6 years, there was a graded increase in risk of ASCVD events in intermediate risk (hazard ratio=1.15 [1.07-1.24]) and high risk (hazard ratio=1.27 [1.17-1.37]) when comparing no statin use with GDSI therapy. Similarly, mortality risk among intermediate and high-risk groups was higher in no statin use versus GDSI.Conclusions: In a real-world primary prevention cohort, over one-third of statin-eligible patients were not prescribed statin therapy. Among those receiving a statin, mean time to GDSI was ≈2 years. The consequences of nonadherence to guidelines are illustrated by greater incident ASCVD and mortality events. Further research can develop and optimize health care system strategies for primary prevention. [ABSTRACT FROM AUTHOR]

Primary total elbow arthroplasty (TEA) is an uncommon operation and performed less frequently than total shoulder (TSA), knee (TKA), and hip (THA) arthroplasty. Despite lower implant survival rates and higher complications rates compared to TSA, TKA, and THA, the Centers for Medicare and Medicaid (CMS) have assigned similar work relative value unit (wRVU) allotments and estimated operative times across all 4 forms of major joint arthroplasty. In this study, we determine temporal trends in CMS wRVU allotments, and operative time estimates for these 4 surgeries and compare actual operative times and postoperative complication rates. CMS wRVU allotments and estimated operative times were collected from all publicly available CMS publications for primary TEA, TSA, TKA, and TSA. We used the National Quality Improvement Program database from 2010 to 2017 to determine actual operative times for these surgeries. Multiple linear regression analysis was used to compare wRVU/h amongst the 4 surgeries, controlling for patient demographics, comorbidity, and hospital setting. Thirty-day complication rates were also compared. From 2012 to 2017, Medicare observed a 13% decline in total TEA procedures performed in comparison to a 70% increase for TSA and 29% increase in THA. The number of unique providers performing TEA declined (−6%) in comparison to a growth in surgeons performing TSA, TKA, and THA. TEA was associated with the longest operative time (152 ± 57 minutes, P <.0001) and lowest wRVU/h (10.2, P <.0001). TKA and THA had the shortest operative time (90 ± 29 and 90 ± 32, respectively) with the greatest wRVU/h (15.78 and 15.71). TEA remained the lowest wRVU/h procedure even after controlling for patient age, sex, body mass index, hospital setting, and comorbidity (P <.0001). Thirty-day complication rates for all surgeries were low, but TEA had higher rates of wound dehiscence, deep infection, pneumonia, reintubation, pulmonary embolism, and myocardial infarction (all P <.01). Despite similar wRVU assignments and operative time estimates for primary TEA, TSA, TKA, and THA; TEA is on average a longer surgery and carries a greater 30-day postoperative risk profile. Although CMS has assessed primary TEA to have similar work and time requirements compared to its counterparts, this procedure may be under-valued in comparison to other forms of major joint arthroplasty. Level III; Economics. [ABSTRACT FROM AUTHOR]

Pantoprazole sodium, a substituted benzimidazole derivative, is an irreversible proton pump inhibitor which is primarily used for the treatment of duodenal ulcers, gastric ulcers, and gastroesophageal reflux disease (GERD). The monographs of European Pharmacopoeia (Ph. Eur.) and United States Pharmacopoeia (USP) specify six impurities, viz. ; impurities A, B, C, D, E and F, respectively for its active pharmaceutical ingredient (API). The identification and synthesis of all impurities except impurity E are well described in the literature; however, there is no report related to impurity E. The prospects to the formation and controlling of impurity E up to ≤0.03% in the synthesis of pantoprazole sodium sesquihydrate (PAN) were discussed in detail for the first time. The present work described the journey towards the successful development of an optimal preparation procedure of dimer impurity E. The most plausible mechanism involved in the formation of impurity E has been proposed. Image 1 • An optimal preparation procedure for Impurity E (dimer) of pantoprazole is reported for the first time. • Prospects to the formation and controlling of Impurity E in the synthesis of pantoprazole API were discussed in detail. • The plausible mechanism for the formation of Impurity E is discussed. • Oxidation of sulfide to sulfoxide has been carried out in water. [ABSTRACT FROM AUTHOR]

Summary Background Increased detection of small-sized, peripheral, non-small-cell lung cancer has renewed interest in sublobar resection instead of lobectomy, the traditional standard of care for early-stage lung cancer. We aimed to assess morbidity and mortality associated with lobar and sublobar resection for early-stage lung cancer. Methods CALGB/Alliance 140503 is a multicentre, international, non-inferiority, phase 3 trial in patients with peripheral non-small-cell lung cancer clinically staged as T1aN0. Patients were recruited from 69 academic and community-based institutions in Australia, Canada, and the USA. Patients were randomly assigned intraoperatively to either lobar or sublobar resection. The random assignment was based on permuted block randomisation without concealment and was stratified according to radiographic tumour size, histology, and smoking status. The primary endpoint of the trial is disease-free survival; here, we report a post-hoc, exploratory, comparative analysis of perioperative mortality and morbidity associated with lobar and sublobar resection. Perioperative mortality was defined as death from any cause within 30 days and 90 days of surgical intervention and was calculated for all randomised patients. Morbidity was graded using Common Terminology Criteria for Adverse Events version 4.0. All analyses were done on an intention-to-treat basis for randomised patients with data available. This trial is registered with ClinicalTrials.gov , number NCT00499330. Findings Between June 15, 2007, and March 13, 2017, 697 patients were randomly allocated to either lobar resection (n=357) or sublobar resection (n=340; 59% wedge resection). Six (0·9%) patients died by 30 days, four (1·1%) after lobar resection and two (0·6%) after sublobar resection; by 90 days, ten (1·4%) patients had died, six (1·7%) after lobar resection and four (1·2%) after sublobar resection (difference at 30 days, 0·5%, 95% CI −1·1 to 2·3; difference at 90 days, 0·5%, 95% CI −1·5 to 2·6). An adverse event of any grade occurred in 193 (54%) of 355 patients after lobar resection and 172 (51%) of 337 patients after sublobar resection. Adverse events of grade 3 or worse occurred in 54 (15%) patients assigned lobar resection and in 48 (14%) patients assigned sublobar resection. No differences between surgical approaches were noted in cardiac or pulmonary complications. Grade 3 haemorrhage (requiring transfusion) occurred in six (2%) patients assigned lobar resection and eight (2%) patients assigned sublobar resection. Prolonged air leak occurred in nine (3%) patients after lobar resection and two (1%) patients after sublobar resection. Interpretation Our post-hoc analysis showed that perioperative mortality and morbidity did not seem to differ between lobar and sublobar resection in physically and functionally fit patients with clinical T1aN0 non-small-cell lung cancer. These data may affect the daily choices made by patients and their doctors in establishing the best treatment approach for stage I lung cancer. Funding National Cancer Institute. [ABSTRACT FROM AUTHOR]

Background: Percutaneous coronary intervention (PCI) has witnessed rapid technological advancements, resulting in improved safety and effectiveness over time. Little, however, is known about the temporal impact on patient-reported symptoms and quality of life after PCI.Methods and Results: Temporal trends in post-PCI symptoms were analyzed using 8879 consecutive patients enrolled in the National Heart, Lung, and Blood Institute-sponsored Dynamic Registry (wave 1: 1997 [bare metal stents], wave 2: 1999 [uniform use of stents], wave 3: 2001 [brachytherapy], wave 4, 5: 2004, 2006 [drug eluting stents]). Patients undergoing PCI in the recent waves were older and more often reported comorbidities. However, fewer patients across the waves reported post-PCI angina at one year (wave 1 to 5: 24%, 23%, 18%, 20%, 20%; P(trend)<0.001). The lower risk of angina in recent waves was explained by patient characteristics including use of antianginal medications at discharge (relative risk [95% CI] for waves 2, 3, 4 versus 1: 1.0 [0.9 to 1.2], 0.9 [0.7 to 1.1], 1.0 [0.8 to 1.3], 0.9 [0.7 to 1.1]). Similar trend was seen in the average quality of life scores over time (adjusted mean score for waves 1 to 5: 6.2, 6.5, 6.6 and 6.6; P(trend)=0.01). Other factors associated with angina at 1 year included younger age, female gender, prior revascularization, need for repeat PCI, and hospitalization for myocardial infarction over 1 year.Conclusions: Favorable temporal trends are seen in patient-reported symptoms after PCI in routine clinical practice. Specific subgroups, however, remain at risk for symptoms at 1 year and thus warrant closer attention. [ABSTRACT FROM AUTHOR]

The article analyzes the evolution and use of percutaneous coronary intervention and its impact on clinical outcomes in patients in the 1985-1986 percutaneous transluminal coronary angioplasty (PTCA) sponsored by the U.S. National Heart, Lung, and Blood Institute and the 1997-2006 Dynamic Registries waves. It highlights observations on in-hospital rates of myocardial infarction and emergency coronary artery bypass surgery. The in-hospital rates were compared with the PTCA Registry, including the risk for repeat revascularization.

The article discusses pedagogical aspects and importance of World Englishes in academic writing. An essay titled "English Only and U.S. College Composition," by Bruce Horner and John Trimbur depicted the educational developments that have led to the English writing composition in the U.S. There are several ways through which World Englishes can find a place in academic writing. The demography of English is changing in the U.S. with each passing day. Applied linguist David Graddol said that English language will be widely used in multilingual contexts in the future.

Background & Aims: Although diabetes occurs frequently in pancreatic cancer, the value of new-onset diabetes as a marker of underlying pancreatic cancer is unknown. Methods: We assembled a population-based cohort of 2122 Rochester, Minnesota, residents age ≥50 years who first met standardized criteria for diabetes between January 1, 1950, and December 31, 1994, and identified those who developed pancreatic cancer within 3 years of meeting criteria for diabetes. We compared observed rates of pancreatic cancer with expected rates based on the Iowa Surveillance Epidemiology and End Results registry. In a nested case control study, we compared body mass index (BMI) and smoking status in diabetes subjects with and without pancreatic cancer. Results: Of 2122 diabetic subjects, 18 (0.85%) were diagnosed with pancreatic cancer within 3 years of meeting criteria for diabetes; 10 of 18 (56%) were diagnosed <6 months after first meeting criteria for diabetes, and 3 were resected. The observed-to-expected ratio of pancreatic cancer in the cohort was 7.94 (95% CI, 4.70–12.55). Compared with subjects without pancreatic cancer, diabetic subjects with pancreatic cancer were more likely to have met diabetes criteria after age 69 (OR = 4.52, 95% CI, 1.61–12.74) years but did not differ significantly with respect to BMI values (29.2 ± 6.8 vs 26.5 ± 5.0, respectively). A larger proportion of those who developed pancreatic cancer were ever smokers (92% vs 69%, respectively), but this did not reach statistical significance. Conclusions: Approximately 1% of diabetes subjects aged ≥50 years will be diagnosed with pancreatic cancer within 3 years of first meeting criteria for diabetes. The usefulness of new-onset diabetes as marker of early pancreatic cancer needs further evaluation. [Copyright &y& Elsevier]

This paper quantifies and compares the life cycle GHG emissions and costs of production of diesel and jet fuel derived from municipal solid waste (MSW) in the United States via three thermochemical conversion pathways: conventional gasification and Fischer-Tropsch (FT middle distillate, MD), plasma gasification and Fischer-Tropsch (Plasma FT MD), and conventional gasification, catalytic alcohol synthesis, and alcohol-to-jet upgrading (ATJ MD). We use expanded system boundaries to capture the change in existing MSW use and disposal, and account for parameter uncertainty with Monte Carlo simulations. We estimate median life cycle GHG emissions of 32.9, 62.3, and 52.7 gCO 2 e/MJ for FT, Plasma FT and ATJ MD fuels, respectively, compared to a baseline of 90 gCO 2 e/MJ for conventional MD fuels. Median minimum selling prices are estimated at 0.99, 1.78, and 1.20 $ per liter with the probability of achieving a positive net present value of fuel production at market prices of 14%, 0.1% and 7% for FT, Plasma FT and ATJ MD fuels, respectively. If the societal perspective rather than an investor's perspective is evaluated, then the probability of positive net present value of fuel production increases to 93%, 67%, and 92.5% for the FT, Plasma FT, and ATJ MD fuels, respectively.

DNA vaccination (or genetic immunization) strategies provide important opportunities for improving immunization, since both humoral and cell-mediated responses are induced. The use of genetic vaccines for inducing immunity to infectious agents can eliminate or significantly alleviate the pathology associated with a broad range of infections. A requirement for efficient DNA vaccination is the development of gene delivery systems capable of overcoming barriers to gene transfection. Compared to viral systems, nonviral systems are considered to be safe, cheap, multiple delivery is possible and able to deliver larger pieces of DNA. Also, these nanocarriers avoid DNA degradation and facilitate targeted delivery to antigen presenting cells. This review describes the potential of non-viral nanocarrier construct(s) in genetic immunization. Issued patents in the field were retrieved from the US patent database. Various carrier systems used to deliver plasmid DNA were reviewed in detail.

Background: Recent studies have suggested that gastroesophageal reflux disease (GERD) increases the risk of developing adenocarcinoma of the distal esophagus and cardia. In order to further define this risk, we studied the relationship of GERD in patients with or without gastroesophageal junction adenocarcinomas., Methods: The records of all patients with adenocarcinoma of the distal esophagus and cardia treated between 1991 and 1999 were reviewed for the following data: gender, age of diagnosis, presence of GERD, presence of GERD for >4 years, and GERD treatment. A control group of patients without gastroesophageal junction adenocarcinoma were matched for age and gender. Data obtained from the control group included presence of GERD and treatment for GERD., Results: 60 patients with adenocarcinoma of the distal esophagus and cardia were identified. 40% of cancer patients had GERD at the time of diagnosis, (odds ratio 39, p < 0.0001). 27% of cancer patients had GERD for >4 years (odds ratio 21, p < 0.0001). 50% of cancer patients with GERD were being treated with either H(2)-blockers or proton pump inhibitors at the time of cancer diagnosis, with an average duration of treatment of 17 months, compared to none of the patients without GERD (p = 0.006)., Conclusions: Patients with gastroesophageal junction adenocarcinoma had a higher prevalence of GERD-like symptoms compared to age- and gender-matched controls. This supports an association between GERD and gastroesophageal junction cancers. In addition, cancer patients with GERD may be treated for prolonged periods of time with acid-suppression medication prior to the diagnosis of cancer, masking the symptoms of cancer. Patients with long-standing GERD or older patients with new onset GERD may need endoscopy or imaging studies to evaluate for cancer of the distal esophagus or cardia., (Copyright 2002 S. Karger AG, Basel)