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The purpose of this study is to conduct a bibliometric analysis of Service Quality (SERVQUAL) research in private higher education institutions (HEIs). This analysis aims to provide a comprehensive evaluation of SERVQUAL's current state and future potential in private HEIs. This study collected 205 journal articles from the Web of Science database using a bibliometric approach. Then, co-citation and co-word analyses were conducted to determine the most influential publications, analyze the knowledge structure, and forecast future trends. This review offers valuable insight into the expanding field of SERVQUAL research, despite its limitations, as the analysis revealed five clusters in co-citation and co-word analysis, respectively. This study contributes to the existing body of knowledge by offering a comprehensive understanding of SERVQUAL in the context of private HEIs. Additionally, it provides insight into potential future developments in this field.

The purpose of this study is to conduct a bibliometric analysis of Service Quality (SERVQUAL) research in private higher education institutions (HEIs). This analysis aims to provide a comprehensive evaluation of SERVQUAL's current state and future potential in private HEIs. This study collected 205 journal articles from the Web of Science database using a bibliometric approach. Then, co-citation and co-word analyses were conducted to determine the most influential publications, analyze the knowledge structure, and forecast future trends. This review offers valuable insight into the expanding field of SERVQUAL research, despite its limitations, as the analysis revealed five clusters in co-citation and co-word analysis, respectively. This study contributes to the existing body of knowledge by offering a comprehensive understanding of SERVQUAL in the context of private HEIs. Additionally, it provides insight into potential future developments in this field.

Research shows that videoconferencing tools can be used for delivering high-quality instruction in real-time to a large number of students simultaneously during and even in the aftermath of the pandemic. However, there is a lack of data on how favourable it is among students, particularly in the Philippine setting, in the field of Physical Education (PE). In this regard, this study aimed at inspecting exogenous factors linked to students’ acceptance of a video-conferencing platform in learning knowledge- and skill-based concepts in Physical Education through the adaptation of the Technology Acceptance Model. After performing the Partial Least Square-Structural Equation Modelling from a purposively selected sample of 250 teacher education students, the results showed that perceived ease of use (PEOU) positively affected perceived usefulness (PU). It was also found that PEOU and PU impacted behavioural intention. Lastly, behavioural intention (BI) positively leverages actual use of the Zoom platform. It can be inferred that students can benefit greatly from using the video-conferencing platform to learn various PE concepts. Moreover, another surprising discovery was that students could use the platform to efficiently learn, thus capitalising on the university’s educational system, even in the New Normal.

Research shows that videoconferencing tools can be used for delivering high-quality instruction in real-time to a large number of students simultaneously during and even in the aftermath of the pandemic. However, there is a lack of data on how favourable it is among students, particularly in the Philippine setting, in the field of Physical Education (PE). In this regard, this study aimed at inspecting exogenous factors linked to students’ acceptance of a video-conferencing platform in learning knowledge- and skill-based concepts in Physical Education through the adaptation of the Technology Acceptance Model. After performing the Partial Least Square-Structural Equation Modelling from a purposively selected sample of 250 teacher education students, the results showed that perceived ease of use (PEOU) positively affected perceived usefulness (PU). It was also found that PEOU and PU impacted behavioural intention. Lastly, behavioural intention (BI) positively leverages actual use of the Zoom platform. It can be inferred that students can benefit greatly from using the video-conferencing platform to learn various PE concepts. Moreover, another surprising discovery was that students could use the platform to efficiently learn, thus capitalising on the university’s educational system, even in the New Normal.

Post-traumatic epilepsy (PTE) occurs in some patients after moderate/severe traumatic brain injury (TBI). Although there are no approved therapies to prevent epileptogenesis, levetiracetam (LEV) is commonly given for seizure prophylaxis due to its good safety profile. This led us to study LEV as part of the Epilepsy Bioinformatics Study for Antiepileptogenic Therapy (EpiBioS4Rx) Project. The objective of this work is to characterize the pharmacokinetics (PK) and brain uptake of LEV in naïve control rats and in the lateral fluid percussion injury (LFPI) rat model of TBI after either single intraperitoneal doses or a loading dose followed by a 7-day subcutaneous infusion. Sprague-Dawley rats were used as controls and for the LFPI model induced at the left parietal region using injury parameters optimized for moderate/severe TBI. Naïve and LFPI rats received either a bolus injection (intraperitoneal) or a bolus injection followed by subcutaneous infusion over 7 days. Blood and parietal cortical samples were collected at specified time points throughout the study. LEV concentrations in plasma and brain were measured using validated high-performance liquid chromatography-tandem mass spectrometry (HPLC-MS/MS) methods. Noncompartmental analysis and a naive-pooled compartmental PK modeling approach were used. Brain-to-plasma ratios ranged from 0.54 to 1.4 to 1. LEV concentrations were well fit by one-compartment, first-order absorption PK models with a clearance of 112 ml/h per kg and volume of distribution of 293 ml/kg. The single-dose pharmacokinetic data were used to guide dose selection for the longer-term studies, and target drug exposures were confirmed. Obtaining LEV PK information early in the screening phase allowed us to guide optimal treatment protocols in EpiBioS4Rx. SIGNIFICANCE STATEMENT: The characterization of levetiracetam pharmacokinetics and brain uptake in an animal model of post-traumatic epilepsy is essential to identify target concentrations and guide

Literacy skills empower students to seek information, delve into subjects deeply, and enhance their comprehension of the surrounding world. Proficiency in these skills proved crucial for mastering various macro skills, with reading being paramount. A student's disposition towards reading significantly influences multiple facets of their educational journey. When junior high school students exhibited a favorable reading attitude, it indicated their attainment of fluency, adept comprehension, expansive vocabulary, writing prowess, analytical acumen, and more. Conversely, an unfavorable attitude was not uncommon; however, rectifying these issues was plausible with proper understanding. This investigation aimed to gauge the extent of reading attitudes held by Grade 9 students. Employing a modified questionnaire adapted from Jensen (2010), this descriptive research encompassed 84 students from Union Christian College. The analysis relied on weighted means to portray the participants' reading attitudes. The findings unveiled a high overall level of reading attitude among the respondents, underscoring their positive perspective on reading. Most agreed that reading held paramount importance across subjects like science, writing, social studies, art, and math, signifying their recognition of reading as a conduit to knowledge acquisition and academic excellence. The respondents demonstrated a proclivity for reading materials aligned with their interests, a principle consonant with the progressive educational philosophy advocating engagement with subjects that resonate with students. Additionally, the inclination to discuss ideas and disseminate information post-reading indicated the participants' enthusiasm for sharing their acquired knowledge, particularly if the subject matter piqued their interest. Paradoxically, the inclination towards listening while someone read aloud garnered lower enthusiasm, suggesting a preference for silent reading. The respondents' i

Literacy skills empower students to seek information, delve into subjects deeply, and enhance their comprehension of the surrounding world. Proficiency in these skills proved crucial for mastering various macro skills, with reading being paramount. A student's disposition towards reading significantly influences multiple facets of their educational journey. When junior high school students exhibited a favorable reading attitude, it indicated their attainment of fluency, adept comprehension, expansive vocabulary, writing prowess, analytical acumen, and more. Conversely, an unfavorable attitude was not uncommon; however, rectifying these issues was plausible with proper understanding. This investigation aimed to gauge the extent of reading attitudes held by Grade 9 students. Employing a modified questionnaire adapted from Jensen (2010), this descriptive research encompassed 84 students from Union Christian College. The analysis relied on weighted means to portray the participants' reading attitudes. The findings unveiled a high overall level of reading attitude among the respondents, underscoring their positive perspective on reading. Most agreed that reading held paramount importance across subjects like science, writing, social studies, art, and math, signifying their recognition of reading as a conduit to knowledge acquisition and academic excellence. The respondents demonstrated a proclivity for reading materials aligned with their interests, a principle consonant with the progressive educational philosophy advocating engagement with subjects that resonate with students. Additionally, the inclination to discuss ideas and disseminate information post-reading indicated the participants' enthusiasm for sharing their acquired knowledge, particularly if the subject matter piqued their interest. Paradoxically, the inclination towards listening while someone read aloud garnered lower enthusiasm, suggesting a preference for silent reading. The respondents' i

Allopregnanolone (ALLO) is a neurosteroid that modulates synaptic and extrasynaptic GABAA receptors. We hypothesize that ALLO may be useful as first-line treatment of status epilepticus (SE). Our objectives were to (1) characterize ALLO pharmacokinetics-pharmacodynamics PK-PD after intravenous (IV) and intramuscular (IM) administration and (2) compare IV and IM ALLO safety and tolerability. Three healthy dogs and two with a history of epilepsy were used. Single ALLO IV doses ranging from 1-6 mg/kg were infused over 5 minutes or injected IM. Blood samples, vital signs, and sedation assessment were collected up to 8 hours postdose. Intracranial EEG (iEEG) was continuously recorded in one dog. IV ALLO exhibited dose-proportional increases in exposure, which were associated with an increase in absolute power spectral density in all iEEG frequency bands. This relationship was best described by an indirect link PK-PD model where concentration-response was described by a sigmoidal maximum response (Emax) equation. Adverse events included site injection pain with higher IM volumes and ataxia and sedation associated with higher doses. IM administration exhibited incomplete absorption and volume-dependent bioavailability. Robust iEEG changes after IM administration were not observed. Based on PK-PD simulations, a 2 mg/kg dose infused over 5 minutes is predicted to achieve plasma concentrations above the EC50, but below those associated with heavy sedation. This study demonstrates that ALLO is safe and well tolerated when administered at 1-4 mg/kg IV and up to 2 mg/kg IM. The rapid onset of effect after IV infusion suggests that ALLO may be useful in the early treatment of SE. SIGNIFICANCE STATEMENT: The characterization of the pharmacokinetics and pharmacodynamics of allopregnanolone is essential in order to design clinical studies evaluating its effectiveness as an early treatment for status epilepticus in dogs and people. This study has proposed a target dose/therapeutic ra

BackgroundPrior studies attempting to identify disparities in the care of patients with appendiceal (AC) or colorectal cancer (CRC) with peritoneal metastasis (PM) are limited to single-institution, highly selected patient populations. This observational cohort study sought to identify factors associated with specialty care for Medicare beneficiaries with AC/CRC-PM.Materials and methodsPatients >65 years old in the United States diagnosed with AC/CRC and isolated PM were identified within the Medicare Standard Analytic File (2013-2017). Mixed-effects analyses assessed patient factors associated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/HIPEC) and outpatient consultation with a peritoneal surface malignancy (PSM) surgeon, and Cox proportional-hazards analysis compared 3-year overall survival (OS) between patients receiving CRS/HIPEC versus systemic therapy alone.ResultsAmong 7,653 patients, only 250 (3.3%) underwent CRS/HIPEC. Among those individuals who did not undergo CRS/HIPEC (N=7,403), only 475 (6.4%) had outpatient consultation with a PSM surgeon. Patient factors independently associated with lower odds of CRS/HIPEC and PSM surgery consultation included older age, greater comorbidity burden, higher social vulnerability index, and further distance from a PSM center (p<0.05). CRS/HIPEC was independently associated with better 3-year OS compared with systemic therapy alone (HR=0.29, 95%CI=0.21-0.38).ConclusionAn exceedingly small proportion of Medicare beneficiaries with AC/CRC-PM undergo CRS/HIPEC or even have an outpatient consultation with a PSM surgeon. Significant disparities in treatment and access to care exist for patients with higher levels of social vulnerability and those that live further away from a PSM center. Future research and interventions should focus on improving access to care for these at-risk patient populations.

Background: The prognostic impact of tumor necrosis among patients undergoing resection for intrahepatic cholangiocarcinoma (ICC) remains ill-defined. Methods: Patients who underwent curative-intent resection for ICC between 2000 and 2017 were identified using a multi-institutional database. The association of pathologic tumor necrosis with overall survival (OS) and recurrence-free survival (RFS) was examined. Results: Among 757 patients who underwent resection for ICC, tumor necrosis was present in 384 (50.7%) patients (no necrosis: n = 373, 49.3%; <50% necrosis: n = 291, 38.4%; ≥50% necrosis: n = 93, 12.3%). Tumor necrosis was associated with worse OS (5-year OS: no necrosis 39.3% vs. <50% necrosis 34.7% and ≥50% necrosis 24.0%; p = 0.03) and RFS (5-year RFS: no necrosis 25.7% vs. <50% necrosis 13.9% and ≥50% necrosis 18.8%; p < 0.001). After stratifying by T stage, tumor necrosis was able to further stratify prognosis among patients with T1a ICC (5-year RFS: T1a and no necrosis 46.7% vs. T1a and necrosis 36.1%; p = 0.02), and T1b ICC (5-year RFS: T1b and no necrosis 31.1% vs. T1b and necrosis 11.2%; p = 0.006), but was not associated with outcomes among patients with more advanced T2–T3 disease. Patients with T1a ICC and tumor necrosis had similar 5-year RFS as individuals with T1b ICC and no tumor necrosis (36.1% vs. 31.1%; p = 0.66). Conclusion: Tumor necrosis was associated with worse prognosis among patients with T1 ICC. Tumor necrosis for T1 ICC should be considered as an important factor to further stratify outcomes of patients with early T-stage ICC.

BackgroundWhile parenchymal hepatic metastases were previously considered a contraindication to cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC), liver resection (LR) is increasingly performed with CRS/HIPEC.MethodsPatients from the US HIPEC Collaborative (2000-2017) with invasive appendiceal or colorectal adenocarcinoma undergoing primary, curative intent CRS/HIPEC with CC0-1 resection were included. LR was defined as a formal parenchymal resection. Primary endpoints were postoperative complications and overall survival (OS).ResultsA total of 658 patients were included. About 83 (15%) underwent LR of colorectal (58%) or invasive appendiceal (42%) metastases. LR patients had more complications (81% vs. 60%; p = .001), greater number of complications (2.3 vs. 1.5; p < .001) per patient and required more reoperations (22% vs. 11%; p = .007) and readmissions (39% vs. 25%; p = .014) than non-LR patients. LR patients had decreased OS (2-year OS 62% vs. 79%, p < .001), even when accounting for peritoneal carcinomatosis index and histology type. Preoperative factors associated with decreased OS on multivariable analysis in LR patients included age < 60 years (HR, 3.61; 95% CI, 1.10-11.81), colorectal histology (HR, 3.84; 95% CI, 1.69-12.65), and multiple liver tumors (HR, 3.45; 95% CI, 1.21-9.85) (all p < .05). When assigning one point for each factor, there was an incremental decrease in 2-year survival as the risk score increased from 0 to 3 (0: 100%; 1: 91%; 2: 58%; 3: 0%).ConclusionsAs CRS/HIPEC + LR has become more common, we created a simple risk score to stratify patients considered for CRS/HIPEC + LR. These data aid in striking the balance between an increased perioperative complication profile with the potential for improvement in OS.

ObjectiveThis study was undertaken to describe patterns of benzodiazepine use as first-line treatment of status epilepticus (SE) and test the association of benzodiazepine doses with response to second-line agents in patients enrolled in the Established Status Epilepticus Treatment Trial (ESETT).MethodsPatients refractory to an adequate dose of benzodiazepines for the treatment of SE were enrolled in ESETT. Choice of benzodiazepine, doses given prior to administration of second-line agent, route of administration, setting, and patient weight were characterized. These were compared with guideline-recommended dosing. Logistic regression was used to determine the association of the first dose of benzodiazepine and the cumulative benzodiazepine dose with the response to second-line agent.ResultsFour hundred sixty patients were administered 1170 doses of benzodiazepines (669 lorazepam, 398 midazolam, 103 diazepam). Lorazepam was most frequently administered intravenously in the emergency department, midazolam intramuscularly or intravenously by the emergency medical services personnel, and diazepam rectally prior to ambulance arrival. The first dose of the first benzodiazepine (N = 460) was lower than guideline recommendations in 76% of midazolam administrations and 81% of lorazepam administrations. Among all administrations, >85% of midazolam and >76% of lorazepam administrations were lower than recommended. Higher first or cumulative benzodiazepine doses were not associated with better outcomes or clinical seizure cessation in response to second-line medications in these benzodiazepine-refractory seizures.SignificanceBenzodiazepines as first-line treatment of SE, particularly midazolam and lorazepam, are frequently underdosed throughout the United States. This broad and generalizable cohort confirms prior single site reports that underdosing is both pervasive and difficult to remediate. (ESETT ClinicalTrials.gov identifier: NCT01960075.).

ObjectiveTo quantify the association between early neurologic recovery, practice pattern variation, and endotracheal intubation during established status epilepticus, we performed a secondary analysis within the cohort of patients enrolled in the Established Status Epilepticus Treatment Trial (ESETT).MethodsWe evaluated factors associated with the endpoint of endotracheal intubation occurring within 120 minutes of ESETT study drug initiation. We defined a blocked, stepwise multivariate regression, examining 4 phases during status epilepticus management: (1) baseline characteristics, (2) acute treatment, (3) 20-minute neurologic recovery, and (4) 60-minute recovery, including seizure cessation and improving responsiveness.ResultsOf 478 patients, 117 (24.5%) were intubated within 120 minutes. Among high-enrolling sites, intubation rates ranged from 4% to 32% at pediatric sites and 19% to 39% at adult sites. Baseline characteristics, including seizure precipitant, benzodiazepine dosing, and admission vital signs, provided limited discrimination for predicting intubation (area under the curve [AUC] 0.63). However, treatment at sites with an intubation rate in the highest (vs lowest) quartile strongly predicted endotracheal intubation independently of other treatment variables (adjusted odds ratio [aOR] 8.12, 95% confidence interval [CI] 3.08-21.4, model AUC 0.70). Site-specific variation was the factor most strongly associated with endotracheal intubation after adjustment for 20-minute (aOR 23.4, 95% CI 6.99-78.3, model AUC 0.88) and 60-minute (aOR 14.7, 95% CI 3.20-67.5, model AUC 0.98) neurologic recovery.ConclusionsEndotracheal intubation after established status epilepticus is strongly associated with site-specific practice pattern variation, independently of baseline characteristics, and early neurologic recovery and should not alone serve as a clinical trial endpoint in established status epilepticus.Trial registration informationClinicalTrials.gov Identifier: NCT

BackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis can be performed in two ways: Open or closed abdominal technique.AimTo evaluate the impact of HIPEC method on post-operative and long-term survival outcomes.MethodsPatients undergoing CRS with HIPEC from 2000-2017 were identified in the United States HIPEC collaborative database. Post-operative, recurrence, and overall survival outcomes were compared between those who received open vs closed HIPEC.ResultsOf the 1812 patients undergoing curative-intent CRS and HIPEC, 372 (21%) patients underwent open HIPEC and 1440 (79%) underwent closed HIPEC. There was no difference in re-operation or severe complications between the two groups. Closed HIPEC had higher rates of 90-d readmission while open HIPEC had a higher rate of 90-d mortalities. On multi-variable analysis, closed HIPEC technique was not a significant predictor for overall survival (hazards ratio: 0.75, 95% confidence interval: 0.51-1.10, P = 0.14) or recurrence-free survival (hazards ratio: 1.39, 95% confidence interval: 1.00-1.93, P = 0.05) in the entire cohort. These findings remained consistent in the appendiceal and the colorectal subgroups.ConclusionIn this multi-institutional analysis, the HIPEC method was not independently associated with relevant post-operative or long-term outcomes. HIPEC technique may be left to the discretion of the operating surgeon.

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000-2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.

BackgroundCytoreductive surgery (CRS) with hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal carcinomatosis can be performed in two ways: Open or closed abdominal technique.AimTo evaluate the impact of HIPEC method on post-operative and long-term survival outcomes.MethodsPatients undergoing CRS with HIPEC from 2000-2017 were identified in the United States HIPEC collaborative database. Post-operative, recurrence, and overall survival outcomes were compared between those who received open vs closed HIPEC.ResultsOf the 1812 patients undergoing curative-intent CRS and HIPEC, 372 (21%) patients underwent open HIPEC and 1440 (79%) underwent closed HIPEC. There was no difference in re-operation or severe complications between the two groups. Closed HIPEC had higher rates of 90-d readmission while open HIPEC had a higher rate of 90-d mortalities. On multi-variable analysis, closed HIPEC technique was not a significant predictor for overall survival (hazards ratio: 0.75, 95% confidence interval: 0.51-1.10, P = 0.14) or recurrence-free survival (hazards ratio: 1.39, 95% confidence interval: 1.00-1.93, P = 0.05) in the entire cohort. These findings remained consistent in the appendiceal and the colorectal subgroups.ConclusionIn this multi-institutional analysis, the HIPEC method was not independently associated with relevant post-operative or long-term outcomes. HIPEC technique may be left to the discretion of the operating surgeon.

Cytoreductive surgery (CRS) with or without hyperthermic intraperitoneal chemotherapy (HIPEC) is associated with improved survival for patients with colorectal peritoneal metastases (CR-PM). However, the role of neoadjuvant chemotherapy (NAC) prior to CRS-HIPEC is poorly understood. A retrospective review of adult patients with CR-PM who underwent CRS+/-HIPEC from 2000-2017 was performed. Among 298 patients who underwent CRS+/-HIPEC, 196 (65.8%) received NAC while 102 (34.2%) underwent surgery first (SF). Patients who received NAC had lower peritoneal cancer index score (12.1 + 7.9 vs. 14.3 + 8.5, p = 0.034). There was no significant difference in grade III/IV complications (22.4% vs. 16.7%, p = 0.650), readmission (32.3% vs. 23.5%, p = 0.114), or 30-day mortality (1.5% vs. 2.9%, p = 0.411) between groups. NAC patients experienced longer overall survival (OS) (median 32.7 vs. 22.0 months, p = 0.044) but similar recurrence-free survival (RFS) (median 13.8 vs. 13.0 months, p = 0.456). After controlling for confounding factors, NAC was not independently associated with improved OS (OR 0.80) or RFS (OR 1.04). Among patients who underwent CRS+/-HIPEC for CR-PM, the use of NAC was associated with improved OS that did not persist on multivariable analysis. However, NAC prior to CRS+/-HIPEC was a safe and feasible strategy for CR-PM, which may aid in the appropriate selection of patients for aggressive cytoreductive surgery.

The Established Status Epilepticus Treatment Trial was a blinded, comparative-effectiveness study of fosphenytoin, levetiracetam, and valproic acid in benzodiazepine-refractory status epilepticus. The primary outcome was clinical seizure cessation and increased responsiveness without additional anticonvulsant medications. Weight-based dosing was capped at 75 kg. Hence, patients weighing >75 kg received a lower mg/kg dose. Logistic regression models were developed in 235 adults to determine the association of weight (≤ or >75 kg, ≤ or >90 kg), sex, treatment, and weight-normalized dose with the primary outcome and solely seizure cessation. The primary outcome was achieved in 45.1% and 42.5% of those ≤75 kg and >75 kg, respectively. Using univariate analyses, the likelihood of success for those >75 kg (odds ratio [OR] = 0.9, 95% confidence interval [CI] = 0.54-1.51) or >90 kg (OR = 0.85, 95% CI = 0.42-1.66) was not statistically different compared with those ≤75 kg or ≤90 kg, respectively. Similarly, other predictors were not significantly associated with primary outcome or clinical seizure cessation. Our findings suggest that doses, capped at 75 kg, likely resulted in concentrations greater than those needed for outcome. Studies that include drug concentrations and heavier individuals are needed to confirm these findings.

BackgroundPostoperative complications (POCs) are associated with worse oncologic outcomes in various cancer histologies. The impact of POCs on the survival of patients with appendiceal or colorectal cancer after cytoreductive surgery (CRS) and heated intraperitoneal chemotherapy (HIPEC) is unknown.MethodsThe US HIPEC Collaborative (2000-2017) was reviewed for patients who underwent CCR0/1 CRS/HIPEC for appendiceal/colorectal cancer. The analysis was stratified by noninvasive appendiceal neoplasm versus invasive appendiceal/colorectal adenocarcinoma. The POCs were grouped into infectious, cardiopulmonary, thromboembolic, and intestinal dysmotility. The primary outcomes were overall survival (OS) and recurrence-free survival (RFS).ResultsOf the 1304 patients, 33% had noninvasive appendiceal neoplasm (n = 426), and 67% had invasive appendiceal/colorectal adenocarcinoma (n = 878). In the noninvasive appendiceal cohort, POCs were identified in 55% of the patients (n = 233). The 3-year OS and RFS did not differ between the patients who experienced a complication and those who did not (OS, 94% vs 94%, p = 0.26; RFS, 68% vs 60%, p = 0.15). In the invasive appendiceal/colorectal adenocarcinoma cohort, however, POCs (63%; n = 555) were associated with decreased 3-year OS (59% vs 74%; p < 0.001) and RFS (32% vs 42%; p < 0.001). Infectious POCs were the most common (35%; n = 196). In Multivariable analysis accounting for gender, peritoneal cancer index (PCI), and incomplete resection (CCR1), infectious POCs in particular were associated with decreased OS compared with no complication (hazard ratio [HR] 2.08; p < 0.01) or other types of complications (HR, 1.6; p < 0.01). Similarly, infectious POCs were independently associated with worse RFS (HR 1.61; p < 0.01).ConclusionPostoperative complications are associated with decreased OS and RFS after CRS/HIPEC for invasive histology, but not for an indolent disease such as noninvasive appendiceal neoplasm

BackgroundBenzodiazepine-refractory, or established, status epilepticus is thought to be of similar pathophysiology in children and adults, but differences in underlying aetiology and pharmacodynamics might differentially affect response to therapy. In the Established Status Epilepticus Treatment Trial (ESETT) we compared the efficacy and safety of levetiracetam, fosphenytoin, and valproate in established status epilepticus, and here we describe our results after extending enrolment in children to compare outcomes in three age groups.MethodsIn this multicentre, double-blind, response-adaptive, randomised controlled trial, we recruited patients from 58 hospital emergency departments across the USA. Patients were eligible for inclusion if they were aged 2 years or older, had been treated for a generalised convulsive seizure of longer than 5 min duration with adequate doses of benzodiazepines, and continued to have persistent or recurrent convulsions in the emergency department for at least 5 min and no more than 30 min after the last dose of benzodiazepine. Patients were randomly assigned in a response-adaptive manner, using Bayesian methods and stratified by age group (<18 years, 18-65 years, and >65 years), to levetiracetam, fosphenytoin, or valproate. All patients, investigators, study staff, and pharmacists were masked to treatment allocation. The primary outcome was absence of clinically apparent seizures with improved consciousness and without additional antiseizure medication at 1 h from start of drug infusion. The primary safety outcome was life-threatening hypotension or cardiac arrhythmia. The efficacy and safety outcomes were analysed by intention to treat. This study is registered in ClinicalTrials.gov, NCT01960075.FindingsBetween Nov 3, 2015, and Dec 29, 2018, we enrolled 478 patients and 462 unique patients were included: 225 children (aged <18 years), 186 adults (18-65 years), and 51 older adults (>65 years). 175 (38%) patients were randomly

Aims: Preventive interventions for children of parents with mental illness are widely recommended. Mental health services entrust concern for patients’ children by referrals to child protection services. We investigated service coverage for children following referrals. Methods: Data from referrals regarding 376 children of adult psychiatry patients over 2008–2012 was linked to information from municipal records and Danish national registers. We conducted Cox regression and used Kaplan–Meier curves to show time to intervention and cumulative incidence of any child and family support services with one-year follow-up from referral date. Results: At follow-up, 32% of children were provided with a child and family support service on average 73.4 days after referral. The most common services were family treatment (18%) and family counseling (11%). A statutory child assessment was conducted for 21% of children. Contents of the referrals suggested that 60% of children experienced adverse home environments and/or acute situations due to parents’ psychiatric illness. Predictors of initiation of support services included a child living alone with the patient, hazard ratio 2.09 (1.41–3.08), the patient being the mother, hazard ratio 1.72 (1.11–2.65), and an adverse home environment presenting an acute situation specified in referral, hazard ratio 1.89 (1.01–3.51). Conclusion: Our finding that only one third of children receive support after referrals from psychiatry within an average of three months suggests an underserved population of at-risk children. These findings warrant reconsideration of resource allocation and creation of more efficient intervention strategies to protect at-risk children and prevent development of mental illness and adversity.

Aims: Preventive interventions for children of parents with mental illness are widely recommended. Mental health services entrust concern for patients’ children by referrals to child protection services. We investigated service coverage for children following referrals. Methods: Data from referrals regarding 376 children of adult psychiatry patients over 2008–2012 was linked to information from municipal records and Danish national registers. We conducted Cox regression and used Kaplan–Meier curves to show time to intervention and cumulative incidence of any child and family support services with one-year follow-up from referral date. Results: At follow-up, 32% of children were provided with a child and family support service on average 73.4 days after referral. The most common services were family treatment (18%) and family counseling (11%). A statutory child assessment was conducted for 21% of children. Contents of the referrals suggested that 60% of children experienced adverse home environments and/or acute situations due to parents’ psychiatric illness. Predictors of initiation of support services included a child living alone with the patient, hazard ratio 2.09 (1.41–3.08), the patient being the mother, hazard ratio 1.72 (1.11–2.65), and an adverse home environment presenting an acute situation specified in referral, hazard ratio 1.89 (1.01–3.51). Conclusion: Our finding that only one third of children receive support after referrals from psychiatry within an average of three months suggests an underserved population of at-risk children. These findings warrant reconsideration of resource allocation and creation of more efficient intervention strategies to protect at-risk children and prevent development of mental illness and adversity.

BackgroundThe choice of drugs for patients with status epilepticus that is refractory to treatment with benzodiazepines has not been thoroughly studied.MethodsIn a randomized, blinded, adaptive trial, we compared the efficacy and safety of three intravenous anticonvulsive agents - levetiracetam, fosphenytoin, and valproate - in children and adults with convulsive status epilepticus that was unresponsive to treatment with benzodiazepines. The primary outcome was absence of clinically evident seizures and improvement in the level of consciousness by 60 minutes after the start of drug infusion, without additional anticonvulsant medication. The posterior probabilities that each drug was the most or least effective were calculated. Safety outcomes included life-threatening hypotension or cardiac arrhythmia, endotracheal intubation, seizure recurrence, and death.ResultsA total of 384 patients were enrolled and randomly assigned to receive levetiracetam (145 patients), fosphenytoin (118), or valproate (121). Reenrollment of patients with a second episode of status epilepticus accounted for 16 additional instances of randomization. In accordance with a prespecified stopping rule for futility of finding one drug to be superior or inferior, a planned interim analysis led to the trial being stopped. Of the enrolled patients, 10% were determined to have had psychogenic seizures. The primary outcome of cessation of status epilepticus and improvement in the level of consciousness at 60 minutes occurred in 68 patients assigned to levetiracetam (47%; 95% credible interval, 39 to 55), 53 patients assigned to fosphenytoin (45%; 95% credible interval, 36 to 54), and 56 patients assigned to valproate (46%; 95% credible interval, 38 to 55). The posterior probability that each drug was the most effective was 0.41, 0.24, and 0.35, respectively. Numerically more episodes of hypotension and intubation occurred in the fosphenytoin group and more deaths occurred in the levetiracetam group tha

Convulsive status epilepticus (SE) is a relatively common emergency condition affecting individuals of all ages. The primary goal of treatment is prompt termination of seizures. Where first-line treatment with benzodiazepine has failed to achieve this, a condition known as established SE (ESE), there is uncertainty about which agent to use next. The Established Status Epilepticus Treatment Trial (ESETT) is a 3-arm (valproate (VPA), fosphenytoin (FOS), levetiracetam (LEV)), phase III, double-blind randomized comparative effectiveness study in patients aged 2 years and above with established convulsive SE. Enrollment was completed in January 2019, and the results are expected later this year. We discuss lessons learnt during the conduct of the study in relation to the following: ethical considerations; trial design and practical implementation in emergency settings, including pediatric and adult populations; quality assurance; and outcome determination where treating emergency clinicians may lack specialist expertise. We consider that the ESETT is already informing both clinical practice and future trial design. This article is part of the Special Issue "Proceedings of the 7th London-Innsbruck Colloquium on Status Epilepticus and Acute Seizures".

The quantity and complexity of scientific and technological information provided to policymakers have been on the rise for decades. Yet little is known about how to provide science advice to legislatures, even though scientific information is widely acknowledged as valuable for decision-making in many policy domains. We asked academics, science advisers, and policymakers from both developed and developing nations to identify, review and refine, and then rank the most pressing research questions on legislative science advice (LSA). Experts generally agree that the state of evidence is poor, especially regarding developing and lower-middle income countries. Many fundamental questions about science advice processes remain unanswered and are of great interest: whether legislative use of scientific evidence improves the implementation and outcome of social programs and policies; under what conditions legislators and staff seek out scientific information or use what is presented to them; and how different communication channels affect informational trust and use. Environment and health are the highest priority policy domains for the field. The context-specific nature of many of the submitted questions—whether to policy issues, institutions, or locations—suggests one of the significant challenges is aggregating generalizable evidence on LSA practices. Understanding these research needs represents a first step in advancing a global agenda for LSA research.

The purpose of this qualitative, phenomenological study is to describe how family achievement guilt is experienced by first-generation college students (FGCS) at a less selective, public, mid-Atlantic university. Festinger’s theory of cognitive dissonance was used to guide this study that explored the central research question: How do FGCS at a less selective, public, mid-Atlantic university describe their experiences with family achievement guilt? Sub-questions included (a) What factors do participants describe as contributors to their family achievement guilt?, (b) How do participants describe the impacts of family achievement guilt to both their home and college lives?, and (c) How do participants describe their efforts to minimize or remediate their family achievement guilt? Criterion and snowball sampling was used to select 11 participants from a less selective, public, mid-Atlantic university. Data was collected through a survey, individual interviews, and an on-line focus group. The data was be analyzed using the modified Stevick-Colaizzi-Keen method of data analysis method as described by Moustakas. Through this analysis, three themes emerged to include (a) journey of leaving, (b) dynamic understanding of the college experience, and (c) pressure to perform. The findings in this study suggested the experience of family achievement guilt for FGCS is a progressive experience. Implications for these findings and recommendations for further research are provided.

Black text on white background. The center of the poster contains a rainbow drawing of a cowboy on a horse inset over a roman numeral 'X.'

Objective: The objective of this study was to develop a child-friendly biofeedback-mediated relaxation device called BrightHearts. Methods: Qualitative data were collected at a tertiary pediatric hospital to inform an iterative design process. Clinicians participated in expert group interviews to identify practical considerations that would facilitate the use of BrightHearts during procedures and provide feedback on prototype designs. Children 7 to 18 years of age participated in interactive exhibitions of the prototypes and were interviewed about their experiences using BrightHearts. Results: Twenty-four clinicians participated in 6 group interviews. Thirty-nine children participated in interactive exhibitions, and 21 were interviewed. Clinicians placed high value on the following factors in the management of procedural pain: providing children with an element of control, the use of relaxation techniques, and the use of portable electronic devices such as iPads. They highlighted the need for BrightHearts to be cost effective, portable, and capable of engaging children's interest. They confirmed the utility of developing a biofeedback-assisted relaxation device for children. Based on the factors identified by clinicians, BrightHearts was developed as an iPad application (app) paired with a wireless heart rate monitor. The BrightHearts heart rate biofeedback app displays digital geometric artwork that responds to changes in heart rate. Children 7 to 17 years of age understood the concept of biofeedback and operated the app by slowing their heart rates. Conclusion: The BrightHearts app can be used to teach children biofeedback-assisted relaxation. Ongoing studies are evaluating its efficacy for the management of procedural pain in children.

James Cloyd Bowman (Iowa State College ), 20 Greenough Avenue, Cambridge, Massachusetts, USA, letter, 1915 July 17, to Hamlin Garland, New York, New York, USA. "I should like your permission to reprint your short story." -- first line.

The living umbrella is resembling of a traditional patio umbrella but with a canopy made of a layer of plants rather than fabric or metal. It is thought to provide comfort and shade to users while increasing nature in hardscaped areas. The study aimed to compare the microclimates of metal canopy umbrella to that of living umbrellas. Metrics used were Wet Bulb Globe Temperature (WBGT), UV transmittance, solar transmittance, air temperature, canopy temperature, and humidity. Compared to ambient conditions, the living umbrella reduced WBGT by 1.5˚C, and UV and solar transmittance by 24.2% and 18%, respectively. The metal umbrella reduced UV and solar transmittance more than the living umbrella, but not WBGT. A second aim was to determine whether there was a Biophilic connection between the living umbrella and its users, which was explored through surveys. The Biophilic connection is exemplified by people who experience feelings of comfort when they are close to nature. The majority of respondents felt strong positive emotions towards the living umbrella, while 81% preferred a living umbrella over a metal umbrella. The research showed that an innovative green technology can improve the microclimate experienced by people while making them feel better.

This dissertation addresses user responses to the introduction of Brain-Computer Interface technologies (BCI) for gaming and consumer applications in the early part of the 21st century. BCI technology has emerged from the contexts of interrelated medical, academic, and military research networks including an established computer and gaming industry. First, I show that the emergence and development of BCI technology are based on specific economic, socio-cultural, and material factors, and secondly, by utilizing user surveys and interviews, I argue that the success of BCI are not determined by these contextual factors but are dependent on user acceptance and interpretation. Therefore, this project contributes to user-technology studies by developing a model which illustrates the interrelations between producers, users, values, and technology and how they contribute to the acceptance, resistance, and modification in the technological development of emerging BCI technologies. This project focuses on human computer interaction researchers, independent developers, the companies producing BCI headsets, and neuro-gadget companies who are developing BCI's for users as an alternative interface for the enhancement of human performance and gaming and computer simulated experience. Moreover, BCI production and use as modes of enhancement align significantly with social practices of play which allows an expanded definition of technology to include cultural dimensions of play.

This dissertation addresses user responses to the introduction of Brain-Computer Interface technologies (BCI) for gaming and consumer applications in the early part of the 21st century. BCI technology has emerged from the contexts of interrelated medical, academic, and military research networks including an established computer and gaming industry. First, I show that the emergence and development of BCI technology are based on specific economic, socio-cultural, and material factors, and secondly, by utilizing user surveys and interviews, I argue that the success of BCI are not determined by these contextual factors but are dependent on user acceptance and interpretation. Therefore, this project contributes to user-technology studies by developing a model which illustrates the interrelations between producers, users, values, and technology and how they contribute to the acceptance, resistance, and modification in the technological development of emerging BCI technologies. This project focuses on human computer interaction researchers, independent developers, the companies producing BCI headsets, and neuro-gadget companies who are developing BCI's for users as an alternative interface for the enhancement of human performance and gaming and computer simulated experience. Moreover, BCI production and use as modes of enhancement align significantly with social practices of play which allows an expanded definition of technology to include cultural dimensions of play.

Show me the way: protein building blocks are programmed to assemble hierarchically and yield a defined fiber morphology of micrometric length and precise nanometric diameter. The key step of this method is to align the building blocks with an AC field prior to assembly. The resulting protein nanofibers are straightforwardly integrated with the circuitry for potential applications in bionanotechnology. (Figure Presented)., Postprint (published version)

Diazepam rectal gel (Diastat (R)) is the only FDA-approved product indicated for acute repetitive seizures. Despite its proven efficacy, most older children and adults object to this route of administration. As a result, many patients do not realize the benefit of a therapy that can improve outcomes and decrease healthcare costs. Intranasal administration of benzodiazepines offers a potential alternative. The primary objective of this study was to compare the bioavailability and pharmacokinetics of two novel intranasal (IN) diazepam (DZP) formulations versus intravenous (IV) administration in healthy volunteers. Twenty-four healthy volunteers were randomized into an open-label, three-way crossover study. 10 mg doses of two investigational intranasal DZP formulations (solution, suspension) and a 5 mg IV dose of commercially available DZP injectable, USP were given. A two-week washout period separated treatments. Plasma samples for DZP analysis were collected pre-dose and at regular intervals up to 240 h post-dose. DZP concentration-time data were analyzed using a non-compartmental pharmacokinetics approach. Exposure following administration of DZP IN solution (absolute bioavailability - 97%) was greater than the IN suspension (absolute bioavailability - 67%). Mean C-max values for the suspension and solution formulations were 221 ng/mL and 272 ng/mL, respectively. Median time to maximum concentration (T-max) was 1 h and 1.5 h for suspension and solution formulation, respectively. Both investigational intranasal formulations were well tolerated. The results of this pilot study indicate that development of an intranasal diazepam formulation with high bioavailability, reasonable variability, and good tolerability is feasible.

Benzodiazepine-refractory status epilepticus (established status epilepticus, ESE) is a relatively common emergency condition with several widely used treatments. There are no controlled, randomized, blinded clinical trials to compare the efficacy and tolerability of currently available treatments for ESE. The ESE treatment trial is designed to determine the most effective and/or the least effective treatment of ESE among patients older than 2 years by comparing three arms: fosphenytoin (fPHT) levetiracetam (LVT), and valproic acid (VPA). This is a multicenter, randomized, double-blind, Bayesian adaptive, phase III comparative effectiveness trial. Up to 795 patients will be randomized initially 1:1:1, and response-adaptive randomization will occur after 300 patients have been recruited. Randomization will be stratified by three age groups, 2-18, 19-65, and 66 and older. The primary outcome measure is cessation of clinical seizure activity and improving mental status, without serious adverse effects or further intervention at 60 min after administration of study drug. Each subject will be followed until discharge or 30 days from enrollment. This trial will include interim analyses for early success and futility. This trial will be considered a success if the probability that a treatment is the most effective is >0.975 or the probability that a treatment is the least effective is >0.975 for any treatment. Proposed total sample size is 795, which provides 90% power to identify the most effective and/or the least effective treatment when one treatment arm has a true response rate of 65% and the true response rate is 50% in the other two arms.

The events of September 11, 2001, catapulted America's military into two wars, and the possibility of others is looming on the horizon. The type of warfare the U.S. military is conducting is far different from what it trained for during the last quarter of a century. Because the enemy and the environment in which the fighting takes place are different from before, the expectations placed upon the U.S. military have changed as well. To guide its actions, the Army, in concert with the Marine Corps, has created a new counterinsurgency doctrine that is set forth in FM 3-24, "Counterinsurgency." Although counterinsurgency is new to today's military, this type of conflict is not novel. The United States, Great Britain, and numerous other countries have fought counterinsurgencies in the past. This monograph analyzes two successful counterinsurgency efforts of the past: the United States in Greece from 1947 to 1949, and Great Britain in Oman from 1964 to 1975. These counterinsurgencies are viewed through the lens of the principles, paradoxes, and imperatives advocated in FM 3-24., The original document contains color images.

When Dr. Jess Parker, head of SERC’s Forest Ecology Lab, walks through a forest, he looks up. The forest canopy is a microclimate of its own, one that absorbs sunlight and rain, removes particles like dust and pollen, and even affects the pH of rainwater as it makes its way down to the forest floor. The forest ceiling houses the machinery of photosynthesis, controls the growth of the entire forest, and provides habitat for many organisms. The challenge has always been how to get to the tops of these trees and collect data there. SERC scientists have developed unique ways to access these treetops, such as balloon-mounted sensors, towers and cranes. These methods are not always as fast, accurate or easy to use as scientists need them to be, and they provide a glimpse of only the outer surface of the canopy. Just recently, however, Dr. Parker developed a new instrument to measure the vertical profile of forest canopies, one that is portable and accurate. Using laser range finder technology, Dr. Parker and his staff are now seeing aspects of the forests never before seen. Developed along with the LIDAR instrument is visualization software to display the 3-D organization of canopies measured by the system. The result is the equivalent of the first CAT-scan of a forest. During this Electronic Field Trip, students will go into a forest canopy with Dr. Parker to learn about forest ecology and the technology available to study it., An electronic field trip from the Wind River Canopy Crane Research Facility., This archival material has been provided for educational purposes. Ball State University Libraries recognizes that some historic items may include offensive content. Our statement regarding objectionable content is available at: https://dmr.bsu.edu/digital/about

The public accounting profession's difficulties with litigation have been widely asserted (e.g., Hill and Metzger, 1992, pp. 263-265; Mednick and Peck, 1994. pp. 897-898; Miller and Young, 1997, pp. 1990-1991, 2027). Public accountants have recently won several major victories in their efforts to reduce litigation based on allegedly negligent auditing. We discuss three of the more important of these recent victories for public accountants and their implications for auditor litigation. We conclude that, despite recent events, the debate over independent auditor litigation is far from over and long-term trends are uncertain. We also briefly examine some of the recent research in response to the public accounting profession's call in the early 1990s for academic research related to independent auditor litigation. In doing so, we briefly comment on some of the articles in this and the Winter 1997 issue of the Journal of Accounting and Public Policy which was dedicated to independent auditor litigation issues. We conclude that research to date in response to this call is providing useful evidence on litigation issues involving the profession, but that additional research is needed to shed light on unresolved issues. Suggestions are made for research that might address some of these questions.

The public accounting profession's difficulties with litigation have been widely asserted (e.g., Hill and Metzger, 1992, pp. 263-265; Mednick and Peck, 1994. pp. 897-898; Miller and Young, 1997, pp. 1990-1991, 2027). Public accountants have recently won several major victories in their efforts to reduce litigation based on allegedly negligent auditing. We discuss three of the more important of these recent victories for public accountants and their implications for auditor litigation. We conclude that, despite recent events, the debate over independent auditor litigation is far from over and long-term trends are uncertain. We also briefly examine some of the recent research in response to the public accounting profession's call in the early 1990s for academic research related to independent auditor litigation. In doing so, we briefly comment on some of the articles in this and the Winter 1997 issue of the Journal of Accounting and Public Policy which was dedicated to independent auditor litigation issues. We conclude that research to date in response to this call is providing useful evidence on litigation issues involving the profession, but that additional research is needed to shed light on unresolved issues. Suggestions are made for research that might address some of these questions.

The public accounting profession's difficulties with litigation have been widely asserted (e.g., Hill and Metzger, 1992, pp. 263-265; Mednick and Peck, 1994. pp. 897-898; Miller and Young, 1997, pp. 1990-1991, 2027). Public accountants have recently won several major victories in their efforts to reduce litigation based on allegedly negligent auditing. We discuss three of the more important of these recent victories for public accountants and their implications for auditor litigation. We conclude that, despite recent events, the debate over independent auditor litigation is far from over and long-term trends are uncertain. We also briefly examine some of the recent research in response to the public accounting profession's call in the early 1990s for academic research related to independent auditor litigation. In doing so, we briefly comment on some of the articles in this and the Winter 1997 issue of the Journal of Accounting and Public Policy which was dedicated to independent auditor litigation issues. We conclude that research to date in response to this call is providing useful evidence on litigation issues involving the profession, but that additional research is needed to shed light on unresolved issues. Suggestions are made for research that might address some of these questions.