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High operational costs of modern medical devices and the required specialized, skilled personnel with certifications to operate most medical instrumentation remains a challenge and an impediment to...

Background:The Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ) older adult population may have a heightened need of medical and supportive care while aging. This makes appointment of a healthcare power of attorney (HCPoA) an essential component of end-of-life care to ensure patients’ wishes are honored at the end of their lives. The objective of this study was to evaluate the prevalence and preferences for HCPoA appointment among older LGBTQ adults living in the Southern United States.Methods:An online survey was distributed to older LGBTQ adults living in the Southern US regarding appointment of a HCPoA between January-March 2018.Participants:The survey was completed by 789 older LGBTQ adults from North Carolina, South Carolina, Georgia, Alabama, Mississippi, Louisiana, and Florida in January-March 2018.Results:Overall, 61.6% of respondents had appointed a HCPoA. Respondents with an appointed HCPoA were more likely to be married (aOR = 5.04, p < .001), have larger social networks (aOR = 3.87, p < .001) and be older (aOR = 1.07, p < .001). Gender diverse respondents were less likely to have an appointed HCPoA relative to cisgender respondents (aOR = 0.39, p = .04). Overall, the majority of respondents indicated a spouse or significant other served as their HCPoA ( n = 311, 64.5%).Conclusions:Nearly 40% of older LGBTQ adults in the Southern US did not have an appointed HCPoA. Specifically, those who were more socially isolated, single, or who identified as transgender or gender non-binary were less likely to have an appointed HCPoA. These people may benefit from targeted outreach regarding advance care planning.

Background Little is known about how early alterations in white matter relate to clinically relevant behaviors such as emotional dysregulation. Thus, our goal was to examine how the white matter structural integrity of key limbic (i.e., uncinate fasciculus and cingulum) and commissural (i.e., forceps minor) bundles in 3-month-old infants prospectively predicts emotional regulation behaviors at 9 months. Methods Three-month-old infants underwent multishell diffusion-weighted imaging. Following image processing, tractography was performed for each tract within each infant's native space (n=20). Measures of white matter integrity, including microstructure and morphology, were extracted from each tract. At 9 months, negative emotionality (NE) and positive emotionality (PE) were elicited using Laboratory Assessment of Temperament tasks. Elastic net regressions were performed for variable selection, which included white matter integrity variables from each of the 3 tracts, along with several covariates, including age, sex, use of public assistance, and the mother's depressive symptoms. Outcome variables were NE and PE composite scores evaluated in two separate models. Results Notably, following hierarchical regression using elastic net-selected variables, uncinate structural integrity was the most robust predictor of NE (s=-0.631, p=0.005). Limitations The sample size of our study is a limitation, however, as a preliminary study, our goal was to describe our findings to inform future, larger studies. Conclusions Greater uncinate structural integrity predicted lower NE, suggesting that greater uncinate structural integrity at 3 months allows greater emotional regulation capacity at 9 months. To our knowledge, this is the first study to demonstrate prospective brain-to-emotional behavior relationships in infants.

How people walk in natural conditions often reveals key insights into health, quality of life and independence. However, topological properties of the environment in which walking takes place should be taken into account for accurate and reliable gait assessments. Here, to begin to tackle this problem a novel smartphone-based gait assessment framework is introduced, and the implementation and performance analysis of two of its data processing modules are described. The first module employs a fuzzy rough nearest neighbour classifier for automatic labelling of walking environments. Tested on a publicly available dataset, the fuzzy classifier reached up to 82% classification accuracy outperforming other state-of-the-art classical machine learning methods and matching deep neural networks reported in the literature. The second module employs a novel algorithm to detect steps and extract temporal gait parameters (such as stride time, double support time and step variability) from heel strike and toe off time points. Tested on a new dataset collected for this study, the algorithm successfully detected more than 97% of the steps and estimated gait parameters with high accuracy and precision matching with the performance levels achieved in controlled laboratory trials.

Despite many initiatives to reframe and support inclusion for people with disabilities, people with intellectual disabilities continue to experience social exclusion in their local communities. This study shares the perspectives of people with an intellectual disability on what matters to them in their local communities. This study aims to inform local governments of the value of engaging with and listening to local people with intellectual disabilities and is an important exploration of how the social sustainability of cities is framed and valued by people who have historically been socially and geographically excluded. Focus groups and interviews were conducted in six local government areas, with a mix of metropolitan and regional areas, in two states of Australia—NSW and Victoria. The study analysed how 45 Australian adults with intellectual disabilities described their local communities and conceptualised better inclusion. The results were collated and organised by applying an adapted framework of inclusive cities. The participants expressed the need for safe, accessible and clean public amenities, accessible information, appropriate communication, and for people to be more respectful, friendly and understanding of the needs of people with intellectual disabilities. This study suggests that local governments can take action in order to improve social sustainability by engaging with local people with intellectual disabilities as citizens, advisors and employees, and by educating the wider community about respect and social inclusion for all.

A crystal plasticity model has been developed for describing the plastic and viscoplastic behaviour of 316H stainless steel. The model has been used successfully to predict the macroscopic response of the material for monotonic and cyclic loading, however the robustness of the model is now being scrutinised to ensure that it captures the underlying mechanisms and local meso-scale deformation characteristics correctly. In order to look at this in more detail, the model has been scripted to allow simulation of diffraction studies on the grains. This is being used to compare the simulation output with neutron and synchrotron experiments. A theoretical study has been completed which adjusts the values of each material parameter within the crystal plasticity finite element (CPFE) framework in isolation to analyse the effect each has upon the shape of the hysteresis loop and how this relates to predictions. A further study had been conducted to investigate the amount of scatter that is produced by altering the initial microstructure of a relatively small volume. The results show that changing the initial microstructure has a negligible effect on the subsequent stress-strain response. This indicates the influence that the grain morphology will have upon the diffraction measurements and that there is no need to consider this further when testing small specimens. To conclude this investigation two further aspects of the model have being scrutinised; the effects of constraining boundary conditions and altering the local environment of a single grain, again to explore the influences which these may have on diffraction studies. The plane boundaries of the volume are currently fixed at zero displacement which will influence the local grains on these boundaries as they are over constrained, but should not alter the overall stress-strain response. To investigate this, grains within the model that have boundary conditions applied have be discarded from the final results to leave the response from the central volume that should be free of the boundary condition effects. The results show that the macroscopic response of the bulk volume and the central volume are very similar but when the individual grain family responses are analysed, it can be seen that the boundary condition do alter the response of the representative volume element (RVE). To analyse how the local environment surrounding a single grain affects its stress-strain response, a centrally located grain will be selected and kept constant while the orientation of the surrounding grains are randomly altered. It has been found that changing the local environment surrounding a single grain will impact the stress-strain response seen by that grain.

The tall poppy syndrome (TPS) is a culturally specific term defined as the “habit of denigrating or ‘cutting down’ those who are successful or who are high achievers”. The purpose of this study was to understand TPS from the perspective of elite New Zealand athletes. Specifically, this study sought to gain elite athletes’ perceptions of whether TPS exists and how it influences New Zealand sporting culture, their personal experiences of being a target of TPS, and how they personally responded to being a target of TPS. Nine current and 11 former New Zealand athletes were interviewed who had competed at Olympic, Commonwealth, or World Championship events. Athletes suggested that TPS was infused throughout society and influenced how the public celebrated winners and viewed success. Athletes believed they had been targets of TPS and viewed it both a positive and negative influence on athlete development. TPS-related criticisms were seen as providing motivation for hard work by some athletes, while others ident...

Interleukin (IL)-1R3 is the co-receptor in three signaling pathways that involve six cytokines of the IL-1 family (IL-1α, IL-1β, IL-33, IL-36α, IL-36β and IL-36γ). In many diseases, multiple cytokines contribute to disease pathogenesis. For example, in asthma, both IL-33 and IL-1 are of major importance, as are IL-36 and IL-1 in psoriasis. We developed a blocking monoclonal antibody (mAb) to human IL-1R3 (MAB-hR3) and demonstrate here that this antibody specifically inhibits signaling via IL-1, IL-33 and IL-36 in vitro. Also, in three distinct in vivo models of disease (crystal-induced peritonitis, allergic airway inflammation and psoriasis), we found that targeting IL-1R3 with a single mAb to mouse IL-1R3 (MAB-mR3) significantly attenuated heterogeneous cytokine-driven inflammation and disease severity. We conclude that in diseases driven by multiple cytokines, a single antagonistic agent such as a mAb to IL-1R3 is a therapeutic option with considerable translational benefit. Multiple cytokines in the proinflammatory IL-1 family share the co-receptor IL-1R3. Dinarello and colleagues show that a fully humanized antibody to IL-1R3 can effectively control inflammation and disease mediated not only by IL-1 but also by IL-33 and IL-36.

This article presents a model for developing a university press based around three guiding principles and six key stages of the publishing process, with associated activities. The model is designed to be applicable to a range of business models, including subscription, open access and hybrid. The guiding principles, publishing stages and strategic points all constitute the building blocks necessary to implement and maintain a sustainable university press. At the centre of the model there are three interconnected main guiding principles: strategic alignment, stakeholder relationships and demonstrating impact. The publishing process outlined in the outer ring of the model is made up of six sections: editorial, production, dissemination, preservation, communication and analytics. These sections were based on the main stages that a journal article or monograph goes through from proposal or commissioning stage through to publication and beyond. The model highlights the overall importance of working in partnership and building relationships as key to developing and maintaining a successful press.

While critics have long acknowledged Jane Austen’s literary debt to William Shakespeare, little attention has been paid to her infrequent use of direct quotations from his work. Perhaps because these instances of quotation are so rare, most critics who take note of them classify them as purely ironic: Austen quotes the Bard as a means by which to satirize the eighteenth-century vogue for Shakespeare epigrams, mocking other writers who ineptly or inaptly cite well-worn passages in a transparent bid for artistic legitimacy. While true to a certain extent, this conclusion does not do justice to Austen’s admiration of Shakespeare nor to the range of her sophisticated irony. Opening up such a critical standpoint in this article, I closely examine instances of direct quotations from Shakespeare in Austen’s novels and argue that Austen does not simply mock those writers who misuse Shakespeare; her quotations also reinvigorate his most clichéd aphorisms and demonstrate both their continuing relevance and her own keen understanding of their complex original contexts.

Cervical cancer offers a salient example of how sociocultural factors such as gender, ethnicity/race, class, and attitudes toward sexuality converge to shape the risk and experience of cancer among women. This article takes a sociocultural approach in considering how increased public knowledge about human papillomavirus (HPV) may be changing the climate of cervical cancer prevention for Latinas. Specifically, it describes relevant sociocultural norms found in some Latino/a communities and discusses how they may act as barriers to and facilitators of health behavior change. Recommendations for incorporating this information in the development of interventions and research are also presented.

Managing a New University Press (NUP) is often a one-person operation and, with limits on time and resources, efficiency and effectiveness are key to having a successful production process and providing a high level of author, editor and reader services. This article looks at the challenges faced by open access (OA) university presses throughout the publishing journey and considers ways in which these challenges can be addressed. In particular, the article focuses on six key stages throughout the lifecycle of an open access publication: commissioning, review, production, discoverability, marketing, analytics. Approached from the point of view of the University of Huddersfield Press, this article also draws on discussions and experiences of other NUPs from community-led forums and events. By highlighting the issues faced, and the potential solutions to them, this research recognises the need for a tailored and formalised production workflow within NUPs and also provides guidance how to begin implementing possible solutions.

Introduction Deep T inversions in the anterior leads (Wellens' syndrome) are a sign of life-threatening coronary artery occlusion. The purpose of this simulation experience is to present a Wellens' syndrome case that allows medical students, emergency medicine residents, and emergency medical service providers to test their knowledge base and critically evaluate the management of the following type of acute coronary syndrome: a Wellens' syndrome (deep T wave inversions in anterior leads) that develops into a ST-elevation myocardial infarction (STEMI) during management. Methods The module contains four elements to help direct the simulation experience. The first element is the case narrative, which includes all pertinent case information, interpretations of the case information, and anticipated case branch points. The second element is a PowerPoint presentation that contains pertinent case lab information, X-ray, and ECGs to be used during the case simulation. The third element is a PowerPoint presentation that contains teaching points for the debriefing session. Finally, an evaluation form is included containing recommended actions. Results A pilot simulation was performed with emergency medicine residents. Residents felt the case emphasized the importance of patient reevaluation, comparing new and old ECGs, and obtaining new ECGs with changes in clinical status. Discussion The case was effective in familiarization and teaching about Wellens' Syndrome. Additionally, most of the participants identified a general lack of comfort in recognizing Wellens' ECG changes (even when the management decisions were correct), secondary to lack of familiarity. In this regard, the case was received well as it is an opportunity to critically review and discuss the Wellens' phenomenon.

Objective Most men diagnosed with prostate cancer in the USA will survive. Of the many aspects of survivorship affected by prostate cancer, body image receives limited attention despite some indication that it may be important to men with the disease. The present study investigated how body image changes over time and the relations between changes in body image and quality of life (QOL) in men with prostate cancer. Methods In a longitudinal design, patients (N = 74) completed questionnaires before treatment (T1) and at 1 month (T2) and 2 years (T3) following treatment completion. Results Growth curve modeling indicated that there was no significant change over time in group-level body image scores. However, hormone treatment was associated with a negative trajectory of change over 2 years. Also, analysis of individual difference scores indicated that ≥50% of patients demonstrated change of at least 0.5 standard deviation between time points. Hierarchical regression indicated that change in body image between T1 and T2 was significantly associated with change in QOL between T1 and T3, while controlling for demographic variables, treatment, treatment-related functioning, and general and treatment-specific positive expectations. In predicting change in body image between T1 and T2, treatment-specific positive expectation was the only significant predictor. Conclusions The present study demonstrates that body image is an important component of the prostate cancer experience. Findings suggest that body image has a meaningful association with QOL among prostate cancer survivors.Copyright © 2012 John Wiley & Sons, Ltd.

In this paper we explore how the development of The University of Huddersfield Press, a publisher of open access scholarly journals and monographs, has enabled the sharing of research with a wider online audience. We situate the development of the Press within a wider research environment and growing community of New University Presses (NUPs) where there is an increasing demand for demonstrating research impact, which drives the need for improved analysis and reporting of impact data, a task that often falls within the remit of library and academic support services. We detail the benefits of the University Press Manager role in terms of ensuring professional service that delivers consistency and sustainability. We go on to outline the experiences of engaging with different online spaces and detail the extensive support for student authors. We argue that in order for the Press to support building a strong and engaged scholarly community and provide new spaces for emerging research, continued investment in both platform development and infrastructure is required.

Advanced cancer is a life-limiting condition, but improvements in medical care are contributing to longer survival among some patients. As a result, it is likely that mental health professionals will be called upon to assist more patients with advanced cancer. The present paper reviews the psychological literature and from it draws clinical considerations for working with individuals affected by advanced cancer. It begins with a brief description of advanced cancer and the medical attributes of an advanced cancer diagnosis, and then catalogues salient medical, psychological, existential, and interpersonal challenges faced by this patient population. The review concludes with recommendations for treatment planning including an overview of some of the more recently tested and widely available interventions. It is hoped that this review will serve as a resource for professionals working with patients affected by advanced cancer.

Achondroplasia and hypochondroplasia are two of the most common forms of skeletal dysplasia. They are both caused by activating mutations in FGFR3 and are inherited in an autosomal dominant manner. Our patient was born to parents with presumed achondroplasia, and found on prenatal testing to have p.G380R and p.N540K FGFR3 mutations. In addition to having typical problems associated with both achondroplasia and hypochondroplasia, our patient had several atypical findings including: abnormal lobulation of the lungs with respiratory insufficiency, C1 stenosis, and hypoglycemia following a Nissen fundoplication. After his reflux and aspiration were treated, the persistence of the tachypnea and increased respiratory effort indicated this was not the primary source of the respiratory distress. Our subsequent hypothesis was that primary restrictive lung disease was the cause of his respiratory distress. A closer examination of his chest circumference did not support this conclusion either. Following his death, an autopsy found the right lung had 2 lobes while the left lung had 3 lobes. A literature review demonstrates that other children with achondroplasia-hypochondroplasia complex have been described with abnormal pulmonary function and infants with thanatophoric dysplasia have similar abnormal pulmonary anatomy. We hypothesize that there may be a primary pulmonary phenotype associated with FGFR3-opathies, unrelated to chest size which leads to the consistent finding of increased respiratory signs and symptoms in these children. Further observation of respiratory status, combined with the macroscopic and microscopic analysis of pulmonary branching anatomy and alveolar structure in this patient population will be important to explore this hypothesis.

Background: The most common form of cancer in children is acute leukemia, with acute lymphoblastic leukemia (ALL) comprising approximately seventy-five percent of these. The initial month of therapy (induction) for all children with ALL includes high dose steroids. One of the side effects of these steroids is hypertension. Objective: To determine the incidence and risk factors of hypertension during induction chemotherapy for acute lymphoblastic leukemia in children. Methods: Retrospective analysis was performed of data collected from all children diagnosed with acute lymphoblastic leukemia (ALL) at Hershey Medical Center (HMC) in 2004 and 2005 (n = 37). Each blood pressure from presentation through the four weeks of induction was recorded. To minimize the effect of a single high blood pressure measurement, median systolic and diastolic pressures were determined for each of the four weeks of induction therapy. These pressures were compared to published age matched norms. For each patient and each week of therapy, the percentile (99) was determined. Results: Thirty-seven children (21 male, 16 female) met study criteria, with a median age of five. Thirteen of these patients received prednisone and twenty-four received dexamethasone. Overall, 95% of children had mean systolic or diastolic pressures >90th percentile, 81 had pressures >95th percentile, and 51% were above the 99th percentile for at least one week of induction. By contrast, only 32%, 19%, and 11% had pressures at these levels at initial presentation. The incidence of significant hypertension increased significantly during the four weeks of induction. Only three children (10%) with pressures above the 95th percentile were clearly noted in the medical record to be hypertensive, and only two children (6.7%) with pressures this high were treated. Conclusions: Hypertension is common and underrecognized during induction chemotherapy for childhood ALL. The incidence of hypertension increases weekly during induction chemotherapy.