Search

Environmental water management often benefits from a risk‐based approach where information on the area of interest is characterized, assembled, and incorporated into a decision model considering uncertainty. This includes prior information from literature, field measurements, professional interpretation, and data assimilation resulting in a decision tool with a posterior uncertainty assessment accounting for prior understanding and what is learned through model development and data assimilation. Model construction and data assimilation are time consuming and prone to errors, which motivates a repeatable workflow where revisions resulting from new interpretations or discovery of errors can be addressed and the analyses repeated efficiently and rigorously. In this work, motivated by the real world application of delineating risk‐based (probabilistic) sources of water to supply wells in a humid temperate climate, a scripted workflow was generated for groundwater model construction, data assimilation, particle‐tracking and post‐processing. The workflow leverages existing datasets describing hydrogeology, hydrography, water use, recharge, and lateral boundaries. These specific data are available in the United States but the tools can be applied to similar datasets worldwide. The workflow builds the model, performs ensemble‐based history matching, and uses a posterior Monte Carlo approach to provide probabilistic capture zones describing source water to wells in a risk‐based framework. The water managers can then select areas of varying levels of protection based on their tolerance for risk of potential wrongness of the underlying models. All the tools in this workflow are open‐source and free, which facilitates testing of this repeatable and transparent approach to other environmental problems. [ABSTRACT FROM AUTHOR]

A critical social sciences perspective, critical race and disability studies, media studies, lived experience, and the neurodivergence movement shape a conceptual framework in this paper to critique and resist popular media tropes of autistic people and their families. 'Normal' and its modern meanings are presented, followed by a theoretical re-framing. Then, an irreverent and informal critique of one example US newscast highlights the dominant narrative and invites readers to unlearn these myths of normal. Recurring hegemonic news frames reflect a larger culture where familial abuse and violence against autistic people is dangerously presented as reasonable. Counter narratives exist, however. Autism can be understood as a natural, integral, welcome part of a wider human neurodiversity that enriches society. Families and autistic advocates must work together to resist and respond to pressure to conform to myths of normality. [ABSTRACT FROM AUTHOR]

Aim To evaluate the relationships between early growth and regional variations in type 1 diabetes (T1D) incidence in an international cohort of children with familial and genetic risk for T1D. Methods Anthropometric indices between birth to 5 yr of age were compared among regions and T1D proband in 2160 children participating in the Trial to Reduce Insulin-dependent diabetes mellitus in the Genetically at Risk study. Results Children in Northern Europe had the highest weight z-score between birth to 12 months of age, while those in Southern Europe and USA had the lowest weight and length/height z-scores at most time points (p < 0.005 to p < 0.001). Few differences in z-score values for weight, height, and body mass index were found by maternal T1D status. Using International Obesity Task Force criteria, the obesity rates generally increased with age and at 5 yr were highest in males in Northern Europe (6.0%) and in females in Canada (12.8%). However, no statistically significance difference was found by geographic region. In Canada, the obesity rate for female children of mothers with and without T1D differed significantly at 4 and 5 yr (6.0 vs. 0.0% and 21.3 vs. 1.9%, respectively; p < 0.0125) but no differences by maternal T1D status were found in other regions. Conclusions There are regional differences in early childhood growth that are consistent with the higher incidence of T1D in Northern Europe and Canada as compared to Southern Europe. Our prospective study from birth will allow evaluation of relationships between growth and the emerging development of autoimmunity and progression to T1D by region in this at-risk population of children. [ABSTRACT FROM AUTHOR]

OBJECTIVE--Type 1 diabetes results from an immune-mediated destruction of β-cells, likely to be mediated by T lymphocytes, but the sensitivity, specificity, and other measures of validity of existing assays for islet autoreactive T-cells are not well established. Such assays are vital for monitoring responses to interventions that may modulate disease progression. RESEARCH DESIGN AND METHODS--We studied the ability of cellular assays to discriminate responses in patients with type 1 diabetes and normal control subjects in a randomized blinded study in the U.S. and U.K. We evaluated the reproducibility of these measurements overall and to individual analytes from repeat collections. RESULTS--Responses in the cellular immunoblot, U.K.-ELISPOT, and T-cell proliferation assays could differentiate patients from control subjects with odds ratios of 21.7, 3.44, and 3.36, respectively, with sensitivity and specificity as high as 74 and 88%. The class II tetramer and U.S. ELISPOT assays performed less well. Despite the significant association of the responses with type 1 diabetes, the reproducibility of the measured responses, both overall and individual analytes, was relatively low. Positive samples from normal control subjects (i.e., false positives) were generally isolated to single assays. CONCLUSIONS--The cellular immunoblot, U.K.-ELISPOT, and T-cell proliferation assays can distinguish responses from patients with type 1 diabetes and healthy control subjects. The limited reproducibility of the measurements overall and of responses to individual analytes may reflect the difficulty in detection of low frequency of antigen-specific T-cells or variability in their appearance in peripheral blood. Diabetes 58:2588-2595, 2009. [ABSTRACT FROM AUTHOR]

The article discusses Vietnam in 2008, domestic issues including political and economic conditions, and Vietnam's successes in foreign policy. Actions of the Vietnamese Communist Party are noted including its arrest of newspaper journalists for infringing on government interests. Vietnam's economy is said to affected by rising inflation. It notes Prime Minister Nguyen Tan Dung and the political relationship between Vietnam and China.

The purpose of this study was to identify teaching styles that complement the learning preferences of undergraduate dental students while enhancing the quality of patient care. A formidable challenge to reform in dental education has been overcoming the resistance by faculty and administration to recommended changes. The organizational structure of dental institutions, with their independent departments, makes obtaining consensus on educational issues difficult. For beneficial change to occur, clear evidence of the benefits to all within the organization must be presented. The objectives of the study were to 1) idenlify the most common personality types among first- and second-year undergraduate dental students at the University of Texas Dental Branch at Houston using the Myers-Briggs Type Indicator (MBTF); 2) identify Ihe learning preferences of these personality types: and 3) deterntine a more effective approach to teaching clinical dentistry based upon student personality types and learning preferences. Four common personality types were identified among respondents: ISTJ, ESFJ, ESTJ, and ISFJ, with a predisposition for Sensing (S) (desire for facts, use of senses) over Intuition (N) (look for possibilities, relationships) and Judging (J) (prefers decisiveness, closure) over Perceiving (P) (desire flexibility, spontaneity). The most common occurring personality type, ISTJ, represents an Introverted, Sensing, Thinking, Judging individual. Specific clinical curricular techniques that would appeal to these common personality types are identified, and an explanation of their benefit is provided. Results of this study demonstrate the importance of faculty understanding and acknowledging different student personality types and related learning preferences as a way to initiate improvement of undergraduate dental education, promote student motivation, and allow for an expression of learning style preference. [ABSTRACT FROM AUTHOR]

Investigates the effects of Tai Chi Chuan on the health of Hmong American older adults. Use of Tai Chi Chuan Program Inventory; Improvements in Tai Chi Chuan Program; Documentation of beneficial health effects; References.

Analyzes a national sample of anesthesia records for the presence or absence of noteworthy record indicators in the U.S. Basis for the inclusion of noteworthy indicators; Record indicators and the rate of omission for each indicator; List of human factors in which the records are based; Reason for errors based on the human factor perspective.

The purpose of this study was to assess the prevalence, demographic factors, outcomes, and preventative measures for substance abuse among nurse anesthesia students over a 5-year period from 2008 to 2012. An electronic survey was sent to 111 program directors of accredited nurse anesthesia programs in the United States. Twenty-three programs (response rate = 21.7%) reported data related to 2,439 students. Sixteen incidents of substance abuse were reported for a 5-year prevalence of 0.65%. Opioids were the most frequent drug of choice (n = 9). The programs identified no predisposing risk factors in 50% of the incidents. For the students, reported outcomes included voluntary entry into treatment (n = 10), dismissal from the program (n = 7), loss of nursing license (n = 2), and 1 death. Pre-enrollment background checks and drug testing for cause were the most commonly reported screening practices. The most frequently reported prevention strategy was wellness promotion education. The prevalence was lower among student registered nurse anesthetists, as compared with certified registered nurse anesthetists. Although additional studies are necessary to verify this finding, an opportunity might exist for programs to be proactive in assessing risk postgraduation. Future studies evaluating the effectiveness of wellness promotion efforts might lead toward a standardized, best practice approach to risk reduction strategies. [ABSTRACT FROM AUTHOR]

Background: The role of neoadjuvant chemotherapy (NAC) in advanced sigmoid colon carcinoma remains to be further characterized. Rationale for NAC includes downstaging on final pathology and optimization of microscopically negative margins (R0 resection). We investigated rates of neoadjuvant chemotherapy use in advanced sigmoid colon cancer at academic cancer centers and assessed factors associated with likelihood of NAC administration., Methods: The National Cancer Database was queried from 2004 to 2017 for patients with clinical T3 or T4, N0-2, M0 sigmoid colon cancer who underwent surgical resection. Those with neoadjuvant radiation or metastatic disease were excluded. The outcomes of patients who did and did not receive neoadjuvant chemotherapy were evaluated for this retrospective cohort study., Results: There were 23,597 patients of whom 364 (1.5%) received NAC. More patients received NAC at academic (41%, P < .001) and high-volume centers (27%, P < .001). Patients with Medicare/Medicaid (39%) and private insurance (52%) were more likely to receive NAC ( P < .001). There was a significantly higher rate of N2 to N1 downstaging in the NAC group. Propensity-score matching demonstrated comprehensive community cancer programs (CCCP) were less likely to provide NAC (OR 0.4; 95% CI 0.23, 0.70, P < .001). There was no difference in survival ( P = .20), R0 resection ( P = .090), or 30-day readmission rates ( P = .30) in the NAC cohort compared to the non-NAC cohort., Conclusions: Access to centers offering multi-disciplinary care with NAC prior to surgical resection is important. This care was associated with academic and high-volume centers and private or government-sponsored insurance. There was no difference in survival between NAC and non-NAC cohort., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.