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The deadlift exercise is one of the most effective exercises for developing lower-body strength; however, technique errors can lead to low back injuries. The use of a “walk-in” deadlift machine removes the weight bar by using a lever system with independent handles on either side of the body. Theoretically, this would allow alignment of the load with the center of gravity, encouraging a more upright torso and decreasing the involvement of the low back extensors. This study compared trunk angle, knee angle, and electrical activity of key muscles between the conventional deadlift (CDL) and 2 foot positions (ball of foot or toe alignment) with pronated grip (called BallPro and ToePro) of a walk-in deadlift machine among high-skilled and low-skilled lifters. Although there were no skill group differences, in the combined groups, the walk-in deadlift resulted in a significantly more upright trunk angle (p

Breast conserving therapy (BCT), lumpectomy followed by radiotherapy, is an effective treatment for a majority of breast cancers. According to the National Comprehensive Cancer Network, mammographic imaging should be completed at least six months after completion of radiation. This study evaluates the clinical significance and financial cost of postoperative breast imaging within one year of BCT. Patients treated with BCT between 2014 and 2016 at an academic center were identified retrospectively. The medical records were reviewed to identify the timing and type of the first imaging study after BCT. This study evaluated the clinical significance and the cost of postoperative imaging. A total of 128 patients were included into the study. Seventy-six patients received mammograms 3 to 12 months after BCT. Six of the 76 postoperative mammograms required additional imaging/intervention for a total of seven additional imaging studies and three procedures, all of which revealed benign findings. None of these patients had physical examination findings that were of clinical concern. The total cost of postoperative imaging and procedures performed less than a year after BCT was estimated to be $32,506. Postoperative imaging performed on breast cancer patients less than a year after BCT proved to be of no medical benefit and revealed no additional significant pathology. The mammographic surveillance in this study did not lead to the diagnosis of recurrent malignancy or second primary lesions and placed additional financial burden on the patient population. This study demonstrates that breast imaging within a year after BCT had no clinical impact and resulted in increased cost of care.

In patients treated with macitentan (Opsumit®, Actelion Pharmaceuticals Ltd., Basel, Switzerland) for pulmonary arterial hypertension (PAH), prevention and/or effective management of treatment-related adverse events may improve adherence. However, management of these adverse events can be challenging and the base of evidence and clinical experience for macitentan is limited. In the absence of evidence, consensus recommendations from physicians experienced in using macitentan to treat PAH may benefit patients and physicians who are using macitentan. Consensus recommendations were developed by a panel of physicians experienced with macitentan and PAH using a modified Delphi process. Over three iterations, panelists developed and refined a series of statements on the use of macitentan in PAH and rated their agreement with each statement on a Likert scale. The panel of 18 physicians participated and developed a total of 118 statements on special populations, add-on therapy, drug-drug interactions, warnings and precautions, hospitalization and functional class, and adverse event management. The resulting consensus recommendations are intended to provide practical guidance on real-world issues in using macitentan to treat patients with PAH.

Fatigue crack growth behavior of a rolled AZ31 magnesium plate is investigated and modelled in this study. Fatigue crack growth tests were performed on compact tension specimens at load ratios of R = 0.1 and R = 0.7 to provide data for a strip-yield based fatigue crack growth model. Minimal differences in crack closure were observed between the two load ratios. Threshold values for the stress intensity factor range were found to be often less than those reported in previous literature. The reason for lower threshold values could be related to the nontraditional compression pre-cracking method used in this study, which was employed in an attempt to produce a more accurate measurement of the fatigue crack threshold. In addition to the long crack fatigue crack growth testing using compact tension specimens, load controlled fatigue tests were conducted on flat, reduced gage specimens at load ratios of R = 0.1 and R = −1.0 to study the microstructurally small crack growth behavior and to extend the model capability to predict the microstructurally small crack growth behavior. The reduced gage specimens were found to spend the majority of their life in the crack growth stage. Cracks primarily grew in a planar fashion other than where multiple cracks coalesced. The microstructurally small crack growth data from these experiments were also compared with predictions from the fatigue crack growth model. Crack growth modeling revealed that traditional calculations using plasticity-induced crack closure concepts and an effective stress intensity factor range were not able to predict the microstructurally small crack growth behavior of these specimens. In contrast, computing crack growth rate from crack tip opening displacement was shown to give satisfactory results. Crack opening stresses for the fully reversed tests revealed that the compressive loading largely nullified the effect of the plastic wake on fatigue crack growth.

Background Although heightened inflammation and autoimmune responses have been well described in patients with heart failure, the role of cell-mediated immune function in the pathogenesis and progression of heart failure is unclear. The aim of our study is to evaluate the prognostic role of cell-mediated immune function in patients with advanced heart failure. Methods We studied patients with advanced heart failure referred for evaluation of candidacy for advanced heart failure therapies between 2007 and 2010. Cell-mediated immune response was categorized into 3 groups—low or poor immune response (≤225 ng/mL), moderate or normal immune response (226-524 ng/mL), and strong immune response (≥525 ng/mL)—using a phytohemagglutinin-stimulated T-cell response assay. Results Out of 368 patients, 41 patients (11.1%) had poor immune function, 258 patients (70.1%) had normal immune function, and 69 patients (18.7%) had strong immune function. The primary outcome of all-cause mortality or cardiac transplantation occurred in 63.4%, 45.3%, and 34.8% in the poor immunity, normal immunity, and strong immune function groups, respectively. In univariate analysis, cell-mediated immune function was strongly associated with the primary outcome ( P =.014). Poor immune function portended worse prognosis (hazard ratio=2.18, 95% CI 1.01-4.70, P =.047), and strong immune function was associated with better survival (hazard ratio=0.67, 95% CI 0.43-1.04). However, when adjusted for multiple variables in multivariate analysis, immune function status lost its overall significance to predict primary outcome ( P =.11), but the direction to an increased risk of primary outcome was maintained in the poor immune function group. Conclusions Poor cell-mediated immune function measured by a clinically available assay could be associated with more adverse long-term prognosis in patients with advanced heart failure.

As attacks against password-based authentication increase, the need for robust biometrics becomes apparent. Currently, two of the most popular biometric authentication systems are fingerprint and facial recognition. However, both of these biometrics become unusable once compromised. Also, an attacker might coerce the user to force authentication. Therefore, we propose an authentication mechanism that depends on the participant’s neurological responses to chosen pieces of music measured using electroencephalographic (EEG) signals. The current study proposes an authentication system that uses neurological responses to music for classification. Participants listened to individually selected music and music selected by other participants during an EEG reading. The change in the Alpha and Beta band frequencies across seven electrodes served as the input to a user specific K-Nearest Neighbors (KNN). The classifier attempts to determine if we can identify a user based on their EEG response to music. Our pilot data collection and analysis has shown promise of this authentication system with an accuracy rate between 76.4%-92.3%.

Reservable student space is an essential resource for student organizations at universities. The ability to provide equitable access to spaces is a key role of the administration. The focus of this paper is a case study exploring mechanisms to improve both spaces and how students access them at the University of Virginia, taking a human-centered design approach to 1) analyzing the current system, 2) identifying, evaluating, and evolving recommendations to improve system performance, and 3) assessing impact of recommendations. Based on prior studies, usage data, surveys, interviews, and focus groups, we identified two driving questions: 1) Does the university have the needed spaces? 2) Are these spaces accessible by student groups? In response, the team developed a dual focus: Space Design and Utilization (SDU) to address the idea of “right spaces” and Reservation System Design (RSD) to address issues related to ease of access. SDU revealed issues with overly-strict policies and space design, a disparity in the spread of spaces across campus, and a shortage of spaces equipped to diverse student activity. To address these issues, we recommend the university audit its policies, focus future construction on creating hubs of space near student housing, and emphasize the ideal of multi-use space during new construction and renovations. RSD revealed a lack of procedural transparency leads to feelings of inequity between student groups, incorrect assumptions regarding users lead to dysfunctional interactions, and the system was not making optimal use of the limited spatial resources. To address issues, we recommend the university increase transparency through clear and consistent communication, refrain from making unjustified assumptions of users, and allocate spaces to proper events while allowing flexibility within spaces.

Extrusion deposition additive manufacturing produces parts with inherent porosity, which typically manifests as easily accessible voids between beads. This open porosity can also be accompanied by voids within the beads themselves, and both types can impact a part���s desired performance. Porosity is influenced by a variety of factors, including infill percentage, layer height, nozzle diameter, print speed, and raster orientation. While their influence on mechanical properties and porosity have been studied previously, there has been minimal work connecting print parameters to porosity and subsequently to mechanical performance. This study investigates the relationships between print parameters, volumetric porosity, and mechanical performance. In addition, this study measures both open and closed porosity through use of a helium pycnometer rather than image analysis of a cross-section. Thus, this study will identify correlations between the volumetric density of parts and the resulting mechanical performance as a function of print parameters.

Integrating Multiple Materials (MM) into large-scale Additive Manufacturing (AM) is a key for various industrial applications wishing to incorporate site-specific properties into geometrically complex designs that are difficult to manufacture with traditional techniques. Printing with multiple materials is typically accomplished by using layers as natural material boundaries, but having the capability to switch between materials within a single layer without pausing would further expand MM possibilities. This study used Cincinnati Incorporated’s Big Area Additive Manufacturing (BAAM) system to explore material transitions with a novel dual-hopper that enables in-situ material blending of a pelletized feedstock. Constructing MM and functionally graded material (FGM) structures requires depositing a specific material composition at a specific geometric location to achieve a desired performance. Accurately implementing this with the BAAM’s blended extrusion system requires a thorough understanding of the transition between distinct material compositions. This study characterizes a step-change transition between neat acrylonitrile butadiene styrene (ABS) and carbon fiber-reinforced ABS. Three distinct techniques were compared for analyzing the fiber content, and the transition zone between materials was characterized as a function of transition direction. The transition process was consistent to within 0.7 wt% carbon fiber variation between different layers and prints. The transition between materials was found to be directionally dependent, with ABS to CF/ABS having a transition length of 3.5 m compared to 3.2 m for CF/ABS to ABS. Furthermore, the transition from Material A to Material B was found to be repeatable with a possible variance in transition length of 0.3 m.

This chapter begins the exploration of what leadership education is through examining the relationship between educational involvement and academic autonomy in the development of socially responsible leaders.

Heart failure (HF) affects millions of Americans and causes financial burdens because of the need for rehospitalization. For this reason, health care systems and patients alike are seeking methods to decrease readmissions. We assessed the potential for reducing readmissions of patients with postacute care HF through an educational program combined with enhanced external counterpulsation (EECP). We examined 99 patients with HF who were referred to EECP centers and received heart failure education and EECP treatment within 90 days of hospital discharge from March 2013 to January 2015. We compared observed and predicted 90-day readmission rates and examined results of 6-minute walk tests, Duke Activity Status Index, New York Heart Association classification, and Canadian Cardiovascular Society classification before and after EECP. Patients were treated with EECP at a median augmentation pressure of 280 mm Hg (quartile 1 = 240, quartile 3 = 280), achieved as early as the first treatment. Augmentation ratios varied from 0.4 to 1.9, with a median of 1.0 (quartile 1 = 0.8, quartile 3 = 1.2). Only 6 patients (6.1%) had unplanned readmissions compared to the predicted 34%, p

We tested the hypothesis that Pseudomonas aeruginosa type 3 secretion system effectors exoenzymes Y and U (ExoY and ExoU) induce release of a high-molecular-weight endothelial tau, causing transmissible cell injury characteristic of an infectious proteinopathy. Both the bacterial delivery of ExoY and ExoU and the conditional expression of an activity-attenuated ExoU induced time-dependent pulmonary microvascular endothelial cell gap formation that was paralleled by the loss of intracellular tau and the concomitant appearance of high-molecular-weight extracellular tau. Transfer of the high-molecular-weight tau in filtered supernatant to naïve endothelial cells resulted in intracellular accumulation of tau clusters, which was accompanied by cell injury, interendothelial gap formation, decreased endothelial network stability in Matrigel, and increased lung permeability. Tau oligomer monoclonal antibodies captured monomeric tau from filtered supernatant but did not retrieve higher-molecular-weight endothelial tau and did not rescue the injurious effects of tau. Enrichment and transfer of high-molecular-weight tau to naïve cells was sufficient to cause injury. Thus we provide the first evidence for a pathophysiological stimulus that induces release and transmissibility of high-molecular-weight endothelial tau characteristic of an endothelial proteinopathy.