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• Patients explore meaning of their crisis in light of self-identity and quality of life. • Providers evaluate treatment decisions relative to patients' values and identity. • Patients describe sources of strength and resilience, new insights, and hope for the future. • Narrative Medicine sessions encourage rapport, patient trust, and mutual understanding. We explore the applications of Narrative Medicine (NM) in the clinical care of brain cancer patients whose self-identity and quality of life are challenged by their disease and treatment. This paper considers how NM may help patients retain and rediscover self-identity during treatment. We performed a retrospective review of NM sessions at our institution in 2016 with focus on life perspectives and priorities along with outlook or attitude and any changes in their symptoms and possible impact on their lives. The narratives shared by four brain cancer patients provided examples of loss of self-identity during illness and treatment, along with ways that NM sessions encouraged patient resilience and discovery of meaning. NM sessions made visible contributions for the patients mentioned in these case studies. Understanding the patient's story is critical for evaluating the significance of impairments due to brain cancer and treatment relative to the patient's unique sense of self and quality of life. NM is at the nexus of clinical management and quality of life concerns for brain cancer patients. Insights from NM sessions may also help the treatment team as they assess patient needs, attitudes, and abilities. [ABSTRACT FROM AUTHOR]

Given the rarity of retroperitoneal soft tissue sarcoma, few studies have assessed if radical excision of retroperitoneal soft tissue sarcoma with adjacent organs improves survival outcomes. This propensity score–matched study aimed to evaluate the impact of radical excision versus resection of tumor alone. The National Cancer Database 2004 to 2015 was used to assess short- and long-term outcomes of resection of tumor alone versus radical excision (tumor plus ≥1 adjacent organs) via 1:1 propensity-matched analyses. Subgroup analyses included low-grade, high-grade, liposarcoma, leiomyosarcoma, adjacent organ involvement alone, localized tumors alone, and high-volume hospitals (≥10 resections/y). Multivariable logistic regression models identified factors associated with radical excision. Comparison of propensity-matched groups (N = 1,139/group) revealed no significant differences in 30-day mortality, 90-day mortality, or overall survival (for all, P >.580). For all subgroup analyses comparing resection of tumor alone with radical excision, including localized tumors without organ invasion (N = 208/group), there were no identified differences in short- or long-term survival. Although it yielded lower R2 resection rates (P =.007), radical excision was associated with greater mean length of stay (P <.001). Radical excision was not associated with improved retroperitoneal soft tissue sarcoma survival irrespective of grade, histology, hospital volume, or adjacent organ involvement. Resection of ostensibly involved adjacent viscera may increase morbidity without survival benefit. These results inform ongoing discussion regarding histology-tailored, situation-specific extent of retroperitoneal soft tissue sarcoma resections. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Duchenne muscular dystrophy (DMD) is an inherited X-linked recessive neuromuscular disease caused by mutations of the dystrophin gene, leading to early and progressive muscle deterioration and dilated cardiomyopathy. The aim of this investigation was to assess whether treatment with sacubitril/ valsartan (S/V) is well tolerated and may have beneficial effects in DMD patients with left ventricle (LV) dysfunction. PATIENTS AND METHODS: We administered S/V to 3 DMD patients (19-29 yeard old) with LV ejection fraction <35% at echocardiography but no symptoms of heart failure. All patients were on optimal medical therapy. S/V was initiated at a very low dose of 12/13 mg/die, after withdrawal of angiotensin-converting enzyme inhibitor therapy, and slowly titrated to the dose of 49/51 mg twice daily or the maximally tolerated dose. Clinical and echocardiographic follow-up was performed after 3, 6 and 12 months. RESULTS: At baseline, the LV ejection fraction was 32±1%. A significant improvement of LV ejection fraction was observed at 3 months (44.0±6.0%; p<0.05), which was maintained at 6 (45.7±5.0%) and 12 (43.3±3.2%) months (p<0.05 for both). No relevant side effects were reported throughout the period of the study. CONCLUSIONS: Our preliminary data suggest that, in DMD patients with reduced LV ejection fraction, S/V is safe and may improve LV function. [ABSTRACT FROM AUTHOR]

Background  Highly diluted and succussed solutions interact with solvatochromic dyes, indicating that changes in solvent and solute polarity could be related to their mechanism of action. It is not known, however, how the activity associated with succussed high dilutions is transferred to untreated water and what the limits of this process are. Aims  The aims of the present study were to ascertain whether a succussed high dilution of phosphorus (1.5 × 1 −59 M; Phos 30cH) seeded into a natural water source that fed a fjord and two connected lakes could propagate itself through the lake system (total volume 2200 m 3) and, moreover, whether the process could be tracked using solvatochromic dyes. Methods  Samples of water were collected before and after seeding, at different times and places throughout the lake system. Controls comprised water taken from an untreated and adjacent, but independent, lake (1385 m 3). Results  Water samples taken up to 72 hours after the source treatment produced significant increases (p  ≤ 0.03) in the absorbance of the solvatochromic dye methylene violet (MV), while samples from the control lake produced no changes. Conclusions  The study indicates that activity associated with Phos 30c can propagate itself through large volumes of water, causing changes throughout a whole connected lake system, and that these changes can be tracked using the solvatochromic dye MV. This in turn means the use of homeopathic medicines in large volumes of drinking water, in farming and ecological contexts, now has the potential to be assessed with physico-chemical monitoring. [ABSTRACT FROM AUTHOR]

Primarily based on laboratory studies, theories of affect propose that emotions are driven by the valence of outcomes as well as the difference between the outcome itself and the expected outcome (i.e., the prediction error [PE]). Yet no work has assessed the drivers of emotion using real-world, personally meaningful events on timescales over which human emotion unfolds. We developed an event-triggered, ecological momentary assessment procedure measuring positive and negative affect (PA and NA, respectively) in university students as they received exam grades for which they had made predictions. We split data into exploratory and confirmatory samples, and built computational models predicting the time course of PA and NA and demonstrate that a model incorporating both exam grade and grade PE accounted for the time course of PA and NA better than a model solely using exam grades. Further, grade PEs were stronger predictors of the time course of PA and NA than the grades themselves. Similarly, the effects of PEs also persisted longer for NA than PA. These data indicate that deviations from expectations are critical determinants of the temporal dynamics of real-world emotion. [ABSTRACT FROM AUTHOR]

Background: Modular dual-mobility (MDM) total hip arthroplasty (THA) is designed with a cobalt-chromium liner inserted into a titanium acetabular component. The purpose of this study is to investigate the potential risks for fretting corrosion at this junction, by measuring serum metal ions, after MDM acetabular revision.Methods: Thirty-seven patients with well-functioning revision THAs participated in a cross-sectional study at mean 5.1 (2-10) years after surgery. All received a trabecular titanium MDM acetabular component. The serum levels of cobalt and chromium were measured using mass spectrometry.Results: The mean values of chromium and cobalt were 2.08 μg/L (95% confidence interval 0.9-3.2, range 0.02-11.8) and 1.99 μg/L (95% confidence interval 0.81-3.17, range 0.07-16.05), respectively. Eleven patients (29, 7%) had ion levels above the normal range, with 6 (16.2%) above 5 μg/L and 5 (13.5%) between 1 and 5 μg/L. A significant correlation was found between an elevated serum metal ion level and University of California Los Angeles score (P = .016).Conclusion: We conclude that serum metal level elevation may occur secondary to metal debris resulting from corrosion of the index MDM THA. This potential risk should be included in the decision-making process when dealing with revision arthroplasty in young and active patients. [ABSTRACT FROM AUTHOR]

Opioid-based analgesia is the most common method for pain control in the postoperative period. Limited data exist to compare the adequacy of pain control in the post thyroidectomy period with nonopioid-based analgesia. We aimed to evaluate the efficacy of nonopioid-based, postoperative analgesia. After institutional review board approval, patients were randomized to 1 of 2 pain control regimens. Sample size was calculated to assess for a pain score difference of 1 based on a visual analog scale. The control group received opioid-based, postoperative analgesia, whereas the study group received nonopioid-based analgesia of acetaminophen and ibuprofen. Pain scores (measured on visual analog scale) and opioid use (converted to morphine equivalent dose) were measured after completion of the operation. The sample sizes for the study and control groups were 49 and 46 patients, respectively. The pain score for the study and control groups 1 hour after the operation (3.3 vs 3.9, P =.35), 6 hours after the operation (2.8 vs 3.0, P =.08), on postoperative day 1 (1.6 vs 2.4, P =.08) and on the first office visit (0.2 vs 0.1, P =.82) did not have a statistically significant difference. Morphine equivalent opioid requirement for pain control in the postoperative period was 0.8 vs 6.9 mg (P <.01), respectively. In a randomized control trial, we showed that patients treated with nonopioid analgesia had similar pain scores to those treated with opioids, with the benefit of having lower opioid exposure in the perioperative period. [ABSTRACT FROM AUTHOR]

Background  The mechanism by which highly diluted and agitated solutions have their effect is still unknown, but the development in recent years of new methods identifying changes in water and solute dipole moments is providing insights into potential modes of action. Objective  The objective of the current study was to compare the biological effects of Antimonium crudum (AC) previously obtained by our group and already described in the literature with now measurable physico-chemical effects on solvatochromic dyes. Methods  Different dilutions of AC and succussed water have been characterized with respect to their effect on the visible spectra of the solvatochromic dyes methylene violet (MV), a pyridinium phenolate (ET33), and a dimethylamino naphthalenone (BDN) compared with in-vitro action against Leishmania amazonensis -infected macrophages. Results  Dye responses varied according to the dye used and the level of AC dilution and results were found to corroborate previously published in-vivo and in-vitro effects of AC. In addition, a very significant enhancement in the absorbance increase of MV was seen using the supernatant from AC 200cH-treated cells (15%; p  < 0.0001) over that seen with AC 200cH itself (4%; p  = 0.034), suggesting the amplification of ultra-high dilution effects by biological systems. Furthermore, supernatants from AC-treated cells increased the range of dilutions of AC that were capable of producing effects on the spectra of MV. The effect of AC dilutions on dye ET33 was eliminated by a weak electric current passed through potency solutions. Conclusion  The data confirm a correspondence between the biological effects of dilutions of AC in-vitro and physico-chemical effects on solvatochromic dyes as measured by changes in their visible spectra. Results also indicate high dilutions of AC are sensitive to exposure to electric currents and biological systems. [ABSTRACT FROM AUTHOR]

Body dissatisfaction is widely recognized as an important public health concern mainly for women because of its increasing incidence worldwide. The aim of this exploratory study was to test the predictive role of family influence on body satisfaction (BS) among young Italian women, during a decade conceptualized as 'emerging adulthood'. Instruments designed to assess BS, appearance-focused parental comments, maternal and paternal criticism were administered to 688 women aged between 18 and 28 years (M age = 23.40; SD = 2.33). Two regression analyses were used with life satisfaction levels, parental comments, and maternal/paternal criticism as independent variables to explain variance in BS for younger (18–23 years) and older (24–28 years) women. The data reveal an interesting difference in the influence of parental criticism on BS depending on the age cohort: maternal criticism negatively predicts BS in younger women, while paternal criticism is a risk factor for BS in older women. [ABSTRACT FROM AUTHOR]

The serine protease inhibitor SerpinB3 has been described as critical mediator of liver fibrosis and it has been recently proposed as an additional hepatokine involved in NASH development and insulin resistance. Protease Activated Receptor 2 has been identified as a novel regulator of hepatic metabolism. A targeted therapeutic strategy for NASH has been investigated, using 1-Piperidine Propionic Acid (1-PPA), since this compound has been recently proposed as both Protease Activated Receptor 2 and SerpinB3 inhibitor. The effect of SerpinB3 on inflammation and fibrosis genes was assessed in human macrophage and stellate cell lines. Transgenic mice, either overexpressing SerpinB3 or carrying Serpinb3 deletion and their relative wild type strains, were used in experimental NASH models. Subgroups of SerpinB3 transgenic mice and their controls were also injected with 1-PPA to assess the efficacy of this compound in NASH inhibition. 1-PPA did not present significant cell and organ toxicity and was able to inhibit SerpinB3 and PAR2 in a dose-dependent manner. This effect was associated to a parallel reduction of the synthesis of the molecules induced by endogenous SerpinB3 or by its paracrine effects both in vitro and in vivo , leading to inhibition of lipid accumulation, inflammation and fibrosis in experimental NASH. At mechanistic level, the antiprotease activity of SerpinB3 was found essential for PAR2 activation, determining upregulation of the CCAAT Enhancer Binding Protein beta (C/EBP-β), another pivotal regulator of metabolism, inflammation and fibrosis, which in turn determined SerpinB3 synthesis. 1-PPA treatment was able to inhibit the PAR2 - C/EBP-β - SerpinB3 axis and to protect from NASH development and progression, supporting the potential use of a similar approach for a targeted therapy of NASH. [Display omitted] • SerpinB3 is a mediator of liver inflammation, steatosis and fibrosis. • The Protease Activated Receptor 2 (PAR2) is activated by SerpinB3. • The CCAAT Enhancer Binding Protein-beta is essential for SerpinB3 synthesis. • 1-Piperidine Propionic Acid inhibits PAR2 and protects from non-alcoholic steatohepatitis. [ABSTRACT FROM AUTHOR]

Video-heavy distance learning programs can put a strain on the campus network. This article describes how three institutions are managing bandwidth to ensure high-quality service for eLearning students.

In this article, the author offers six best practices for physical and data security convergence. These are: (1) assess the cable plant; (2) choose wisely; (3) be patient; (4) engineer for high availability; (5) test the converged network to make sure it works; and (6) don't forget the humans.

In many classrooms, movies are a special occasion--a tool that creative teachers intersperse with regular lessons to supplement the everyday curriculum and make learning fun. At the nine school districts served by the Monroe 2-Orleans Board of Cooperative Educational Services (BOCES) in Spencerport, New York, movies are becoming part of the routine, with the help of specially customized handheld computers that are bringing students engaging instructional math content right into the palms of their hands. After identifying a need to improve math achievement among its middle school students, BOCES enlisted the help of K12 Handhelds, a technology integrator in Long Beach, California, that specializes in building multimedia applications specifically for handhelds. This article talks about handheld computers which educators are turning into to bring multimedia applications such as digital movies and e-books to their students.

In many ways, unified communications (UC) is the Holy Grail in the world of campus telecommunications; everybody wants it, yet the phrase means something different to everyone. "Campus Technology" (CT) tackled this subject in the recent webinar sponsored by Applied Voice & Speech Technologies (AVST), "Ten Steps for Building an Affordable, Reliable Unified Communications Infrastructure". In it, AVST President and CEO Hardy Myers spoke with CT Senior Contributing Editor Matt Villano about the process and challenges of building UC in higher education. This paper presents the highlights of their exchange, which could apply to any consideration of UC-AVST or otherwise.

A long time ago, revamping a school's telecommunications infrastructure was up there with scaling Mount Everest as one of the toughest challenges around. First up was the task of finding a new PBX. Then came the chore of rewiring the campus. Before long, project costs skyrocketed. Even well-funded IT departments struggled to get the job done. Voice over internet protocol (VoIP) changed everything. Suddenly, with the installation of a simple server and some new phones, IT administrators were able to run telecom over existing data lines, saving money and manpower all the while. In this article, the author discusses how two institutions--the San Mateo County Community College District (California) and Robert Morris University (Pennsylvania)--made this switch and have survived to talk about it. As the two institutions learn firsthand, revamping telecommunications infrastructure is not as difficult as it may seem.

Human trafficking is the second largest criminal industry in the United States and almost half of the victims are children. This crime against children is referred to as domestic minor human sex trafficking (DMHST). The majority DMHST victims access health care, often at an emergency department, at some point during their captivity. Trafficking of minors has been cited as the most underreported form of child abuse making education on this topic essential for all health care providers to help meet the needs of this population. A case study provides an illustration of a pediatric trauma patient who was a victim of DMHST and presented to an emergency department for care. As nurses who care for pediatric trauma patients in all settings strive to learn more about child abuse, topics in DMHST should also be included in these educational activities. [ABSTRACT FROM AUTHOR]

Introduction   Encephalitozoon cuniculi (E. cuniculi), a fungus that acts as an intracellular pathogen, causes a marked neurological syndrome in many host species and is a zoonotic concern. Although no well-established treatment for this syndrome is known, previous successful clinical experience using homeopathic phosphorus has been described in which symptom remission with no mortality occurred in 40/42 animals by means of unknown immunological mechanisms. The latter observation was the main motivation for this study. Objective  To verify, in an in-vitro model, if macrophages infected with E. cuniculi can change in function after treatment with different potencies of phosphorus. Materials and Methods  RAW 264.7 macrophages were infected with E. cuniculi in-vitro and treated with various homeopathic potencies of phosphorus. The vehicle was used as a control solution (0.06% succussed ethanol). After 1 and 24 hours, the following parameters were analyzed: parasite internalization (by the Calcofluor staining method), lysosome activity (by the acridine orange method), cytokine/chemokine production (by the MAGPIX system), and cell ultrastructure. Automatic image analysis was used when applicable, and the experiments were performed in triplicate. Results  Treatment with vehicle alone increased interleukin (IL)-6, tumor necrosis factor alpha and monocyte chemotactic protein -1 production (p  ≤ 0.05) and reduced the number of internalized parasites (p  ≤ 0.001). A progressive and time-dependent increase in RANTES (regulated on activation, normal T-cell expressed and secreted) and lysosome activity (p  ≤ 0.002) was observed only after treatment with the highest potency of phosphorus (Phos 200cH), together with decreased apoptosis rate, intense parasite digestion, and the presence of non-internalized spores. Conclusions   Phos 200 cH has a modulatory action on the activity of infected macrophages, especially a specific increase in RANTES, a key element in the prognosis of E. cuniculi -infected and of immunosuppressed patients bearing infections. [ABSTRACT FROM AUTHOR]

Highlights • We examine productivity gaps in different farming systems. • Diversification significantly enhances productivity and efficiency of smallholder farmers. • The further adoption of integrated crop-livestock farming systems would improve productivity and incomes. • Enabling environment to improve access to land, capital and market information is essential. Abstract This paper examines the productivity of diversified farming systems in the Forest-Savannah Transition zone of Ghana. Cross sectional data from 568 smallholder farmers and a metafrontier framework are used to investigate the opportunities for improving the performance of three types of farming systems: crop; livestock; and integrated crop-livestock. The results show that increasing farmers' access to labour and capital improves the productivity of each of the three farming systems, whereas access to land increases the productivity of the livestock and integrated crop-livestock farming systems. The latter system is more productive because of its greater diversification. There are opportunities for improving productivity through enhancing farmers' access to market information and promoting output diversification. Furthermore, policies designed to encourage the adoption of integrated crop-livestock farming systems as a way to enhance productivity, to spread production and market risk, and to promote more stable farm incomes are warranted. [ABSTRACT FROM AUTHOR]

Microbial electrolysis cells (MECs) have emerged as a promising technology for sustainable hydrogen production from wastewater treatment. An MEC consists of a microbial anode and a hydrogen evolution cathode, where microorganisms in the anode oxidize organic compounds, allowing the cathodic hydrogen production at lower potentials compared to abiotic electrolysis. The present study focuses on optimizing the catholyte composition and configuration in a MEC reactor to maximize hydrogen production rates while minimizing energy consumption. Indeed, buffer solutions of HCO 3 -, HPO 4 2-, and H 2 PO 4 - at different concentrations and operation mode were tested as catholytes analysing hydrogen production rates and energy consumptions of the process. The results demonstrate the stability of the anodic electroactive biofilm over a 220-day period, achieving consistent COD removal and hydrogen production. The findings reveal that the catholyte composition and operating mode significantly affect the cathodic performances of the MEC. Indeed, catholytes with higher buffer concentrations allow for a limited catholyte alkalinisation improving hydrogen production rates while a low buffer solution promotes an increase in process energy consumption. Bicarbonate buffer solution utilized under batch operation mode showed the better performances for hydrogen production at the cathodic side of MECs showing a higher cathodic coulombic efficiency coupled with stable pH levels and cathodic potentials. Overall, this research demonstrates the potential of MECs for sustainable hydrogen production and highlights the importance of optimizing catholyte composition and operating mode to increase energy efficiency of process. • 40% of influent COD was diverted into hydrogen in a microbial electrolysis cell. • Catholyte composition and operation mode was optimized for H 2 production increase. • Batch mode and HCO 3 - as catholyte allowed to reach an energy recovery of 55%. • Under optimized conditions, energy consumption for H 2 reached 4.46 kWh/Nm3 H 2. • Overpotential losses were minimized by utilizing a HCO 3 - as catholyte in batch mode. [ABSTRACT FROM AUTHOR]

Microalgae are promising resources for the sustainable production of biofuels, feed, and high-value chemicals. Several strains can grow heterotrophically or mixotrophically on multiple organic substrates even if the high cost associated to their use can hinder scalability and economical sustainability of the overall process. The use of agri-food waste biomass hydrolysates might make the cultivation procedure more sustainable, while at the same time valorising underutilized by-products. In this study, Chlorella vulgaris biomass production and sugar utilization was investigated during mixotrophic cultivation on hydrolysates of two inexpensive and widely available recalcitrant agri-food waste biomasses: barley straw (BS) and citrus processing waste (CPW). CPW hydrolysate supported enhanced biomass production, compared to BS digestate, likely because of the presence, besides glucose, of significant amounts of galactose, which is rapidly metabolized by the algae. Notably, when pure monosaccharides were provided as sole organic carbon, growth stopped before complete sugar consumption. Arrested growth in presence of pure monosaccharides correlated with a drastic drop in extracellular pH, which appears to depend on both carbon and nitrogen sources. Our results show that mixotrophic cultivation of C. vulgaris on BS or CPW hydrolysates results in more efficient conversion of organic carbon into biomass, compared to growth on pure sugars, indicating that these agri-food by-products can be utilized as valid feedstocks for sustainable algal biomass production. • Agri-food waste digestates support C. vulgaris growth and biomass accumulation. • C. vulgaris uptakes biomass derived monosaccharides more efficiently than pure sugars. • C. vulgaris sugar metabolism is deeply influenced by the available nitrogen source. [ABSTRACT FROM AUTHOR]