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This single case study concerns an 11-year-old girl, Agata, who recently moved to a rural community in the United States from the Philippines. Agata is profoundly deaf, has had no access to amplification, and has had very limited access to language and formal school. The journey through the next year, including the COVID-19 pandemic, saw Agata's language and literacy skills blossom at an unexpected rate. The study examines the "how" and "why" of Agata's progress by using multiple sources of both quantitative and qualitative data. A conceptual framework of both direct instruction theory (Engelmann & Carnine, 1982) and resilience theory (Garmezy, 1993) was used to systematically analyze the factors that contributed to Agata's growth and offer a more thorough understanding of the complex challenges and potential successes in supporting students from Asian communities who are d/Deaf or hard of hearing (d/DHH).

Cup anemometers measure average wind speed in the atmosphere and have been used for one and a half centuries by meteorologists. Within the last half century, cup anemometers have been used extensively in wind energy to measure wind resources and performance of wind turbines. Meteorologists researched cup anemometer behaviour and found dynamic overspeeding to be an inherent and significant systematic error. The wind energy community has strong accuracy requirements for power performance measurements on wind turbines, and this led in the last 2 decades to new research on cup anemometer characteristics, which was taken to a new level with the development of improved calibration procedures, cup anemometer calculation models and classification methods. Research projects in wind energy demonstrated, by field and wind tunnel measurements, that angular response was a significant contributor to uncertainty and that dynamic overspeeding was a significant but less important contributor. Earlier research was mainly made on cup anemometers with hemispherical cups on long arms, ​​​​​​​and dynamic overspeeding was considered an inherent and high uncertainty error for cup anemometers. Research on conical cups on short arms has now shown that zero or low overspeeding is present on a well-designed cup anemometer, providing a much lower overspeeding uncertainty error. Different cup anemometer calculation models were investigated in order to find derived overspeeding characteristics. The general and often used parabolic torque coefficient model showed that zero overspeeding is present when the speed ratio roots of the torque coefficient curve go through the equilibrium speed ratio and zero. The two-cup drag model is a special case of the parabolic torque coefficient model but with the second root being reciprocal to the equilibrium speed ratio. The drag model always results in a positive maximum overspeeding of the order of 1.1 times the turbulence intensity squared. A linear torque coefficient results in maximum overspeeding levels equal to the turbulence intensity squared. Torque characteristics of a cup anemometer with hemispherical cups fit slightly well to the drag model, but a cup anemometer with conical cups does not fit to the drag model nor the parabolic model; it fits better to a partial linear model and even better to an optimized torque model. The most accurate modelling of cup anemometer characteristics is at present made with the ACCUWIND model (Dahlberg et al., 2006). This model uses tabulated torque coefficient and angular response data measured in a wind tunnel. The ACCUWIND model is found in International Electrotechnical Commission (IEC) wind turbine power performance standards, where it is used in a classification system for estimation of operational uncertainties. For an actual comparison of two cup anemometers, with respectively hemispherical and conical cups, the influence of dynamic overspeeding was found to be relatively low compared to angular response, but for conical cups it was specifically low.

The itinerant teaching model is the most common service delivery method for students who are deaf and hard of hearing (DHH) in the United States. Itinerant teachers of the deaf and hard of hearing (ITODHHs) may serve several school buildings and travel extensive distances. Substantial literature exists regarding ITODHHs; however, a notable gap exists regarding parent perceptions of itinerant teacher of the deaf and hard of hearing (ITODHH) services for their children in the US. Modelled after work completed in Australia, the current study examined parent perceptions of ITODHH services for their children who were DHH. Results indicated that most parents were mostly satisfied with the ITODHH services and offered specific suggestions for improvement. Implications of these results for service delivery and attending to family-school partnerships are discussed.

Abstract Background The lactate receptor GPR81 contributes to cancer development through unclear mechanisms. Here, we investigate the roles of GPR81 in three-dimensional (3D) and in vivo growth of breast cancer cells and study the molecular mechanisms involved. Methods GPR81 was stably knocked down (KD) in MCF-7 human breast cancer cells which were subjected to RNA-seq analysis, 3D growth, in situ- and immunofluorescence analyses, and cell viability- and motility assays, combined with KD of key GPR81-regulated genes. Key findings were additionally studied in other breast cancer cell lines and in mammary epithelial cells. Results GPR81 was upregulated in multiple human cancer types and further upregulated by extracellular lactate and 3D growth in breast cancer spheroids. GPR81 KD increased spheroid necrosis, reduced invasion and in vivo tumor growth, and altered expression of genes related to GO/KEGG terms extracellular matrix, cell adhesion, and Notch signaling. Single cell in situ analysis of MCF-7 cells revealed that several GPR81-regulated genes were upregulated in the same cell clusters. Notch signaling, particularly the Notch ligand Delta-like-4 (DLL4), was strikingly downregulated upon GPR81 KD, and DLL4 KD elicited spheroid necrosis and inhibited invasion in a manner similar to GPR81 KD. Conclusions GPR81 supports breast cancer aggressiveness, and in MCF-7 cells, this occurs at least in part via DLL4. Our findings reveal a new GPR81-driven mechanism in breast cancer and substantiate GPR81 as a promising treatment target.

Abstract Atherosclerosis is a chronic inflammatory disease of the larger arteries that may lead to cardiovascular events. Identification of patients at highest risk of cardiovascular events is challenging, but molecular imaging using positron emission tomography (PET) may prove useful. The aim of this study was to evaluate and compare head-to-head three different PET tracers. Furthermore, tracer uptake is compared to gene expression alterations of the arterial vessel wall. Male New Zealand White rabbits (control group; n = 10, atherosclerotic group; n = 11) were used for the study. Vessel wall uptake was assessed with the three different PET tracers: [18F]FDG (inflammation), Na[18F]F (microcalcification), and [64Cu]Cu-DOTA-TATE (macrophages), using PET/computed tomography (CT). Tracer uptake was measured as standardized uptake value (SUV), and arteries from both groups were analyzed ex vivo by autoradiography, qPCR, histology, and immunohistochemistry. In rabbits, the atherosclerotic group showed significantly higher uptake of all three tracers compared to the control group [18F]FDG: SUVmean 1.50 ± 0.11 versus 1.23 ± 0.09, p = 0.025; Na[18F]F: SUVmean 1.54 ± 0.06 versus 1.18 ± 0.10, p = 0.006; and [64Cu]Cu-DOTA-TATE: SUVmean 2.30 ± 0.27 versus 1.65 ± 0.16; p = 0.047. Of the 102 genes analyzed, 52 were differentially expressed in the atherosclerotic group compared to the control group and several genes correlated with tracer uptake. In conclusion, we demonstrated the diagnostic value of [64Cu]Cu-DOTA-TATE and Na[18F]F for identifying atherosclerosis in rabbits. The two PET tracers provided information distinct from that obtained with [18F]FDG. None of the three tracers correlated significantly to each other, but [64Cu]Cu-DOTA-TATE and Na[18F]F uptake both correlated with markers of inflammation. [64Cu]Cu-DOTA-TATE was higher in atherosclerotic rabbits compared to [18F]FDG and Na[18F]F.

This paper proposes a transfer learning neural network (TLNN) approach for digital pre-distortion (DPD) of mm-Wave active phased arrays (APA) operated under variable signal bandwidth regimes. Compared with the conventional artificial neural network (ANN) method, the proposed approach can achieve similar linearization performance with much lower computational complexity by transferring part of a trained model from one bandwidth to another bandwidth. In the recently introduced 5G, the increased signal bandwidth triggers considerable memory effects in the APA. Moreover, dealing with different signal bandwidths typically requires a time-consuming recalculation of the predistorter parameters. In this paper, the authors propose to have those challenges solved by using a DPD model based on the transfer learning method. The proposed approach was validated with over-the-air (OTA) measurements on an APA excited with signals of varying bandwidth, namely from 20 MHz to 100 MHz. Experimental results show a significant reduction in the training time while ensuring good linearization performance. With the applied TLNN DPD, an 8.5 dB improvement of adjacent channel leakage ratio (ACLR) and 8.6% points improvement of error vector magnitude (EVM) is achieved. Under the variable bandwidth regime, the complexity of the DPD model in terms of the number of multiplications is reduced from 199168 to 160. The proposed TLNN DPD proved to be robust concerning variation in the bandwidth of the APA excitation signal.

Absorption of therapeutic peptides like glucagon-like peptide or insulin for diabetes therapy upon oral administration is highly restricted by the tight junction (TJ) proteins interconnecting the cells comprising the intestinal epithelium. An approach to improve transepithelial permeation of such biopharmaceuticals via the paracellular pathway is to use functional excipients, which transiently modulate the TJs. Here, we investigated the membrane-interacting peptide, penetramax, and the divalent cation chelator, ethylene glycol tetraacetic acid (EGTA) at different concentrations, to reveal and compare their cellular modes of action when increasing the transepithelial permeation of drug macromolecules. The epithelial integrity was studied in real time along with dextran permeation across differentiated epithelial Caco-2 cell monolayers. TJ protein expression and cytoskeleton organization were investigated during and after exposure to penetramax or EGTA. Based on orthogonal methods, we show that penetramax acts by a mechanism that immediately and transiently widens the paracellular space, resulting in size selective permeant passage and with subsequent reconstitution of the epithelium. At the same time, the expression and organization of different TJ proteins are modulated reversibly. In contrast, the effect of EGTA on modulating the paracellular space is slower and TJ protein unspecific, and without clear permeant size selectivity. Overall, these data provide in-depth insights for understanding intestinal barrier dynamics of importance when evaluating new or existing excipients for oral delivery of biopharmaceuticals, such as peptide therapeutics.

Measurement(s) Seaweed net primary productivity Technology Type(s) photorespirometry, biomass accumulation, eddy covariance Factor Type(s) Annual per-area net primary productivity Sample Characteristic - Organism Phaeophyceae • Rhodophyta • Chlorophyta Sample Characteristic - Environment marine biome Sample Characteristic - Location Global

Abstract Background Older patients with cancer have poorer prognosis compared to younger patients. Moreover, prognosis is related to how cancer is identified, and where in the healthcare system patients present, i.e. routes to diagnosis (RtD). We investigated whether RtD varied by patients’ age. Methods This population-based national cohort study used Danish registry data. Patients were categorized into age groups and eight mutually exclusive RtD. We employed multinomial logistic regressions adjusted for sex, region, diagnosis year, cohabitation, education, income, immigration status and comorbidities. Screened and non-screened patients were analysed separately. Results The study included 137,876 patients. Both younger and older patients with cancer were less likely to get diagnosed after a cancer patient pathways referral from primary care physician compared to middle-aged patients. Older patients were more likely to get diagnosed via unplanned admission, death certificate only, and outpatient admission compared to younger patients. The patterns were similar across comorbidity levels. Conclusions RtD varied by age groups, and middle-aged patients were the most likely to get diagnosed after cancer patient pathways with referral from primary care. Emphasis should be put on raising clinicians’ awareness of cancer being the underlying cause of symptoms in both younger patients and in older patients.

Abstract Accurate diet estimates are necessary to assess trophic interactions and food web dynamics in ecosystems, particularly for apex predators like cetaceans, which can regulate entire food webs. Quantitative fatty acid analysis (QFASA) has been used to estimate the diets of marine predators in the last decade but has yet to be implemented on free-ranging cetaceans, from which typically only biopsy samples containing outer blubber are available, due to a lack of empirically determined calibration coefficients (CCs) that account for fatty acid (FA) metabolism. Here, we develop and validate QFASA for killer whales using full blubber from managed-care and free-ranging individuals. First, we compute full, inner, and outer blubber CCs from the FA signatures across the blubber layers of managed-care killer whales and their long-term diet items. We then run cross-validating simulations on the managed-care individuals to evaluate the accuracy of diet estimates by comparing full-depth and depth-specific estimates to true diets. Finally, we apply these approaches to subsistence-harvested killer whales from Greenland to test the utility of the method for free-ranging killer whales, particularly for the outer blubber. Accurate diet estimates for the managed-care killer whales were only achieved using killer whale-specific and blubber-layer-specific CCs. Modeled diets for the Greenlandic killer whales largely consisted of seals (75.9 ± 4.7%) and/or fish (20.4 ± 2.4%), mainly mackerel, which was consistent with stomach content data and limited literature on this population. Given the remote habitats and below surface feeding of most cetaceans, this newly developed cetacean-specific QFASA method, which can be applied to outer-layer biopsies, offers promise to provide a significant new understanding of diet dynamics of free-ranging odontocetes and perhaps other cetacean species throughout the world’s oceans.

ObjectiveEvidence-based personality disorder (PD) treatments are dominated by interventions targeting Borderline PD, although clinical populations characteristically include different PD features and severity. Personality functioning is a new concept intended to capture common features across PDs. This study aimed to investigate longitudinal improvement of personality functioning in a clinical sample assigned to PD treatment.MethodAn observational, large, longitudinal study of patients in PD treatments on specialist mental health service levels (N = 1,051). DSM-5 PDs were systematically assessed on referral. Personality functioning was repeatedly assessed (LPFS-BF-2.0), supplemented by symptom distress (anxiety: PHQ-GAD-7, depression: PHQ-9), and social/occupational activity (WSAS, work/study activity). Statistics were linear mixed models.ResultsThirty per cent had personality difficulties below PD threshold. Among PDs, 31% had Borderline (BPD), 39% Avoidant (AvPD), 15% not otherwise specified, 15% other PDs, and 24% > one PD. More severe initial LPFS-BF was associated with younger age, presence of PD and increasing number of total PD criteria. Across PD conditions, LPFS-BF, PHQ-9 and GAD-7 improved significantly (overall effect size 0.9). Mean duration of PD treatment was 15 (SD 9) months. Drop-out rates were low (12%). LPFS-BF improvement-rates were higher for BPD. Younger age was moderately associated with slower PHQ-9 improvement. Work/study activity was initially poor, poorer levels associated with AvPD and younger age, and improvement was non-significant across PD conditions. AvPD was associated with slower WSAS improvement-rates.ConclusionPersonality functioning improved across PD conditions. The results highlight BPD improvements. The study points to challenges concerning AvPD treatment, poor occupational activity and age-related differences.

Cycling of organic carbon in the ocean has the potential to mitigate or exacerbate global climate change, but major questions remain about the environmental controls on organic carbon flux in the coastal zone. Here, we used a field experiment distributed across 28° of latitude, and the entire range of 2 dominant kelp species in the northern hemisphere, to measure decomposition rates of kelp detritus on the seafloor in relation to local environmental factors. Detritus decomposition in both species were strongly related to ocean temperature and initial carbon content, with higher rates of biomass loss at lower latitudes with warmer temperatures. Our experiment showed slow overall decomposition and turnover of kelp detritus and modeling of coastal residence times at our study sites revealed that a significant portion of this production can remain intact long enough to reach deep marine sinks. The results suggest that decomposition of these kelp species could accelerate with ocean warming and that low-latitude kelp forests could experience the greatest increase in remineralization with a 9% to 42% reduced potential for transport to long-term ocean sinks under short-term (RCP4.5) and long-term (RCP8.5) warming scenarios. However, slow decomposition at high latitudes, where kelp abundance is predicted to expand, indicates potential for increasing kelp-carbon sinks in cooler (northern) regions. Our findings reveal an important latitudinal gradient in coastal ecosystem function that provides an improved capacity to predict the implications of ocean warming on carbon cycling. Broad-scale patterns in organic carbon decomposition revealed here can be used to identify hotspots of carbon sequestration potential and resolve relationships between carbon cycling processes and ocean climate at a global scale. Cycling of organic carbon in the ocean has the potential to mitigate or exacerbate global climate change, but how is this influenced by the environment? A field experiment at 35 sites spanning 12 geographic regions allows measurement of decomposition rates and changes in carbon content of kelp detritus in coastal habitats, revealing a strong influence of an ocean-temperature gradient on decomposition.

Temporal synchrony between facial motion and acoustic modulations is a hallmark feature of audiovisual speech. The moving face and mouth during natural speech is known to be correlated with low-frequency acoustic envelope fluctuations (below 10 Hz), but the precise rates at which envelope information is synchronized with motion in different parts of the face are less clear. Here, we used regularized canonical correlation analysis (rCCA) to learn speech envelope filters whose outputs correlate with motion in different parts of the speakers face. We leveraged recent advances in video-based 3D facial landmark estimation allowing us to examine statistical envelope-face correlations across a large number of speakers (∼4000). Specifically, rCCA was used to learn modulation transfer functions (MTFs) for the speech envelope that significantly predict correlation with facial motion across different speakers. The AV analysis revealed bandpass speech envelope filters at distinct temporal scales. A first set of MTFs showed peaks around 3-4 Hz and were correlated with mouth movements. A second set of MTFs captured envelope fluctuations in the 1-2 Hz range correlated with more global face and head motion. These two distinctive timescales emerged only as a property of natural AV speech statistics across many speakers. A similar analysis of fewer speakers performing a controlled speech task highlighted only the well-known temporal modulations around 4 Hz correlated with orofacial motion. The different bandpass ranges of AV correlation align notably with the average rates at which syllables (3-4 Hz) and phrases (1-2 Hz) are produced in natural speech. Whereas periodicities at the syllable rate are evident in the envelope spectrum of the speech signal itself, slower 1-2 Hz regularities thus only become prominent when considering crossmodal signal statistics. This may indicate a motor origin of temporal regularities at the timescales of syllables and phrases in natural speech. Author summary Natural speech signals are dominated by slow fluctuations (

Abstract This paper proposes a dual‐polarised cavity backed patch antenna for next generation phased arrays for mobile handsets. The antenna exhibits multi‐band performance, allowing to cover the 5G bands n257 (26.5–29.5 GHz), n258 (24.25–27.5 GHz), n261 (27.5–28.35 GHz) and a portion of band n260 (37–40 GHz). Two orthogonal modes are excited in the substrate integrated waveguide (SIW) cavity and show similar impedance matching and symmetric radiation patterns. A parasitic element is introduced on top of the cavity and shifted off‐centre to improve the port‐to‐port isolation and guide the main beam. A parametric study of the antenna dimensions is conducted to verify the multi‐resonance operating mechanism. The design is validated by the measurements of the fabricated four‐element array. The array scanning angle is from −35° to 38° for V‐pol and from −29° to 31° for H‐pol at 28 GHz, where the realised gain raises from 8 to 12 dBi.

Abstract Background To explore and compare safety, efficiency, and health-related quality of telephone triage in out-of-hours primary care (OOH-PC) services performed by general practitioners (GPs), nurses using a computerised decision support system (CDSS), or physicians with different medical specialities. Methods Natural quasi-experimental cross-sectional study conducted in November and December 2016. We randomly selected 1294 audio-recorded telephone triage calls from two Danish OOH-PC services triaged by GPs (n = 423), nurses using CDSS (n = 430), or physicians with different medical specialities (n = 441). An assessment panel of 24 physicians used a validated assessment tool (Assessment of Quality in Telephone Triage - AQTT) to assess all telephone triage calls and measured health-related quality, safety, and efficiency of triage. Results The relative risk (RR) of poor quality was significantly lower for nurses compared to GPs in four out of ten items regarding identifying and uncovering of problems. For most items, the quality tended to be lowest for physicians with different medical specialities. Compared to calls triaged by GPs (reference), the risk of clinically relevant undertriage was significantly lower for nurses, while physicians with different medical specialties had a similar risk (GP: 7.3%, nurse: 3.7%, physician: 6.1%). The risk of clinically relevant overtriage was significantly higher for nurses (9.1%) and physicians with different medical specialities (8.2%) compared to GPs (4.3%). GPs had significantly shorter calls (mean: 2 min 57 s, SD: 105 s) than nurses (mean: 4 min 44 s, SD: 168 s). Conclusions Our explorative study indicated that nurses using CDSS performed better than GPs in telephone triage on a large number of health-related items, had a lower level of clinically relevant undertriage, but were perceived less efficient. Calls triaged by physicians with different medical specialities were perceived less safe and less efficient compared to GPs. Differences in the organisation of telephone triage may influence the distribution of workload in primary and secondary OOH services. Future research could compare the long-term outcomes following a telephone call to OOH-PC related to safety and efficiency.

The new generation of 5G mobile communication systems is using millimeter wave (mmWave) active phased arrays (APA) which have up to hundreds of individual analog transmitter and receiver chains and antennas. For these highly integrated systems linearization of each analog path is very challenging. Therefore a single input single output (SISO) system in combination with over the air (OTA) measurement is considered as an efficient approach for linearization. However, the knowledge about the dependency of the total SISO nonlinearity on the contributions from different blocks in the antenna array, as well as the linearization trade-offs is still missing. In this paper, an overview of the possible linearization trade-offs in an OTA setup with a mmWave APA is provided. The linearization technique is applied to a $4\times 4$ active phased array containing up-conversion of a sub 6 GHz LTE10 signal to an RF frequency of 28 GHz. Through measurements, the effects on adjacent channel power ratio (ACPR) and error vector magnitude (EVM) have been investigated for the following scenarios: i. impact from the up-converter, ii. impact of the steering angle due to antenna crosstalk and iii. a linearity comparison between a linearized and a backed-off system.

Background and purpose — Length of hospital stay (LOS) following total hip arthroplasty (THA) has been markedly reduced. Recently, same-day THA (SD-THA) was introduced, and previous studies have indicated satisfactory safety. However, studies are heterogeneous and only a few report results on SD-THA when using a posterolateral surgical approach. Thus, our aim was to evaluate the feasibility of and complications after SD-THA when using a posterolateral approach. Patients and methods — Consecutive patients scheduled for SD-THA between October 2015 and June 2016 were included. Eligibility criteria for SD-THA were: primary THA, motivation for same-day procedure, age > 18 years, ASA I or II, and the presence of a support person who could remain with the patient for 24 hours after surgery. A posterolateral surgical approach was used. Data were collected retrospectively from hospital records and the Danish National Patient Registry. Outcome measures were: complications during admission, LOS, causes of prolonged admission, and prevalence and causes of readmission at 90 days’ follow-up. Results — 102 of 116 (88%) patients scheduled for SD-THA were discharged on the day of surgery. The remaining 14 patients were discharged the following day. Primary causes of prolonged admission were: dizziness/nausea, pain, and wound seepage. 7 patients had an estimated blood loss above 400 mL, but all were discharged as planned. No major complications occurred during admission. At follow-up, 3 patients had been readmitted due to pneumonia, wound infection, and dislocation, respectively. Interpretation — The results indicate that SD-THA performed with a posterolateral approach is feasible and can be performed with a low complication rate in a selected group of patients.

The mechanism by which Ser/Thr protein phosphatases specifically recruit and dephosphorylate their substrates is largely unclear. Hear, the authors elucidate how the Ser/Thr protein phosphatase calcineurin is recruited to its substrate NHE1 and how site-specific dephosphorylation is achieved.

This article displays a dataset obtained in a field trial conducted in 2016 on a sandy loam and a coarse sandy soil, Denmark. Leaf phosphorus (P) and nitrogen (N) concentrations at the five-leaf stage (V5) and final dry matter (DM) yields of silage maize were determined in response to seven treatments with placed slurry below the maize row. Two row-injection methods combined with slurry acidification or addition of a nitrification inhibitor were tested. Furthermore final crop P uptake and P surplus at field level were determined.This dataset can be used to assess the effect of placed slurry with or without slurry acidification and addition of a nitrification inhibitor on silage maize yields and to enhance our knowledge on maize P uptake and P surpluses at field level. In turn this can support the design of appropriate row-injection machinery of slurry.The data supplied in this article is related to the research article entitled “Row-injected cattle slurry can replace mineral P starter fertiliser and reduce P surpluses without compromising final yields of silage maize” [1], where results from 2017 and 2018 are presented and discussed. The trials in 2016, 2017 and 2018 were conducted on the same study sites. The experimental design in 2017 and 2018 was a full-factorial design and did also include reference treatments with evenly injected slurry, whereas these reference treatments were not included in the present article.

Pancreatic ductal adenocarcinoma (PDAC) is a major cause of cancer-related death, with a 5-year survival of

Objective: To develop a valid and reliable assessment tool able to measure quality of communication, patient safety and efficiency in out-of-hours (OOH) telephone triage conducted by both general practitioners (GP) and nurses. Design: The Dutch KERNset tool was translated into Danish and supplemented with items from other existing tools. Face validity, content validity and applicability in OOH telephone triage (OOH-TT) were secured through a two-round Delphi process involving relevant stakeholders. Forty-eight OOH patient contacts were assessed by 24 assessors in test-retest and inter-rater designs. Setting: OOH-TT services in Denmark conducted by GPs, nurses or doctors with varying medical specialisation. Patients: Audio-recorded OOH patient contacts. Main outcome measures: Test-retest and inter-rater reliability were analysed using ICCagreement, Fleiss’ kappa and percent agreement. Results: Major adaptations during the Delphi process were made. The 24-item assessment tool (Assessment of Quality in Telephone Triage – AQTT) measured communicative quality, health-related quality and four overall quality aspects. The test-retest ICCagreement reliability was good for the overall quality of communication (0.85), health-related quality (0.83), patient safety (0.81) and efficiency (0.77) and satisfactory when assessing specific aspects. Inter-rater reliability revealed reduced reliability in ICCagreement and in Fleiss’ kappa. Percent agreement revealed satisfactory agreements when differentiating between ‘poor’ and ‘sufficient’ quality). Conclusion: The AQTT demonstrated high face, content and construct validity, satisfactory test-retest reliability, reduced inter-rater reliability, but satisfactory percent agreement when differentiating between ‘poor’ and ‘sufficient’ quality. The AQTT was found feasible and clinically relevant for assessing the quality of GP- and nurse-led OOH-TT.KEYPOINTS Comparative knowledge is sparse regarding quality of out-of-hours telephone triage conducted by general practitioners and nurses. The assessment tool (AQTT) enables assessment of quality in OOH telephone triage conducted by nurses and general practitioners AQTT is feasible and clinically relevant for assessment of communication, patient safety and efficiency. AQTT can be used to identify areas for improvement in telephone triage

The foremost reason for unscheduled maintenance of hydraulic cylinders in industry is caused by wear of the hydraulic seals. Therefore, condition monitoring and subsequent estimation of remaining useful life (RUL) methods are highly sought after by the maintenance professionals. This study aimed at investigating the use of acoustic emission (AE) sensors to identify the early stages of external leakage initiation in hydraulic cylinders through run to failure studies (RTF) in a test rig. In this study, the impact of sensor location and rod speeds on the AE signal were investigated using both time- and frequency-based features. Furthermore, a frequency domain analysis was conducted to investigate the power spectral density (PSD) of the AE signal. An accelerated leakage initiation process was performed by creating longitudinal scratches on the piston rod. In addition, the effect on the AE signal from pausing the test rig for a prolonged duration during the RTF tests was investigated. From the extracted features of the AE signal, the root mean square (RMS) feature was observed to be a potent condition indicator (CI) to understand the leakage initiation. In this study, the AE signal showed a large drop in the RMS value caused by the pause in the RTF test operations. However, the RMS value at leakage initiation is seen to be a promising CI because it appears to be linearly scalable to operational conditions such as pressure and speed, with good accuracy, for predicting the leakage threshold.

Abstract Adipose tissue takes up glucose and releases lactate, thereby contributing significantly to systemic glucose and lactate homeostasis. This implies the necessity of upregulation of net acid and lactate flux capacity during adipocyte differentiation and function. However, the regulation of lactate- and acid/base transporters in adipocytes is poorly understood. Here, we tested the hypothesis that adipocyte thermogenesis, browning and differentiation are associated with an upregulation of plasma membrane lactate and acid/base transport capacity that in turn is important for adipocyte metabolism. The mRNA and protein levels of the lactate-H+ transporter MCT1 and the Na+,HCO3 − cotransporter NBCe1 were upregulated in mouse interscapular brown and inguinal white adipose tissue upon cold induction of thermogenesis and browning. MCT1, MCT4, and NBCe1 were furthermore strongly upregulated at the mRNA and protein level upon differentiation of cultured pre-adipocytes. Adipocyte differentiation was accompanied by increased plasma membrane lactate flux capacity, which was reduced by MCT inhibition and by MCT1 knockdown. Finally, in differentiated brown adipocytes, glycolysis (assessed as ECAR), and after noradrenergic stimulation also oxidative metabolism (OCR), was decreased by MCT inhibition. We suggest that upregulation of MCT1- and MCT4-mediated lactate flux capacity and NBCe1-mediated HCO3 −/pH homeostasis are important for the physiological function of mature adipocytes.

While the vital role that fathers play in the development of their children is emphasized in recent literature, the majority of research relative to child development focuses on mothers. This imbalance is even more evident relative to research with parents of children with disabilities, leaving human service providers with few evidence based practices for appropriately addressing the needs of fathers raising children with disabilities. Research suggests that having a child with a disability, while challenging, can also have a significant positive impact on the family system and potentially offer a transformational experience for the parent. Guided by a theoretical model of transformational outcomes, the purpose of this qualitative case study was to investigate how two veteran fathers of children with disabilities describe their transformative process. Using qualitative inquiry methods, the fathers’ were interviewed and their narratives were transcribed and analyzed to discover emerging themes. Findings indicated that laughter was a prominent emotion throughout the narrative and that the fathers used both positive and negative descriptors to define their experiences. Implications of these findings for human service professionals supporting families of children with disabilities are discussed. Attending to the unique needs of fathers can improve the overall functionality of the family system.

Abstract Background Chronic angiogenesis is a hallmark of most tumors and takes place in a hostile tumor microenvironment (TME) characterized by hypoxia, low nutrient and glucose levels, elevated lactate and low pH. Despite this, most studies addressing angiogenic signaling use hypoxia as a proxy for tumor conditions. Here, we compared the effects of hypoxia and TME conditions on regulation of the Na+/H+ exchanger NHE1, Ser/Thr kinases Akt1–3, and downstream effectors in endothelial cells. Methods Human umbilical vein endothelial cells (HUVEC) and Ea.hy926 endothelial cells were exposed to simulated TME (1% hypoxia, low serum, glucose, pH, high lactate) or 1% hypoxia for 24 or 48 h, with or without NHE1 inhibition or siRNA-mediated knockdown. mRNA and protein levels of NHE1, Akt1–3, and downstream effectors were assessed by qPCR and Western blotting, vascular endothelial growth factor (VEGF) release by ELISA, and motility by scratch assay. Results Within 24 h, HIF-1α level and VEGF mRNA level were increased robustly by TME and modestly by hypoxia alone. The NHE1 mRNA level was decreased by both hypoxia and TME, and NHE1 protein was reduced by TME in Ea.hy926 cells. Akt1–3 mRNA was detected in HUVEC and Ea.hy926 cells, Akt1 most abundantly. Akt1 protein expression was reduced by TME yet unaffected by hypoxia, while Akt phosphorylation was increased by TME. The Akt loss was partly reversed by MCF-7 human breast cancer cell conditioned medium, suggesting that in vivo, the cancer cell secretome may compensate for adverse effects of TME on endothelial cells. TME, yet not hypoxia, reduced p70S6 kinase activity and ribosomal protein S6 phosphorylation and increased eIF2α phosphorylation, consistent with inhibition of protein translation. Finally, TME reduced Retinoblastoma protein phosphorylation and induced poly-ADP-ribose polymerase (PARP) cleavage consistent with inhibition of proliferation and induction of apoptosis. NHE1 knockdown, mimicking the effect of TME on NHE1 expression, reduced Ea.hy926 migration. TME effects on HIF-1α, VEGF, Akt, translation, proliferation or apoptosis markers were unaffected by NHE1 knockdown/inhibition. Conclusions NHE1 and Akt are downregulated by TME conditions, more potently than by hypoxia alone. This inhibits endothelial cell migration and growth in a manner likely modulated by the cancer cell secretome.

We demonstrate an x-ray coherent imaging method that combines high spatial resolution with the ability to map grains within thick polycrystalline specimens. An x-ray objective serves to isolate an embedded grain. Iterative oversampling routines and Fourier synthesis are used to reconstruct the shape and strain field from the far-field intensity pattern. In a demonstration experiment a ∼500-nm Pt grain embedded in a polycrystalline Pt matrix is mapped in three dimensions without compromising the spatial resolution. No information on the pupil function of the lens is required and lens aberrations are not critical.