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PurposeThis study surveyed sources of moral distress within rehabilitation counseling practice.MethodA mixed-methods approach, the study used both quantitative and qualitative analyses.ResultsOf the 83 participants who completed the survey, the average rating of moral distress was 4.32 (uncomfortable), with 43% reporting a distress rating of 5 (uncomfortable/distressing) or higher. Based on the descriptions, common sources of moral distress involved (a) compromised service delivery, client welfare, and resources, (b) conflicts between client, treatment team, and family, (c) leadership and climate, and (d) organizational policy and practice.ConclusionsImplications address areas for ongoing discussion, including considerations for how to address moral distress to potentially reduce professional burnout and compassion fatigue with in rehabilitation counseling.

BackgroundRehabilitation counselors are becoming more adept at providing distance services.ObjectiveFocused on the ethical use of digital technology, the purpose of this article is to highlight ethical considerations when using digital technologies professionally.MethodsReviewing the ethical standards of the 2017 Code of Professional Ethics for Rehabilitation Counselors, this article examines the current ethical standards governing the use of technology, distance counseling, and social media.FindingsIt is critical for rehabilitation counselors to understand how affordances and constraints of technology will continue to mediate the professional practice of rehabilitation counseling.ConclusionThe professional practice of rehabilitation counseling will increasingly involve digital technology.

This paper is based on the analysis of miscible WAG for an onshore Middle-East field, with strongly undersaturated light oil. Water Alternate Gas operations have been ongoing for around 5 years, which is relatively recent compared to more than 40 years of production history. Goal of this work was to assess the efficiency of this miscible hydrocarbon WAG and to optimize it on the different compartments, with respect to miscibility, voidage replacement, and recycling.As this is a large mature field, with WAG operations dispatched on around 50 injectors and 9 fault blocks (compartments), the method of analysis had to be robust with respect to the different injection strategies followed in the past. It was essentially based on injection and production data, but also used pressure data when available. We computed the following dimensionless variables: oil recovery factor, BSW, voidage replacement ratio (VRR), and also WAG ratio and gas recycling ratio (GRR). Their evolution versus time was analyzed and compared between fault blocks.Using dimensionless variables allowed to compare fault blocks with different initial volumes in place, and to illustrate trends versus time. It was also found beneficial to lump some compartments, when communication was substantiated by pressure data. On the production side, we used the conventional BSW and GOR variables to quantify the water and gas recycling ratio. On the injection side, we observed that in some compartments, the historical WAG ratio was too low in the oil zone, which could be quantified by excluding the peripheral water injection volumes.The analysis allowed also to estimate the gas utilization factor and efficiency, which confirmed the overall high efficiency of miscible gas injection in 3-phase mode. It was also found that the injected fluid efficiency correlated with geology: gas injection tends to be more efficient in zones with high permeabilities at the bottom (coarsening downwards), while water injection is better adapted to zones with high permeabilities at the top (coarsening upwards). Estimating these water and gas efficiencies also allowed to optimize the injection strategy on a field level, by comparing the water efficiency with other units of the field only under waterflood.

Aims: A multicenter simulation-based research study to assess the ability of interprofessional code-teams and individual members to perform high-quality CPR (HQ-CPR) at baseline and following an educational intervention with a CPR feedback device. Methods: Five centers recruited ten interprofessional teams of AHA-certified adult code-team members with a goal of 200 participants. Baseline testing of chest compression (CC) quality was measured for all individuals. Teams participated in a baseline simulated cardiac arrest (SCA) where CC quality, chest compression fraction (CCF), and peri-shock pauses were recorded. Teams participated in a standardized HQ-CPR and abbreviated TeamSTEPPS® didactic, then engaged in deliberate practice with a CPR feedback device. Individuals were assessed to determine if they could achieve ≥80% combined rate and depth within 2020 AHA guidelines. Teams completed a second SCA and CPR metrics were recorded. Feedback was disabled for assessments except at one site where real-time CPR feedback was the institutional standard. Linear regression models were used to test for site effect and paired t-tests to evaluate significant score changes. Logistic univariate regression models were used to explore characteristics associated with the individual achieving competency. Results: Data from 184 individuals and 45 teams were analyzed. Baseline HQ-CPR mean score across all sites was 18.5% for individuals and 13.8% for teams. Post-intervention HQ-CPR mean score was 59.8% for individuals and 37.0% for teams. There was a statistically significant improvement in HQ-CPR mean scores of 41.3% (36.1, 46.5) for individuals and 23.2% (17.1, 29.3) for teams (p

Although epidermal growth factor receptor (EGFR)-targeted therapies are approved for colorectal cancer (CRC) treatment, only 15% of CRC patients respond to EGFR inhibition. Here, we show that colorectal cancers (CRC) can initiate and grow faster through an EGFR-independent mechanism, irrespective of the presence of EGFR, in two different mouse models using tissue-specific ablation of Egfr. The growth benefit in the absence of EGFR is also independent of Kras status. An EGFR-independent gene expression signature, also observed in human CRCs, revealed that anergy-inducing genes are overexpressed in EGFR-independent polyps, suggesting increased infiltration of anergic lymphocytes promotes an accelerated growth rate that is partially caused by escape from cell-mediated immune responses. Many genes in the EGFR-independent gene expression signature are downstream targets of interleukin 10 receptor alpha (IL10RA). We further show that IL10 is detectable in serum from mice with EGFR-independent colon polyps. Using organoids in vitro and Src ablation in vivo, we show that IL10 contributes to growth of EGFR-independent CRCs, potentially mediated by the well-documented role of SRC in IL10 signaling. Based on these data, we show that the combination of an EGFR inhibitor with an anti-IL10 neutralizing antibody results in decreased cell proliferation in organoids and in decreased polyp size in pre-clinical models harboring EGFR-independent CRCs, providing a new therapeutic intervention for CRCs resistant to EGFR inhibitor therapies.

Importance: Despite criticisms of disability simulation and the limited research on the topic, disability simulation activities are often used to increase understanding of the challenges faced by people with disabilities. Objective: To compare two disability awareness activities (disability simulation and an accessibility audit). Design: A matched pretest–posttest design with two disability awareness activities to study attitudes, affect, cognitions, and behaviors toward disability. Setting: A small college in New England. Participants: Eighty-eight undergraduate students. Intervention: Participants took baseline tests online, after which they participated in a 1-hr on-campus activity. Participants were randomly assigned to either the disability simulation activity or the accessibility audit activity. Participants took posttest surveys online within 1 wk of completing the intervention. Results: Results demonstrated that both activities lowered negative emotional responses toward people with disabilities, but participants who completed the tape measure activity had a larger decrease in scores. No significant differences were found between the scores of people who completed the different disability awareness activities. Conclusions: Given the many criticisms of disability simulation practices and marginal differences between activities, it is time for disability simulation activities to be retired from use. What This Article Adds: The results of this study demonstrate that disability simulation is no better than an accessibility audit in improving attitudes toward people with disabilities. Therefore, educators should cease use of these activities.

Background: Sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB) are the most frequent bariatric surgery procedures worldwide. In this prospective study, we examined the association of a genetic risk score (GRS) with loss of excess weight after bariatric surgery. Methods: A total of forty-seven morbidly obese Greek patients who underwent SG (81%) or RYGB were recruited, followed up for 2 years and genotyped. Weight loss after surgery was reported as the percentage of excess weight that was lost (%EWL) at 12 and 24 months after surgery. A GRS was constructed based on previously BMI- and WHR-related single nucleotide polymorphisms (SNPs) that were found significantly correlated with weight loss after bariatric surgery in our population. The level of post-surgery %EWL after 12 and 24 months was estimated through two multiple linear regression models that considered the effects of relevant genetic risk variants. Results: The first proposed model suggested that the predictor variables of GRS, age, and BMI had a significant effect on %EWL12m. GRS was significantly associated with %EWL12m, indicating a 4.618% decrease of %EWL12m per score unit. The second model indicated a positive correlation between %EWL24m and %EWL12m, suggesting that while post-surgery weight loss increased during the first 12 months, an increase was expected in the next 12 months as well. GRS was also significantly associated with %EWL24m, indicating approximately 3% decrease of %EWL24m per score unit. Conclusion: GRS can be used in the future together with other preoperative parameters in order to predict the outcome of bariatric surgery. © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

This case series follows CEO Naresh Kumra of JMATEK, an a global leader in evaporative air coolers and portable air conditioners. Although Amazon had been a major sales channel in the previous year, 2017 sales were down significantly, threatening a major new round of funding. The (A) case allow students the opportunity to troubleshoot new business sales in a growing digital marketplace, and the (B) case shows how Kumra applied both his Hindu background and American MBA training to lead JMATEK out of its dilemma. Excerpt UVA-S-0310 Jan. 15, 2020 Naresh Kumra and the Amazon Debacle (A) Hong Kong 2017 "There was nothing we could do wrong," began Naresh Kumra, CEO of JMATEK, a 2007 pioneer in evaporative air coolers and a global leader in portable air conditioners. I had bought into the partnership with a management buy-in (MBI) in April 2013, and, with existing management in place, we grew quickly and improved gross margins and went from loss-making in 2012 to industry top-quartile profitability by 2016. We had tremendous growth in global sales, with offices in Buenos Aires, Mexico City, two offices in Europe, a few in Asia, and in New Jersey. We were the leaders in e-commerce in our segment, with a good position on Amazon, and retail presence in Lowe's and Best Buy and other, smaller, shops, and had global exclusive rights to represent Honeywell. . . .