Fanciful Examples

This article defends the use of fanciful examples within the method of wide reflective equilibrium. First, it characterizes the general persuasive role of described cases within that method. Second, it suggests three criteria any example must meet in order to succeed in this persuasive role; fancifulness has little or nothing to do with whether an example is able to meet these criteria. Third, it discusses several general objections to fanciful examples and concludes that they are objections to the abuse of described cases; they identify no special problem with fanciful examples

Determinants of Coverage Decisions in Health Insurance Marketplaces: Consumers\u27 Decision-Making Abilities and the Amount of Information in Their Choice Environment

Objective To investigate the determinants and quality of coverage decisions among uninsured choosing plans in a hypothetical health insurance marketplace. Study Setting Two samples of uninsured individuals: one from an Internet-based sample comprised largely of young, healthy, tech-savvy individuals (n = 276), and the other from low-income, rural Virginians (n = 161). Study Design We assessed whether health insurance comprehension, numeracy, choice consistency, and the number of plan choices were associated with participants\u27 ability to choose a cost-minimizing plan, given their expected health care needs (defined as choosing a plan costing no more than $500 in excess of the total estimated annual costs of the cheapest plan available). Data Collection Primary data were collected using an online questionnaire. Principal Findings Uninsured who were more numerate showed higher health insurance comprehension; those with more health insurance comprehension made choices of health insurance plans more consistent with their stated preferences; and those who made choices more concordant with their stated preferences were less likely to choose a plan that cost more than$500 in excess of the cheapest plan available. Conclusions Increasing health insurance comprehension and designing exchanges to facilitate plan comparison will be critical to ensuring the success of health insurance marketplaces

Brookside Gardens Stroll for Wellness

Final project for LARC489Z Special Topics (Spring 2018). University of Maryland, College Park.The positive benefits of exposure to nature and green spaces related to wellness are well-documented. A structured walk in a garden or park setting, in combination with reflective journaling, has proven to be invaluable and life-changing to community members suffering from the adverse effects of stress and trauma suffering from grief, depression, Post-Traumatic Stress Disorder (PTSD), and other types of trauma, all of which are becoming more prevalent in our society. The Morikami Japanese Gardens in Florida, the Bloedel Reserve in Washington, and other publicly accessible gardens have developed these types of guided wellness programs. These are often referred to as prescribed or suggested “strolls” that are mapped for improving mindful, active, and engaged contact with nature. A therapeutic walking program promotes well-being and resilience in the face of adversity. With the large population of veterans in Maryland communities, plus countless local medical providers serving clients suffering from a diverse challenges, Brookside Gardens is located and poised to serve these populations and improve wellness outcomes for a range of Maryland and regional residents. As Brookside Gardens is poised to expand on health and wellness programming, it has sought the assistance of the University of Maryland’s Partnership for Action Learning in Sustainability (PALS). PALS assists local governments while offering valuable real-world problem-solving experience for graduate and undergraduate students. In spring 2018, the Landscape Architecture Program collaborated with PALS and Brookside Gardens to create a Special Topics Course (LARC 489Z) that offered research and technical support for the proposed “Stroll for Wellness” program. There are many populations near the Gardens who might benefit from guided wellness programming, including those suffering from trauma, depression or chronic illness. A growing body of research has documented nature’s healing effects and Brookside Gardens offers a safe, inspirational setting where visitors can immerse themselves in nature with the kinetic experience of moving through garden spaces, a resource that can spark creativity and introspection.Montgomery Count

New Market Plains Vineyard Redesign

Final Project for LARC 340 Site Planning and Design Studio (Fall 2018). University of Maryland, College Park.New Market Plains Vineyard is situated on a 260+ acre farm in the town of New Market within Fredrick County, Maryland. The town of New Market and the owners of New Market Plains Vineyard, in coordination with the Partnership for Action Learning in Sustainability (PALS) and undergraduate Landscape Architecture students at the University of Maryland, are interested in developing the site to support and expand amenities available to visitors. Because the property has been in the family since its acquisition in 1747, the owners have a strong tie to the land and hope to continually display its historical significance and interpretive natural systems as part of the project, as they expand the event potential and expanded operations of the winery. The town of New Market is interested in promoting tourism and sharing in the rich history of the site. The site is impacted by highway noise, rock outcroppings, invasive plant species and some hydric soils. The attributes include vistas to the surrounding countryside, abundant water supply, meadows, grasslands, forest, elevation and exposure suitable for growing grapes, and excellent public access. To approach this project, four design teams were tasked with identifying the site’s opportunities and constraints with a focus on historic qualities, natural systems, and expanding vineyard operations. Each team expanded on these opportunities and constraints, some placing emphasis on business operations and others on historic value and educational opportunities. Using this analysis of the existing site conditions, the teams developed individual design programs of what elements they felt would best realize the property’s full potential. The teams made two visits to the site over the course of the project, to locate and identify areas of significance to their designs. Halfway through the design process the teams delivered an interim presentation to the vineyard owners; to receive feedback on the direction their work was taking. Using this review the teams completed their final designs, which include a master plan for the site, an enlarged plan for the main winery complex, and a grading plan for a new underground wine storage facility. The size of the site facilitated the implementation of nature trails of varying difficulty, which each team has incorporated in their design. Each individual member of the class also participated in a competition to design the new entry sign for the vineyard. The winning sign was designed by Rachel Greenhawk and is displayed on the cover of this document. Compiled in this booklet are the materials produced by the teams over the duration of this project. The results are a diverse and innovative selection of proposals, with the goal of serving as an examination of possibilities for future development. These designs provide the owners with various suggestions for how to restore their property and to elevate New Market Plains Vineyards into a thriving local destination.Prince George's Count

On the mesoscale structure of surface wind and pressure fields near tornadic and nontornadic cold fronts

Observations from a mesoscale network of automatic weather stations are analyzed for 15 U.K. cold fronts exhibiting narrow cold frontal rainbands (NCFRs). Seven of the NCFRs produced tornadoes. A time-compositing approach is applied to the minute-resolution data using the radar-observed motion vectors of NCFR precipitation segments. Interpolated onto a 5-km grid, the analyses resolve much of the small-mesoscale structure in surface wind, temperature, and pressure fields. Postfrontal winds varied substantially between cases. Tornadic NCFRs exhibited a near-90° wind veer and little or no reduction in wind speed on NCFR passage; these attributes were generally associated with large vertical vorticity, horizontal convergence, and vorticity stretching at the NCFR. Nontornadic NCFRs exhibited smaller wind veers and/or marked decreases in wind speed across the NCFR, and weaker vorticity, convergence, and vorticity stretching. In at least four tornadic NCFRs, increases in vorticity stretching preceded tornadogenesis. Doppler radar observations of two tornadic NCFRs revealed the development of misocyclones, some tornadic, during the latter stages of vorticity-stretching increase. The presence of cyclonic vortices only, in one case occurring at regular intervals along the NCFR, provides limited circumstantial evidence for horizontal shearing instability (HSI), though other vortex-genesis mechanisms cannot be discounted. Vorticity-stretching increases were associated with coherent mesoscale structures in the postfrontal wind field, which modified the cross-frontal convergence. Where cross-frontal convergence was large, extremely narrow, intense shear zones were observed; results suggest that tornadoes occurred when such shear zones developed in conjunction with conditional instability in the prefrontal environment

Systemic Biomarkers of Neutrophilic Inflammation, Tissue Injury and Repair in COPD Patients with Differing Levels of Disease Severity

The identification and validation of biomarkers to support the assessment of novel therapeutics for COPD continues to be an important area of research. The aim of the current study was to identify systemic protein biomarkers correlated with measures of COPD severity, as well as specific protein signatures associated with comorbidities such as metabolic syndrome. 142 protein analytes were measured in serum of 140 patients with stable COPD, 15 smokers without COPD and 30 non-smoking controls. Seven analytes (sRAGE, EN-RAGE, NGAL, Fibrinogen, MPO, TGF-α and HB-EGF) showed significant differences between severe/very severe COPD, mild/moderate COPD, smoking and non-smoking control groups. Within the COPD subjects, univariate and multivariate analyses identified analytes significantly associated with FEV1, FEV1/FVC and DLCO. Most notably, a set of 5 analytes (HB-EGF, Fibrinogen, MCP-4, sRAGE and Sortilin) predicted 21% of the variability in DLCO values. To determine common functions/pathways, analytes were clustered in a correlation network by similarity of expression profile. While analytes related to neutrophil function (EN-RAGE, NGAL, MPO) grouped together to form a cluster associated with FEV1 related parameters, analytes related to the EGFR pathway (HB-EGF, TGF-α) formed another cluster associated with both DLCO and FEV1 related parameters. Associations of Fibrinogen with DLCO and MPO with FEV1/FVC were stronger in patients without metabolic syndrome (r  =  −0.52, p  = 0.005 and r  =  −0.61, p  = 0.023, respectively) compared to patients with coexisting metabolic syndrome (r  =  −0.25, p  = 0.47 and r  =  −0.15, p  = 0.96, respectively), and may be driving overall associations in the general cohort. In summary, our study has identified known and novel serum protein biomarkers and has demonstrated specific associations with COPD disease severity, FEV1, FEV1/FVC and DLCO. These data highlight systemic inflammatory pathways, neutrophil activation and epithelial tissue injury/repair processes as key pathways associated with COPD

Dectin-1: a role in antifungal defense and consequences of genetic polymorphisms in humans

The clinical relevance of fungal infections has increased dramatically in recent decades as a consequence of the rise of immunocompromised populations, and efforts to understand the underlying mechanisms of protective immunity have attracted renewed interest. Here we review Dectin-1, a pattern recognition receptor involved in antifungal immunity, and discuss recent discoveries of polymorphisms in the gene encoding this receptor which result in human disease

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700