Home Point of Care INR Testing in Left Ventricular Assist Device Patients: A Clinical Evaluation

Purpose: The purpose of this project was to evaluate the complications and adverse events in left ventricular assist device (LVAD) patients when comparing those using home point of care (POCT) international normalized ratio (INR) testing versus lab testing. Additionally, the time in therapeutic window for both these groups was studied. A cost benefit analysis was performed. All this data was compiled into a provider education evaluated by a pre and post-survey design. Methods: The project is a single-center study that will occur at the University of Kentucky Chandler Medical Center. It is a cross-sectional, pre/post-test design. Data will be collected retrospectively starting January 2019, and prospectively for three months starting in October 2020. Complications and adverse events were collected through chart review. Time in therapeutic window (TTR) was calculated using the Rosendaal method. INR results were collected from the patient’s medical record. A three question pre and post-test was used to evaluate provider understanding of the topic. Results: 32 LVAD patients were evaluated for this study. Four providers completed the pre- and post-test with the educational video intervention. While there were more complications in the home point of care group, the results were not statistically significant (p=.15). Further evaluation of TTR yielded a higher TTR for the POCT group, however it was also not statistically significant (p=.17). There was also only a mild increase in provider understanding of the topic. Conclusion: The findings from this study indicate that more research should be done on the topic. While there were more complications in the POCT group, they were not significant enough to warrant a move to utilizing all lab testing instead of POCT

America\u27s Main Street misremembered: The myth of Route 66

Most Americans’ idea of Route 66 is misinformed. The collective memory of the iconic highway was built on the existing problematic image of the American West, shaped by early Route 66 boosters, and perpetuated through popular media and amateur preservationists, all of whom stood to benefit from a selective, marketable version of the highway’s past. The gaps left by these promotional revisions are indicative of problems with the transmission of collective memory on a larger scale, in which elements of history that do not align with the desired image are softened or removed. The sense of continuity and shared identity created by collective memory gives an unbalanced proportion of privilege and power to those it represents. Thus, groups excluded from the accepted narrative face a similar displacement from the group’s collective identity and decreased influence within the community. This thesis examines expanded historical narratives and fills in gaps in the collective memory, correcting the flawed understanding most Americans have about Route 66. National Register of Historic Places nominations for sites along Route 66 provide a lot of insight into these overlooked histories, but still lack the stories of people excluded from nominated sites and those of sites that were never nominated, meaning that even this improved Route 66 history is still incomplete. Correcting the popular misunderstanding perpetuated in the collective memory through the information found in sources like the National Register nominations, those whose history has been ignored or altered might regain the authority that representation provides

Analytical Model of the Anisotropic Dimensional Change on Sintering of Ferrous PM Parts

Abstract This work proposes an analytical model developed from experimental data to describe the anisotropic dimensional change on sintering. Axial-symmetric iron parts differing for geometry and sintering conditions have been investigated, aiming at highlighting the influence of geometry. The specimens were measured in the green and sintered state by a coordinate measuring machine (CMM). The dimensional changes of height, external diameter and internal diameter were derived from measurement results. The anisotropy of the dimensional variations has been studied with reference to the isotropic dimensional change derived from the change in volume of the parts. The influence of geometry and sintering temperature was highlighted. To properly describe the dimensional variations in the compaction plane, the dimensional change of the external diameter versus the dimensional change of the internal one has been analysed. By means of the experimental data, a reliable analytical relationship has been found, dependent on the parts geometry. An anisotropy parameter has been identified, which allows relating the dimensional change in the compaction plane and in the axial direction to the isotropic dimensional change. This parameter depends both on geometry and on sintering conditions. By means of the anisotropy parameter an analytical model for the anisotropic behaviour has been developed

Presepsis Depressive Symptoms Are Associated with Incident Cognitive Impairment in Survivors of Severe Sepsis: A Prospective Cohort Study of Older Americans

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/95538/1/jgs12001.pd

Religiosity is negatively associated with later-life intelligence, but not with age-related cognitive decline

AbstractA well-replicated finding in the psychological literature is the negative correlation between religiosity and intelligence. However, several studies also conclude that one form of religiosity, church attendance, is protective against later-life cognitive decline. No effects of religious belief per se on cognitive decline have been found, potentially due to the restricted measures of belief used in previous studies. Here, we examined the associations between religiosity, intelligence, and cognitive change in a cohort of individuals (initial n=550) with high-quality measures of religious belief taken at age 83 and multiple cognitive measures taken in childhood and at four waves between age 79 and 90. We found that religious belief, but not attendance, was negatively related to intelligence. The effect size was smaller than in previous studies of younger participants. Longitudinal analyses showed no effect of either religious belief or attendance on cognitive change either from childhood to old age, or across the ninth decade of life. We discuss differences between our cohort and those in previous studies – including in age and location – that may have led to our non-replication of the association between religious attendance and cognitive decline

Apolipoprotein E genotype does not moderate the associations of depressive symptoms, neuroticism and allostatic load with cognitive ability and cognitive aging in the Lothian Birth Cohort 1936

<div><p>Objectives</p><p>In this replication-and-extension study, we tested whether depressive symptoms, neuroticism, and allostatic load (multisystem physiological dysregulation) were related to lower baseline cognitive ability and greater subsequent cognitive decline in older adults, and whether these relationships were moderated by the E4 allele of the apolipoprotein E (<i>APOE</i>) gene. We also tested whether allostatic load mediated the relationships between neuroticism and cognitive outcomes.</p><p>Methods</p><p>We used data from the Lothian Birth Cohort 1936 (<i>n</i> at Waves 1–3: 1,028 [<i>M</i> age = 69.5 y]; 820 [<i>M</i> duration since Wave 1 = 2.98 y]; 659 [<i>M</i> duration since Wave 1 = 6.74 y]). We fitted latent growth curve models of general cognitive ability (modeled using five cognitive tests) with groups of <i>APOE</i> E4 non-carriers and carriers. In separate models, depressive symptoms, neuroticism, and allostatic load predicted baseline cognitive ability and subsequent cognitive decline. In addition, models tested whether allostatic load mediated relationships between neuroticism and cognitive outcomes.</p><p>Results</p><p>Baseline cognitive ability had small-to-moderate negative associations with depressive symptoms (<i>β</i> range = -0.20 to -0.17), neuroticism (<i>β</i> range = -0.27 to -0.23), and allostatic load (<i>β</i> range = -0.11 to 0.09). Greater cognitive decline was linked to baseline allostatic load (<i>β</i> range = -0.98 to -0.83) and depressive symptoms (<i>β</i> range = -1.00 to -0.88). However, <i>APOE</i> E4 allele possession did not moderate the relationships of depressive symptoms, neuroticism and allostatic load with cognitive ability and cognitive decline. Additionally, the associations of neuroticism with cognitive ability and cognitive decline were not mediated through allostatic load.</p><p>Conclusions</p><p>Our results suggest that <i>APOE</i> E4 status does not moderate the relationships of depressive symptoms, neuroticism, and allostatic load with cognitive ability and cognitive decline in healthy older adults. The most notable positive finding in the current research was the strong association between allostatic load and cognitive decline.</p></div

Development of a design procedure accounting for the anisotropy of the dimensional change in Powder Metallurgy parts

The dimensional control is a crucial aspect for any manufacturing process. In Powder Metallurgy, and in particular in net shape press and sinter process, dimensional control assumes a particular relevance, since sintering of green parts involves dimensional variations that can be from 0 to 2-3% in volume. The dimensional variation in sintering is either shrinkage or swelling. Both depend on the material and on several process parameters relevant to the compaction and the sintering operations. Experimental evidences proved dimensional variations to be affected by an anisotropic behavior. This important phenomenon affects the effectiveness of the dimensional control if not opportunely taken into consideration in the design process. Professor Ilaria Cristofolini and Professor Alberto Molinari have started a deep investigation on this phenomenon, about five years ago, involving an important experimental campaign. The main idea is to collect a large quantity of data, both on ad-hoc designed samples and on parts produced by qualified PM companies cooperating with the University of Trento. The purpose is to develop a realistic model, able to explain and describe the mechanisms involved in the anisotropy of dimensional changes, and the dependence on the geometry of the parts, building a robust knowledge to improve the design methodologies in the industrial production. The present work investigates the effect of the geometrical characteristics of the part on the dimensional variations in sintering, giving a particular importance on its anisotropic behavior. The influence of geometry has been investigated using rings and disks with varying heights, external diameters and internal diameters. The influence of the sintering temperature has been also evaluated. The dimensional variation has been measured by a tri-dimensional Coordinate Measuring Machine. The anisotropy has been defined through a specifically determined parameter, which has been used to develop a predictive model estimating the anisotropy of the dimensional variations. This model has been then validated on complex parts produced by a Powder Metallurgy company

Understanding Caregivers, the Caregiving Experience and the Impact of Counseling and Support Interventions for Caregiver Interventions (Care Partner Counseling and Support Interventions)

There are over 40 million care partners in the United States providing unpaid care to adults and children with a disability or illness. The short and long-term effects of caregiving on the care partner can be debilitating. Many care partners are experiencing depression, isolation, anxiety, and increased stress due to caregiving responsibilities. Care partners may self-medicate, leading to substance abuse. Often the care partner becomes ill or may even die before the person they are caring for. Care partners need self-care and coping strategies. This presentation will introduce the types of caregiving personalities and the changing relationship between care partners and loved ones. In addition to helping the care partner, we need to look at the family and couple dynamics which create either a supportive environment or a stressful tug of war. A discussion of the stages of caregiving will introduce the challenges from diagnosis shock to end stage grief. An emphasis will be placed on seeing the care partner as a whole person, to help them work through their own life tasks while also providing care