The Eyes and Ears of Engagement: Using RAs to Assess Resident Engagement

This article analyzes the effectiveness of an effort to assess the extent of student engagement at Fairfield University through the assistance of resident assistants (RAs) and the adaptation of a methodology used by the university’s schools of engineering and education. Asking RAs to participate in an assessment of their residents provides several clear benefits: the assessment rubric sets clear expectations in plain language; the rubric sets out clear expectations to the residents; and the assessment data appear to be a valid indicator of student engagement and allow the institution to identify students who may benefit from additional counseling or attention

Role of the Seasonal Cycle in the Subduction Rates of Upper–Southern Ocean Waters

Abstract A kinematic approach is used to diagnose the subduction rates of upper–Southern Ocean waters across seasonally migrating density outcrops at the base of the mixed layer. From an Eulerian viewpoint, the term representing the temporal change in the mixed layer depth (which is labeled as the temporal induction in this study; i.e., Stemp = ∂h/∂t where h is the mixed layer thickness, and t is time) vanishes over several annual cycles. Following seasonally migrating density outcrops, however, the temporal induction is attributed partly to the temporal change in the mixed layer thickness averaged over a density outcrop following its seasonally varying position and partly to the lateral movement of the outcrop position intersecting the sloping mixed layer base. Neither the temporal induction following an outcrop nor its integral over the outcrop area vanishes over several annual cycles. Instead, the seasonal eddy subduction, which arises primarily because of the subannual correlations between the seasonal cycles of the mixed layer depth and the outcrop area, explains the key mechanism by which mode waters are transferred from the mixed layer to the underlying pycnocline. The time-mean exchange rate of waters across the base of the mixed layer is substantially different from the exchange rate of waters across the fixed winter mixed layer base in mode water density classes. Nearly 40% of the newly formed Southern Ocean mode waters appear to be diapycnally transformed within the seasonal pycnocline before either being subducted into the main pycnocline or entrained back to the mixed layer through lighter density classes

Case of placental insufficiency and premature delivery in a Fontan pregnancy:physiological insights and considerations on risk stratification

Objectives The coexistence of two complex physiologies such as Fontan and pregnancy is still not fully understood. We aim to add a unique and essential knowledge to help our colleagues in the management of Fontan patients that undergo pregnancy as well as the fetus and the placenta perfusion.Methods and results We analyse the coexistence of Fontan and pregnancy physiology on a complex case of a woman with hypoplastic left heart syndrome palliated with a univentricular repair who became pregnant, delivered very prematurely and had atypical placental findings.Conclusion Histopathological analysis of the placenta could help us to refine the understanding of Fontan physiology adaptation during pregnancy, predict women and fetal outcomes as well as to plan a better pre-pregnancy status. However, further evidence is needed in order to reach a more solid and unified conclusion

Strategies to Reduce Non-Ventilator-Associated Hospital-Acquired Pneumonia: A Systematic Review

Background Point prevalence studies identify that pneumonia is the most common healthcare associated infection. However, non-ventilator associated healthcare associated pneumonia (NV-HAP) is both underreported and understudied. Most research conducted to date, focuses on ventilator associated pneumonia. We conducted a systematic review, to provide the latest evidence for strategies to reduce NV-HAP and describe the methodological approaches used. Methods We performed a systematic search to identify research exploring and evaluating NV-HAP preventive measures in hospitals and aged-care facilities. The electronic database Medline was searched, for peer-reviewed articles published between 1st January 1998 and 31st August 2018. An assessment of the study quality and risk of bias of included articles was conducted using the Newcastle–Ottawa Scale. Results The literature search yielded 1551 articles, with 15 articles meeting the inclusion criteria. The majority of strategies for NV-HAP prevention focussed on oral care (n = 9). Three studies evaluated a form of physical activity, such as passive movements, two studies used dysphagia screening and management; and another study evaluated prophylactic antibiotics. Most studies (n = 12) were conducted in a hospital setting. Six of the fifteen studies were randomised controlled trials. Conclusion There was considerable heterogeneity in the included studies, including the type of intervention, study design, methods and definitions used to diagnose the NV-HAP. To date, interventions to reduce NV-HAP appear to be based broadly on the themes of improving oral care, increased mobility or movement and dysphagia management

Isolating the Effect of Arch Architecture on Aortic Hemodynamics Late After Coarctation Repair: A Computational Study

OBJECTIVES: Effective management of aortic coarctation (CoA) affects long-term cardiovascular outcomes. Full appreciation of CoA hemodynamics is important. This study aimed to analyze the relationship between aortic shape and hemodynamic parameters by means of computational simulations, purposely isolating the morphological variable. METHODS: Computational simulations were run in three aortic models. MRI-derived aortic geometries were generated using a statistical shape modeling methodology. Starting from n = 108 patients, the mean aortic configuration was derived in patients without CoA (n = 37, “no-CoA”), with surgically repaired CoA (n = 58, “r-CoA”) and with unrepaired CoA (n = 13, “CoA”). As such, the aortic models represented average configurations for each scenario. Key hemodynamic parameters (i.e., pressure drop, aortic velocity, vorticity, wall shear stress WSS, and length and number of strong flow separations in the descending aorta) were measured in the three models at three time points (peak systole, end systole, end diastole). RESULTS: Comparing no-CoA and CoA revealed substantial differences in all hemodynamic parameters. However, simulations revealed significant increases in vorticity at the site of CoA repair, higher WSS in the descending aorta and a 12% increase in power loss, in r-CoA compared to no-CoA, despite no clinically significant narrowing (CoA index >0.8) in the r-CoA model. CONCLUSIONS: Small alterations in aortic morphology impact on key hemodynamic indices. This may contribute to explaining phenomena such as persistent hypertension in the absence of any clinically significant narrowing. Whilst cardiovascular events in these patients may be related to hypertension, the role of arch geometry may be a contributory factor

Protective effects of β-Funaltrexamine against LPS-induced CCL2 expression and behavioral deficits

Background: Inflammation is present in both neurological and peripheral disorders. Specifically, inflammation is one of the common factors in diseases such as Alzheimer’s disease (AD), Parkinson’s disease (PD), mood disorders which include anxiety and depression, and even inflammatory bowel disease (IBD). Thus, exploring potential treatments geared toward the assessment of inflammation is crucial to the continuation of treatment development. One pharmacological agent researched for its antiinflammatory effects is β-funaltrexamine (β-FNA), a selective mu-opioid receptor antagonist. Preclinical studies using in vitro human astroglial cells showed that β-FNA inhibited inflammatory signaling, NF-κB signaling, and chemokine expression in a mechanism unrelated to MOR. Also, β-funaltrexamines neuroprotective effects were discovered in a preclinical model of lipopolysaccharide (LPS)-induced neuroinflammation and sickness-like behavior when administered before LPS.Methods: This study determines the effects of β-FNA (50 mg/kg, i.p.) on LPS-induced (0.83 mg/kg, i.p.) sickness-like behavior using a 10 min open field test, and anxiety-like behavior, using a 5 min elevated plus maze in male and female C57BL/6J. It also assesses the effects on LPS-induced neuro and peripheral inflammation when β-FNA is administered immediately or 10 h post-LPS. Tissue collected included whole brain, hippocampus, prefrontal cortex, cerebellum/brain stem, spleen, liver, small intestine, large intestine, and plasma.Results and Conclusions: Levels of inflammatory chemokine Monocyte Chemoattractant Protein-1 (MCP1, also known as CCL2) was measured using an enzyme-linked immunosorbent assay (ELISA). Two-way analysis of variance revealed that at 24 hours, LPS increased chemokines, and β-FNA treatment was protective depending on the dosing schedule and had region-specific effects. Also, to our knowledge, this is the first time β-FNAs effect on female mice has been assessed. Differential effects of β-FNA were found between the whole brain vs. brain regions, central vs. peripheral, and sexes. This study provides insight into the inflammatory protection offered by β-FNA in both the central and peripheral systems and further knowledge of the potential therapeutic options for inflammatory disorders

β-Funaltrexamine protects against lipopolysaccharide-induced neuroinflammation and behavioral impairment

Background: One of the commonalities present in a multitude of neurological disorders is inflammation. For this reason, targeting inflammation has emerged as a viable option for the potential treatment of neurological disorders. Previous work indicated that beta-funaltrexamine (β-FNA), a selective mu-opioid receptor (MOR) antagonist, not only inhibited inflammatory signaling in vitro in human astroglial cells but also inhibited lipopolysaccharide (LPS)-induced neuroinflammation and sickness-like behavior in mice when administered post-LPS immediately.Methods: The present study explores the extent to which β-FNA is protective when treatment occurs 10 hours after LPS administration. Male and female C57BL/6J mice were administered LPS (0.83 mg/kg, i.p.) followed by treatment with β-FNA (50 mg/kg, i.p.) immediately or 10h post-LPS. Sickness-like and anxiety-like behavior was assessed using a 10-min open-field test and a 5-min elevated plus-maze test followed by the collection of the whole brain, hippocampus, frontal cortex, cerebellum/brain stem, and plasma. Levels of inflammatory chemokines/cytokines(interferon γ-induced protein, CXCL10; monocyte chemotactic protein 1, CCL2; interleukin-6, IL-6; interleukin-1β, IL-1β, and Tumor Necrosis Factor Alpha, TNF-α) in tissues were measured using an enzyme-linked immunosorbent assay.Results: Two-way analysis of variance revealed that at 24 hours, LPS increased chemokines and cytokines, and β-FNA treatment was protective depending on the dosing schedule and had region-specific effects. β-FNA inhibited levels of CXCL10 in the hippocampus, frontal cortex, cerebellum/brain stem, and plasma, and more so in males. CCL2 had differential effects between males and females in the frontal cortex, cerebellum/brain stem, and plasma. β-FNA treatment also varied in IL-6, IL-1β, and TNF-α in a region-specific and sex-specific manner. Sickness-like behavior and anxiety-like behavior also differentiated between males and females.Conclusions: This study indicates that LPS-induced neuroinflammation was differentially affected by βFNA treatment across different brain regions. This shows that the treatment might have a regional effect more than a global one. Sex differences between males and females showed differential effects in the timing of treatment, tissue, and in some cases, even in their response to the LPS-induced stimulation. Further examination of β-FNA’s anti-inflammatory and neuroprotective actions is still necessary

Measuring Bird Damage to Three Fruit Crops: A Comparison of Grower and Field Estimates

Birds are common pests in fruit orchards. They frequently consume and damage fruit resulting in decreased yields for growers. The true extent of damage is difficult to measure. Producer surveys are often implemented to estimate damage, but the accuracy of these estimates is uncertain. We compared damage estimates obtained through field studies with estimates from a producer survey for three fruit crops: wine grapes, sweet cherries, and ‘Honeycrisp’ apples. We also analyzed relationships between use of various damage management methods and levels of bird damage. We found wine grape and sweet cherry growers accurately assessed bird damage, while ‘Honeycrisp’ apple growers may overestimate damage. Growing region appears to be an important damage predictor for wine grape and sweet cherry crops. Significant relationships between management methods and damage were positive, suggesting growers only use these methods when bird damage is substantial

Analysing functional implications of differences in left ventricular morphology using statistical shape modelling

Functional implications of left ventricular (LV) morphological characterization in congenital heart disease are not widely explored. This study qualitatively and quantitatively assessed LV shape associations with a) LV function and b) thoracic aortic morphology in patients with aortic coarctation (CoA) with/without bicuspid aortic valve (BAV), and healthy controls. A statistical shape modelling framework was employed to analyse three-dimensional (3D) LV shapes from cardiac magnetic resonance (CMR) data in isolated CoA (n = 25), CoA + BAV (n = 30), isolated BAV (n = 30), and healthy controls (n = 25). Average 3D templates and deformations were computed. Correlations between shape data and CMR-derived morphometric parameters (i.e., sphericity, conicity) or global and apical strain values were assessed to elucidate possible functional implications. The relationship between LV shape features and arch architecture was also explored. The LV template was shorter and more spherical in CoA patients. Sphericity was overall associated with global and apical radial (p = 0.001, R(2) = 0.09; p < 0.0001, R(2) = 0.17) and circumferential strain (p = 0.001, R(2) = 0.10; p = 0.04, R(2) = 0.04), irrespective of the presence of aortic stenosis and/or regurgitation and controlling for age and hypertension status. LV strain was not associated with arch architecture. Differences in LV morphology were observed between CoA and BAV patients. Increasing LV sphericity was associated with reduced strain, independent of aortic arch architecture and functional aortic valve disease