Ethics roundtable: 'Open-ended ICU care: Can we afford it?'

The patient is a 27-year-old previously healthy male with a diagnosis of viral encephalitis with a lymphocytic pleocytosis on cerebrospinal fluid examination. For 3 months, he has been in status epilepticus (SE) on high doses of barbiturates, benzodiazepines, and ketamine and a ketogenic feeding-tube formula. He remains in burst suppression on continuous electroencephalography (EEG). He is trached and has a percutaneous endoscopic gastrostomy (PEG) feeding tube. He has been treated several times for pneumonia, and he is on a warming blanket and is on vasopressors to maintain his blood pressure. His vitals are stable and his lab work is within limits. The sedation is decreased under EEG guidance every 72 hours, after which he goes back into SE and heavy sedation is resumed. The latest magnetic resonance imaging (MRI) shows edema but otherwise no obvious permanent cortical damage. The family wants a realistic assessment of the likely outcome. The neurologist tells them the literature suggests the outlook is poor but not 100% fatal. As long as all of his other organs are functioning on life support, there is always a chance the seizures will stop at some time in the future, and so the neurologist recommends an open-ended intensive care unit (ICU) plan and hopes for that outcome. © 2010 BioMed Central Ltd

NAVY EXPEDITIONARY ADDITIVE MANUFACTURING (NEAM) CAPABILITY INTEGRATION

This capstone report analyzes the current and future use of additive manufacturing (AM) technologies within the Department of Defense (DOD). This analysis provided the technical background necessary to develop the Additive Manufacturing Process and Analysis Tool (AMPAT). AMPAT will help stakeholders identify what AM equipment best serves warfighters and their missions in expeditionary environments. Furthermore, the tool can be used by stakeholders to identify the most advantageous dispersions of AM capabilities across the fleet and make decisions on how those capabilities should be integrated into the greater naval mission and larger DOD enterprise. A systems engineering (SE) approach was implemented to gather information on current and prospective AM methods in order to understand and define the AM system operational requirements. Additionally, an SE process was utilized to analyze alternative software options to build the tool, implement agile software development processes to develop the tool, and verify and validate that the tool met the project requirements. The study found that AMPAT successfully outputs a ranked list of AM systems recommendations based upon user-defined input parameters and weighting values. Recommendations for choosing AM equipment and developing dispersion plans for the fleet include using the AMPAT deliverable to conduct customized, iterative analysis with user-defined inputs that are tailored to specific expeditionary environments.Outstanding ThesisCivilian, Department of the NavyCivilian, Department of the NavyCivilian, Department of the NavyCivilian, Department of the ArmyCivilian, Department of the NavyApproved for public release. Distribution is unlimited

Portfolio Vol. IV N 4

Wager, Dick. Collective Bargaining. Prose. 3-5. Raymond, Toby. Lochinvar Rides Again. Poetry. 6. Wyman, John. Lily of the Alley. Prose. 8-9. Benson, Virginia. Lost Cause. Prose. 10. Collins, Peg. The Curtain Falls. Prose. 11. Dorsey, Ann. Jack. Picture. 12. Sulke, Jim. Old Pete. Picture. 12. Myers, Sue. Jerry. Picture. 12. Rosenthal, Joan. Canadian Farmhouse. Picture. 13. Deeds, Ed. Mirror Lake. Picture. 13. Peters, Doris. Trees. Picture. 13. Seagrave, Leslie. Chinese Coins. Poetry. 14. White, Molly. Thoughts in the Rain. Poetry. 14. Smith, Duke. Keeping the Records Straight. Prose. 15. Stocker, Ed. Joe. Prose. 16-17. Saunders, John. Seven Year\u27s Luck. Prose. 19-22

Portfolio Vol. V N 3

Koons, Marilyn. Apology . Poem. 5. Koons, Marilyn. A Woman\u27s Request Poem. 5. Davidson, Sally. Of the Present . Poem. 5. Koons, Marilyn. Escape in Memory . Poem. 5. Stander, Marianna. Self Portrait . Picture. 5. Morton, John. Consumer\u27s Victory . Prose. 6. Rhu, Helen. Prize Winning Poem . Poem. 8. Rhu, Helen. To the Victor . Poem. 8. Rhu, Helen. Fantasy at Midnight . Poem. 8. Tomlin, Bonnie. The Drag . Picture. 8. Morse, Kay. In Spite of all... Prose. 9. Metcalf, Carolyn. Isolation . Cartoon. 12. Koons, Marilyn. In Black and White . Prose. 14. Harvey, Dick. Through Enemy Eyes . Prose. 15. Vercoe, Mary. Storm .Poem. 16. Vercoe, Mary. Refuge .Poem. 16. Vercoe, Mary. Recovery .Poem. 16. Vercoe, Mary. Temporary Address .Poem. 16. Hill, Jacque. Weary Words . Poem. 17. Brannon, Earl W. The Fall . Poem. 17. T.W. Gardenias . Poem. 17. Hayne, Barbara. Window Tears . Poem. 17. Burrows, Pete. Family Portrait . Prose. 18. Seagrave, Leslie. Retribution . Prose. 19. Benson, Virginia. The Moon Came Up . Prose. 21. Reynolds, Virginia. Matter Over Mind . Prose. 22

Small CCI – Exploring App Evaluation with Preschoolers

Child-Computer Interaction (CCI) is predominantly studied with school aged children. Working with preschool children, generally unable to read or write, involves addressing many challenges around planning, recruitment, and interpretation of findings. There are few examples in the literature of the challenges faced when conducting evaluations of technology with preschool children and very few evaluations conducted for commercial software companies. Our case study paper describes a six-week, twelve session, evaluation study of a commercial app (Lingokids) with children aged three and four in two nursery (preschool / kindergarten) schools. We describe challenges we met and describe how we adapted our plans to fit the context. We show how we were able to explore engagement and learning without gathering any personal data. With our practical tips and reflections, we hope our work will encourage others to work with young children in ways that respect their limited ability to understand assent and participation

CAPICE:a computational method for Consequence-Agnostic Pathogenicity Interpretation of Clinical Exome variations

Exome sequencing is now mainstream in clinical practice. However, identification of pathogenic Mendelian variants remains time-consuming, in part, because the limited accuracy of current computational prediction methods requires manual classification by experts. Here we introduce CAPICE, a new machine-learning-based method for prioritizing pathogenic variants, including SNVs and short InDels. CAPICE outperforms the best general (CADD, GAVIN) and consequence-type-specific (REVEL, ClinPred) computational prediction methods, for both rare and ultra-rare variants. CAPICE is easily added to diagnostic pipelines as pre-computed score file or command-line software, or using online MOLGENIS web service with API. Download CAPICE for free and open-source (LGPLv3) at https://github.com/molgenis/capice.

A computer simulation study of the effect of pressure on Mg diffusion in forsterite

Computer simulation techniques were used to investigate the effect of pressure on magnesium diffusionin forsterite between 0 and 10 GPa. We studied the diffusion path along the c crystallographic axis (we always refer to the Pbnm system) via a vacancy mechanism. Using a Mott-Littleton approach withinthe code GULP, we were able to precisely map the diffusion path of a Mg vacancy and we found theactivation energy, E = 3.97 eV at 0 GPa (with Ef = 3.35 eV for the formation energy and Em = 0.62 eV for the migration) and E = 4.46 eV at 10 GPa (Ef = 3.81 eV and Em = 0.65 eV). Preliminary results using the supercell technique gave the same saddle point coordinates and energies. This saddle point of the Mg vacancy diffusion found with GULP was then introduced in an ab initio code, confirming the values of the migration energy both at 0 and 10 GPa. We were therefore able to estimate the activation volume (V) to be around 5 cm3/mol and d(V)/dP = 0. The effect of pressure applies mostly on defect formation and little on migration

Understanding resilience capitals, agency and habitus in household experiences of water scarcity, floods and fire in marginalized settlements in the Cape Flats, South Africa

A significant percentage of the urban population in most low- and middle-income countries live in informal settlements. Due to poor quality housing, dense settlement patterns and lack of risk reducing infrastructure, informal settlements are least prepared and at higher risk for climate change issues. Marginalized communities in settlements in the Cape Flats region of South Africa face a range of environmental hazards and risks including recurrent large-scale fires, localised flooding and inconsistent access to water. This paper presents findings from a household survey with 600 participants from three economically marginalised settlements in this region. The paper explores how different forms of capital come into play in the shaping of these experiences and responses and uses these to consider power structures and the creation of particular types of habitus amongst settlement residents. Results show that cultural (knowledge) capital is one of the most important capitals enabling resilience and adaptive capacities across all three sites. Findings show the complex interplay of forms of capital and the importance of recognizing ownership, control and power structures. Our findings also illustrate how repeated exposure to risk can shape a habitus of risk acceptance and a focus on coping rather than change. Insights from this study further enhance knowledge of community resilience that could potentially inform policy development and institutional disaster risk reduction strategies for climate change resilience of cities in low- and middle-income countries

The epidemiology, pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis.

Global tuberculosis incidence has declined marginally over the past decade, and tuberculosis remains out of control in several parts of the world including Africa and Asia. Although tuberculosis control has been effective in some regions of the world, these gains are threatened by the increasing burden of multidrug-resistant (MDR) and extensively drug-resistant (XDR) tuberculosis. XDR tuberculosis has evolved in several tuberculosis-endemic countries to drug-incurable or programmatically incurable tuberculosis (totally drug-resistant tuberculosis). This poses several challenges similar to those encountered in the pre-chemotherapy era, including the inability to cure tuberculosis, high mortality, and the need for alternative methods to prevent disease transmission. This phenomenon mirrors the worldwide increase in antimicrobial resistance and the emergence of other MDR pathogens, such as malaria, HIV, and Gram-negative bacteria. MDR and XDR tuberculosis are associated with high morbidity and substantial mortality, are a threat to health-care workers, prohibitively expensive to treat, and are therefore a serious public health problem. In this Commission, we examine several aspects of drug-resistant tuberculosis. The traditional view that acquired resistance to antituberculous drugs is driven by poor compliance and programmatic failure is now being questioned, and several lines of evidence suggest that alternative mechanisms-including pharmacokinetic variability, induction of efflux pumps that transport the drug out of cells, and suboptimal drug penetration into tuberculosis lesions-are likely crucial to the pathogenesis of drug-resistant tuberculosis. These factors have implications for the design of new interventions, drug delivery and dosing mechanisms, and public health policy. We discuss epidemiology and transmission dynamics, including new insights into the fundamental biology of transmission, and we review the utility of newer diagnostic tools, including molecular tests and next-generation whole-genome sequencing, and their potential for clinical effectiveness. Relevant research priorities are highlighted, including optimal medical and surgical management, the role of newer and repurposed drugs (including bedaquiline, delamanid, and linezolid), pharmacokinetic and pharmacodynamic considerations, preventive strategies (such as prophylaxis in MDR and XDR contacts), palliative and patient-orientated care aspects, and medicolegal and ethical issues

The Built Environment and Health: Introducing Individual Space-Time Behavior

Many studies have examined the relationship between the built environment and health. Yet, the question of how and why the environment influences health behavior remains largely unexplored. As health promotion interventions work through the individuals in a targeted population, an explicit understanding of individual behavior is required to formulate and evaluate intervention strategies. Bringing in concepts from various fields, this paper proposes the use of an activity-based modeling approach for understanding and predicting, from the bottom up, how individuals interact with their environment and each other in space and time, and how their behaviors aggregate to population-level health outcomes