Perspectives On The Sources And Eventual Outcome Of The 2008 Economic And Financial Crisis: A Panel Discussion

In October 2008 the Southern Utah University School of Business held a panel discussion on the current economic crisis. This discussion was part of the School’s Business Convocation series and was open to the public. The panel was designed with two components in mind. First, a pair of academics with expertise in financial institutions and business cycles offered historical and theoretical perspectives on the crisis. Second, a pair of professionals – a local banking official and a fund manager – offered perspectives on the current financial situation and practical experience based on the policy responses to past crises. As moderator, Joe Baker asked each panelist to make a short presentation on a question of general interest that was related to their area of expertise; this was followed by an open question and answer session. The participating panelists and opening questions follow. 1. Stephen Evans, Professor of Finance: Dr. Evans teaches courses on financial institutions and was asked to provide background of how the crisis occurred and what the proposed government bailout plan is expected to accomplish. 2. David Tufte, Associate Professor of Economics: Dr. Tufte is a macroeconomist and was asked to discuss the macroeconomic implications of the crisis in such areas as inflation, interest rates, economic growth and unemployment. 3. Mr. Robb Kerry, Chief Credit Officer of ADB Bank: Mr. Kerry has an extensive background in banking as a bank regulator and banker. Mr. Kerry was asked to discuss the implications of the crisis on banking credit and lending. Mr. Steve Harrop, Finance Professional in Residence: Mr. Harrop was a mutual fund manager for several decades before joining the School of Business faculty where he teaches investments and manages (pro bono) an investment fund. Mr. Harrop will discuss the implications of the crisis on the stock and bond markets

Surgical Decision Making for Unstable Thoracolumbar Spine Injuries: Results of a Consensus Panel Review by the Spine Trauma Study Group

Objectives: The optimal surgical approach and treatment of unstable thoracolumbar spine injuries are poorly defined owing to a lack of widely accepted level I clinical literature. This lack of evidence based standards has led to varied practice patterns based on individual surgeon preferences. The purpose of this study was to survey the leaders in the field of spine trauma to define the major characteristics of thoracolumbar injuries that influence their surgical decision making. In the absence of good scientific data, expert consensus opinions may provide surgeons with a practical framework to guide therapy and to conduct future research. Methods: A panel of 22 leading spinal surgeons from 20 level I trauma centers in seven countries met to discuss the indications for surgical approach selection in unstable thoracolumbar injuries. Injuries were presented to the surgeons in a case scenario survey format. Preferred surgical approaches to the clinical scenarios were tabulated and comments weighed. Results: All members of the panel agreed that three independent characteristics of thoracolumbar injuries carry primary importance in surgical decision making: the injury morphology, the neurologic status of the patient, and the integrity of the posterior ligaments. Six clinical scenarios based on the neurologic status of the patient (intact, incomplete, or complete) and on the status of the posterior ligamentous complex (intact or disrupted) were created, and consensus treatment approaches were described. Additional circumstances capable of altering the treatments were acknowledged. Conclusions: Decision making for the surgical treatment of thoracolumbar injuries is largely dependent on three patient characteristics: injury morphology, neurologic status, and posterior ligament integrity. A logical and practical decision-making process based on these characteristics may guide treatment even for the most complicated fracture patterns

The DOE E3SM Coupled Model Version 1: Overview and Evaluation at Standard Resolution

This work documents the first version of the U.S. Department of Energy (DOE) new Energy Exascale Earth System Model (E3SMv1). We focus on the standard resolution of the fully coupled physical model designed to address DOE mission-relevant water cycle questions. Its components include atmosphere and land (110-km grid spacing), ocean and sea ice (60 km in the midlatitudes and 30 km at the equator and poles), and river transport (55 km) models. This base configuration will also serve as a foundation for additional configurations exploring higher horizontal resolution as well as augmented capabilities in the form of biogeochemistry and cryosphere configurations. The performance of E3SMv1 is evaluated by means of a standard set of Coupled Model Intercomparison Project Phase 6 (CMIP6) Diagnosis, Evaluation, and Characterization of Klima simulations consisting of a long preindustrial control, historical simulations (ensembles of fully coupled and prescribed SSTs) as well as idealized CO2 forcing simulations. The model performs well overall with biases typical of other CMIP-class models, although the simulated Atlantic Meridional Overturning Circulation is weaker than many CMIP-class models. While the E3SMv1 historical ensemble captures the bulk of the observed warming between preindustrial (1850) and present day, the trajectory of the warming diverges from observations in the second half of the twentieth century with a period of delayed warming followed by an excessive warming trend. Using a two-layer energy balance model, we attribute this divergence to the model’s strong aerosol-related effective radiative forcing (ERFari+aci = -1.65 W/m2) and high equilibrium climate sensitivity (ECS = 5.3 K).Plain Language SummaryThe U.S. Department of Energy funded the development of a new state-of-the-art Earth system model for research and applications relevant to its mission. The Energy Exascale Earth System Model version 1 (E3SMv1) consists of five interacting components for the global atmosphere, land surface, ocean, sea ice, and rivers. Three of these components (ocean, sea ice, and river) are new and have not been coupled into an Earth system model previously. The atmosphere and land surface components were created by extending existing components part of the Community Earth System Model, Version 1. E3SMv1’s capabilities are demonstrated by performing a set of standardized simulation experiments described by the Coupled Model Intercomparison Project Phase 6 (CMIP6) Diagnosis, Evaluation, and Characterization of Klima protocol at standard horizontal spatial resolution of approximately 1° latitude and longitude. The model reproduces global and regional climate features well compared to observations. Simulated warming between 1850 and 2015 matches observations, but the model is too cold by about 0.5 °C between 1960 and 1990 and later warms at a rate greater than observed. A thermodynamic analysis of the model’s response to greenhouse gas and aerosol radiative affects may explain the reasons for the discrepancy.Key PointsThis work documents E3SMv1, the first version of the U.S. DOE Energy Exascale Earth System ModelThe performance of E3SMv1 is documented with a set of standard CMIP6 DECK and historical simulations comprising nearly 3,000 yearsE3SMv1 has a high equilibrium climate sensitivity (5.3 K) and strong aerosol-related effective radiative forcing (-1.65 W/m2)Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151288/1/jame20860_am.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151288/2/jame20860.pd

Recommendations for effective documentation in regional anesthesia: an expert panel Delphi consensus project

Background and objectives: Documentation is important for quality improvement, education, and research. There is currently a lack of recommendations regarding key aspects of documentation in regional anesthesia. The aim of this study was to establish recommendations for documentation in regional anesthesia. Methods: Following the formation of the executive committee and a directed literature review, a long list of potential documentation components was created. A modified Delphi process was then employed to achieve consensus amongst a group of international experts in regional anesthesia. This consisted of 2 rounds of anonymous electronic voting and a final virtual round table discussion with live polling on items not yet excluded or accepted from previous rounds. Progression or exclusion of potential components through the rounds was based on the achievement of strong consensus. Strong consensus was defined as ≥75% agreement and weak consensus as 50%-74% agreement. Results: Seventy-seven collaborators participated in both rounds 1 and 2, while 50 collaborators took part in round 3. In total, experts voted on 83 items and achieved a strong consensus on 51 items, weak consensus on 3 and rejected 29. Conclusion: By means of a modified Delphi process, we have established expert consensus on documentation in regional anesthesia

Supporting Runtime Tool Interaction for Parallel Simulations

: Scientists from many disciplines now routinely use modeling and simulation techniques to study physical and biological phenomena. Advances in high-performance architectures and networking have made it possible to build complex simulations with parallel and distributed interacting components. Unfortunately, the software needed to support such complex simulations has lagged behind hardware developments. We focus here on one aspect of such support: runtime program interaction. We have developed a runtime interaction framework and we have implemented a specific instance of it for an application in seismic tomography. That instance, called TierraLab, extends the geoscientists' existing (legacy) tomography code with runtime interaction capabilities which they access through a MATLAB interface. The scientist can stop a program, retrieve data, analyze and visualize that data with existing MATLAB routines, modify the data, and resume execution. They can do this all within a familiar MATLAB..

Emerging Safety of Intramedullary Transplantation of Human Neural Stem Cells in Chronic Cervical and Thoracic Spinal Cord Injury

Abstract BACKGROUND Human central nervous system stem cells (HuCNS-SC) are multipotent adult stem cells with successful engraftment, migration, and region-appropriate differentiation after spinal cord injury (SCI). OBJECTIVE To present data on the surgical safety profile and feasibility of multiple intramedullary perilesional injections of HuCNS-SC after SCI. METHODS Intramedullary free-hand (manual) transplantation of HuCNS-SC cells was performed in subjects with thoracic (n = 12) and cervical (n = 17) complete and sensory incomplete chronic traumatic SCI. RESULTS Intramedullary stem cell transplantation needle times in the thoracic cohort (20 M HuCNS-SC) were 19:30 min and total injection time was 42:15 min. The cervical cohort I (n = 6), demonstrated that escalating doses of HuCNS-SC up to 40 M range were well tolerated. In cohort II (40 M, n = 11), the intramedullary stem cell transplantation needle times and total injection time was 26:05 ± 1:08 and 58:14 ± 4:06 min, respectively. In the first year after injection, there were 4 serious adverse events in 4 of the 12 thoracic subjects and 15 serious adverse events in 9 of the 17 cervical patients. No safety concerns were considered related to the cells or the manual intramedullary injection. Cervical magnetic resonance images demonstrated mild increased T2 signal change in 8 of 17 transplanted subjects without motor decrements or emerging neuropathic pain. All T2 signal change resolved by 6 to 12 mo post-transplant. CONCLUSION A total cell dose of 20 M cells via 4 and up to 40 M cells via 8 perilesional intramedullary injections after thoracic and cervical SCI respectively proved safe and feasible using a manual injection technique

P244. Crowd wisdom among experts and reduction of fusion failure for spondylolisthesis

Recent published RCTs have created uncertainty around the appropriate utilization of lumbar fusion when performing a laminectomy for symptomatic lumbar degenerative spondylolisthesis. SLIP II is an RCT that explores how spinal expert review might help to classify patients as most appropriate for fusion versus decompression alone. To determine if use of a surgical expert review panel recommending fusion might reduce surgical failures. We performed a multi-center prospective RCT at 14 sites. Patients (age > 18 years) with symptomatic lumbar stenosis with degenerative spondylolisthesis were enrolled. Outcomes (EQ-5D and ODI) were assessed preoperatively, 3 months, 6 months, 12 months, and 24 months. NASS patient satisfaction was also assessed at 1 year. Patients were randomized to either receive an expert panel review of their case or not. Spinal expert review consisted of 10-15 surgeons’ review of patient imaging and history regarding appropriateness of fusion that was shared with both treating surgeon and patient. Patients had surgical treatment at the discretion of the treating surgeon. Analysis was focused upon whether a strong majority (>80% consensus) of spinal experts recommending fusion might reduce operative failures. Operative failure was defined as no improvement or worsening of ODI or EQ5D score. Fourteen sites randomized 662 patients. One-year follow-up was 82%. 321 underwent review and 341 no review. Mean age was 66 years (59.7% female). Baseline characteristics were comparable. Overall, fusion was performed on 418/662 (63.1%) of patients. For patients randomized to an expert review- fusion was strongly recommended in 102/232 (44%) of cases, and in 91/102 (89%) of cases, fusion was performed as recommended. Super majority recommendation for fusion (SM) outcome was compared to patients in the control group (no review). SM was associated with –25.5-point ODI change vs –23.8-point ODI change (p=0.485) and 0.302 change in Eq5D vs 0.250 change in Eq5D (p=0.089). The proportion of failure in fusion with super majority review measured by ODI score was 6.6% vs 14.9% in nonreview group (p=0.067). The proportion of failure in fusion with super majority review measured by EQ-5D score was 7.9% vs 18.8% in nonreview group (p=0.036; Figure 1). NASS patient satisfaction was graded at 1 (treatment met my expectations) in 81.0% of patients who had super majority review favoring fusion as compared to 72.3% of other cases (P=0.20). ODI and EQ-5D outcomes for patients treated with decompression alone versus decompression and fusion were not different at 1 years; ODI (20.09-point change vs 22.94 -point change, respectively [p=0.161]) and EQ-5D (0.235 change vs 0.255 change, respectively [p=0.478]). Complication rates were similar for decompression vs decompression with fusion as well (11.4% vs 14.4% [p=0.533]. Expert panel review does not reduce the number of fusion operations performed but fusion cases where a super majority expert panel favored fusion was associated with fewer failures in health-related quality of life. This abstract does not discuss or include any applicable devices or drugs