What is the effect of a decision aid in potentially vulnerable parents? Insights from the head CT choice randomized trial.

ObjectiveTo test the hypotheses that use of the Head CT Choice decision aid would be similarly effective in all parent/patient dyads but parents with high (vs low) numeracy experience a greater increase in knowledge while those with low (vs high) health literacy experience a greater increase in trust.MethodsThis was a secondary analysis of a cluster randomized trial conducted at seven sites. One hundred seventy-two clinicians caring for 971 children at intermediate risk for clinically important traumatic brain injuries were randomized to shared decision making facilitated by the DA (n = 493) or to usual care (n = 478). We assessed for subgroup effects based on patient and parent characteristics, including socioeconomic status (health literacy, numeracy and income). We tested for interactions using regression models with indicators for arm assignment and study site.ResultsThe decision aid did not increase knowledge more in parents with high numeracy (P for interaction [Pint ] = 0.14) or physician trust more in parents with low health literacy (Pint  = 0.34). The decision aid decreased decisional conflict more in non-white parents (decisional conflict scale, -8.14, 95% CI: -12.33 to -3.95; Pint  = 0.05) and increased physician trust more in socioeconomically disadvantaged parents (trust in physician scale, OR: 8.59, 95% CI: 2.35-14.83; Pint  = 0.04).ConclusionsUse of the Head CT Choice decision aid resulted in less decisional conflict in non-white parents and greater physician trust in socioeconomically disadvantaged parents. Decision aids may be particularly effective in potentially vulnerable parents

Estimating Fixed Effects: Perfect Prediction and Bias in Binary Response Panel Models, with an Application to the Hospital Readmissions Reduction Program

The maximum likelihood estimator for the regression coefficients, β, in a panel binary response model with fixed effects can be severely biased if N is large and T is small, a consequence of the incidental parameters problem. This has led to the development of conditional maximum likelihood estimators and, more recently, to estimators that remove the O(T–1) bias in β^. We add to this literature in two important ways. First, we focus on estimation of the fixed effects proper, as these have become increasingly important in applied work. Second, we build on a bias-reduction approach originally developed by Kosmidis and Firth (2009) for cross-section data, and show that in contrast to other proposals, the new estimator ensures finiteness of the fixed effects even in the absence of within-unit variation in the outcome. Results from a simulation study document favourable small sample properties. In an application to hospital data on patient readmission rates under the 2010 Affo

Natural gas production problems : solutions, methodologies, and modeling.

Natural gas is a clean fuel that will be the most important domestic energy resource for the first half the 21st centtuy. Ensuring a stable supply is essential for our national energy security. The research we have undertaken will maximize the extractable volume of gas while minimizing the environmental impact of surface disturbances associated with drilling and production. This report describes a methodology for comprehensive evaluation and modeling of the total gas system within a basin focusing on problematic horizontal fluid flow variability. This has been accomplished through extensive use of geophysical, core (rock sample) and outcrop data to interpret and predict directional flow and production trends. Side benefits include reduced environmental impact of drilling due to reduced number of required wells for resource extraction. These results have been accomplished through a cooperative and integrated systems approach involving industry, government, academia and a multi-organizational team within Sandia National Laboratories. Industry has provided essential in-kind support to this project in the forms of extensive core data, production data, maps, seismic data, production analyses, engineering studies, plus equipment and staff for obtaining geophysical data. This approach provides innovative ideas and technologies to bring new resources to market and to reduce the overall environmental impact of drilling. More importantly, the products of this research are not be location specific but can be extended to other areas of gas production throughout the Rocky Mountain area. Thus this project is designed to solve problems associated with natural gas production at developing sites, or at old sites under redevelopment

Recent Shuttle Post Flight MMOD Inspection Highlights

Post flight inspections on the Space Shuttle Atlantis conducted after the STS-11.5 mission revealed a 0.11 inch (2.8 mm) hole in the outer face sheet of the starboard payload bay door radiator panel #4. The payload bay door radiators in this region are 0.5 inch (12.7 mm) thick aluminum honeycomb with 0.011 in (0.279 mm) thick aluminum face sheets topped with 0.005 in (0.127 mm) silver-Teflon tape. Inner face sheet damage included a 0.267 in (6.78 mm) long through crack with measureable deformation in the area of 0.2 in (5.1 mm). There was also a 0.031 in (0.787 nun) diameter hole in the rear face sheet. A large approximately l in (25 mm) diameter region of honeycomb was also destroyed. Since the radiators are located on the inside of the shuttle payload bay doors which are closed during ascent and reentry, the damage could only have occurred during the on-orbit portion of the mission. During the August 2007 STS-118 mission to the International Space Station, a micro-meteoroid or orbital debris (MMOD) particle impacted and completely penetrated one of shuttle Endeavour's radiator panels and the underlying thermal control system (TCS) blanket, leaving deposits on (but no damage to) the payload bay door. While it is not unusual for shuttle orbiters to be impacted by small MMOD particles, the damage from this impact is larger than any previously seen on the shuttle radiator panels. One of the largest impacts ever observed on a crew module window occurred during the November 2008 STS-126 mission to the International Space Station. Damage to the window was documented by the crew on orbit. Post flight inspection revealed a 0.4 in (10.8 mm) crater in the window pane, with a depth of 0.03 in (0.76 mm). The window pane was replaced due to the damage caused by this impact. Analysis performed on residue contained in dental mold impressions taken of the site indicated that a meteoroid particle produced this large damage site. The post flight inspection after the subsequent mission, STS-119 in March of 2009, produced a large MMOD impact feature in a wing leading edge reinforced carbon-carbon panel. The crater measured 0.18 in (4.5 nun) in diameter and was nearly 0.037 in (0.93 nun) deep. The thickness of the silicon carbide coating that protects the carbon substrate is nominally 0.02 in (0.5 nun) to 0.04 in (1 mm), making this a significant impact into the RCC. The damage occurred on the upper surface of the panel, which experiences lower heat loads on re-entry. This poster will document the data collected from the impact sites and will include results of the Scanning Electron Microscope/Energy Dispersive X-ray (SEM/EDX) analysis. Evidence will be presented that suggests a source of the impacts

Effects of Bilateral Assistance for Hemiparetic Gait Post-Stroke Using a Powered Hip Exoskeleton

Abstract Hemiparetic gait due to stroke is characterized by an asymmetric gait due to weakness in the paretic lower limb. These inter-limb asymmetries increase the biomechanical demand and reduce walking speed, leading to reduced community mobility and quality of life. With recent progress in the field of wearable technologies, powered exoskeletons have shown great promise as a potential solution for improving gait post-stroke. While previous studies have adopted different exoskeleton control methodologies for restoring gait post-stroke, the results are highly variable due to limited understanding of the biomechanical effect of exoskeletons on hemiparetic gait. In this study, we investigated the effect of different hip exoskeleton assistance strategies on gait function and gait biomechanics of individuals post-stroke. We found that, compared to walking without a device, powered assistance from hip exoskeletons improved stroke participants’ self-selected overground walking speed by 17.6 ± 2.5% and 11.1 ± 2.7% with a bilateral and unilateral assistance strategy, respectively (p < 0.05). Furthermore, both bilateral and unilateral assistance strategies significantly increased the paretic and non-paretic step length (p < 0.05). Our findings suggest that powered assistance from hip exoskeletons is an effective means to increase walking speed post-stroke and tuning the balance of assistance between non-paretic and paretic limbs (i.e., a bilateral strategy) may be most effective to maximize performance gains

Bifunctional Electrophiles Cross-Link Thioredoxins with Redox Relay Partners in Cells

Thioredoxin protects cells against oxidative damage by reducing disulfide bonds in improperly oxidized proteins. Previously, we found that the baker\u27s yeast cytosolic thioredoxin Trx2 undergoes cross-linking to form several protein-protein complexes in cells treated with the bifunctional electrophile divinyl sulfone (DVSF). Here, we report that the peroxiredoxin Tsa1 and the thioredoxin reductase Trr1, both of which function in a redox relay network with thioredoxin, become cross-linked in complexes with Trx2 upon DVSF treatment. Treatment of yeast with other bifunctional electrophiles, including diethyl acetylenedicarboxylate (DAD), mechlorethamine (HN2), and 1,2,3,4-diepoxybutane (DEB), resulted in the formation of similar cross-linked complexes. Cross-linking of Trx2 and Tsa1 to other proteins by DVSF and DAD is dependent on modification of the active site Cys residues within these proteins. In addition, the human cytosolic thioredoxin, cytosolic thioredoxin reductase, and peroxiredoxin 2 form cross-linked complexes to other proteins in the presence of DVSF, although each protein shows different susceptibilities to modification by DAD, HN2, and DEB. Taken together, our results indicate that bifunctional electrophiles potentially disrupt redox homeostasis in yeast and human cells by forming cross-linked complexes between thioredoxins and their redox partners. © 2013 American Chemical Society