The Making of \u3ci\u3eAlways Coming Home\u3c/i\u3e

Transcript of panel discussion from 1988 Mythopoeic Conference. Author, illustrator, composer, and cartographer/ researcher discuss the genesis of Always Coming Home

Building a semantically annotated corpus of clinical texts

In this paper, we describe the construction of a semantically annotated corpus of clinical texts for use in the development and evaluation of systems for automatically extracting clinically significant information from the textual component of patient records. The paper details the sampling of textual material from a collection of 20,000 cancer patient records, the development of a semantic annotation scheme, the annotation methodology, the distribution of annotations in the final corpus, and the use of the corpus for development of an adaptive information extraction system. The resulting corpus is the most richly semantically annotated resource for clinical text processing built to date, whose value has been demonstrated through its use in developing an effective information extraction system. The detailed presentation of our corpus construction and annotation methodology will be of value to others seeking to build high-quality semantically annotated corpora in biomedical domains

Active foundering of a continental arc root beneath the southern Sierra Nevada in California

Seismic data provide images of crust–mantle interactions during ongoing removal of the dense batholithic root beneath the southern Sierra Nevada mountains in California. The removal appears to have initiated between 10 and 3 Myr ago with a Rayleigh–Taylor-type instability, but with a pronounced asymmetric flow into a mantle downwelling (drip) beneath the adjacent Great Valley. A nearly horizontal shear zone accommodated the detachment of the ultramafic root from its granitoid batholith. With continuing flow into the mantle drip, viscous drag at the base of the remaining ~35-km-thick crust has thickened the crust by ~7 km in a narrow welt beneath the western flank of the range. Adjacent to the welt and at the top of the drip, a V-shaped cone of crust is being dragged down tens of kilometres into the core of the mantle drip, causing the disappearance of the Moho in the seismic images. Viscous coupling between the crust and mantle is therefore apparently driving present-day surface subsidence

Building a collaborative culture in cardiothoracic operating rooms: Pre and postintervention study protocol for evaluation of the implementation of teamSTEPPS training and the impact on perceived psychological safety

IntroductionThe importance of effective communication, a key component of teamwork, is well recognised in the healthcare setting. Establishing a culture that encourages and empowers team members to speak openly in the cardiothoracic (CT) operating room (OR) is necessary to improve patient safety in this high-risk environment.Methods and analysisThis study will take place at Barnes-Jewish Hospital, an academic hospital in affiliation with Washington University School of Medicine located in the USA. All team members participating in cardiac and thoracic OR cases during this 17-month study period will be identified by the primary surgical staff attending on the OR schedule.TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety) training course will be taught to all CT OR staff. Before TeamSTEPPS training, staff will respond to a 39-item questionnaire that includes constructs from the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture, Edmondson’s ‘Measure of psychological safety’ questionnaire, and questionnaires on turnover intentions, job satisfaction and ‘burnout’. The questionnaires will be readministered at 6 and 12 months.The primary outcomes to be assessed include the perceived psychological safety of CT OR team members, the overall effect of TeamSTEPPS on burnout and job satisfaction, and observed turnover rate among the OR nurses. As secondary outcomes, we will be assessing self-reported rates of medical error and near misses in the ORs with a questionnaire at the end of each case.Ethics and disseminationEthics approval is not indicated as this project does not meet the federal definitions of research requiring the oversight of the Institutional Review Board (IRB). Patient health information (PHI) will not be generated during the implementation of this project. Results of the trial will be made accessible to the public when published in a peer-reviewed journal following the completion of the study.</jats:sec

Is resilience relevant to smoking abstinence for Indigenous Australians?

This article is under embargo for 12 months from the date of publication, in accordance with the publisher's policy. This is a pre-copyedited, author-produced PDF of an article accepted for publication in HEALTH PROMOTION INTERNATIONAL following peer review. The version of record [Tsourtos G, Ward P, Lawn S, Winefield A, Hersh D and Coveney J (2014) Is resilience relevant to smoking abstinence for Indigenous Australians? . Health Promotion International 30 (1): pp. 64-76] is available online at: http://heapro.oxfordjournals.org/content/30/1/64The prevalence rate of tobacco smoking remains high for Australian Indigenous people despite declining rates in other Australian populations. Given many Indigenous Australians continue to experience a range of social and economic structural problems, stress could be a significant contributing factor to preventing smoking abstinence. The reasons why some Indigenous people have remained resilient to stressful adverse conditions, and not rely on smoking to cope as a consequence, may provide important insights and lessons for health promotion policy and practice. In-depth interviews were employed to collect oral histories from 31 Indigenous adults who live in metropolitan Adelaide. Participants were recruited according to smoking status (non-smokers were compared to current smokers to gain a greater depth of understanding of how some participants have abstained from smoking). Perceived levels of stress were associated with encouraging smoking behaviour. Many participants reported having different stresses compared to non-Indigenous Australians, with some participants reporting having additional stressors such as constantly experiencing racism. Resilience often occurred when participants reported drawing upon internal psychological assets such as being motivated to quit and where external social support was available. These findings are discussed in relation to a recently developed psycho-social interactive model of resilience, and how this resilience model can be improved regarding the historical and cultural context of Indigenous Australians’ experience of smoking

Shear wave velocities in the Pampean flat-slab region from Rayleigh wave tomography: Implications for slab and upper mantle hydration

The Pampean flat-slab region, located in central Argentina and Chile between 29° and 34°S, is considered a modern analog for Laramide flat-slab subduction within western North America. Regionally, flat-slab subduction is characterized by the Nazca slab descending to ∼100 km depth, flattening out for ∼300 km laterally before resuming a more “normal” angle of subduction. Flat-slab subduction correlates spatially with the track of the Juan Fernandez Ridge, and is associated with the inboard migration of deformation and the cessation of volcanism within the region. To better understand flat-slab subduction we combine ambient-noise tomography and earthquake-generated surface wave measurements to calculate a regional 3D shear velocity model for the region. Shear wave velocity variations largely relate to changes in lithology within the crust, with basins and bedrock exposures clearly defined as low- and high-velocity regions, respectively. We argue that subduction-related hydration plays a significant role in controlling shear wave velocities within the upper mantle. In the southern part of the study area, where normal-angle subduction is occurring, the slab is visible as a high-velocity body with a low-velocity mantle wedge above it, extending eastward from the active arc. Where flat-slab subduction is occurring, slab velocities increase to the east while velocities in the overlying lithosphere decrease, consistent with the slab dewatering and gradually hydrating the overlying mantle. The hydration of the slab may be contributing to the excess buoyancy of the subducting oceanic lithosphere, helping to drive flat-slab subduction

Heme metabolism genes Downregulated in COPD Cachexia.

IntroductionCachexia contributes to increased mortality and reduced quality of life in Chronic Obstructive Pulmonary Disease (COPD) and may be associated with underlying gene expression changes. Our goal was to identify differential gene expression signatures associated with COPD cachexia in current and former smokers.MethodsWe analyzed whole-blood gene expression data from participants with COPD in a discovery cohort (COPDGene, N = 400) and assessed replication (ECLIPSE, N = 114). To approximate the consensus definition using available criteria, cachexia was defined as weight-loss &gt; 5% in the past 12 months or low body mass index (BMI) (&lt; 20 kg/m2) and 1/3 criteria: decreased muscle strength (six-minute walk distance &lt; 350 m), anemia (hemoglobin &lt; 12 g/dl), and low fat-free mass index (FFMI) (&lt; 15 kg/m2 among women and &lt; 17 kg/m2 among men) in COPDGene. In ECLIPSE, cachexia was defined as weight-loss &gt; 5% in the past 12 months or low BMI and 3/5 criteria: decreased muscle strength, anorexia, abnormal biochemistry (anemia or high c-reactive protein (&gt; 5 mg/l)), fatigue, and low FFMI. Differential gene expression was assessed between cachectic and non-cachectic subjects, adjusting for age, sex, white blood cell counts, and technical covariates. Gene set enrichment analysis was performed using MSigDB.ResultsThe prevalence of COPD cachexia was 13.7% in COPDGene and 7.9% in ECLIPSE. Fourteen genes were differentially downregulated in cachectic versus non-cachectic COPD patients in COPDGene (FDR &lt; 0.05) and ECLIPSE (FDR &lt; 0.05).DiscussionSeveral replicated genes regulating heme metabolism were downregulated among participants with COPD cachexia. Impaired heme biosynthesis may contribute to cachexia development through free-iron buildup and oxidative tissue damage

Paired inspiratory-expiratory chest CT scans to assess for small airways disease in COPD

Background: Gas trapping quantified on chest CT scans has been proposed as a surrogate for small airway disease in COPD. We sought to determine if measurements using paired inspiratory and expiratory CT scans may be better able to separate gas trapping due to emphysema from gas trapping due to small airway disease. Methods: Smokers with and without COPD from the COPDGene Study underwent inspiratory and expiratory chest CT scans. Emphysema was quantified by the percent of lung with attenuation < −950HU on inspiratory CT. Four gas trapping measures were defined: (1) Exp−856, the percent of lung < −856HU on expiratory imaging; (2) E/I MLA, the ratio of expiratory to inspiratory mean lung attenuation; (3) RVC856-950, the difference between expiratory and inspiratory lung volumes with attenuation between −856 and −950 HU; and (4) Residuals from the regression of Exp−856 on percent emphysema. Results: In 8517 subjects with complete data, Exp−856 was highly correlated with emphysema. The measures based on paired inspiratory and expiratory CT scans were less strongly correlated with emphysema. Exp−856, E/I MLA and RVC856-950 were predictive of spirometry, exercise capacity and quality of life in all subjects and in subjects without emphysema. In subjects with severe emphysema, E/I MLA and RVC856-950 showed the highest correlations with clinical variables. Conclusions: Quantitative measures based on paired inspiratory and expiratory chest CT scans can be used as markers of small airway disease in smokers with and without COPD, but this will require that future studies acquire both inspiratory and expiratory CT scans

Paired inspiratory-expiratory chest CT scans to assess for small airways disease in COPD

Abstract Background Gas trapping quantified on chest CT scans has been proposed as a surrogate for small airway disease in COPD. We sought to determine if measurements using paired inspiratory and expiratory CT scans may be better able to separate gas trapping due to emphysema from gas trapping due to small airway disease. Methods Smokers with and without COPD from the COPDGene Study underwent inspiratory and expiratory chest CT scans. Emphysema was quantified by the percent of lung with attenuation < −950HU on inspiratory CT. Four gas trapping measures were defined: (1) Exp−856, the percent of lung < −856HU on expiratory imaging; (2) E/I MLA, the ratio of expiratory to inspiratory mean lung attenuation; (3) RVC856-950, the difference between expiratory and inspiratory lung volumes with attenuation between −856 and −950 HU; and (4) Residuals from the regression of Exp−856 on percent emphysema. Results In 8517 subjects with complete data, Exp−856 was highly correlated with emphysema. The measures based on paired inspiratory and expiratory CT scans were less strongly correlated with emphysema. Exp−856, E/I MLA and RVC856-950 were predictive of spirometry, exercise capacity and quality of life in all subjects and in subjects without emphysema. In subjects with severe emphysema, E/I MLA and RVC856-950 showed the highest correlations with clinical variables. Conclusions Quantitative measures based on paired inspiratory and expiratory chest CT scans can be used as markers of small airway disease in smokers with and without COPD, but this will require that future studies acquire both inspiratory and expiratory CT scans.http://deepblue.lib.umich.edu/bitstream/2027.42/134586/1/12931_2012_Article_1346.pd

Unusually deep earthquakes in the central Sierra Nevada (California, USA): Foundering ultramafic lithosphere?

Using a network of temporarily deployed broadband seismometers, we characterize an unusual region of crustal earthquakes in the west-central Sierra Nevada, California (USA). We locate 131 earthquakes, which occurred from 3.1 to 47.1 km deep during June 2005 to May 2006. We detect more events, at greater depths, than are present in the Northern California Seismic Network catalog during this period. Most of the events occur at depths of 20&ndash;35 km and cluster into two distinct groups. In addition, some of the events appear to be repeating due to the similarity of their waveforms and locations. We calculate focal mechanisms for 52 of these events, and about half exhibit reverse faulting, which represents a state of horizontal compressional stress that is distinct from the regional stress field. From first arrivals, we calculate a one-dimensional model of crustal P-wavespeeds, which resolves a gradational increase from 5.8 km/s near the surface to 6.7 km/s at 35 km depth. The events overlie a significant variation in the character of the Moho, and two long-period events occur near the seismically imaged Moho at nearly 40 km depth. We suggest that these earthquakes could be the seismogenic response of the crust to active foundering of mafic-ultramafic lithosphere and resultant asthenospheric upwelling beneath the central Sierra Nevada. </div