Fact-checking of timetabling principles: a case study on the relationship between planned headways and delays

The tradeoff between reliability and level of service is a central focus for railway operators and infrastructure managers. A well-performing timetable must include an optimal level of buffer time between conflicting train movements, such that a high service delivery and a high service quality are maintained. This focus on buffer time has informed the research within the fields of timetable optimization, capacity utilization and delay propagation modeling. Despite recent and ongoing advancements in these fields, there are still disconnects between the theoretical models and their application in the design, planning and evaluation of railway timetabling. Parameters that are used in timetabling, as well as, as input to the analytical assessment models, are typically derived from practical experience and based on the macroscopic limitations of a system, rather than the microscopic conflicts inherent in its signaling system.  The objective of this paper is to support the design of fact-based timetables by introducing a method of applying statistical analysis of the relationship between planned headways and recorded delays to estimate the minimum feasible headway between conflicting train movements in a railway system. This method is applied on the busiest railway line in Denmark and the results from recorded operations are validated through microsimulation.&nbsp

Association of Dietary Intake Patterns with Emotion Regulation

Background: Western dietary patterns, characterized by high intakes of trans fatty acids (TFA’s), are associated with numerous preventable chronic diseases. Conversely, a Mediterranean dietary pattern is known to be favorably associated with health. Recent findings suggest a correlation between Mediterranean dietary patterns and positive affect, and an inverse correlation with negative affect. Trans fatty acid intake is also associated with negative affect. Further, affect disturbances are associated with emotion dysregulation. We have yet to understand the association of diet with emotion regulation after taking affect disturbances into consideration. The purpose of this study was to examine effects of Mediterranean diet adherence and TFA intake on emotion regulation in a sample of 4992 adults. Methods: Existing data was used from Adventist Health Study-II (AHS-2; 2002- 2006), and a sub-study of the AHS-II, the Biopsychosocial Religion and Health Study (BRHS). The BRHS in 2006-2007 measured affect with the Positive and Negative Affect Schedule (PANAS). The Difficulties in Emotion Regulation Scale (DERS) sub-scales for clarity, awareness and regulation strategies were contained in wave two of BRHS from 2010-2011. Multiple linear regression was used to examine associations of a Mediterranean diet score and TFA’s with DERS subscale scores. Negative and positive affect were examined as mediators in the relationship between diet and emotion regulation. Results. Findings revealed an inverse relationship between Mediterranean diet score and difficulty with clarity (p=0.006), and this relationship was mediated by positive and negative affect. Further, intake of TFA’s directly related to difficulties with awareness (p=0.045), clarity (p=0.012) and regulation strategies (p=0.009), and all three relationships were mediated by positive and negative affect. Positive affect was associated with enhanced emotion regulation, and negative affect with difficulties with emotion regulation. Conclusions: Intakes characteristic of a Mediterranean diet and low in TFA appear to have a favorable correlation with emotion regulation via positive and negative affect. Future directions include examining whether affect and emotion regulation form a chain of variables mediating the diet and depression correlation, and developing a randomized control trial to clearly assess the relationship between diet and emotion regulation

Drawing Coagulation Studies from Heparinized Central Lines

A literature review was conducted between the months of September and December 2017 to determine whether using heparinized central lines to draw coagulation studies is best evidence based practice. The purpose was to research the efficacy of using a heparinized central line to draw coagulation studies. This research is for the Abben Cancer Center affiliated with Spencer Hospital in Spencer, Iowa. Ten articles focusing on patients with heparinized lines or discard volume were reviewed. Results showed that heparin primarily has an effect on Activated Partial Thromboplastin Time (aPTT). It was found that using heparinized central lines to draw blood studies could have a positive impact on patient anxiety and comfort levels

Stratified Multilevel Logistic Regression Modeling for Risk Factors of Adolescent Obesity in Tennessee

Background: US adolescent obesity rates have quadrupled over the past 3 decades. Research examining complex factors associatedwith obesity is limited.Objectives: The purpose of this study was to utilize a representative sample of students (grades 6 - 8) in Tennessee to determine theco-occurrence of risk behaviors with adolescent obesity prevalence and to analyze variations by strata. Methods: The 2010 youth risk behavior survey dataset was used to examine associations of obesity with variables related to sampledemographics, risk and protective behaviors, and region. Hierarchical logistic regression analyses stratified by demographics andregion were conducted to evaluate variation in obesity risk occurring on three hierarchical levels: class, school and district. Results: The sample consisted of 60715 subjects. The overall obesity rate was 22%. High prevalence of obesity existed in males, non-white race, those ever smoked and was positively correlated with age. Across three state regions, race, gender, and specific behaviors (smoking, weight misperception, disordered eating, +3 hours TV viewing, and no sports team participation) persisted as significantpredictors of adolescent obesity, although variations by region and demographics were observed. Multilevel analyses indicate that\u3c 1%, 0 - 1.97% and4.03 - 13.06% of the variation in obesity was associated with district, school and class differences, respectively, whenstratifying the sample by demographic characteristics or region. Conclusions: Uniform school-based prevention efforts targeting adolescent obesity risk may have limited impact if they fail torespond to geographical and demographic nuances that hierarchal modeling can detect. Study results reveal that stratified hi-erarchical analytic approaches to examine adolescent obesity risk have tremendous potential to elucidate significant prevention insights

Prophylactic antibiotic regimens in tumour surgery (PARITY): protocol for a multicentre randomised controlled study.

IntroductionLimb salvage with endoprosthetic reconstruction is the standard of care for the management of lower-extremity bone tumours in skeletally mature patients. The risk of deep postoperative infection in these procedures is high and the outcomes can be devastating. The most effective prophylactic antibiotic regimen remains unknown, and current clinical practice is highly varied. This trial will evaluate the effect of varying postoperative prophylactic antibiotic regimens on the incidence of deep infection following surgical excision and endoprosthetic reconstruction of lower-extremity bone tumours.Methods and analysisThis is a multicentre, blinded, randomised controlled trial, using a parallel two-arm design. 920 patients 15 years of age or older from 12 tertiary care centres across Canada and the USA who are undergoing surgical excision and endoprosthetic reconstruction of a primary bone tumour will receive either short (24 h) or long (5 days) duration postoperative antibiotics. Exclusion criteria include prior surgery or infection within the planned operative field, known colonisation with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus at enrolment, or allergy to the study antibiotics. The primary outcome will be rates of deep postoperative infections in each arm. Secondary outcomes will include type and frequency of antibiotic-related adverse events, patient functional outcomes and quality-of-life scores, reoperation and mortality. Randomisation will be blocked, with block sizes known only to the methods centre responsible for randomisation, and stratified by location of tumour and study centre. Patients, care givers and a Central Adjudication Committee will be blinded to treatment allocation. The analysis to compare groups will be performed using Cox regression and log-rank tests to compare survival functions at α=0.05.Ethics and disseminationThis study has ethics approval from the McMaster University/Hamilton Health Sciences Research Ethics Board (REB# 12-009). Successful completion will significantly impact on clinical practice and enhance patients' lives. More broadly, this trial will develop a network of collaboration from which further high-quality trials in Orthopaedic Oncology will follow

Transgender and Gender Diverse Clients’ Experiences in Therapy: Responses to Sociopolitical Events and Helpful and Unhelpful Experiences

We examined transgender and gender-diverse (TGD) people’s reports of their therapy experiences over the course of a year. We explored how participants’ therapists integrated discussions about current events, as well as their more general perspectives on helpful and unhelpful experiences. A total of 107 participants provided data on these questions at least once over 12 months of surveys (M age = 33.79; 70.1% White), reflecting on their current therapy experiences. Through thematic analysis of qualitative data, the following themes were constructed regarding discussing sociopolitical events: (a) facilitating coping via bearing witness to clients’ internal experiences and implementing other therapeutic interventions; (b) moving beyond the individual by integrating identity, systems, or contexts; (c) feeling disconnected and misunderstood. We grouped participants’ helpful experiences into the following themes: (1) availability, connection, and therapeutic approaches facilitate positive experiences; (2) the necessity of knowledge, education, and affirmation of TGD identities; (3) helpful therapy means seeing the world in which clients live. We grouped participants’ unhelpful experiences into the following themes: (1) logistical issues can interfere with therapy; (2) lack of depth and disconnection results in subpar therapy; (3) insufficient understandings of TGD identities results in potentially harmful practices. These findings deepen understandings of how to integrate discussions about current events into therapy and provide competent and affirming care to TGD clients

Novel nesprin-1 mutations associated with dilated cardiomyopathy cause nuclear envelope disruption and defects in myogenesis

Nesprins-1 and -2 are highly expressed in skeletal and cardiac muscle and together with SUN (Sad1p/UNC84)-domain containing proteins and lamin A/C form the LInker of Nucleoskeleton-and-Cytoskeleton (LINC) bridging complex at the nuclear envelope (NE). Mutations in nesprin-1/2 have previously been found in patients with autosomal dominant Emery-Dreifuss muscular dystrophy (EDMD) as well as dilated cardiomyopathy (DCM). In this study, three novel rare variants (R8272Q, S8381C and N8406K) in the C-terminus of the SYNE1 gene (nesprin-1) were identified in seven DCM patients by mutation screening. Expression of these mutants caused nuclear morphology defects and reduced lamin A/C and SUN2 staining at the NE. GST pull-down indicated that nesprin-1/lamin/SUN interactions were disrupted. Nesprin-1 mutations were also associated with augmented activation of the ERK pathway in vitro and in hearts in vivo. During C2C12 muscle cell differentiation, nesprin-1 levels are increased concomitantly with kinesin light chain (KLC-1/2) and immunoprecipitation and GST pull-down showed that these proteins interacted via a recently identified LEWD domain in the C-terminus of nesprin-1. Expression of nesprin-1 mutants in C2C12 cells caused defects in myoblast differentiation and fusion associated with dysregulation of myogenic transcription factors and disruption of the nesprin-1 and KLC-1/2 interaction at the outer nuclear membrane. Expression of nesprin-1α2 WT and mutants in zebrafish embryos caused heart developmental and conduction defects that varied in severity. These findings support a role for nesprin-1 in myogenesis and muscle disease, and uncover a novel mechanism whereby disruption of the LINC complex may contribute to the pathogenesis of DCM