The effect of infusion rate titration on taxane-related hypersensitivity

The purpose of this project is to determine if an initial three-step, gradual infusion rate titration provided with first and second lifetime exposure taxane infusions reduces the occurrence and severity of immediate hypersensitivity reactions

Using iPhones to Enhance and Reduce Face-to-Face Home Safety Sessions

Innovative handheld technologies are changing the possibilities for delivering public health interventions. The present research describes a preliminary examination of the effects of iPhone™ both as an assessment tool for data collection and as an enhancement to an in-home child safety intervention. Three families with children under age seven were trained to use an iPhone to video targeted rooms in their homes following SafeCare® safety module intervention implementation during which rooms were secured for accessible safety and health hazards. The iPhone was used to communicate feedback, logistical information, and clarification of safety content. The effectiveness of iPhone and iPhone video was examined using a multiple baseline design across settings replicated across families. All rooms across subjects demonstrated significant decreases in home hazards. Face-to-face (F2F), in-home time of the home visitor was progressively reduced and replaced by video data collection over the course of the intervention. These data suggest that handheld technology tools are a promising means of data collection for in situ safety interventions and for augmenting interaction during intervention. Implications of these findings for reducing costs of F2F intervention as high-quality handheld video capabilities become increasingly ubiquitous and for engaging and retaining participants are discussed

An Analysis of the Hurricane Insurance Markets in the Southeastern United States

As hurricanes are some of the most devastating natural catastrophes in the United States, property insurance for coastal home and business owners is a consistently evolving market. The southeast, specifically the Gulf of Mexico region, is where most hurricanes are concentrated and has accumulated a large amount of losses over the past few decades. After Hurricane Katrina struck in 2005, less private insurers have offered windstorm coverage for coastal property owners and the state wind pools have increased their amounts of risk exposure. This thesis analyzes the use of wind pools in the Gulf of Mexico, specifically Mississippi, and other residual market tools to offer windstorm and flooding coverage for policyholders who aren’t able to find coverage in the private market. It offers suggestions for improvement of the residual markets and for increased participation by the private insurance market. Coastal insurers have difficulty in charging rates that reflect the true cost of risk of a hurricane occurring due to rate regulation. The NFIP also has similar issues of paying out more in claims than it makes in premium, leaving it with an annual underwriting loss. The state wind pools also tend to operate at underwriting losses. depending on the state and the program’s structure. They also spread the hurricane risk throughout the state to policyholders that aren’t affected by windstorms or flood. To diffuse these problems, this thesis offers three solutions. First would be to create a regional wind pool that would operate in the five Gulf of Mexico states: Alabama, Mississippi, Florida, Louisiana and Texas. There should also be a federal government agency created to oversee and operate this wind pool. Secondly, the flood 111 and windstorm markets should be merged to reduce wind versus water litigation. This would involve reform of the current NFIP. Third, risk mitigation standards should be structured through the government agency and transparent to policyholders. These changes could improve coverage for policyholders and motivate more insurers to enter the hurricane insurance market. I

Development of a decision aid for unaffected BRCA mutation carriers

Purpose: Deleterious BRCA mutations confer high risks for developing breast and ovarian cancer (Chen & Parmigiani, 2007; Mavaddat, et al., 2013). For healthy women, diagnosis of a mutation is associated with emotional trauma, fear, and a sense of urgency to make health protective decisions. Cancer risk management decision making support needs are exigent and ongoing throughout the decision making process. Women depict the process as a life journey (Jabaley Leonarczyk & Mawn, 2015). Priorities are survival, reducing the risk for cancer development, and maximizing quality of life (Stan et al., 2013). Making decisions necessitates a complex analysis of clinical variables, individual characteristics, and personal preferences. As emerging research elucidates the issues affecting cancer risk management decision making for BRCA+ women, guidelines evolve. Despite the rapid evolution of knowledge, evidence clearly supports risk management intervention. Primary health care providers, particularly those practicing in rural areas, lack resources for this population. Care may be fragmented, and specialists often view BRCA+ women through the lens of their specialty, neglecting the comprehensive approach needed (Jabaley Leonarczyk & Mawn, 2015). Current decision support resources have various limitations. Clinical guidelines available online are not amenable to general population use, requiring a post graduate reading comprehension level and specialized knowledge in genomics and medicine (NCCN, 2016; Petrucelli, Daly, & Feldman, 2013; Schackmann, Munoz, Mills, Plevritis, & Kurian, 2013). In many studies, samples include both affected and unaffected mutation carriers, making it difficult to differentiate issues unique to each of these populations (Culver, et al., 2012; Llort, et al., 2015). Some resources do not address all options available to unaffected carriers (Metcalfe et al., 2007), and others exclude psychosocial issues impacting the decisional process (Petrucelli, Daly, & Feldman, 2013; Schackmann, Munoz, Mills, Plevritis, & Kurian, 2013). The purpose of this study was to develop an evidence-based, comprehensive decision aid for women who are unaffected BRCA mutation carriers. Specific aims were to develop an aid based on decisional theory; consistent with internationally accepted clinical guidelines; at a reading level suitable for general population use; and to conduct an analysis of the aid. Methods: The Ottawa Decision Support Framework (O Connor, 2006) guided the development of the decision aid. According to the method recommended by Coulter, et al. (2013), the decision aid was developed by a steering committee and evaluated by twenty-two participants; seven experts and fifteen end users. Experts were genetic counselors and advanced practice nurses specializing in cancer genomics. End users were unaffected BRCA mutation carriers, recruited from the Facing our Risk of Cancer Empowered (FORCE), a support group for those with hereditary breast and ovarian cancer syndrome (HBOC). Quantitative and qualitative data were collected by survey. Results: Expert reviewers were genetic counselors specializing in genetic cancer risk and advanced practice nurses specializing in cancer genomics. All were women. End user participants were all Caucasian women; all reported some level of college education; fifty percent reported a BRCA1 and fifty percent reported a BRCA2 mutation. The mean age of participants was 48.5 years; with an age range of 33-62. The mean time since receiving a positive BRCA mutation testing result was 5.2 years, with a range of 1-13 years. Results of the BRCA Decision Aid evaluation by expert reviewers revealed mean scores of 3.8 or higher on a four point likert scale from poor to excellent for organization, clarity, usefulness, comprehensiveness, and ease of understanding; and a mean score of 4.0 on a four point likert scale from not relevant to highly relevant for all sections of the decision aid. Results of the BRCA Decision Aid evaluation by end user reviewers revealed mean scores of 3.44 or higher on a four point likert scale from poor to excellent for organization, clarity, usefulness, comprehensiveness, and ease of understanding; and mean scores of 3.43 or higher on a four point likert scale from not relevant to highly relevant for all sections of the decision aid. Qualitative data indicated an increase in knowledge among end users reviewing the aid and the acute need for the tool in clinical practice among both experts and end users. Conclusions: Quantitative findings from this study suggest that the decision aid is well-organized, clear, comprehensive, and highly relevant to the cancer risk management decision making experience of unaffected BRCA+ women. Qualitative findings suggest that the decision aid is needed in practice and that it increases knowledge among end users. Through use of the decision aid with patients, nurses have a means of improving the quality and integration of care for unaffected BRCA+ women by guiding and coaching, clarifying values, and monitoring and facilitating progress in the cancer risk management decision making process. The aid prompts consideration of the unique values, characteristics and preferences of each BRCA+ woman and supports active collaboration of all members of the interdisciplinary team caring for unaffected mutation carriers

Intraneural stimulation elicits discrimination of textural features by artificial fingertip in intact and amputee humans.

Restoration of touch after hand amputation is a desirable feature of ideal prostheses. Here, we show that texture discrimination can be artificially provided in human subjects by implementing a neuromorphic real-time mechano-neuro-transduction (MNT), which emulates to some extent the firing dynamics of SA1 cutaneous afferents. The MNT process was used to modulate the temporal pattern of electrical spikes delivered to the human median nerve via percutaneous microstimulation in four intact subjects and via implanted intrafascicular stimulation in one transradial amputee. Both approaches allowed the subjects to reliably discriminate spatial coarseness of surfaces as confirmed also by a hybrid neural model of the median nerve. Moreover, MNT-evoked EEG activity showed physiologically plausible responses that were superimposable in time and topography to the ones elicited by a natural mechanical tactile stimulation. These findings can open up novel opportunities for sensory restoration in the next generation of neuro-prosthetic hands

Cell surface differences within the genus Methanosarcina shape interactions with the extracellular environment

Methanosarcina are metabolically versatile methanogenic archaea that can perform extracellular electron transfer (EET), with important ecological and biotechnological implications. These archaea are broadly classified into two types (Type I and Type II) based on their energy metabolism and also differ in their aggregation-disaggregation behavior, cell surface properties, and electron transfer strategies. Type I Methanosarcina typically form large multicellular aggregates within a methanochondroitin extracellular matrix, thrive in organic-rich environments, play a key role in anaerobic digestion during wastewater treatment, and can perform EET. However, their mechanism of EET remains unresolved. In contrast, Type II Methanosarcina rely on multiheme c-type cytochromes for EET and are better adapted to low-organic, mineral-rich environments such as deep-sea sediments and aquifers, where they contribute to methane emissions. Despite their significance, the molecular mechanisms behind EET in Methanosarcina—particularly for Type I—remain poorly understood. This review highlights what is known and what is unknown regarding the surface biology of Methanosarcina, their EET strategies, and biogeochemical and industrial roles, emphasizing the need for further research to unlock their full potential in sustainable methane management

Impact of COVID-19 response on global surgical volumes:an ongoing observational study

Objective: To determine whether location-linked anaesthesiology calculator mobile application (app) data can serve as a qualitative proxy for global surgical case volumes and therefore monitor the impact of the coronavirus disease 2019 (COVID-19) pandemic. Methods: We collected data provided by users of the mobile app "Anesthesiologist" during 1 October 2018-30 June 2020. We analysed these using RStudio and generated 7-day moving-average app use plots. We calculated country-level reductions in app use as a percentage of baseline. We obtained data on COVID-19 case counts from the European Centre for Disease Prevention and Control. We plotted changing app use and COVID-19 case counts for several countries and regions. Findings: A total of 100 099 app users within 214 countries and territories provided data. We observed that app use was reduced during holidays, weekends and at night, correlating with expected fluctuations in surgical volume. We observed that the onset of the pandemic prompted substantial reductions in app use. We noted strong cross-correlation between COVID-19 case count and reductions in app use in low- and middle-income countries, but not in high-income countries. Of the 112 countries and territories with non-zero app use during baseline and during the pandemic, we calculated a median reduction in app use to 73.6% of baseline. Conclusion: App data provide a proxy for surgical case volumes, and can therefore be used as a real-time monitor of the impact of COVID-19 on surgical capacity. We have created a dashboard for ongoing visualization of these data, allowing policy-makers to direct resources to areas of greatest need

Evaluation of General Large Language Models in Contextually Assessing Semantic Concepts Extracted from Adult Critical Care Electronic Health Record Notes

The field of healthcare has increasingly turned its focus towards Large Language Models (LLMs) due to their remarkable performance. However, their performance in actual clinical applications has been underexplored. Traditional evaluations based on question-answering tasks don't fully capture the nuanced contexts. This gap highlights the need for more in-depth and practical assessments of LLMs in real-world healthcare settings. Objective: We sought to evaluate the performance of LLMs in the complex clinical context of adult critical care medicine using systematic and comprehensible analytic methods, including clinician annotation and adjudication. Methods: We investigated the performance of three general LLMs in understanding and processing real-world clinical notes. Concepts from 150 clinical notes were identified by MetaMap and then labeled by 9 clinicians. Each LLM's proficiency was evaluated by identifying the temporality and negation of these concepts using different prompts for an in-depth analysis. Results: GPT-4 showed overall superior performance compared to other LLMs. In contrast, both GPT-3.5 and text-davinci-003 exhibit enhanced performance when the appropriate prompting strategies are employed. The GPT family models have demonstrated considerable efficiency, evidenced by their cost-effectiveness and time-saving capabilities. Conclusion: A comprehensive qualitative performance evaluation framework for LLMs is developed and operationalized. This framework goes beyond singular performance aspects. With expert annotations, this methodology not only validates LLMs' capabilities in processing complex medical data but also establishes a benchmark for future LLM evaluations across specialized domains