Preventing Isolated Perioperative Reintubation: Who is at highest risk?

Objectives: 1. We aim to characterize IPR nationally through a retrospective review of the National Surgical Quality Improvement Program participant user file (NSQIP PUF). 2.Identify risk factors for IPR including analysis of procedure type and preoperative characteristics.https://jdc.jefferson.edu/patientsafetyposters/1041/thumbnail.jp

Adding Fish Oil to Whey Protein, Leucine and Carbohydrate Over a 6 Week Supplementation Period Attenuates Muscle Soreness Following Eccentric Exercise in Competitive Soccer Players

Soccer players often experience eccentric exercise-induced muscle damage given the physical demands of soccer match-play. Since long chain n-3 polyunsaturated fatty acids (n-3PUFA) enhance muscle sensitivity to protein supplementation, dietary supplementation with a combination of fish oil-derived n-3PUFA, protein, and carbohydrate may promote exercise recovery. This study examined the influence of adding n-3PUFA to a whey protein, leucine, and carbohydrate containing beverage over a six-week supplementation period on physiological markers of recovery measured over three days following eccentric exercise. Competitive soccer players were assigned to one of three conditions (2 × 200 mL): a fish oil supplement beverage (FO; n = 10) that contained n-3PUFA (1100 mg DHA/EPA - approximately 550 mg DHA, 550 mg EPA), whey protein (15 g), leucine (1.8 g), and carbohydrate (20 g); a protein supplement beverage (PRO; n = 10) that contained whey protein (15 g), leucine (1.8 g), and carbohydrate (20 g); and a carbohydrate supplement beverage (CHO; n = 10) that contained carbohydrate (24 g). Eccentric exercise consisted of unilateral knee extension/flexion contractions on both legs separately. Maximal force production was impaired by 22% during the 72-hour recovery period following eccentric exercise (p < 0.05). Muscle soreness, expressed as area under the curve (AUC) during 72-hour recovery, was less in FO (1948 ± 1091 mm × 72 h) than PRO (4640 ± 2654 mm × 72 h, p < 4 0.05) and CHO (4495 ± 1853 mm × 72 h, p = 0.10). Blood concentrations of creatine kinase, expressed as AUC, were ~60% lower in FO compared to CHO (p < 0.05) and tended to be lower (~39%, p = 0.07) than PRO. No differences in muscle function, soccer performance, or blood c-reactive protein concentrations were observed between groups. In conclusion, the addition of n-3PUFA to a beverage containing whey protein, leucine, and carbohydrate ameliorates the increase in muscle soreness and blood concentrations of creatine kinase following eccentric exercise in competitive soccer players

Probing the Optical Dynamics of Quantum Emitters in Hexagonal Boron Nitride

Hexagonal boron nitride is a van der Waals material that hosts visible-wavelength quantum emitters at room temperature. However, experimental identification of the quantum emitters' electronic structure is lacking, and key details of their charge and spin properties remain unknown. Here, we probe the optical dynamics of quantum emitters in hexagonal boron nitride using photon emission correlation spectroscopy. Several quantum emitters exhibit ideal single-photon emission with noise-limited photon antibunching, $g^{(2)}(0)=0$. The photoluminescence emission lineshapes are consistent with individual vibronic transitions. However, polarization-resolved excitation and emission suggests the role of multiple optical transitions, and photon emission correlation spectroscopy reveals complicated optical dynamics associated with excitation and relaxation through multiple electronic excited states. We compare the experimental results to quantitative optical dynamics simulations, develop electronic structure models that are consistent with the observations, and discuss the results in the context of ab initio theoretical calculations.Comment: 31 pages, 16 figures, 6 table

Comparative effectiveness of treatment options for subacromial shoulder conditions:a systematic review and network meta-analysis

Background: There are currently many treatment options for patients with subacromial shoulder conditions (SSCs). Clinical decision-making regarding the best treatment option is often difficult. This study aims to evaluate the comparative effectiveness of treatment options for relieving pain and improving function in patients with SSCs. Methods: Eight databases [including MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Database of Systematic Reviews and World Health Organization (WHO) International Clinical Trials Registry] were searched from inception until April 2020. Randomised clinical/controlled trials of adult patients investigating the effects of nonsurgical (e.g. corticosteroid injections, therapeutic exercise, shockwave therapy) and surgical treatment for SSCs, compared with each other, placebo, usual care or no treatment, were retrieved. Pairs of reviewers screened studies independently, quality appraised eligible studies using the Cochrane risk of bias tool, extracted and checked data for accuracy. Primary outcomes were pain and disability in the short term (⩽3 months) and long term (⩾6 months). Direct and indirect evidence of treatment effectiveness was synthesised using random-effects network meta-analysis. Results: The review identified 177 eligible trials. Summary estimates (based on 99 trials providing suitable data, 6764 patients, 20 treatment options) showed small to moderate effects for several treatments, but no significant differences on pain or function between many active treatment comparisons. The primary analysis indicated that exercise and laser therapy may provide comparative benefit in terms of both pain and function at different follow-up time-points, with larger effects found for laser in the short term at 2–6 weeks, although direct evidence was provided by one trial only, and for exercise in the longer term [standardised mean difference (SMD) 0.39, 95% confidence interval (CI) 0.18, 0.59 at 3–6 months] compared with control. Sensitivity analyses excluding studies at increased risk of bias confirmed only the comparative effects of exercise as being robust for both pain and function up until 3-month follow-up. Conclusion: Current evidence shows small to moderate effect sizes for most treatment options for SSCs. Six treatments had a high probability of being most effective, in the short term, for pain and function [acupuncture, manual therapy, exercise, exercise plus manual therapy, laser therapy and Microcurrent (MENS) (TENS)], but with low certainty for most treatment options. After accounting for risk of bias, there is evidence of moderate certainty for the comparative effects of exercise on function in patients with SSCs. Future large, high-quality pragmatic randomised trials or meta-analyses are needed to better understand whether specific subgroups of patients respond better to some treatments than others

Research and Education in Computational Science and Engineering

Over the past two decades the field of computational science and engineering (CSE) has penetrated both basic and applied research in academia, industry, and laboratories to advance discovery, optimize systems, support decision-makers, and educate the scientific and engineering workforce. Informed by centuries of theory and experiment, CSE performs computational experiments to answer questions that neither theory nor experiment alone is equipped to answer. CSE provides scientists and engineers of all persuasions with algorithmic inventions and software systems that transcend disciplines and scales. Carried on a wave of digital technology, CSE brings the power of parallelism to bear on troves of data. Mathematics-based advanced computing has become a prevalent means of discovery and innovation in essentially all areas of science, engineering, technology, and society; and the CSE community is at the core of this transformation. However, a combination of disruptive developments---including the architectural complexity of extreme-scale computing, the data revolution that engulfs the planet, and the specialization required to follow the applications to new frontiers---is redefining the scope and reach of the CSE endeavor. This report describes the rapid expansion of CSE and the challenges to sustaining its bold advances. The report also presents strategies and directions for CSE research and education for the next decade.Comment: Major revision, to appear in SIAM Revie

In-the-loop or on-the-loop? Interactional arrangements to support team coordination with a planning agent

In this paper we present the study of interactional arrangements that support the collaboration of headquarters (HQ), field responders and a computational planning agent in a time-critical task setting created by a mixed-reality game. Interactional arrangements define the extent to which control is distributed between the collaborative parties.We provide two field trials, one to study an “on-the-loop” arrangement in which HQ monitors and intervenes in agent instructions to field players on demand, and the other to study a version that places headquarters more tightly “in-the-loop”. The studies provide and understanding of the sociotechnical collaboration between players and the agent in these interactional arrangements, by conducting interaction analysis of video recordings and game log data. The first field trial focuses on the collaboration of field responders with the planning agent. Findings highlight how players negotiate the agent guidance within the social interaction of the collocated teams. The second field trial focuses on the collaboration between the automated planning agent and the headquarters. We find that the human coordinator and the agent can successfully work together in most cases, with human coordinators inspecting and ‘correcting’ the agent-proposed plans. Through this field trial-driven development process, we generalise interaction design implications of automated planning agents around the themes of supporting common ground and mixed-initiative planning

Attribution of disturbance change agent from Landsat time-series in support of habitat monitoring in the Puget Sound region, USA

To understand causes and consequences of landscape change, it is often not enough to simply detect change. Rather, the agent causing the change must also be determined. Here, we describe and test a method of change agent attribution built on four tenets: agents operate on patches rather than pixels; temporal context can provide insight into the agent of change; human interpretation is critical because agent labels are inherently human-defined; and statistical modeling must be flexible and non-parametric. In the Puget Sound, USA, we used LandTrendr Landsat time-series-based algorithms to identify abrupt disturbances, and then applied spatial rules to aggregate these to patches. We then derived a suite of spectral, patch-shape, and landscape position variables for each patch. These were then linked to patch-level training labels determined by interpreters at 1198 training patches, and modeled statistically using the Random Forest machine-learning algorithm. Labeled agents of change included urbanization, forest management, and natural change (largely fire), as well as labels associated with spectral change that was non-informative (false change). The success of the method was evaluated using both out-of-bag (OOB) error and a small, fully-independent validation interpretation dataset. Overall OOB accuracy was above 80%, but most successful in the numerically well-represented forest management class. Validation with the independent data was generally lower than that estimated with the OOB approach, but comparable when either first or second voting scores were used for prediction. Spatial and temporal patterns within the study area followed expectations well, with most urbanization occurring in the lower elevation regions around Seattle–Tacoma, most forest management occurring in mid-slope managed forests, and most natural disturbance occurring in protected areas. Temporal patterns of change agent aggregated to the watershed level suggest substantial year-over-year variability that could be used to examine year-over-year variability in fish species populations.Keywords: Disturbance, Change attribution, Puget Sound, Salmon, LandTrendr, Time series, Change detection, Landsa