The Effect of Printed Educational Material from the Coroner in Victoria, Australia, on Changing Aged Care Health Professional Practice: A Subscriber Survey

There are substantial knowledge and research gaps about the effects of printed educational material on professional practice. This study has examined whether the Residential Aged Care Coronial (RACC) Communiqué, an electronic newsletter of narrative case reports about lessons learned from deaths in residential aged care settings reported to the coroner in Victoria, Australia, prompted subscribers to initiate change in professional practice to improve care. An anonymous electronic survey was distributed to all registered subscribers of the RACC Communiqué to collect information about self-reported changes in professional practice, respondent characteristics, reading behavior, and an assessment of effect and content of the publication. Researchers from the Victoria Institute of Forensic Medicine, Victoria, Australia, conducted the study in 2008. Of 778 subscribers invited to participate in the study, 426 (54.8%) provided valid responses. The majority of respondents were aged 45 and older, female, and working at a residential aged care facility in a management role. Half of the survey respondents reported making a change to their professional practice as a result of reading the RACC Communiqué, with one-fifth of these respondents agreeing that they would not have made the self-reported change if they had not read this publication. These findings are greater than the previously reported small effects of education through printed education material and make an important contribution to understanding the use of printed education material for initiating professional practice change.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/79369/1/j.1532-5415.2010.02742.x.pd

JMFit : A SAS Macro for Joint Models of Longitudinal and Survival Data

Joint models for longitudinal and survival data now have a long history of being used in clinical trials or other studies in which the goal is to assess a treatment effect while accounting for a longitudinal biomarker such as patient-reported outcomes or immune responses. Although software has been developed for fitting the joint model, no software packages are currently available for simultaneously fitting the joint model and assessing the fit of the longitudinal component and the survival component of the model separately as well as the contribution of the longitudinal data to the fit of the survival model. To fulfill this need, we develop a SAS macro, called JMFit. JMFit implements a variety of popular joint models and provides several model assessment measures including the decomposition of AIC and BIC as well as ΔAIC and ΔBIC recently developed in Zhang et al. (2014). Examples with real and simulated data are provided to illustrate the use of JMFit

Motion artifacts in kidney stone imaging using single-source and dual-source dual-energy CT scanners: a phantom study

PURPOSE: Dual-energy computed tomography (DECT) has shown the capability of differentiating uric acid (UA) from non-UA stones with 90-100% accuracy. With the invention of dual-source (DS) scanners, both low- and high-energy images are acquired simultaneously. However, DECT can also be performed by sequential acquisition of both images on single-source (SS) scanners. The objective of this study is to investigate the effects of motion artifacts on stone classification using both SS-DECT and DS-DECT. METHODS: 114 kidney stones of different types and sizes were imaged on both DS-DECT and SS-DECT scanners with tube voltages of 80 and 140 kVp with and without induced motion. Postprocessing was conducted to create material-specific images from corresponding low- and high-energy images. The dual-energy ratio (DER) and stone material were determined and compared among different scans. RESULTS: For the motionless scans, all stones were correctly classified with SS-DECT, while two cystine stones were misclassified with DS-DECT. When motion was induced, 94% of the stones were misclassified with SS-DECT versus 11% with DS-DECT (P < 0.0001). Stone size was not a factor in stone misclassification under motion. Stone type was not a factor in stone misclassification under motion with SS-DECT, although with DS-DECT, cystine showed higher number of stone misclassification. CONCLUSIONS: Motion artifacts could result in stone misclassification in DECT. This effect is more pronounced in SS-DECT versus DS-DECT, especially if stones of different types lie in close proximity to each other. Further, possible misinterpretation of the number of stones (i.e., missing one, or thinking that there are two) in DS-DECT could be a potentially significant problem

A Class of Eccentric Binaries with Dynamic Tidal Distortions Discovered with Kepler

We have discovered a class of eccentric binary systems within the Kepler data archive that have dynamic tidal distortions and tidally-induced pulsations. Each has a uniquely shaped light curve that is characterized by periodic brightening or variability at time scales of 4-20 days, frequently accompanied by shorter period oscillations. We can explain the dominant features of the entire class with orbitally-varying tidal forces that occur in close, eccentric binary systems. The large variety of light curve shapes arises from viewing systems at different angles. This hypothesis is supported by spectroscopic radial velocity measurements for five systems, each showing evidence of being in an eccentric binary system. Prior to the discovery of these 17 new systems, only four stars, where KOI-54 is the best example, were known to have evidence of these dynamic tides and tidally-induced oscillations. We perform preliminary fits to the light curves and radial velocity data, present the overall properties of this class and discuss the work required to accurately model these systems.Comment: 13 pages, submitted to Ap

INK4/ARF Transcript Expression Is Associated with Chromosome 9p21 Variants Linked to Atherosclerosis

Genome-wide association studies (GWAS) have linked common single nucleotide polymorphisms (SNPs) on chromosome 9p21 near the INK4/ARF (CDKN2A/B) tumor suppressor locus with risk of atherosclerotic diseases and type 2 diabetes mellitus. To explore the mechanism of this association, we investigated whether expression of proximate transcripts (p16(INK4a), p15(INK4b), ARF, ANRIL and MTAP) correlate with genotype of representative 9p21 SNPs.We analyzed expression of 9p21 transcripts in purified peripheral blood T-cells (PBTL) from 170 healthy donors. Samples were genotyped for six selected disease-related SNPs spanning the INK4/ARF locus. Correlations among these variables were determined by univariate and multivariate analysis. Significantly reduced expression of all INK4/ARF transcripts (p15(INK4b), p16(INK4a), ARF and ANRIL) was found in PBTL of individuals harboring a common SNP (rs10757278) associated with increased risk of coronary artery disease, stroke and aortic aneurysm. Expression of MTAP was not influenced by rs10757278 genotype. No association of any these transcripts was noted with five other tested 9p21 SNPs.Genotypes of rs10757278 linked to increased risk of atherosclerotic diseases are also associated with decreased expression in PBTL of the INK4/ARF locus, which encodes three related anti-proliferative transcripts of known importance in tumor suppression and aging

An exploratory study on the value of service learning projects and their impact on community service involvement and critical thinking

Purpose - This exploratory study attempts to capture some of the principal benefits/factors attributable to service learning/community service projects, from a student perspective. Design/methodology/approach - A sample of 67 males and 83 females (16 graduate, 71 seniors, and 63 juniors) participated in the study. Findings - Students believe that their college experience is preparing them for the job market, that critical thinking has been enhanced, and that their college academic experience has emphasized community service upon graduation. Practical implications - The results increase one's knowledge of the benefits of service learning since so much emphasis is currently being placed on improving the critical thinking and problem-solving ability of undergraduate business students. Originality/value - Practitioners would be interested in understanding the impact that service learning can have on the problem-solving ability of potential employees. If additional research could advance the proposition that students with service learning experience are generally superior in terms of their problem-solving skills to students with no similar experience, then evidence of a service learning component on a student résumeé suddenly adds value to the employer

Detection of different kidney stone types: an ex vivo comparison of ultrashort echo time MRI to reference standard CT

BACKGROUND AND PURPOSE: With the development of ultrashort echo time (UTE) sequences, it may now be possible to detect kidney stones by using magnetic resonance imaging (MRI). In this study, kidney stones of varying composition and sizes were imaged using both UTE MRI as well as the reference standard of computed tomography (CT), with different surrounding materials and scan setups. METHODS: One hundred and fourteen kidney stones were inserted into agarose and urine phantoms and imaged both on a dual-energy CT (DECT) scanner using a standard renal stone imaging protocol and on an MRI scanner using the UTE sequence with both head and body surface coils. A subset of the stones representing all composition types and sizes was then inserted into the collecting system of porcine kidneys and imaged in vitro with both CT and MRI. RESULTS: All of the stones were visible on both CT and MRI imaging. DECT was capable of differentiating between uric acid and nonuric acid stones. In MRI imaging, the choice of coil and large field of view (FOV) did not affect stone detection or image quality. The MRI images showed good visualization of the stones' shapes, and the stones' dimensions measured from MRI were in good agreement with the actual values (R(2)=0.886, 0.895, and 0.81 in the agarose phantom, urine phantom, and pig kidneys, respectively). The measured T2 relaxation times ranged from 4.2 to 7.5ms, but did not show significant differences among different stone composition types. CONCLUSIONS: UTE MRI compared favorably with the reference standard CT for imaging stones of different composition types and sizes using body surface coil and large FOV, which suggests potential usefulness of UTE MRI in imaging kidney stones in vivo

Widespread exposure to Crimean-Congo haemorrhagic fever in Uganda might be driven by transmission from Rhipicephalus ticks: evidence from cross-sectional and modelling studies

BACKGROUND: Crimean-Congo haemorrhagic fever (CCHF) is a widespread tick-borne viral infection, present across Africa and Eurasia, which might pose a cryptic public health problem in Uganda. We aimed to understand the magnitude and distribution of CCHF risk in humans, livestock and ticks across Uganda by synthesising epidemiological (cross-sectional) and ecological (modelling) studies. METHODS: We conducted a cross-sectional study at three urban abattoirs receiving cattle from across Uganda. We sampled humans (n=478), livestock (n=419) and ticks (n=1065) and used commercially-available kits to detect human and livestock CCHF virus (CCHFV) antibodies and antigen in tick pools. We developed boosted regression tree models to evaluate the correlates and geographical distribution of expected tick and wildlife hosts, and of human CCHF exposures, drawing on continent-wide data. FINDINGS: The cross-sectional study found CCHFV IgG/IgM seroprevalence in humans of 10·3% (7·8-13·3), with antibody detection positively associated with reported history of tick bite (age-adjusted odds ratio=2·09 (1·09-3·98)). Cattle had a seroprevalence of 69·7% (65·1-73·4). Only one Hyalomma tick (CCHFV-negative) was found. However, CCHFV antigen was detected in Rhipicephalus (5·9% of 304 pools) and Amblyomma (2·9% of 34 pools) species. Modelling predicted high human CCHF risk across much of Uganda, low environmental suitability for Hyalomma, and high suitability for Rhipicephalus and Amblyomma. INTERPRETATION: Our epidemiological and ecological studies provide complementary evidence that CCHF exposure risk is widespread across Uganda. We challenge the idea that Hyalomma ticks are consistently the principal reservoir and vector for CCHFV, and postulate that Rhipicephalus might be important for CCHFV transmission in Uganda, due to high frequency of infected ticks and predicted environmental suitability. FUNDING: UCL Global Challenges Research Fund (GCRF) and Pan-African Network on Emerging and Re-Emerging Infections (PANDORA-ID-NET) funded by the European and Developing Countries Clinical Trials Partnership (EDCTP) under the EU Horizon 2020 Framework Programme for Research and Innovation

Differential expression analysis with global network adjustment

&lt;p&gt;Background: Large-scale chromosomal deletions or other non-specific perturbations of the transcriptome can alter the expression of hundreds or thousands of genes, and it is of biological interest to understand which genes are most profoundly affected. We present a method for predicting a gene’s expression as a function of other genes thereby accounting for the effect of transcriptional regulation that confounds the identification of genes differentially expressed relative to a regulatory network. The challenge in constructing such models is that the number of possible regulator transcripts within a global network is on the order of thousands, and the number of biological samples is typically on the order of 10. Nevertheless, there are large gene expression databases that can be used to construct networks that could be helpful in modeling transcriptional regulation in smaller experiments.&lt;/p&gt; &lt;p&gt;Results: We demonstrate a type of penalized regression model that can be estimated from large gene expression databases, and then applied to smaller experiments. The ridge parameter is selected by minimizing the cross-validation error of the predictions in the independent out-sample. This tends to increase the model stability and leads to a much greater degree of parameter shrinkage, but the resulting biased estimation is mitigated by a second round of regression. Nevertheless, the proposed computationally efficient “over-shrinkage” method outperforms previously used LASSO-based techniques. In two independent datasets, we find that the median proportion of explained variability in expression is approximately 25%, and this results in a substantial increase in the signal-to-noise ratio allowing more powerful inferences on differential gene expression leading to biologically intuitive findings. We also show that a large proportion of gene dependencies are conditional on the biological state, which would be impossible with standard differential expression methods.&lt;/p&gt; &lt;p&gt;Conclusions: By adjusting for the effects of the global network on individual genes, both the sensitivity and reliability of differential expression measures are greatly improved.&lt;/p&gt

Sudden natural death behind the wheel: Review of driver deaths and fitness to drive assessment history in Victoria, Australia 2012–2013

© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:http://creativecommons.org/licenses/by-nc-nd/4.0/ This author accepted manuscript is made available following 12 month embargo from date of publication (February 2019) in accordance with the publisher’s archiving policyThis study reviews the circumstances and medical causes of death of motor vehicle drivers who died in circumstances of sudden illness whilst behind the wheel in Victoria, Australia 2012-13. The driver's fitness to drive assessment history was also examined to identify prevention opportunities. Deaths included in the study were those referred to a panel responsible for determining whether the driver fatality should be included in the official road toll, where prior doubt exists. A research team comprising of forensic physicians examined the case file of each death involving sudden illness. Forty-five driver deaths during the two-year period were reviewed. Ischaemic heart disease was the most common cause of death. Over 80% of drivers were male with a median age of 64 years. While limited medical history was available, significantly impacting study analysis, findings identified minimal opportunity to improve the fitness to drive review process