The Danger of Apathy: College Students\u27 Receipt of Mumps Vaccine During an Outbreak

A mumps outbreak occurred on the James Madison University campus in Harrisonburg, Virginia, during the Spring 2018 semester. For many of the students, it was probably the first time they had to decide on their own whether or not to receive a vaccine. This study examined the relationships between students’ general vaccine acceptance; measles, mumps, and rubella (MMR) vaccine acceptance; vaccine knowledge; and intent to receive/receipt of the MMR booster. An explanatory, cross-sectional study was distributed in Fall 2019 to students in two health courses (n = 243). For students who were enrolled during the Spring 2018 semester, the surveys evaluated perceptions and behaviors regarding the MMR vaccine; for those not enrolled in Spring 2018, the survey evaluated perceptions of a hypothetical outbreak. As a whole, the surveyed population had a positive attitude towards vaccines, and 97.4% (n = 149) of participants responding to the hypothetical scenario said they would receive a booster shot if recommended when presented the opportunity. Still, attitude alone is not enough to persuade an individual to receive a vaccine. Only 39.7% (n = 33) of the participants enrolled in Spring 2018 elected to receive the MMR vaccine, while 60.3% (n = 52) did not receive the vaccine, with the most popular reason being lack of time. The results indicate more efforts are needed to increase the perceived importance of vaccinations and perceived susceptibility to the consequences of not getting vaccinated

Investigating the Effectiveness of Prehospital Recognition and Administration of Intravenous Antibiotics in Septic Patients

Objective: To compare the 30-day mortality rate of suspected sepsis patients who received prehospital (Emergency Medical Services- EMS) antibiotic administration in an ambulance as compared to antibiotic administration in the hospital. Design: Systematic literature review. Methods: Research was conducted in PubMed and Google Scholar with the search terms: sepsis, antibiotics, prehospital, EMS, ambulance. The 3 articles selected were chosen after removing articles not from a randomized control trial, no antibiotic administration, and not a free article. Results: From our meta-analysis of the three studies, we concluded that providing antibiotics before arriving at the hospital for patients with suspected septic infections. The Alam et al study demonstrated that there was no reduction in mortality when comparing prehospital administration of intravenous antibiotics to those who received their antibiotics in-hospital. Jones et al also showed no improvement in mortality rates in the treatment group but did find a statistically significant reduction in the 3-month readmission rate among the treatment group. In the third study, Chamberlain concluded that prehospital administration of intravenous antibiotics does in fact reduce 28- day mortality but correlating mortality with mean intensive-care unit (ICU) length of stay. Conclusion: 30-day mortality is not improved with early antibiotic administration in septic patients

An Asymptotic Analysis of Space Charge Layers in a Mathematical Model of a Solid Electrolyte

We review a model for a solid electrolyte derived under thermodynamics principles. We non-dimensionalise and scale the model to identify small parameters, where we identify a scaling that controls the width of the space-charge layer in the electrolyte. We present asymptotic analyses and numerical solutions for the one dimensional zero charge flux equilibrium problem. We introduce an auxiliary variable to remove singularities from the domain in order to facilitate robust numerical simulations. From the asymptotics we identify three distinct regions: the bulk, boundary layers, and intermediate layers. The boundary and intermediate layers form the space charge layer of the solid electrolyte, which we can further distinguish as strong and weak space-charge-layers respectively. The weak space-charge-layer is characterised by a length, $\lambda$, which is equivalent to the Debye length of a standard liquid electrolyte. The strong space-charge-layer is characterised by a scaled Debye length, which is larger than $\lambda$. We find that both layers exhibit distinct behaviour, we see quadratic behaviour in the strong space-charge-layer and exponential behaviour in the weak space-charge-layer. We find that matching between these two asymptotic regimes is not standard and we implement a pseudo-matching approach to facilitate the transition between the quadratic and exponential behaviours. We demonstrate excellent agreement between asymptotics and simulation.Comment: 24 pages plus 14 page supplementary materials, 19 figures total (counting subfigures) Submitted to SIAM Journal on Applied Mathematic

A systematic review of treating recurrent head and neck cancer: a reintroduction of brachytherapy with or without surgery.

Purpose: To review brachytherapy use in recurrent head and neck carcinoma (RHNC) with focus on its efficacy and complication rates. Material and methods: A literature search of PubMed, Ovid, Google Scholar, and Scopus was conducted from 1990 to 2017. Publications describing treatment of RHNC with brachytherapy with or without surgery were included. The focus of this review is on oncologic outcomes and the safety of brachytherapy in the recurrent setting. Results: Thirty studies involving RHNC treatment with brachytherapy were reviewed. Brachytherapy as adjunctive treatment to surgical resection appears to be associated with an improved local regional control and overall survival, when compared with the published rates for re-irradiation utilizing external beam radiotherapy (RT) or brachytherapy alone. Safety data remains variable with different isotopes and dose rates with implantable brachytherapy demonstrating a tolerable side effect profile. Conclusions: Although surgery remains a mainstay treatment for RHNC, intraoperative interstitial brachytherapy delivery as adjunctive therapy may improve the treatment outcome and may be associated with fewer complication rates as compared to reirradiation using external beam radiotherapy. Further investigations are required to elucidate the role of brachytherapy for RHNC

Democratizing Artificial Intelligence Imaging Analysis With Automated Machine Learning: Tutorial

Deep learning–based clinical imaging analysis underlies diagnostic artificial intelligence (AI) models, which can match or even exceed the performance of clinical experts, having the potential to revolutionize clinical practice. A wide variety of automated machine learning (autoML) platforms lower the technical barrier to entry to deep learning, extending AI capabilities to clinicians with limited technical expertise, and even autonomous foundation models such as multimodal large language models. Here, we provide a technical overview of autoML with descriptions of how autoML may be applied in education, research, and clinical practice. Each stage of the process of conducting an autoML project is outlined, with an emphasis on ethical and technical best practices. Specifically, data acquisition, data partitioning, model training, model validation, analysis, and model deployment are considered. The strengths and limitations of available code-free, code-minimal, and code-intensive autoML platforms are considered. AutoML has great potential to democratize AI in medicine, improving AI literacy by enabling “hands-on” education. AutoML may serve as a useful adjunct in research by facilitating rapid testing and benchmarking before significant computational resources are committed. AutoML may also be applied in clinical contexts, provided regulatory requirements are met. The abstraction by autoML of arduous aspects of AI engineering promotes prioritization of data set curation, supporting the transition from conventional model-driven approaches to data-centric development. To fulfill its potential, clinicians must be educated on how to apply these technologies ethically, rigorously, and effectively; this tutorial represents a comprehensive summary of relevant considerations

Extracellular Matrix Dynamics in Hepatocarcinogenesis: a Comparative Proteomics Study of PDGFC Transgenic and Pten Null Mouse Models

We are reporting qualitative and quantitative changes of the extracellular matrix (ECM) and associated receptor proteomes, occurring during the transition from liver fibrosis and steatohepatitis to hepatocellular carcinoma (HCC). We compared two mouse models relevant to human HCC: PDGFC transgenic (Tg) and Pten null mice, models of disease progression from fibrosis and steatohepatitis to HCC. Using mass spectrometry, we identified in the liver of both models proteins for 26 collagen-encoding genes, providing the first evidence of expression at the protein level for 16 collagens. We also identified post-transcriptional protein variants for six collagens and lysine hydroxylation modifications for 14 collagens. Tumor-associated collagen proteomes were similar in both models with increased expression of collagens type IV, VI, VII, X, XIV, XV, XVI, and XVIII. Splice variants for Col4a2, Col6a2, Col6a3 were co-upregulated while only the short form of Col18a1 increased in the tumors. We also identified tumor specific increases of nidogen 1, decorin, perlecan, and of six laminin subunits. The changes in these non-collagenous ECM proteins were similar in both models with the exception of laminin β3, detected specifically in the Pten null tumors. Pdgfa and Pdgfc mRNA expression was increased in the Pten null liver, a possible mechanism for the similarity in ECM composition observed in the tumors of both models. In contrast and besides the strong up-regulation of integrin α5 protein observed in the liver tumors of both models, the expression of the six other integrins identified was specific to each model, with integrins α2b, α3, α6, and β1 up-regulated in Pten null tumors and integrins α8 and β5 up-regulated in the PDGFC Tg tumors. In conclusion, HCC–associated ECM proteins and ECM–integrin networks, common or specific to HCC subtypes, were identified, providing a unique foundation to using ECM composition for HCC classification, diagnosis, prevention, or treatment

The powers in PowerPoint: Embedded authorities, documentary tastes, and institutional (second) orders in corporate Korea

Microsoft PowerPoint is both the bane and banality of contemporary South Korean office work. Corporate workers spend countless hours refining and crafting plans, proposals, and reports in PowerPoint that often lead to conflicts with coworkers and overtime work. This article theorizes the excessive attention to documents in modern office contexts. Where scholars have been under the impression that institutional documents align with institutional purposes, I describe a context in which making documents for individual purposes and making them for work exist under a basic tension. Based on fieldwork in corporate Korea between 2013 and 2015, I describe how Korean office workers calibrate documents to the tastes of superiors who populate the managerial chain. These practices leave little trace of real "work" on paper, but they are productive for navigating complex internal labor markets and demonstrating a higher order value of attention toward others. These findings suggest that institutional and individual authorities are not competing projects inside organizations but become entangled in increasingly complex participatory encounters, even as they are channeled through a seemingly simple software like PowerPoint. [documents, expertise, authority, technology, South Korea

Inequality in Europe: What can be done? What should be done?

As economic inequality in Europe has continued to rise, it has become the subject of increasing academic attention. What are the drivers of inequality? How does it affect intergenerational economic and social mobility? At what point does inequality become a drag on economic growth or a threat to social order? What economic policy tools are available to reduce inequality? This Forum addresses these and other aspects of this complex and disturbing trend. Case studies of Ireland, Germany and Spain also highlight the impact of economic inequality on individual member states

New genetic loci implicated in fasting glucose homeostasis and their impact on type 2 diabetes risk.

Levels of circulating glucose are tightly regulated. To identify new loci influencing glycemic traits, we performed meta-analyses of 21 genome-wide association studies informative for fasting glucose, fasting insulin and indices of beta-cell function (HOMA-B) and insulin resistance (HOMA-IR) in up to 46,186 nondiabetic participants. Follow-up of 25 loci in up to 76,558 additional subjects identified 16 loci associated with fasting glucose and HOMA-B and two loci associated with fasting insulin and HOMA-IR. These include nine loci newly associated with fasting glucose (in or near ADCY5, MADD, ADRA2A, CRY2, FADS1, GLIS3, SLC2A2, PROX1 and C2CD4B) and one influencing fasting insulin and HOMA-IR (near IGF1). We also demonstrated association of ADCY5, PROX1, GCK, GCKR and DGKB-TMEM195 with type 2 diabetes. Within these loci, likely biological candidate genes influence signal transduction, cell proliferation, development, glucose-sensing and circadian regulation. Our results demonstrate that genetic studies of glycemic traits can identify type 2 diabetes risk loci, as well as loci containing gene variants that are associated with a modest elevation in glucose levels but are not associated with overt diabetes