First Profunda Artery Perforator Flap for Breast Reconstruction Performed at a VA Hospital

The profunda artery perforator (PAP) flap for breast reconstruction originated by Dr. Robert J. Allen in 2010 after multiple failed attempts at using muscle-sparing transverse rectus abdominal muscle (MS-TRAM) flap and implants. This flap method was initially approached due to the patient’s request for an autologous tissue graft that did not sacrifice muscle. The PAP flap has grown significantly in popularity and usage in breast reconstruction and makes up to about 16% of autologous breast reconstruction, coming second to DIEP flaps (76%). This well-tolerated, muscle-sparing approach is ideal for patients without sufficient abdominal fat (low BMI or previous abdominal liposuction) or those who prefer a non-abdominal donor site. In addition to its gained popularity for breast reconstruction, the PAP flap has also been utilized in defects reconstruction over the entire body such as the head and neck, lower extremities, vulva, and tongue. This is a sophisticated procedure and has never been performed at a VA hospital before this case

Molecular excitation in the Interstellar Medium: recent advances in collisional, radiative and chemical processes

We review the different excitation processes in the interstellar mediumComment: Accepted in Chem. Re

Computer-based technology and student engagement: a critical review of the literature

Computer-based technology has infiltrated many aspects of life and industry, yet there is little understanding of how it can be used to promote student engagement, a concept receiving strong attention in higher education due to its association with a number of positive academic outcomes. The purpose of this article is to present a critical review of the literature from the past 5 years related to how web-conferencing software, blogs, wikis, social networking sites (Facebook and Twitter), and digital games influence student engagement. We prefaced the findings with a substantive overview of student engagement definitions and indicators, which revealed three types of engagement (behavioral, emotional, and cognitive) that informed how we classified articles. Our findings suggest that digital games provide the most far-reaching influence across different types of student engagement, followed by web-conferencing and Facebook. Findings regarding wikis, blogs, and Twitter are less conclusive and significantly limited in number of studies conducted within the past 5 years. Overall, the findings provide preliminary support that computer-based technology influences student engagement, however, additional research is needed to confirm and build on these findings. We conclude the article by providing a list of recommendations for practice, with the intent of increasing understanding of how computer-based technology may be purposefully implemented to achieve the greatest gains in student engagement. © 2017, The Author(s)

Effects of Anacetrapib in Patients with Atherosclerotic Vascular Disease

BACKGROUND: Patients with atherosclerotic vascular disease remain at high risk for cardiovascular events despite effective statin-based treatment of low-density lipoprotein (LDL) cholesterol levels. The inhibition of cholesteryl ester transfer protein (CETP) by anacetrapib reduces LDL cholesterol levels and increases high-density lipoprotein (HDL) cholesterol levels. However, trials of other CETP inhibitors have shown neutral or adverse effects on cardiovascular outcomes. METHODS: We conducted a randomized, double-blind, placebo-controlled trial involving 30,449 adults with atherosclerotic vascular disease who were receiving intensive atorvastatin therapy and who had a mean LDL cholesterol level of 61 mg per deciliter (1.58 mmol per liter), a mean non-HDL cholesterol level of 92 mg per deciliter (2.38 mmol per liter), and a mean HDL cholesterol level of 40 mg per deciliter (1.03 mmol per liter). The patients were assigned to receive either 100 mg of anacetrapib once daily (15,225 patients) or matching placebo (15,224 patients). The primary outcome was the first major coronary event, a composite of coronary death, myocardial infarction, or coronary revascularization. RESULTS: During the median follow-up period of 4.1 years, the primary outcome occurred in significantly fewer patients in the anacetrapib group than in the placebo group (1640 of 15,225 patients [10.8%] vs. 1803 of 15,224 patients [11.8%]; rate ratio, 0.91; 95% confidence interval, 0.85 to 0.97; P=0.004). The relative difference in risk was similar across multiple prespecified subgroups. At the trial midpoint, the mean level of HDL cholesterol was higher by 43 mg per deciliter (1.12 mmol per liter) in the anacetrapib group than in the placebo group (a relative difference of 104%), and the mean level of non-HDL cholesterol was lower by 17 mg per deciliter (0.44 mmol per liter), a relative difference of -18%. There were no significant between-group differences in the risk of death, cancer, or other serious adverse events. CONCLUSIONS: Among patients with atherosclerotic vascular disease who were receiving intensive statin therapy, the use of anacetrapib resulted in a lower incidence of major coronary events than the use of placebo. (Funded by Merck and others; Current Controlled Trials number, ISRCTN48678192 ; ClinicalTrials.gov number, NCT01252953 ; and EudraCT number, 2010-023467-18 .)

Essays on Convex Weighting for Global Vector Autoregressive Models

This dissertation focuses on studying the impact that weighting schemes can have on forecasting performance and dynamic analysis in global vector autoregressive (GVAR) models. The first chapter discusses an existing gap in the literature regarding weighting scheme choice and develops a simple, yet powerful method for defining richer spatial linkages in a way that doesn’t sacrifice economic context. The new technique called convex weighting, extends the set of available options for defining spatial linkages in models that handle the curse of dimensionality via compression and offers a justifiable approach to alleviating uncertainty. The second and third chapters apply the newly developed convex weighting method to regional and international level models to show that improvements in forecasting performance are possible and that inferences drawn from dynamic analysis can be highly sensitive to the underlying weighting scheme