Alton Ochsner, MD (1896-1981): surgical pioneer and legacy linking smoking and disease.

Edward William Alton Ochsner kept a plain, metal card file in which he recorded close to 50 years worth of medical experiences, research, and insights. The most populated topics were filed as Cancer, Lung and Cancer, Bronchogenic. These reflected his areas of greatest interest, for which he would go on to produce groundbreaking work. Of his many lifetime accomplishments, he is perhaps best known for being the first to report a link between cigarette smoking and lung cancer. This was just one of the many ways in which Ochsner worked to effect social change. The establishment of the Ochsner Health System in New Orleans was born from this similar passion. Ochsner went on to become one of the giants of his generation as a result of this tireless work as a leader, educator, and mentor

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

John H. Gibbon, Jr., M.D.: surgical innovator, pioneer, and inspiration.

Throughout history there have been many discoveries that have changed the world, including Albert Einstein’s theory of relativity, Alexander Graham Bell’s telephone, and Jack Kilby and Robert Noyce’s microchip. There are a few analogous contributions that have been made in medicine: Sir Alexander’s discovery of penicillin, Lister’s principles of antiseptic technique, Salk and Sabin’s vaccines for polio, as well as numerous others. These innovative thinkers all had two factors in common. First, they were pioneers who faced problems that had no solutions at the time and who refused to accept the status quo in the face of great scrutiny and resistance. Second, their contributions would forever change the world. In 1930, a profound experience with a patient would forever change Dr. John H. Gibbon, Jr. and stimulate an idea to create a device that at the time sounded audacious and impossible. His device would temporarily take the role of both the heart and lungs to make repairs inside the heart or the great vessels. Twentythree years later, Dr. Gibbon used his machine to perform the first successful bypass-assisted open heart surgery

Patient Attitudes Toward a Physician Led Radiology Review: Improved Understanding of Medical Conditions and a Potential New Quality Metric

Objectives: We were interested in understanding patient perspectives regarding the importance of reviewing their imaging studies with a surgeon. Specific Aims: 1. What value do patients place on viewing their imaging? 2. Do patients have a better understanding of their disease and planned operation after a surgeon led review of imaging studies? 3. Do patients find viewing images an accessible educational tool?https://jdc.jefferson.edu/patientsafetyposters/1022/thumbnail.jp

Scalable Bayesian Non-Negative Tensor Factorization for Massive Count Data

We present a Bayesian non-negative tensor factorization model for count-valued tensor data, and develop scalable inference algorithms (both batch and online) for dealing with massive tensors. Our generative model can handle overdispersed counts as well as infer the rank of the decomposition. Moreover, leveraging a reparameterization of the Poisson distribution as a multinomial facilitates conjugacy in the model and enables simple and efficient Gibbs sampling and variational Bayes (VB) inference updates, with a computational cost that only depends on the number of nonzeros in the tensor. The model also provides a nice interpretability for the factors; in our model, each factor corresponds to a "topic". We develop a set of online inference algorithms that allow further scaling up the model to massive tensors, for which batch inference methods may be infeasible. We apply our framework on diverse real-world applications, such as \emph{multiway} topic modeling on a scientific publications database, analyzing a political science data set, and analyzing a massive household transactions data set.Comment: ECML PKDD 201

Modeling ice-ocean interaction in ice-shelf crevasses

Ocean freezing within ice-shelf basal crevasses could potentially act as a stabilizing influence on ice shelves; however, ice-ocean interaction and ocean dynamics within these crevasses are as yet poorly understood. To this end, an idealized 2-D model of an ice-shelf basal crevasse has been developed using Fluidity, a finite-element ocean model using an unstructured mesh. A simple model of frazil ice formation and deposition has been incorporated into Fluidity to better represent the freezing process. Model results show two different flow regimes, dependent on the amount of freezing in the crevasse: one driven by freezing at the top of the crevasse and the other by the ingress of meltwater from outside the crevasse. In the first, freezing at the top of the crevasse leads to the formation of an unstable overturning circulation due to the rejection of dense, salty water. In the second, a buoyant layer is formed along the sides and roof of the crevasse, stratifying the water column. Frazil ice precipitation is found to be the dominant freezing process at the top of the basal crevasse in the freeze-driven case, with direct freezing being dominant in the melt-driven case. In both cases, melting occurs lower down on the walls of the crevasse due to the strong overturning circulation. The freezing in ice-shelf crevasses and rifts is found to be highly dependent upon ocean temperature, providing a stabilizing influence on ice shelves underlain by cold waters that is not present elsewhere

Bronchoscopic lung volume reduction with endobronchial valves for patients with heterogeneous emphysema and intact interlobar fissures (the BeLieVeR-HIFi study): a randomised controlled trial

Background Lung volume reduction surgery improves survival in selected patients with emphysema, and has generated interest in bronchoscopic approaches that might achieve the same effect with less morbidity and mortality. Previous trials with endobronchial valves have yielded modest group benefits because when collateral ventilation is present it prevents lobar atelectasis. Methods We did a single-centre, double-blind sham-controlled trial in patients with both heterogeneous emphysema and a target lobe with intact interlobar fissures on CT of the thorax. We enrolled stable outpatients with chronic obstructive pulmonary disease who had a forced expiratory volume in 1 s (FEV1) of less than 50% predicted, significant hyperinflation (total lung capacity >100% and residual volume >150%), a restricted exercise capacity (6 min walking distance <450 m), and substantial breathlessness (MRC dyspnoea score ≥3). Participants were randomised (1:1) by computer-generated sequence to receive either valves placed to achieve unilateral lobar occlusion (bronchoscopic lung volume reduction) or a bronchoscopy with sham valve placement (control). Patients and researchers were masked to treatment allocation. The study was powered to detect a 15% improvement in the primary endpoint, the FEV1 3 months after the procedure. Analysis was on an intention-to-treat basis. The trial is registered at controlled-trials.com, ISRCTN04761234. Findings 50 patients (62% male, FEV1 [% predicted] mean 31·7% [SD 10·2]) were enrolled to receive valves (n=25) or sham valve placement (control, n=25) between March 1, 2012, and Sept 30, 2013. In the bronchoscopic lung volume reduction group, FEV1 increased by a median 8·77% (IQR 2·27–35·85) versus 2·88% (0–8·51) in the control group (Mann-Whitney p=0·0326). There were two deaths in the bronchoscopic lung volume reduction group and one control patient was unable to attend for follow-up assessment because of a prolonged pneumothorax. Interpretation Unilateral lobar occlusion with endobronchial valves in patients with heterogeneous emphysema and intact interlobar fissures produces significant improvements in lung function. There is a risk of significant complications and further trials are needed that compare valve placement with lung volume reduction surgery

The Public Health Approach to Human Trafficking Prevention

Sex and labor trafficking of adults and children are global public health issues that demand a public health approach to eradication. Rigorous scientific research is needed to create an evidence base that drives multi-sector collaborative prevention efforts addressing trafficking at all levels of the socioecological model. Programs need to be evaluated carefully and modified accordingly, then scaled up to disseminate critical information to the large body of people at risk of exploitation. Legal professionals have an important role to play in combatting human trafficking by educating themselves, their colleagues and clients, and the public, as well as advocating for legislative and policy changes to prevent trafficking and protect exploited persons. Working with clients at a high risk of exploitation and with businesses at risk for enabling or directly supporting labor trafficking, the legal practitioner can directly and indirectly change the lives of vulnerable persons in their own communities and throughout the world

Validation of non-REM sleep stage decoding from resting state fMRI using linear support vector machines

A growing body of literature suggests that changes in consciousness are reflected in specific connectivity patterns of the brain as obtained from resting state fMRI (rs-fMRI). As simultaneous electroencephalography (EEG) is often unavailable, decoding of potentially confounding sleep patterns from rs-fMRI itself might be useful and improve data interpretation. Linear support vector machine classifiers were trained on combined rs-fMRI/EEG recordings from 25 subjects to separate wakefulness (S0) from non-rapid eye movement (NREM) sleep stages 1 (S1), 2 (S2), slow wave sleep (SW) and all three sleep stages combined (SX). Classifier performance was quantified by a leave-one-subject-out cross-validation (LOSO-CV) and on an independent validation dataset comprising 19 subjects. Results demonstrated excellent performance with areas under the receiver operating characteristics curve (AUCs) close to 1.0 for the discrimination of sleep from wakefulness (S0|SX), S0|S1, S0|S2 and S0|SW, and good to excellent performance for the classification between sleep stages (S1|S2:~0.9; S1|SW:~1.0; S2|SW:~0.8). Application windows of fMRI data from about 70 s were found as minimum to provide reliable classifications. Discrimination patterns pointed to subcortical-cortical connectivity and within-occipital lobe reorganization of connectivity as strongest carriers of discriminative information. In conclusion, we report that functional connectivity analysis allows valid classification of NREM sleep stages