Paging: a Collection of Short Stories

Introduction: Paging is a series of thematically interconnected short stories that take place at a single fictional urban hospital center. The guiding questions that the stories explore are twofold: other than doctors and patients, what kinds of people spend their time in a hospital? And, what kind of place is the hospital for these people? Methods: The background research for Paging began by exploring written works of fiction, nonfiction, and memoir set in hospitals. After I had developed a set of guiding research questions, I spent the summer at a major hospital in New York City, where I was able to observe the people and employees that comprised the environment of an urban medical center. These observations were used draft fiction about the kinds of dilemmas various characters in a hospital might grapple with on a daily basis. Results: Paging is a series of three short stories that explore the lives of three different hospital employees at the same hospital center. The first story is about a medical assistant at an outpatient clinic who encounters an ethical dilemma that brings his personal life to work. The second is about a custodian who gets to know the patients of a hospital in a very different, but equally intimate, manner to the doctors and nurses who take care of the patients’ medical needs. The third is about a woman who assists in the distribution of organs that have been harvested for transplant. Discussion: We often think of the hospital as a place where patients go to seek care from doctors. In reality, the hospital is a far richer environment than this. Paging explores the other inhabitants of a hospital that allow it to be a bustling ecosystem, and offers stories from perspectives that are often overlooked

Stop Requested: A Collection of ALS Poetry

Introduction: This project aims to use poetry to convey the lessons, challenges, and experiences encountered by patients in the Jefferson Weinberg ALS Center diagnosed with Amyotrophic Lateral Sclerosis (ALS). This will not only allow for individual patients to freely discuss, reminisce, and reflect on their journey with this disease, but distributing the collection to our community will aid in a better understanding of ALS patients, serve to humanize ALS, and deepen the empathic beyond between community members and patients. Additionally, it will create an environment in which both myself and physicians can reflect on the human experience and how disease affects a patient holistically. Methods: A questionnaire was drafted and used to guide conversations with patients about their experiences living with ALS. After the interview, the conversation was analyzed for themes and a first draft of a poem inspired by their story was created. Edits were obtained from advisors and peers, and poems were then organized into a final collection, to be printed and distributed to clinic patients and the Jefferson community. Results: This project resulted in a printed collection of poetry titled Stop Requested: A Collection of ALS Poetry. The final product is to be distributed to each patient at the Jefferson Weinberg ALS Center and more broadly to the ALS and Jefferson communities. This collection details intimate accounts of confusion, suffering, fight, hope, and change that ALS patients experience during their disease progression. Discussion: By using poetry to portray the human experience specific to ALS, this collection helps to connect patients to each other, providers to patients, and community members to patients. The experiences outlined in this collection help to build compassion within the medical field and community for those experiencing ALS and offers a unique perspective of the spectrum of suffering, and triumph in neurodegenerative disease

What It’s Like to Study the Brain: A Creative Exploration

Introduction: In recent years, medicine and the humanities have evolved to be adopted synergistically in dual practice. Employing principles of narrative medicine, this multimodal piece explores the experience of hunger to draw parallels between creativity in art and creativity in medicine. By stimulating reading, writing, listening, and seeing, this account aims to represent these faculties as necessary to both art and medicine and to exemplify synergy between the two. Methods: As codified by the field of narrative medicine, methods consisted of a repetitive practice of close reading, writing, and reflecting. In viewing medicine as interconnected provider-patient narrative, scholars of narrative medicine write to contribute to these accounts of “self”. This engages them in healing, intersubjective contact that enhances empathy, self-awareness, and ethical consideration. This project serves a dual function: first, as an account of the enrichment of skills of observation, interpretation, and reflection that result from a purposeful practice of narrative medicine and second, as a platform for engagement for those who wish to develop their own practice. Results: Reflection on the neuroscience and psychology inherent to medical education has yielded six (6) chapters of topical creative writing consisting of short story, prose, and poetry: hunger (1) for knowledge, (2) for meaning, (3) for food, (4) as ambition, (5) as struggle, and (6) for wellness. Each chapter consists of original writing resulting from subjective and objective experience in medicine such as neurosurgical research and patient interaction at needle exchange clinics. Discussion: This project serves as a tangible representation of the multimodality of both art and medicine. It underscores the importance of narrative in the enrichment of empathy within medical practice and enhances accessibility to narrative medicine by inviting active engagement. Further extrapolations would facilitate more opportunities for narrative training based on this project, such as workshops or interactive exhibitions

Vermonters’ Opinions on Low-Dose CT Lung Cancer Screening

Introduction: Lung cancer is the number one cause of cancer death among men and women in Vermont and the United States. Smoking increases the risk of lung cancer—nearly 90% of lung cancer is due to smoking. Frequently, lung cancers do not present clinically until they are advanced stage and therefore prognosis is poor. However, if detected early lung cancers are more operable and patients have better outcomes. In December 2013 the US Preventive Services Task Force released new guidelines for lung cancer screening among current and former smokers ages 55 to 80. It is recommended that current and former (within 15 years of quitting) smokers of 30 pack years receive an annual low-dose CT scan. The objective of this project was to assess the level of knowledge and attitudes towards lung cancer screening with low-dose CT scanning among Vermonters in the Burlington area.https://scholarworks.uvm.edu/comphp_gallery/1205/thumbnail.jp

State-of-the-Art Review and Synthesis: A Requirement-based Roadmap for Standardized Predictive Maintenance Automation Using Digital Twin Technologies

Recent digital advances have popularized predictive maintenance (PMx), offering enhanced efficiency, automation, accuracy, cost savings, and independence in maintenance. Yet, it continues to face numerous limitations such as poor explainability, sample inefficiency of data-driven methods, complexity of physics-based methods, and limited generalizability and scalability of knowledge-based methods. This paper proposes leveraging Digital Twins (DTs) to address these challenges and enable automated PMx adoption at larger scales. While we argue that DTs have this transformative potential, they have not yet reached the level of maturity needed to bridge these gaps in a standardized way. Without a standard definition for such evolution, this transformation lacks a solid foundation upon which to base its development. This paper provides a requirement-based roadmap supporting standardized PMx automation using DT technologies. A systematic approach comprising two primary stages is presented. First, we methodically identify the Informational Requirements (IRs) and Functional Requirements (FRs) for PMx, which serve as a foundation from which any unified framework must emerge. Our approach to defining and using IRs and FRs to form the backbone of any PMx DT is supported by the track record of IRs and FRs being successfully used as blueprints in other areas, such as for product development within the software industry. Second, we conduct a thorough literature review spanning fields to determine the ways in which these IRs and FRs are currently being used within DTs, enabling us to point to the specific areas where further research is warranted to support the progress and maturation of requirement-based PMx DTs.Comment: (1)This work has been submitted to the IEEE for possible publication. Copyright may be transferred without notice, after which this version may no longer be accessibl

Repression of the Glucocorticoid Receptor Aggravates Acute Ischemic Brain Injuries in Adult Mice.

Strokes are one of the leading causes of mortality and chronic morbidity in the world, yet with only limited successful interventions available at present. Our previous studies revealed the potential role of the glucocorticoid receptor (GR) in the pathogenesis of neonatal hypoxic-ischemic encephalopathy (HIE). In the present study, we investigate the effect of GR knockdown on acute ischemic brain injuries in a model of focal cerebral ischemia induced by middle cerebral artery occlusion (MCAO) in adult male CD1 mice. GR siRNAs and the negative control were administered via intracerebroventricular (i.c.v.) injection 48 h prior to MCAO. The cerebral infarction volume and neurobehavioral deficits were determined 48 h after MCAO. RT-qPCR was employed to assess the inflammation-related gene expression profiles in the brain before and after MCAO. Western Blotting was used to evaluate the expression levels of GR, the mineralocorticoid receptor (MR) and the brain-derived neurotrophic factor/tropomyosin receptor kinase B (BDNF/TrkB) signaling. The siRNAs treatment decreased GR, but not MR, protein expression, and significantly enhanced expression levels of pro-inflammatory cytokines (IL-6, IL-1β, and TNF-α) in the brain. Of interest, GR knockdown suppressed BDNF/TrkB signaling in adult mice brains. Importantly, GR siRNA pretreatment significantly increased the infarction size and exacerbated the neurobehavioral deficits induced by MCAO in comparison to the control group. Thus, the present study demonstrates the important role of GR in the regulation of the inflammatory responses and neurotrophic BDNF/TrkB signaling pathway in acute ischemic brain injuries in adult mice, revealing a new insight into the pathogenesis and therapeutic potential in acute ischemic strokes

Assessing the Sensitivity of Different Life Stages for Sexual Disruption in Roach (Rutilus rutilus) Exposed to Effluents from Wastewater Treatment Works

Surveys of U.K. rivers have shown a high incidence of sexual disruption in populations of wild roach (Rutilus rutilus) living downstream from wastewater treatment works (WwTW), and the degree of intersex (gonads containing both male and female structural characteristics) has been correlated with the concentration of effluent in those rivers. In this study, we investigated feminized responses to two estrogenic WwTWs in roach exposed for periods during life stages of germ cell division (early life and the postspawning period). Roach were exposed as embryos from fertilization up to 300 days posthatch (dph; to include the period of gonadal sex differentiation) or as postspawning adult males, and including fish that had received previous estrogen exposure, for either 60 or 120 days when the annual event of germ cell proliferation occurs. Both effluents induced vitellogenin synthesis in both life stages studied, and the magnitude of the vitellogenic responses paralleled the effluent content of steroid estrogens. Feminization of the reproductive ducts occurred in male fish in a concentration-dependent manner when the exposure occurred during early life, but we found no effects on the reproductive ducts in adult males. Depuration studies (maintenance of fish in clean water after exposure to WwTW effluent) confirmed that the feminization of the reproductive duct was permanent. We found no evidence of ovotestis development in fish that had no previous estrogen exposure for any of the treatments. In wild adult roach that had previously received exposure to estrogen and were intersex, the degree of intersex increased during the study period, but this was not related to the immediate effluent exposure, suggesting a previously determined programming of ovotestis formation

Unraveling the Multi-Scale Solar Wind Structure Between Lagrange 1-point, Lunar Orbit and Earth’s Bow Shock: Better Space Weather Prediction Through Information Theory

The space weather effects at the Earth’s magnetosphere are mostly driven by the solar wind that carries the Interplanetary Magnetic Field (IMF). The incoming solar wind properties at L1 are typically used for developing various space weather forecasts. In this presentation we use several years of data in the solar wind from lunar orbiting ARTEMIS spacecraft and MMS upstream Earth’s bow shock to study the multi-scale structure of the IMF as determined by the Wavelet analysis. We determine the lag times between different scales and their dependence on 1) solar wind plasma properties and 2) spacecraft positions. Many solar wind parameters are correlated and anticorrelated with one another. We test the concept of conditional mutual information to isolate the effect of a single parameter and the dependence of various solar wind parameters on the time lags to provide the best/worse correlations between different scales. This will aid in isolating solar wind conditions when single point measurements of the IMF at Lagrange 1 point will likely lead to compromised space weather prediction accuracy