Emergency Medical Treatment Statute: A Federal How to on Avoiding Mandatory Arbitration of Medical Malpractice Claims - Brooks v. Maryland Hospital, Inc., The

To combat the explosion of medical malpractice claims, some states have made arbitration a mandatory prerequisite to filing medical malpractice suits. These states hope that mandatory arbitration will decrease the number of claims and lessen the impact of medical malpractice suits. The federal government has created an obstacle to this effort in the form of the emergency medical treatment statute. This federal statute regulates emergency room care, but courts have been hesitant to call it a medical malpractice statute. As a result of the ambiguity in the federal statute, claimants are able to avoid state-mandated arbitration, thereby circumventing the goals of reducing the number of claims and lessening their impact. This problem is illustrated in the case of Brooks v. Maryland General Hospital, Inc.2 This Note addresses the problem and offers solutions

A Certified Trust Region Reduced Basis Approach to PDE-Constrained Optimization

Parameter optimization problems constrained by partial differential equations (PDEs) appear in many science and engineering applications. Solving these optimization problems may require a prohibitively large number of computationally expensive PDE solves, especially if the dimension of the design space is large. It is therefore advantageous to replace expensive high-dimensional PDE solvers (e.g., finite element) with lower-dimensional surrogate models. In this paper, the reduced basis (RB) model reduction method is used in conjunction with a trust region optimization framework to accelerate PDE-constrained parameter optimization. Novel a posteriori error bounds on the RB cost and cost gradient for quadratic cost functionals (e.g., least squares) are presented and used to guarantee convergence to the optimum of the high-fidelity model. The proposed certified RB trust region approach uses high-fidelity solves to update the RB model only if the approximation is no longer sufficiently accurate, reducing the number of full-fidelity solves required. We consider problems governed by elliptic and parabolic PDEs and present numerical results for a thermal fin model problem in which we are able to reduce the number of full solves necessary for the optimization by up to 86%. Key words: model reduction, optimization, trust region methods, partial differential equations, reduced basis methods, error bounds, parametrized systemsFulbright U.S. Student ProgramNational Science Foundation (U.S.). Graduate Research Fellowship ProgramHertz FoundationUnited States. Department of Energy. Office of Advanced Scientific Computing Research (Award DEFG02-08ER2585)United States. Department of Energy. Office of Advanced Scientific Computing Research (Award DE-SC0009297

#5 - Identifying cellular mechano-biological responses to PEG-based hydrogels

Cells sense and respond to mechanical stimuli from their external environment through a process called mechanotransduction. Focal adhesions are integrin-containing, multiprotein structures through which mechanical force is transmitted between the extracellular matrix and the interacting cell. Cells convert the transmitted force into biological responses including migration, proliferation and differentiation. The Garcia lab has previously engineered an integrin-specific hydrogel system resulting in changes in mesenchymal stem cell (MSC) gene expression, secretome, and ultimately regenerative capacity in a murine bone repair model. However, the mechano-biological mechanism driving this cell response to varying hydrogel biophysical and biochemical properties has yet to be studied. Here we have developed relationships between various hydrogel properties and cellular responses (cell adhesion, YAP localization, cell area, and cell shape). We engineered PEG-based hydrogel systems with two different polymerization chemistries, malemide and norbornene, to explore the effect of hydrogel chemistry on MSC cell adhesion and spreading. Using rheology, we demonstrated that hydrogel mechanical properties can be tuned by altering the weight percent of PEG macromer, while adhesion ligand type and density had no effect on hydrogel mechanical properties. PEG-4MAL gels were used for the remaining studies because that chemistry resulted in improved spreading and cell adhesion over norbornene hydrogels. By varying the density of RGD, the adhesive ligand for αvβ3 integrin, on the hydrogels, we showed that higher RGD densities resulted in greater YAP nuclear localization. We sought to understand the mechano-biological signaling pathway involved in YAP nuclear localization by inhibiting ROCK and FAK, proteins critical in mechanosensing via focal adhesion complexes. The inhibition of ROCK, and FAK decreased cell spread area, increased cell circularity and decreased YAP nuclear localization. Taken together this data demonstrates that external signals from PEG-based hydrogels as well as the intracellular signaling cascades involving ROCK and FAK can modulate YAP mechanosensing in MSCs

An Examination of the Benefits, Preferred Training Delivery Modes, and Preferred Topics of 4-H Youth Development Volunteers

Training is a critical component of any successful volunteer management system. The evaluation reported here examined the benefits of the 4-H Youth Development Volunteer training as well as ranks preferred training methods and topics. Participants in leader training reported that training yielded motivational and educational benefits. As part of the evaluation, volunteers identified the preferred training delivery modes as group trainings and electronic communication. Volunteers were most interested in learning about 4-H opportunities and leadership development

Preventing adolescents’ externalizing and internalizing symptoms : effects of the Penn Resiliency Program

This study reports secondary outcome analyses from a past study of the Penn Resiliency Program (PRP), a cognitive-behavioral depression prevention program for middle-school aged children. Middle school students (N = 697) were randomly assigned to PRP, PEP (an alternate intervention), or control conditions. Gillham et al., (2007) reported analyses examining PRP’s effects on average and clinical levels of depression symptoms. We examine PRP’s effects on parent-, teacher-, and self-reports of adolescents’ externalizing and broader internalizing (depression/anxiety, somatic complaints, and social withdrawal) symptoms over three years of follow-up. Relative to no intervention control, PRP reduced parent-reports of adolescents’ internalizing symptoms beginning at the first assessment after the intervention and persisting for most of the follow-up assessments. PRP also reduced parent-reported conduct problems relative to no-intervention. There was no evidence that the PRP program produced an effect on teacher- or self-report of adolescents’ symptoms. Overall, PRP did not reduce symptoms relative to the alternate intervention, although there is a suggestion of a delayed effect for conduct problems. These findings are discussed with attention to developmental trajectories and the importance of interventions that address common risk factors for diverse forms of negative outcomes.peer-reviewe

Early Elemental and Ionic Changes in Cultured Cells After Stimulation with Epidermal Growth Factor

Stimulation of A43 l cells (a human vulval epidermal cell line) with 50 ng/ml of epidermal growth factor (EGF) in the presence of 1. 7 mM extracellular calcium produced a sharp and sustained rise in intracellular ionic Ca2+, increased elemental Na, decreased K and a rise in Ca. In the absence of extracellular calcium, the initial Ca2+ rise remained but the sustained elevation of intracellular Ca2+ was abolished, Na and K fluxes were variable and the Ca did not change. Increased Na and decreased K was marked at 2 minutes and returned to the control value after 60 minutes. The increase in Ca was an early event. Cells stimulated with EGF showed a pronounced morphological disruption, especially the mitochondria. The response of NR6/SA3 and NR6/DC7 cells (genetically engineered rodent fibroblast cell lines) to EGF stimulation was higher than that of the A431 cells, as was the resting cytoplasmic Ca2+. Untreated NR6/SA3 and NR6/DC7 cells possessed an increased Na/K ratio when compared with A431 cells

Simulating the Response of a Composite Honeycomb Energy Absorber

NASA has sponsored research to evaluate an externally deployable composite honeycomb designed to attenuate loads in the event of a helicopter crash. The concept, designated the Deployable Energy Absorber (DEA), is an expandable Kevlar(Registered TradeMark) honeycomb. The DEA has a flexible hinge that allows the honeycomb to be stowed collapsed until needed during an emergency. Evaluation of the DEA began with material characterization of the Kevlar(Registered TradeMark)-129 fabric/epoxy, and ended with a full-scale crash test of a retrofitted MD-500 helicopter. During each evaluation phase, finite element models of the test articles were developed and simulations were performed using the dynamic finite element code, LS-DYNA(Registered TradeMark). The paper will focus on simulations of two full-scale impact tests involving the DEA, a mass-simulator and a full-scale crash of an instrumented MD-500 helicopter. Isotropic (MAT24) and composite (MAT58) material models, which were assigned to DEA shell elements, were compared. Based on simulations results, the MAT58 model showed better agreement with test

Material Model Evaluation of a Composite Honeycomb Energy Absorber

A study was conducted to evaluate four different material models in predicting the dynamic crushing response of solid-element-based models of a composite honeycomb energy absorber, designated the Deployable Energy Absorber (DEA). Dynamic crush tests of three DEA components were simulated using the nonlinear, explicit transient dynamic code, LS-DYNA . In addition, a full-scale crash test of an MD-500 helicopter, retrofitted with DEA blocks, was simulated. The four material models used to represent the DEA included: *MAT_CRUSHABLE_FOAM (Mat 63), *MAT_HONEYCOMB (Mat 26), *MAT_SIMPLIFIED_RUBBER/FOAM (Mat 181), and *MAT_TRANSVERSELY_ANISOTROPIC_CRUSHABLE_FOAM (Mat 142). Test-analysis calibration metrics included simple percentage error comparisons of initial peak acceleration, sustained crush stress, and peak compaction acceleration of the DEA components. In addition, the Roadside Safety Verification and Validation Program (RSVVP) was used to assess similarities and differences between the experimental and analytical curves for the full-scale crash test

Contributing Factors to Withdrawal Decisions of Military and Nonmilitary Nursing Students

Retaining nursing students in courses is key to increasing the number of new nurses. This study examined factors associated with nursing course or program withdrawal among students with and without prior military experience. The purpose of this study was to uncover differences between groups of students who withdrew compared to those who did not. A cross-sectional study using an online questionnaire surveyed current or recent nursing students (n = 420) using the Educational Requirement Subscale and the Student Withdrawal Questionnaire from Jeffreys’ toolkit. Uncovering differences between groups of students who did and did not withdraw from nursing courses or programs shows opportunities for nurse educators to improve strategies for student retention. Students with and without prior military experience reported statistically similar confidence levels, withdrawal rates, and reasons for withdrawal. There was a positive relationship between higher confidence levels and rates of withdrawal. Factors with the strongest influence for withdrawal were academic difficulties (mean = 2.56), family responsibilities (mean = 2.59) and family crisis (mean = 2.62). First generation students reported the greatest level of course withdrawals. Participation in nursing clubs and faculty advisement and helpfulness were most helpful to participants who reported past withdrawal. Data from this study can guide nurse educators to create greater program support and opportunity for peer support for students experiencing factors associated with course withdrawal

Multi-Dimensional Calibration of Impact Dynamic Models

NASA Langley, under the Subsonic Rotary Wing Program, recently completed two helicopter tests in support of an in-house effort to study crashworthiness. As part of this effort, work is on-going to investigate model calibration approaches and calibration metrics for impact dynamics models. Model calibration of impact dynamics problems has traditionally assessed model adequacy by comparing time histories from analytical predictions to test at only a few critical locations. Although this approach provides for a direct measure of the model predictive capability, overall system behavior is only qualitatively assessed using full vehicle animations. In order to understand the spatial and temporal relationships of impact loads as they migrate throughout the structure, a more quantitative approach is needed. In this work impact shapes derived from simulated time history data are used to recommend sensor placement and to assess model adequacy using time based metrics and orthogonality multi-dimensional metrics. An approach for model calibration is presented that includes metric definitions, uncertainty bounds, parameter sensitivity, and numerical optimization to estimate parameters to reconcile test with analysis. The process is illustrated using simulated experiment data