Effect of Deictic Gestures on Direction-Giving in Virtual Humans

Virtual agents are animated characters that use speech and gesture to interact with human users. They can serve as an intuitive interface for a variety of purposes. I am investigating the use of deictic gestures by a direction-giving agent. Deictic gestures are pointing gestures that humans often use in direction-giving to help clarify the route and destination. In my experiment, I developed a virtual agent to give directions to people to six different locations with the following spatial relationships to the starting point: left, right, left behind, right behind, left up, and right up. Three versions of the virtual agent were programmed to give directions to these locations. The versions differed in their use of gesture: no gestures; only body orientation and head gestures; and body orientation, head gestures, and arm movements. Participants received directions from my agent to six different locations using different gesture modes. Reception of the virtual agent was recorded through a survey and video recordings of the participants’ reactions to the direction-giving, as well as the path the participants took to follow the directions. The data was analyzed to assess the agent’s effectiveness. Upon analysis, the higher levels of deictic gesture appeared to be more effective, but data collected did not have statistical significance

Geochemical and Economic Evaluation of Brine Exchange as a Means of Produced Water Management

The extraction of crude oil generates large amounts of wastewater, also referred to as brine or produced water. This water is often high in salinity, heavy metals, and other toxic compounds. Its constituents make conventional treatment difficult and expensive, so a common practice is to inject this water deep underground for long-term storage. While convenient, deep well injection of produced water has been linked to environmental concerns, such as increased water stress and induced seismic activity. Alternative methods to produced water management are critical to alleviating concerns associated with current produced water disposal practices. Produced water brine exchange is one such alternative method that involves exchanging produced water between reservoirs to create a salinity gradient. A lower salinity brine is injected into a high salinity reservoir for use in Low Salinity Waterflooding (LSWF)—a practice that can lead to increased oil recovery. The high salinity brine is injected into the low salinity reservoir for long-term disposal, maintaining reservoir pressure.This study evaluates brine exchange between the Arbuckle formation (~20,000 mg/L TDS) and Lansing-Kansas City (LKC) formation (~150,000 mg/L TDS). To ensure geochemical compatibility between the injected brine, the in-situ brine, and reservoir rock and to evaluate the economic potential of brine exchange, a series of mixing experiments, geochemical modeling, and economic analysis were conducted. Bulk mixing and coreflooding experiments were conducted to evaluate brine-solid compatibility under both non-transport limited conditions and transport dominated conditions experienced in real-world environments. Experimental results were supplemented with geochemical modeling using PHREEQC with three sets of thermodynamic databases (PHREEQC, PITZER, and MINTEQ) to aid with compatibility analysis. Additionally, a techno-economic assessment was conducted to gauge economic viability of potential brine exchange projects. Results from the mixing experiments showed the risk of calcium carbonate scale formation is present in brine-brine-rock systems with low salinities (high ratio of Arbuckle:LKC brines) but only to a minor degree. None of the three databases used for geochemical modeling could accurately capture all trends in aqueous cation concentrations due to inherent limitations in each approach. Further study to identify discrepancies between model approaches and experimental results is warranted. Lastly, simulation modeling revealed that the economic viability of conducting brine exchange is highly correlated with the distance between wells and the energy cost of brine transportation. Conditions needed for economically viable operations have been identified, and the boundary between viable and unviable conditions have been found to be resilient to changes to material costs. The results gathered identify scenarios where brine exchange could be feasible and the key parameters needed to assess the risk of geochemical incompatibility

Measuring unmet need for contraception among women in rural areas of Papua New Guinea

Located in the South West Pacific region, with a population of 7.5 million, Papua New Guinea (PNG) is among a group of Pacific countries with sub-optimal health status. The maternal mortality ratio is 171 per 100,000 live births. Unmet need for contraception and family planning services, although poorly understood in PNG, may be one of the underlying causes of poor maternal health. This study set out to measure the prevalence and trends in unmet need for contraception and the identified socioeconomic factors associated with contraceptive use among women of reproductive age (15–49 years) in PNG. Data available from the Integrated Health and Demographic Surveillance System (IHDSS) were used in this study. A sub-population data set was extracted of 1434 women who gave birth in the preceding two years and resided in four rural surveillance sites: Asaro, Hides, Hiri and Karkar. Analyzes of unmet need for contraception were performed with respect to birth spacing and limiting the number of births. Unmet need for contraception was 34% for the previous birth, 37% for the current pregnancy, and 49% for future family planning. The total unmet need for contraception was 35%, of which 49% was for spacing births and 51% for limiting births. Women's age, education and household wealth are the most significant determinants of unmet need for contraception. The high level of unmet need for contraception may contribute to women's poor health status in PNG. Urgent programming responses from the health sector for supporting effective interventions to increase availability and use of contraceptives are required. Analyzes of unmet need for contraception were performed with respect to birth spacing and limiting the number of births. Unmet need for contraception was 34% for the previous birth, 37% for the current pregnancy, and 49% for future family planning. The total unmet need for contraception was 35%, of which 49% was for spacing births and 51% for limiting births. Women's age, education and household wealth are the most significant determinants of unmet need for contraception. The high level of unmet need for contraception may contribute to women's poor health status in PNG. Urgent programming responses from the health sector for supporting effective interventions to increase availability and use of contraceptives are required. Analyzes of unmet need for contraception were performed with respect to birth spacing and limiting the number of births. Unmet need for contraception was 34% for the previous birth, 37% for the current pregnancy, and 49% for future family planning. The total unmet need for contraception was 35%, of which 49% was for spacing births and 51% for limiting births. Women's age, education and household wealth are the most significant determinants of unmet need for contraception. The high level of unmet need for contraception may contribute to women's poor health status in PNG. Urgent programming responses from the health sector for supporting effective interventions to increase availability and use of contraceptives are required. 37% for the current pregnancy, and 49% for future family planning. The total unmet need for contraception was 35%, of which 49% was for spacing births and 51% for limiting births. Women's age, education and household wealth are the most significant determinants of unmet need for contraception. The high level of unmet need for contraception may contribute to women's poor health status in PNG. Urgent programming responses from the health sector for supporting effective interventions to increase availability and use of contraceptives are required. 37% for the current pregnancy, and 49% for future family planning. The total unmet need for contraception was 35%, of which 49% was for spacing births and 51% for limiting births. Women's age, education and household wealth are the most significant determinants of unmet need for contraception. The high level of unmet need for contraception may contribute to women's poor health status in PNG. Urgent programming responses from the health sector for supporting effective interventions to increase availability and use of contraceptives are required. The high level of unmet need for contraception may contribute to women's poor health status in PNG. Urgent programming responses from the health sector for supporting effective interventions to increase availability and use of contraceptives are required. The high level of unmet need for contraception may contribute to women's poor health status in PNG. Urgent programming responses from the health sector for supporting effective interventions to increase availability and use of contraceptives are required

Cremophor-Induced Lupus Erythematosus-Like Reaction with Taxol Administration: A Case Report and Review of the Literature

We report the first case of Cremophor EL-induced cutaneous lupus erythematosus-like reaction in a 40-year-old female undergoing treatment for breast cancer. There have been four reported cases of paclitaxel- and four cases of docetaxel-induced cutaneous lupus reactions in the published literature [Dasanu and Alexandrescu: South Med J 2008;101:1161–1162; Adachi and Horikawa: J Dermatol 2007;34:473–476; Lortholary et al: Presse Med 2007;36:1207–1208; Chen et al: J Rheumatol 2004;31:818–820]. Our patient developed findings of a cutaneous lupus-like reaction with administration of paclitaxel which was subsequently discontinued. She was re-challenged with albumin-bound paclitaxel which has no Cremophor EL compound in its formulation. This administration of albumin-bound paclitaxel did not induce further reaction. She did not develop a cutaneous lupus erythematosus-like reaction with three other subsequent administrations of albumin-bound paclitaxel. The diagnosis of lupus-like reaction in our patient was made based on the development of a malar butterfly rash sparing the nasolabial folds, the appearance of this rash in context of recently receiving treatments with paclitaxel, resolution of the rash after discontinuing the paclitaxel, and the presence of autoimmune antibodies in the patient's serum which resolved with discontinuation of the paclitaxel. This is the first case demonstrating that the cause of the cutaneous lupus erythematosus-like reaction is not likely due to the taxane component of paclitaxel but the chemical composition of Cremophor EL. If the chemotherapeutic agent was causing the reaction then the same reaction should be seen by albumin-bound paclitaxel. We propose that previously reported lupus reactions may actually be due to Cremophor EL, which consists of polyoxyethylated castor oil, and not the chemotherapeutic agent itself

Physician Collective Bargaining

Current antitrust enforcement policy unduly restricts physician collaboration, especially among small physician practices. Among other matters, current enforcement policy has hindered the ability of physicians to implement efficient healthcare delivery innovations, such as the acquisition and implementation of health information technology (HIT). Furthermore, the Federal Trade Commission and Department of Justice have unevenly enforced the antitrust laws, thereby fostering an increasingly severe imbalance in the healthcare market in which dominant health insurers enjoy the benefit of largely unfettered consolidation at the cost of both consumers and providers. This article traces the history of antitrust enforcement in healthcare, describe the current marketplace, and suggest the problems that must be addressed to restore balance to the healthcare market and help to ensure an innovative and efficient healthcare system capable of meeting the demands of the 21st century. Specifically, the writer explains how innovative physician collaborations have been improperly stifled by the policies of the federal antitrust enforcement agencies, and recommend that these policies be relaxed to permit physicians more latitude to bargain collectively with health insurers in conjunction with procompetitive clinical integration efforts. The article also explains how the unbridled consolidation of the health insurance industry has resulted in higher premiums to consumers and lower compensation to physicians, and recommends that further consolidation be prohibited. Finally, the writer discusses how health insurers with market power are improperly undermining the physician-patient relationship, and recommend federal antitrust enforcement agencies take appropriate steps to protect patients and their physicians from this anticompetitive conduct. The article also suggests such steps will require changes in three areas: (1) health insurers must be prohibited from engaging in anticompetitive activity; (2) the continuing improper consolidation of the health insurance industry must be curtailed; and (3) the physician community must be permitted to undertake the collaborative activity necessary for the establishment of a transparent, coordinated, and efficient delivery system

Evolution of Heart Transplantation Surgical Techniques

Organ transplantation has kindled the human imagination since the beginning of time. Prehistorically, transplantation appeared as mythological stories: from creatures with body parts from different species, the heart transplant between two Chinese soldiers by Pien Ch’iao, to the leg transplant by physician Saints Cosmas and Damian. By 19th century, the transplantation concept become possible by extensive contributions from scientists and clinicians whose works had taken generations. Although Alexis Carrel is known as the founding father of experimental organ transplantation, many legendary names had contributed to the experimental works of heart transplantation, including Guthrie, Mann, and Demikhov. The major contribution to experimental heart transplantation before the clinical era were made by a team lead by Richard Lower and Norman Shumway at Stanford University in the early 1960s. They played the vital role in developing experimental and clinical heart transplantation as it is known today. Using Shumway biatrial technique Christiaan Barnard started a new era of clinical heart transplantation, by performing the first in man human-to-human heart transplantation in 1967. The techniques of heart transplant have evolved since the first heart transplant. This chapter will summarize the techniques that have been used in clinical heart transplantation