Child’s play at war memorials: insights from a social media debate

Each year, thousands of children visit memorials and other heritage sites during family or school trips, yet heritage scholars possess little understanding of their experiences. Despite its absence from the scholarly literature, children’s exploratory play at war memorials recurs frequently in the popular media. Extensive social media interest suggests that public sentiment, often emotional and vividly expressed, deserves study as a potential influence on children’s experiences at these and other dark heritage sites. This paper provides new insights of behavioral expectations for children at memorials, based on content analysis of 150 comments on a viral social media post picturing children playing on the Vietnam Women’s Memorial in Washington, DC. Conducting a stance analysis of comments, we considered commenters’ behavioral expectations, meanings they ascribed to memorials, and rationales for their intensely worded positions. Commenters shared several values: that memorials represented soldiers’ sacrifice, veterans’ service, general places for respect or to do what is right, or artistic value. Yet despite these shared rationales, many commenters expressed polarized opinions of children’s play at memorials. Commenters also referenced memorials and battlefields worldwide. This study provides greater understanding of the cultural context of children’s visits to memorials and other sites of painful heritage

Adding a toe joint to a prosthesis: walking biomechanics, energetics, and preference of individuals with unilateral below-knee limb loss

Toe joints play an important functional role in able-bodied walking; however, for prosthesis users, the effect of adding a toe joint to a passive prosthetic foot remains largely unknown. The current study explores the kinematics, kinetics, rate of oxygen consumption and user preference of nine individuals with below-knee limb loss. Participants walked on a passive prosthetic foot in two configurations: with a Flexible, articulating toe joint and with a Locked-out toe joint. During level treadmill gait, participants exhibited a decrease in Push-Off work when using the Flexible toe joint prosthesis versus the Locked toe joint prosthesis: 16% less from the prosthesis (p = 0.004) and 10% less at the center of mass level (p = 0.039). However, between configurations, participants exhibited little change in other gait kinematics or kinetics, and no apparent or consistent difference in the rate of oxygen consumption (p = 0.097). None of the traditional biomechanical or metabolic outcomes seemed to explain user preference. However, an unexpected and intriguing observation was that all participants who wore the prosthesis on their dominant limb preferred the Flexible toe joint, and every other participant preferred the Locked configuration. Although perhaps coincidental, such findings may suggest a potential link between user preference and limb dominance, offering an interesting avenue for future research

Obese individuals do not underreport dietary intake to a greater extent than nonobese individuals when data are allometrically-scaled

Objective: The aim of this study was to assess the extent of misreporting in obese and non-obese adults on an absolute, ratio-scaled, and allometrically-scaled basis. Method: Self-reported daily energy intake (EI) was compared with total energy expenditure (TEE) in 221 adults (106 male,115 female; age 53±17 years, stature 1.68±0.09 m, mass 79.8±17.2 kg) who participated in a doubly-labelled water (DLW) subsection of 2013-2015 National Diet and Nutrition Survey. Data were log-transformed and expressed as absolute values, according to simple ratio-standards (per kg body mass) and adjusted for body mass allometrically. Absolute and ratio-scaled misreporting were examined using full-factorial General Linear Models with repeated measures of the natural logarithms of TEE or EI as the within-subjects factor. The natural logarithm of body mass was included as a covariate in the allometric method. The categorical variables of gender, age, obesity, and Physical Activity Level (PAL) were the between-factor variables. Results: On an absolute-basis, self-reported EI (2759±590 kcal·d-1) was significantly lower than TEE measured by DLW (2759±590 kcal·d-1: F1,205=598.81,p1.75; F1,205=34.15, p<0.001, ηp2=0.14) and in younger individuals (<55 years; F1,205=14.82,p<0.001,ηp2=0.07), which are all categories with higher energy needs. Ratio-scaling data reduced the effect sizes. Allometric-scaling removed the effect of body mass (F1,205=0.02,p=0.887,ηp2=0.00). Conclusion: In weight-stable adults, obese individuals do not underreport dietary intake to a greater extent than non-obese individuals. These results contradict previous research demonstrating that obesity is associated with a greater degree of underreporting

US IOOS coastal and ocean modeling testbed: Inter-model evaluation of tides, waves, and hurricane surge in the Gulf of Mexico

A Gulf of Mexico performance evaluation and comparison of coastal circulation and wave models was executed through harmonic analyses of tidal simulations, hindcasts of Hurricane Ike (2008) and Rita (2005), and a benchmarking study. Three unstructured coastal circulation models (ADCIRC, FVCOM, and SELFE) validated with similar skill on a new common Gulf scale mesh (ULLR) with identical frictional parameterization and forcing for the tidal validation and hurricane hindcasts. Coupled circulation and wave models, SWAN+ADCIRC and WWMII+SELFE, along with FVCOM loosely coupled with SWAN, also validated with similar skill. NOAA\u27s official operational forecast storm surge model (SLOSH) was implemented on local and Gulf scale meshes with the same wind stress and pressure forcing used by the unstructured models for hindcasts of Ike and Rita. SLOSH\u27s local meshes failed to capture regional processes such as Ike\u27s forerunner and the results from the Gulf scale mesh further suggest shortcomings may be due to a combination of poor mesh resolution, missing internal physics such as tides and nonlinear advection, and SLOSH\u27s internal frictional parameterization. In addition, these models were benchmarked to assess and compare execution speed and scalability for a prototypical operational simulation. It was apparent that a higher number of computational cores are needed for the unstructured models to meet similar operational implementation requirements to SLOSH, and that some of them could benefit from improved parallelization and faster execution speed

The combined diabetes and renal control trial (C-DIRECT) - a feasibility randomised controlled trial to evaluate outcomes in multi-morbid patients with diabetes and on dialysis using a mixed methods approach

Background: This cluster randomised controlled trial set out to investigate the feasibility and acceptability of the “Combined Diabetes and Renal Control Trial” (C-DIRECT) intervention, a nurse-led intervention based on motivational interviewing and self-management in patients with coexisting end stage renal diseases and diabetes mellitus (DM ESRD). Its efficacy to improve glycaemic control, as well as psychosocial and self-care outcomes were also evaluated as secondary outcomes. Methods: An assessor-blinded, clustered randomised-controlled trial was conducted with 44 haemodialysis patients with DM ESRD and ≥ 8% glycated haemoglobin (HbA1c), in dialysis centres across Singapore. Patients were randomised according to dialysis shifts. 20 patients were assigned to intervention and 24 were in usual care. The C-DIRECT intervention consisted of three weekly chair-side sessions delivered by diabetes specialist nurses. Data on recruitment, randomisation, and retention, and secondary outcomes such as clinical endpoints, emotional distress, adherence, and self-management skills measures were obtained at baseline and at 12 weeks follow-up. A qualitative evaluation using interviews was conducted at the end of the trial. Results: Of the 44 recruited at baseline, 42 patients were evaluated at follow-up. One patient died, and one discontinued the study due to deteriorating health. Recruitment, retention, and acceptability rates of C-DIRECT were generally satisfactory HbA1c levels decreased in both groups, but C-DIRECT had more participants with HbA1c < 8% at follow up compared to usual care. Significant improvements in role limitations due to physical health were noted for C-DIRECT whereas levels remained stable in usual care. No statistically significant differences between groups were observed for other clinical markers and other patient-reported outcomes. There were no adverse effects. Conclusions: The trial demonstrated satisfactory feasibility. A brief intervention delivered on bedside as part of routine dialysis care showed some benefits in glycaemic control and on QOL domain compared with usual care, although no effect was observed in other secondary outcomes. Further research is needed to design and assess interventions to promote diabetes self-management in socially vulnerable patients

Sphingosine 1-phosphate modulates antigen capture by murine langerhans cells via the S1P2 receptor subtype

Dendritic cells (DCs) play a pivotal role in the development of cutaneous contact hypersensitivity (CHS) and atopic dermatitis as they capture and process antigen and present it to T lymphocytes in the lymphoid organs. Recently, it has been indicated that a topical application of the sphingolipid sphingosine 1-phosphate (S1P) prevents the inflammatory response in CHS, but the molecular mechanism is not fully elucidated. Here we indicate that treatment of mice with S1P is connected with an impaired antigen uptake by Langerhans cells (LCs), the initial step of CHS. Most of the known actions of S1P are mediated by a family of five specific G protein-coupled receptors. Our results indicate that S1P inhibits macropinocytosis of the murine LC line XS52 via S1P2 receptor stimulation followed by a reduced phosphatidylinositol 3-kinase (PI3K) activity. As down-regulation of S1P2 not only diminished S1P-mediated action but also enhanced the basal activity of LCs on antigen capture, an autocrine action of S1P has been assumed. Actually, S1P is continuously produced by LCs and secreted via the ATP binding cassette transporter ABCC1 to the extracellular environment. Consequently, inhibition of ABCC1, which decreased extracellular S1P levels, markedly increased the antigen uptake by LCs. Moreover, stimulation of sphingosine kinase activity, the crucial enzyme for S1P formation, is connected not only with enhanced S1P levels but also with diminished antigen capture. These results indicate that S1P is essential in LC homeostasis and influences skin immunity. This is of importance as previous reports suggested an alteration of S1P levels in atopic skin lesions

The Putative bZIP Transcripton Factor BzpN Slows Proliferation and Functions in the Regulation of Cell Density by Autocrine Signals in Dictyostelium

The secreted proteins AprA and CfaD function as autocrine signals that inhibit cell proliferation in Dictyostelium discoideum, thereby regulating cell numbers by a negative feedback mechanism. We report here that the putative basic leucine zipper transcription factor BzpN plays a role in the inhibition of proliferation by AprA and CfaD. Cells lacking BzpN proliferate more rapidly than wild-type cells but do not reach a higher stationary density. Recombinant AprA inhibits wild-type cell proliferation but does not inhibit the proliferation of cells lacking BzpN. Recombinant CfaD also inhibits wild-type cell proliferation, but promotes the proliferation of cells lacking BzpN. Overexpression of BzpN results in a reduced cell density at stationary phase, and this phenotype requires AprA, CfaD, and the kinase QkgA. Conditioned media from high-density cells stops the proliferation of wild-type but not bzpN− cells and induces a nuclear localization of a BzpN-GFP fusion protein, though this localization does not require AprA or CfaD. Together, the data suggest that BzpN is necessary for some but not all of the effects of AprA and CfaD, and that BzpN may function downstream of AprA and CfaD in a signal transduction pathway that inhibits proliferation

Sins of Omission

Little is known about the relative incidence of serious errors of omission versus errors of commission. Objective : To identify the most common substantive medical errors identified by medical record review. Design : Retrospective cohort study. Setting : Twelve Veterans Affairs health care systems in 2 regions. Participants : Stratified random sample of 621 patients receiving care over a 2-year period. Main Outcome Measure : Classification of reported quality problems. Methods : Trained physicians reviewed the full inpatient and outpatient record and described quality problems, which were then classified as errors of omission versus commission. Results : Eighty-two percent of patients had at least 1 error reported over a 13-month period. The average number of errors reported per case was 4.7 (95% confidence intervals [CI]: 4.4, 5.0). Overall, 95.7% (95% CI: 94.9%, 96.4%) of errors were identified as being problems with underuse. Inadequate care for people with chronic illnesses was particularly common. Among errors of omission, obtaining insufficient information from histories and physicals (25.3%), inadequacies in diagnostic testing (33.9%), and patients not receiving needed medications (20.7%) were all common. Out of the 2,917 errors identified, only 27 were rated as being highly serious, and 26 (96%) of these were errors of omission. Conclusions : While preventing iatrogenic injury resulting from medical errors is a critically important part of quality improvement, we found that the overwhelming majority of substantive medical errors identifiable from the medical record were related to people getting too little medical care, especially for those with chronic medical conditions.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74567/1/j.1525-1497.2005.0152.x.pd