Impact of changing computer technology on hydrologic and water resource modeling

The increasing availability of substantial computer power at relatively low costs and the increasing ease of using computer graphics, of communicating with other computers and data bases, and of programming using high-level problem-oriented computer languages, is providing new opportunities and challenges for those developing and using hydrologic and water resources models. This paper reviews some of the progress made towards the development and application of computer support systems designed to aid those involved in analyzing hydrologic data and in operating, managing, or planning water resource facilities. Such systems of hardware and software are being designed to allow direct and easy access to a broad and heterogeneous group of users. These systems often combine data-base management; simulation and optimization techniques; symbolic colored displays; heuristic, qualitative approaches; and possibly artificial intelligence methods in an interactive, user-controlled, easily accessible interface. Individuals involved in the use of such systems are not only those with technical training, but also those representing different interest groups and having non-technical backgrounds. The essential difference between what is happening now and the more traditional off-line, non-interactive approaches is that instead of generating solutions to specific problems, model developers are now beginning to deliver, in a much more useful and user-friendly form, computer-based turnkey systems for exploring, analyzing and synthesizing plans or policies. Such tools permit the user to evaluate alternative solutions based on his or her own objectives and subjective judgments in an interactive learning and decision-making process

Integrating Hospice and Palliative Medicine Education Within the American Board of Emergency Medicine Model

Background: Hospice and palliative medicine (HPM) is a board-certified subspecialty within emergency medicine (EM), but prior studies have shown that EM residents do not receive sufficient training in HPM. Experts in HPM-EM created a consensus list of competencies for HPM training in EM residency. We evaluated how the HPM competencies integrate within the American Board of Emergency Medicine Milestones, which include the Model of the Clinical Practice of Emergency Medicine (EM Model) and the knowledge, skills, and abilities (KSA) list.Methods: Three emergency physicians independently mapped the HPM-EM competencies onto the 2019 EM Model items and the 2021 KSAs. Discrepancies were resolved by a fourth independent reviewer, and the final mapping was reviewed by all team members.Results: The EM Model included 78% (18/23) of the HPM competencies as a direct match, and we identified recommended areas for incorporating the other five. The KSAs included 43% (10/23). Most HPM competencies included in the KSAs mapped onto at least one level B (minimal necessary for competency) KSA. Three HPM competencies were not clearly included in the EM Model or in the KSAs (treating end-of-life symptoms, caring for the imminently dying, and caring for patients under hospice care).Conclusion: The majority of HPM-EM competencies are included in the current EM Model and KSAs and correspond to knowledge needed to be competent in EM. Programs relying on the EM Milestones to plan their curriculums may miss training in symptom management and care for patients at the end of life or who are on hospice

Integration of Geriatric Education Within the American Board of Emergency Medicine Model

Background: Emergency medicine (EM) resident training is guided by the American Board of Emergency Medicine Model of the Clinical Practice of Emergency Medicine (EM Model) and the EM Milestones as developed based on the knowledge, skills, and abilities (KSA) list. These are consensus documents developed by a collaborative working group of seven national EM organizations. External experts in geriatric EM also developed competency recommendations for EM residency education in geriatrics, but these are not being taught in many residency programs. Our objective was to evaluate how the geriatric EM competencies integrate/overlap with the EM Model and KSAs to help residency programs include them in their educational curricula.Methods: Trained emergency physicians independently mapped the geriatric resident competencies onto the 2019 EM Model items and the 2021 KSAs using Excel spreadsheets. Discrepancies were resolved by an independent reviewer with experience with the EM Model development and resident education, and the final mapping was reviewed by all team members.Results: The EM Model included 77% (20/26) of the geriatric competencies. The KSAs included most of the geriatric competencies (81%, 21/26). All but one of the geriatric competencies mapped onto either the EM Model or the KSAs. Within the KSAs, most of the geriatric competencies mapped onto necessary level skills (ranked B, C, D, or E) with only five (8%) also mapping onto advanced skills (ranked A).Conclusion: All but one of the geriatric EM competencies mapped to the current EM Model and KSAs. The geriatric competencies correspond to knowledge at all levels of training within the KSAs, from beginner to expert in EM. Educators in EM can use this mapping to integrate the geriatric competencies within their curriculums

Effect of O-Phenoxy Caspase Inhibitors on Apoptosis

Apoptosis is a process of cell death, in which a cell commits suicide. Apoptosis is essential for the maintenance of homeostasis and apoptotic dysregulation has been implicated numerous human diseases. Apoptotic events are mediated through a unique family of aspartyl proteases, caspases. Our study tested the effectiveness of nontoxic, O-phenoxy-conjugates caspase inhibitors to prevent cell death. Human leukemia cells were treated with Boc-D(OMe)-OPh, Cbz-D(OMe)-OPh, Q-D(OMe)-OPh, Boc-VD(OMe)-OPh, Cbz-VD(OMe)-OPh, Q-VD(OMe)-OPh, and Q-VE(OMe)-OPh. The cells were induced to undergo apoptosis and the inhibitory effectiveness of the compounds was evaluated. Our results indicate the drugs that contained the dipeptide VD were more effective at inhibiting cell death than those that contained aspartic acid (D) alone. Q-VE(OMe)-OPh had no apoptotic inhibitory activity and was identified as the first true O-phenoxy conjugate, negative control. Our data suggest that N-terminal protecting groups and amino acid composition significantly alter the effectiveness of peptide-based cell death inhibitors

Video-Based Facial Weakness Analysis.

OBJECTIVE: Facial weakness is a common sign of neurological diseases such as Bell\u27s palsy and stroke. However, recognizing facial weakness still remains as a challenge, because it requires experience and neurological training. METHODS: We propose a framework for facial weakness detection, which models the temporal dynamics of both shape and appearance-based features of each target frame through a bi-directional long short-term memory network (Bi-LSTM). The system is evaluated on a in-the-wild video dataset that is verified by three board-certified neurologists. In addition, three emergency medical services (EMS) personnel and three upper level residents rated the dataset. We compare the evaluation of the proposed algorithm with other comparison methods as well as the human raters. RESULTS: Experimental evaluation demonstrates that: (1) the proposed algorithm achieves the accuracy, sensitivity, and specificity of 94.3%, 91.4%, and 95.7%, which outperforms other comparison methods and achieves the equal performance to paramedics; (2) the framework can provide visualizable and interpretable results that increases model transparency and interpretability; (3) a prototype is implemented as a proof-of-concept showcase to show the feasibility of an inexpensive solution for facial weakness detection. CONCLUSION: The experiment results suggest that the proposed framework can identify facial weakness effectively. SIGNIFICANCE: We provide a proof-of-concept study, showing that such technology could be used by non-neurologists to more readily identify facial weakness in the field, leading to increasing coverage and earlier treatment

Effect of O-Phenoxy Caspase Inhibitors on Apoptosis

Apoptosis is a process of cell death, in which a cell commits suicide. Apoptosis is essential for the maintenance of homeostasis and apoptotic dysregulation has been implicated numerous human diseases. Apoptotic events are mediated through a unique family of aspartyl proteases, caspases. Our study tested the effectiveness of nontoxic, O-phenoxy-conjugates caspase inhibitors to prevent cell death. Human leukemia cells were treated with Boc-D(OMe)-OPh, Cbz-D(OMe)-OPh, Q-D(OMe)-OPh, Boc-VD(OMe)-OPh, Cbz-VD(OMe)-OPh, Q-VD(OMe)-OPh, and Q-VE(OMe)-OPh. The cells were induced to undergo apoptosis and the inhibitory effectiveness of the compounds was evaluated. Our results indicate the drugs that contained the dipeptide VD were more effective at inhibiting cell death than those that contained aspartic acid (D) alone. Q-VE(OMe)-OPh had no apoptotic inhibitory activity and was identified as the first true O-phenoxy conjugate, negative control. Our data suggest that N-terminal protecting groups and amino acid composition significantly alter the effectiveness of peptide-based cell death inhibitors

Cigarette Smoking History and Functional Outcomes After Spontaneous Intracerebral Hemorrhage

Background and Purpose- Although cigarette use may be a risk for intracerebral hemorrhage (ICH), animal models suggest that nicotine has a potential neuroprotective effect. The aim of this multicenter study is to determine the effect of smoking history on outcome in ICH patients. Methods- We analyzed prospectively collected data from the Ethnic/Racial Variations of Intracerebral Hemorrhage study and included patients with smoking status data in the analysis. Patients were dichotomized into nonsmokers versus ever-smokers, and the latter group was further categorized as former (>30 days before ICH) or current (≤30 days before ICH) smokers. The primary outcome was 90-day modified Rankin Scale score shift analysis. Secondary outcomes were in-hospital mortality and mortality, Barthel Index, and self-reported health status measures at 90 days. Results- The overall study cohort comprised 1509 nonsmokers and 1423 ever-smokers (841 former, 577 current, 5 unknown). No difference in primary outcome was observed between nonsmokers versus ever-smokers (adjusted odds ratio [aOR], 1.041; 95% CI, 0.904-1.199; P=0.577). No differences in primary outcome were observed between former (aOR, 0.932; 95% CI, 0.791-1.178; P=0.399) or current smokers (aOR, 1.178; 95% CI, 0.970-1.431; P=0.098) versus nonsmokers. Subgroup analyses by race/ethnicity demonstrated no differences in primary outcome when former and current smokers were compared with nonsmokers. Former, but not current, smokers had a lower in-hospital mortality rate (aOR, 0.695; 95% CI, 0.500-0.968; P=0.031), which was only observed in Hispanics (aOR, 0.533; 95% CI, 0.309-0.921; P=0.024). Differences in self-reported health status measures were only observed in whites. Conclusions- Cigarette smoking history does not seem to provide a beneficial effect on 90-day functional outcome in patients with ICH

Q-VE-OPh, a Negative Control for O-Phenoxy-Conjugated Caspase Inhibitors

The broad-spectrum apoptosis (caspase) inhibitor, Q-VD-OPh, has been shown to have no side effects and is effective at a much lower concentration than other FMK-type caspase inhibitors. However, an appropriate negative control to use with this inhibi- tor has not been available. In this study, we developed and analyzed a new compound, based on the Q-VD-OPh backbone, which acts as a cognate negative control. To create the negative control, we substituted a glutamate residue for the aspartate residue to create Q-VE-OPh, thereby retaining the identical charge and molecular properties with only the addition of an extra –CH2 group. The purity and quality were assessed by ion trap mass spectrometry and verified by nuclear magnetic resonance. We determined the effectiveness of Q-VE-OPh, in comparison to Q-VD-OPh, to prevent DNA fragmentation in human Jurkat T leukemia cells that were induced to undergo apoptosis. DNA fragmentation was analyzed by agarose gel electrophoresis for the presence of DNA laddering, the hallmark indicator of apoptosis. Our results indicate that apoptosis was potently inhibited by Q-VD-OPh. In stark contrast, Q-VE-OPh did not inhibit apoptosis at a similar dose but required at least 20 times greater concentration than Q-VD-OPh to have any inhibitory effect. Western blot analysis showed that Q-VE-OPh was similarly less effective at inhibiting the activation of the extrinsic (caspase 8) and intrinsic (caspase 9) initiator caspases. Cell proliferation and viability studies further demonstrate that Q-VE-OPh is non-toxic, even at high concentration. Our data indicate that the specificity, effectiveness, and absence of toxicity of Q-VE-OPh provides the appropriate and superior negative control for in vitro and in vivo studies when analyzing the effects of o-phenoxy caspase inhibitors