Brokering Community–campus Partnerships: An Analytical Framework

Academic institutions and community-based organizations have increasingly recognized the value of working together to meet their different objectives and address common societal needs. In an effort to support the development and maintenance of these partnerships, a diversity of brokering initiatives has emerged. We describe these brokering initiatives broadly as coordinating mechanisms that act as an intermediary with an aim to develop collaborative and sustainable partnerships that provide mutual benefit. A broker can be an individual or an organization that helps connect and support relationships and share knowledge. To date, there has been little scholarly discussion or analysis of the various elements of these initiatives that contribute to successful community–campus partnerships. In an effort to better understand where these features may align and diverge, we reviewed a sample of community–campus brokering initiatives across North America and the United Kingdom to consider their different roles and activities. From this review, we developed a framework to delineate characteristics of different brokering initiatives to better understand their contributions to successful partnerships. The framework is divided into two parts. The first examines the different structural allegiances of the brokering initiatives by identifying their affiliation, principle purpose, and who received primary benefits. The second considers the dimensions of brokering activities in respect to their level of engagement, platforms used, scale of activity, and area of focus. The intention of the community campus engagement brokering framework is to provide an analytical tool for academics and community-based practitioners engaged in teaching and research partnerships. When developing a brokering initiative, these categories describing the different structures and dimensions encourage participants to think through the overall goals and objectives of the partnership and adapt the initiative accordingly

The NASA Langley laminar-flow-control experiment on a swept, supercritical airfoil: Evaluation of initial perforated configuration

The initial evaluation of a large-chord, swept, supercritical airfoil incorporating an active laminar-flow-control (LFC) suction system with a perforated upper surface is documented in a chronological manner, and the deficiencies in the suction capability of the perforated panels as designed are described. The experiment was conducted in the Langley 8-Foot Transonic Pressure Tunnel. Also included is an evaluation of the influence of the proximity of the tunnel liner to the upper surface of the airfoil pressure distribution

The NASA Langley Laminar-Flow-Control Experiment on a Swept Supercritical Airfoil: Basic Results for Slotted Configuration

The effects of Mach number and Reynolds number on the experimental surface pressure distributions and transition patterns for a large chord, swept supercritical airfoil incorporating an active Laminar Flow Control suction system with spanwise slots are presented. The experiment was conducted in the Langley 8 foot Transonic Pressure Tunnel. Also included is a discussion of the influence of model/tunnel liner interactions on the airfoil pressure distribution. Mach number was varied from 0.40 to 0.82 at two chord Reynolds numbers, 10 and 20 x 1,000,000, and Reynolds number was varied from 10 to 20 x 1,000,000 at the design Mach number

Perioperative pain management and opioid-reduction in head and neck endocrine surgery: An American Head and Neck Society Endocrine Surgery Section consensus statement

BACKGROUND: This American Head and Neck Society (AHNS) consensus statement focuses on evidence-based comprehensive pain management practices for thyroid and parathyroid surgery. Overutilization of opioids for postoperative pain management is a major contributing factor to the opioid addiction epidemic however evidence-based guidelines for pain management after routine head and neck endocrine procedures are lacking. METHODS: An expert panel was convened from the membership of the AHNS, its Endocrine Surgical Section, and ThyCa. An extensive literature review was performed, and recommendations addressing several pain management subtopics were constructed based on best available evidence. A modified Delphi survey was then utilized to evaluate group consensus of these statements. CONCLUSIONS: This expert consensus provides evidence-based recommendations for effective postoperative pain management following head and neck endocrine procedures with a focus on limiting unnecessary use of opioid analgesics

Exploring reasons for state-level variation in incidence of dialysis-requiring acute kidney injury (AKI-D) in the United States

Background: There is considerable state-level variation in the incidence of dialysis-requiring acute kidney injury (AKI-D). However, little is known about reasons for this geographic variation. Methods: National cross-sectional state-level ecological study based on State Inpatient Databases (SID) and the Behavioral Risk Factor Surveillance System (BRFSS) in 2011. We analyzed 18 states and six chronic health conditions (diabetes mellitus [diabetes], hypertension, chronic kidney disease [CKD], arteriosclerotic heart disease [ASHD], cancer (excluding skin cancer), and chronic obstructive pulmonary disease [COPD]). Associations between each of the chronic health conditions and AKI-D incidence was assessed using Pearson correlation and multiple regression adjusting for mean age, the proportion of males, and the proportion of non-Hispanic whites in each state. Results: The state-level AKI-D incidence ranged from 190 to 1139 per million population. State-level differences in rates of hospitalization with chronic health conditions (mostly \u3c 3-fold difference in range) were larger than the state-level differences in prevalence for each chronic health condition (mostly \u3c 2.5-fold difference in range). A significant correlation was shown between AKI-D incidence and prevalence of diabetes, ASHD, and COPD, as well as between AKI-D incidence and rate of hospitalization with hypertension. In regression models, after adjusting for age, sex, and race, AKI-D incidence was associated with prevalence of and rates of hospitalization with five chronic health conditions - diabetes, hypertension, CKD, ASHD and COPD - and rates of hospitalization with cancer. Conclusions: Results from this ecological analysis suggest that state-level variation in AKI-D incidence may be influenced by state-level variations in prevalence of and rates of hospitalization with several chronic health conditions. For most of the explored chronic conditions, AKI-D correlated stronger with rates of hospitalizations with the health conditions rather than with their prevalences, suggesting that better disease management strategies that prevent hospitalizations may translate into lower incidence of AKI-D

Quantitative Analysis of Immune Infiltrates in Primary Melanoma.

Novel methods to analyze the tumor microenvironment (TME) are urgently needed to stratify melanoma patients for adjuvant immunotherapy. Tumor-infiltrating lymphocyte (TIL) analysis, by conventional pathologic methods, is predictive but is insufficiently precise for clinical application. Quantitative multiplex immunofluorescence (qmIF) allows for evaluation of the TME using multiparameter phenotyping, tissue segmentation, and quantitative spatial analysis (qSA). Given that CD3+CD8+ cytotoxic lymphocytes (CTLs) promote antitumor immunity, whereas CD68+ macrophages impair immunity, we hypothesized that quantification and spatial analysis of macrophages and CTLs would correlate with clinical outcome. We applied qmIF to 104 primary stage II to III melanoma tumors and found that CTLs were closer in proximity to activated (CD68+HLA-DR+) macrophages than nonactivated (CD68+HLA-DR-) macrophages (P < 0.0001). CTLs were further in proximity from proliferating SOX10+ melanoma cells than nonproliferating ones (P < 0.0001). In 64 patients with known cause of death, we found that high CTL and low macrophage density in the stroma (P = 0.0038 and P = 0.0006, respectively) correlated with disease-specific survival (DSS), but the correlation was less significant for CTL and macrophage density in the tumor (P = 0.0147 and P = 0.0426, respectively). DSS correlation was strongest for stromal HLA-DR+ CTLs (P = 0.0005). CTL distance to HLA-DR- macrophages associated with poor DSS (P = 0.0016), whereas distance to Ki67- tumor cells associated inversely with DSS (P = 0.0006). A low CTL/macrophage ratio in the stroma conferred a hazard ratio (HR) of 3.719 for death from melanoma and correlated with shortened overall survival (OS) in the complete 104 patient cohort by Cox analysis (P = 0.009) and merits further development as a biomarker for clinical application

Comparison of two dose regimens of intravenous tissue plasminogen activator for acute myocardial infarction

Two dosing schedules of intravenous tissue plasminogen activator (t-PA) for acute myocardial infarction were compared in a multicenter trial. At 2.95 +/- 1.1 hours from onset of chest pain, 386 patients received 150 mg of intravenous t-PA. For the first 178 patients (group A), 60 mg were given in the first-hour dose and the remaining 90 mg were infused over 7 hours. In the subsequent 208 patients (group B), the first-hour dose was 1.0 mg/kg and the remaining 150 mg were given over 5 hours. At initial angiography 94 +/- 30 minutes into therapy, the infarct vessel patency was 64% in group A versus 75% in group B (p = 0.02). By final angiography with up to 4 selective contrast injections, patency was 68% versus 77%, respectively (p = 0.06). Repeat angiography at 7 to 10 days demonstrated reocclusion in 17% of group A and 13% of group B patients (p = 0.35). There was no difference in fibrinogen nadir or mean hematocrit drop between the 2 groups: 120 mg/dl and 11 points, respectively, in group A compared with 120 mg/dl and 10 points in group B. However, bleeding was reduced in group B patients as evident by a decrease in requirement for &gt;=2 units of packed red blood cell transfusion (group A 36%, group B 27%, P = 0.05) and lower incidence of gastrointestinal bleeding (group A 12%, group B 4%, P = 0.002). To further study the importance of weight adjustment, patients were divided into 2 groups according to weight (=90 kg). According to the results, lighter weight patients had greater transfusion requirements (35% versus 20%, P = 0.006) and more frequent major bleeding episodes (16% versus 7%, P = 0.025). Thus, a higher, weight-adjusted first-hour dose of intravenous t-PA, with a shorter duration of maintenance infusion, is associated with: (1) improved infarct vessel patency; (2) more rapid recanalization; and (3) less bleeding complications without more fibrinogenolysis.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/27366/1/0000392.pd

Comparing very low birth weight versus very low gestation cohort methods for outcome analysis of high risk preterm infants

Background: Compared to very low gestational age (\u3c32 weeks, VLGA) cohorts, very low birth weight (\u3c1500 g; VLBW) cohorts are more prone to selection bias toward small-for-gestational age (SGA) infants, which may impact upon the validity of data for benchmarking purposes. Method: Data from all VLGA or VLBW infants admitted in the 3 Networks between 2008 and 2011 were used. Two-thirds of each network cohort was randomly selected to develop prediction models for mortality and composite adverse outcome (CAO: mortality or cerebral injuries, chronic lung disease, severe retinopathy or necrotizing enterocolitis) and the remaining for internal validation. Areas under the ROC curves (AUC) of the models were compared. Results: VLBW cohort (24,335 infants) had twice more SGA infants (20.4% vs. 9.3%) than the VLGA cohort (29,180 infants) and had a higher rate of CAO (36.5% vs. 32.6%). The two models had equal prediction power for mortality and CAO (AUC 0.83), and similarly for all other cross-cohort validations (AUC 0.81-0.85). Neither model performed well for the extremes of birth weight for gestation (\u3c1500 g and ≥32 weeks, AUC 0.50-0.65; ≥1500 g and \u3c32 weeks, AUC 0.60-0.62). Conclusion: There was no difference in prediction power for adverse outcome between cohorting VLGA or VLBW despite substantial bias in SGA population. Either cohorting practises are suitable for international benchmarking