Leading Climate Action Planning: A Case Study of Local Community Practices

Given the increasing rate of anthropogenic climate change and the resulting climate impacts that communities around the world will be coping with over the next century, it is becoming increasingly important that communities, cities, and regions begin to develop climate action plans that will assist them in coping with climate impacts. As a result, it is becoming evident that understanding how to effectively develop a climate action plan (CAP) and engage a community in the climate action planning process is a question at the forefront for many municipalities. This research utilized case study to examine the process the City of Imperial Beach engaged in to draft its CAP in an effort to understand the strengths the city was able to leverage and challenges the city faced. A chronological time-series was developed to assist in understanding the critical events that must take place in order to develop a CAP. Findings revealed that the CAP process in Imperial Beach was a years’ long effort championed by city council members and pushed forward by city staff and community members. The central themes found in this case study were community engagement, collaboration, environmental justice, and political polarization. Finally, the findings of this case study were viewed through the lens of complexity leadership theory in order to draw conclusions about the leadership needs in the CAP process

An Exploration of Embodiment, Narrative Identity, and Healing in Dungeons and Dragons

An Exploration of Embodiment, Narrative Identity, and Healing in Dungeons and Dragons is composed of two sister articles: the first is titled Me, Myself, and My D&D Character: The Recursive Process of Embodiment and Narrative Identity in Dungeons and Dragons, and the second is titled Dungeons and Dragons as a Site of Healing: Towards Embodied Writing as Healing. Dungeons and Dragons, or D&D, is a fantasy role-playing game where a Dungeon Master, leader and rules referee, leads a group of players acting as fantasy characters, or avatars, through a story together where outcomes are determined by rolling dice. Since players role-play their designated characters alongside other players, I pose that D&D is a rich and recursive process where players embody their characters through experiences similar to and different from their own lives. This recursive process of embodiment and narrative identity, I pose, also has significant use in allowing players to heal through these embodied experiences. Using an ethnographic approach to autoethnography, I observe in the first article my own experiences playing D&D both as player and Dungeon Master to understand the recursive process between a player, their character, and the other players/characters in the game. In the second article, I take this understanding that D&D is a recursive embodied experience and explore my own healing journey playing my two most recent characters, Shasta and Edris. I found that a character’s embodied experience can interact and overlap with the player’s embodied experience, and that D&D provides opportunity for self-reflection through these experiences to heal and grow

Tuning σ-Holes: Charge Redistribution in the Heavy (Group 14) Analogues of Simple and Mixed Halomethanes Can Impose Strong Propensities for Halogen Bonding

Halogen bonding between halide sites (in substituted organic molecules or inorganic halides) and Lewis bases is a rapidly progressing area of exploration. Investigations of this phenomenon have improved our understanding of weak intermolecular interactions and suggested new possibilities in supramolecular chemistry and crystal engineering. The capacity for halogen bonding is investigated at the MP2(full) level of theory for 100 compounds, including all 80 MH4-nXn systems (M = C, Si, Ge, Sn, and Pb; X = F, Cl, Br, and I). The charge redistribution in these molecules and the (in)stability of the σ-hole at X as a function of M and n are catalogued and examined. For the mixed MH3-mFmI compounds, we identify a complicated dependence of the relative halogen bond strengths on M and m. For m = 0, for example, the H3C-I----NH3 halogen bond is 6.6 times stronger than the H3Pb-I----NH3 bond. When m = 3, however, the F3Pb-I----NH3 bond is shorter and ∼1.6 times stronger than the F3C-I----NH3 bond. This substituent-induced reversal in the relative strengths of halogen bond energies is explained

The Use of Hyperbaric Oxygen Therapy in Idiopathic Sensorineural Hearing Loss: A Case Study

Idiopathic sudden sensorineural hearing loss (ISSHL) is an otologic emergency that can provoke anxiety in the patient and can be clinically challenging for the practitioner. The natural history of the condition can be as varied as its possible etiologies. Adding to the clinical challenge is the current debate of treatment modalities available. In what follows, we provide a case detailing our treatment course, including the novel use of hyperbaric oxygen therapy (HBOT) as an emerging therapy for sensorineural hearing loss. Additionally, we provide a brief review of the current state of treatment options available in the armament for ISSHL. As no identifying information is contained in our discussion, we believe the privacy of the patient has been protected and, as such, feel our manuscript is exempt from prior Institutional Review Board (IRB) approval

Charge Saturation and Neutral Substitutions in Halomethanes and Their Group 14 Analogues

A computational analysis of the charge distribution in halomethanes and their heavy analogues (MH4-nXn: M= C, Si, Ge, Sn, Pb; X = F, Cl, Br, I) as a function of n uncovers a previously unidentified saturation limit for fluorides when M ≠ C. We examine the electron densities obtained at the CCSD, MP2(full), B3PW91, and HF levels of theory for 80 molecules for four different basis sets. A previously observed substituent independent charge at F in fluoromethanes is shown to be a move toward saturation that is restricted by the low polarizability of C. This limitation fades into irrelevance for the more polarizable M central atoms such that a genuine F saturation is realized in those cases. A conceptual model leads to a function of the form [qM(n) -- qM(n)] = a[χA\u27 -- χA] + b that links the electronegativities (χ) of incoming and leaving atoms (e.g., A\u27 = X and A = H for the halogenation of MH4-nXn) and the associated charge shift at M. We show that the phenomenon in which the charge at the central atom, qM, is itself independent of n (e.g., at carbon in CH4-nBrn) is best described as an “M-neutral substitution”—not saturation. Implications of the observed X saturation and M-neutral substitutions for larger organic and inorganic halogenated molecules and polymeric materials are identified

Plane and simple: planar tetracoordinate carbon centers in small moleculesw

A class of neutral 18-electron molecules with planar tetracoordinate carbon (ptC) centers is introduced. We show computationally that when n = 3 the neutral singlet molecule C(BeH)n(BH2)4-n and other isoelectronic (18-valence electron) molecules of main group elements collapse from locally tetrahedral arrangements at the C-center to (near) planar tetracoordinate structures. For C(BeH)3BH2 and C(CH3)(BH2)Li2, for example, the tetrahedral type conformation is not even a minimum on the potential energy surface at the B3PW91, MP2(full), or CCSD levels of theory. The Mg analogue C(MgH)3BH2 of the Be system also features a completely flat global minimum (with even higher energy planar minima in both cases as well). Other neutral compounds that may prefer planar geometries are apparent, and new openings for experimental investigations and theoretical analyses of planar tetracoordinate main group systems are identified. The planar conformation persists at one center in the C(BeH)3BH2 dimer, and may be identifiable in higher order clusters of ptC molecules as well

Robotic-assisted Laparoscopic Surgery in Pediatric Urology: Capacity Building and Reflecting on Five Years’ Experience in West Virginia

Robotic surgery was born at the turn of the millennium as it was first approved by the US food and Drug Administration in 2000 with the introduction of the da Vinci (Intuitive Surgical, Inc., Mountain View, Ca) robotic surgical platform. However, its adoption by pediatric urologists did not occur until 2002, and even then it was used by only a select handful of surgeons. While the use of robotics in pediatric urology has grown steadily worldwide, its implementation in treating pediatric urology patients in West Virginia has been much slower. Reasons for this are twofold: historically, the lack of pediatric urology capability in the state, and comfort with the technology. The efforts in building a pediatric urologic robotics program at WVU are evident in the success of the program thus far. To date, 86 robotic urology cases have been performed in pediatric patients. Importantly, we report no significant complications (Clavien-Dindo Classification 2 or more) and no open conversions for our cohort. Demographically, the average age for our population at date of surgery was 8 years (range 1-19 years) with an average weight of 31.3 kg (10.3-74.7 kg). Intraoperatively, the average duration of surgery (cut-to-close) was 247.6 minutes with minimal blood loss and no patient requiring transfusion. Postoperatively, patients in our group did great, with an average length of hospitalization of 29.71 hours. We hope that our success may serve as an example of implementing robotics within other pediatric specialties where robotic implementation has been slow

Dysfunctional Voiding: Does a validated urine color scale correlate with dysfunctional voiding severity score?

Introduction Dysfunctional voiding (DV), defined as abnormal coordination between the urinary sphincter and the detrusor muscle in a neurologically intact individual, affects approximately 40% of patients that populate pediatric urology clinics. Improper hydration affects the specific gravity and concentration of urinary irritants, resulting in symptoms similar to those seen in DV patients. Methods Herein, we administered a validated DV survey (the Dysfunctional Voiding Symptom Score [DVSS]) and a validated dehydration severity chart (the Urine Color Chart [UCC]) to toilet trained pediatric patients and compared DV patients to patients presenting with non-urologic concerns. Data was analyzed on an item-for-item basis and by the total DVSS and UCC between the two groups. A total of 29 DV pediatric patients and 21 non-urologic pediatric patients were recruited from 2016 to 2018. Results Both patient groups were equivalent with regards to age, sex, height, weight, and BMI. The DV population had significantly higher scores in 7 out of 10 individual items within the DVSS when compared to those presenting for non-urologic complaints (p \u3c 0.05). In addition, DV patients had significantly higher total scores on the DVSS than non-urologic patients (p = 0.0004). No significant difference was noted in UCC scores between patient groups (p = 0.753). Regression analysis showed that within the dysfunctional voiding group, there was a linear relationship between DVSS and UCC scores. Conclusion The present study suggests the DVSS results yield significantly different results for DV patients when compared to age, sex, and BMI matched children with no urologic complaints. The UCC does not reliably vary between DV and non-urologic patients; however, there appears to be a linear relationship between DVSS and UCC scores within the DV cohort. Further studies may elucidate a validated metric by which DV and non-urologic pediatric patients may be differentiated

Traumatic Bladder Ruptures: A Ten-Year Review at a Level 1 Trauma Center

Abstract Bladder rupture occurs in only 1.6% of blunt abdominopelvic trauma cases. Although rare, bladder rupture can result in significant morbidity if undiagnosed or inappropriately managed. AUA Urotrauma Guidelines suggest that urethral catheter drainage is a standard of care for both extraperitoneal and intraperitoneal bladder rupture regardless of the need for surgical repair. However, no specific guidance is given regarding the length of catheterization. The present study seeks to summarize contemporary management of bladder trauma at our tertiary care center, assess the impact of length of catheterization on bladder injuries and complications, and develop a protocol for management of bladder injuries from time of injury to catheter removal. A retrospective review was performed on 34,413 blunt trauma cases to identify traumatic bladder ruptures over the past 10 years (January 2008–January 2018) at our tertiary care facility. Patient data were collected including age, gender, BMI, mechanism of injury, and type of injury. The primary treatment modality (surgical repair vs. catheter drainage only), length of catheterization, and post-injury complications were also assessed. Review of our institutional trauma database identified 44 patients with bladder trauma. Mean age was 41 years, mean BMI was 24.8 kg/m2, 95% were Caucasian, and 55% were female. Motor vehicle collision (MVC) was the most common mechanism, representing 45% of total injuries. Other mechanisms included falls (20%) and all-terrain vehicle (ATV) accidents (13.6%). 31 patients had extraperitoneal injury, and 13 were intraperitoneal. Pelvic fractures were present in 93%, and 39% had additional solid organ injuries. Formal cystogram was performed in 59% on presentation, and mean time to cystogram was 4 hours. Gross hematuria was noted in 95% of cases. Operative management was performed for all intraperitoneal injuries and 35.5% of extraperitoneal cases. Bladder closure in operative cases was typically performed in 2 layers with absorbable suture in a running fashion. The intraperitoneal and extraperitoneal injuries managed operatively were compared, and length of catheterization (28 d vs. 22 d, ), time from injury to normal fluorocystogram (19.8 d vs. 20.7 d, ), and time from injury to repair (4.3 vs. 60.5 h, ) were not statistically different between cohorts. Patients whose catheter remained in place for greater than 14 days had prolonged time to initial cystogram (26.6 d vs. 11.5 d) compared with those whose foley catheter was removed within 14 days. The complication rate was 21% for catheters left more than 14 days while patients whose catheter remained less than 14 days experienced no complications. The present study provides a 10-year retrospective review characterizing the presentation, management, and follow-up of bladder trauma patients at our level 1 trauma center. Based on our findings, we have developed an institutional protocol which now includes recommendations regarding length of catheterization after traumatic bladder rupture. By providing specific guidelines for initial follow-up cystogram and foley removal, we hope to decrease patient morbidity from prolonged catheterization. Further study will seek to allow multidisciplinary trauma teams to standardize management, streamline care, and minimize complications for patients presenting with traumatic bladder injuries