Initiating healthcare agent education in time limited settings

Most patients are willing to have advanced care planning (ACP) discussions with their medical team, even if they may be young and healthy. Yet, time constraints, perceived stigma of conversations surrounding death, and the educational requirement of documentation are known barriers for care providers to have these discussions. Identifying a health care agent (HCA) can be an important first step to continued ACP in the primary care setting. The purpose of this project is to propose a systemic approach to having HCA discussions in a time-efficient manner that can be easily implemented as part of a routine medical interview.https://scholarworks.uvm.edu/fmclerk/1573/thumbnail.jp

Interface parameters of composite sprayed concrete linings in soft ground with spray-applied waterproofing

The presence of a spray-applied waterproofing membrane between the primary and secondary lining layers is important to the behaviour of a composite sprayed concrete lined (SCL) tunnel in soft ground. In order to confirm the feasibility of the composite shell lining concept, the structural adequacy of the concrete-membrane interfaces under the effects experienced in a typical tunnel needs to be investigated. This paper presents a series of laboratory tests on samples cut from composite sprayed concrete panels, to which uniaxial compression, direct tension and direct shear loadings are applied over both short and long-term timeframes under conditions of ambient atmospheric humidity. Test results show that the interfaces are capable of resisting significant compression, tension and shear in both short- and long-term. Failures under these actions should not occur in a typical shallow SCL tunnel, and a degree of composite action between primary and secondary layers should be expected. Influence of substrate roughness and membrane thickness on the measured interface properties has been quantified. Overall, this investigation confirms the existence of composite action for composite sprayed concrete linings in soft ground, and provides parameters based on test results for further research and design

Crack development and effect of ageing on performance of composite shell sprayed concrete tunnel linings

Recent development and application of composite sprayed concrete lining (SCL) in major tunnelling projects have raised concerns on its short- and long-term flexural performance. Little literature has been found on the short-term crack development and the long-term ageing effect on composite SCL. Understanding of these issues will facilitate the efficient design of composite SCL. Four-point bending tests were performed on composite SCL beams to examine some aspects of these concerns. It is concluded that composite SCL beams have high residual flexural capacity; spray-applied membrane can maintain its integrity under big cracks; although the ageing effect reduces the ductility ratio of composite SCL beams in the long term, the absolute residual flexural strength increases. Conclusions drawn from the test results are compared with the current SCL tunnel design methods and the implication of differences is discussed

Numerical calibration of mechanical behaviour of composite shell tunnel linings

Composite shell linings consist of primary and secondary sprayed concrete linings separated by a layer of spray-applied waterproofing membrane. In order to design such a lining configuration, a calibrated numerical simulation approach is needed and the impact of interface properties on the composite mechanical behaviour should be understood. A programme of laboratory tests was carried out on beam samples cut from composite shell test panels and subjected to four-point bending under short-term loading. A range of membrane thicknesses and substrate roughness were compared and composite mechanical behaviour quantification methods developed. The behaviour of composite beams was understood and the strain distribution across composite lining cross-section was identified. A numerical model by the finite difference method was then set up for the beams and verified against the test data. With interface stiffnesses obtained from previous element tests, the composite beam model is capable of predicting the strain distribution across the cross-section and real behaviour of composite beam members to within an acceptable level of accuracy taking into account variations arising from workmanship. Sensitivity studies were carried out to understand the impact of interface properties and membrane interface position on the degree of composite action

Connexins: Mechanisms regulating protein levels and intercellular communication

AbstractIntercellular communication can occur through gap junction channels, which are comprised of connexin proteins. Therefore, levels of connexins can directly correlate with gap junctional intercellular communication. Because gap junctions have a critical role in maintaining cellular homeostasis, the regulation of connexin protein levels is important. In the connexin life cycle, connexin protein levels can be modified through differential gene transcription or altered through trafficking and degradation mechanisms. More recently, significant attention has been directed to the pathways that cells utilize to increase or decrease connexin levels and thus indirectly, gap junctional communication. Here, we review the studies revealing the mechanisms that affect connexin protein levels and gap junctional intercellular communication

Clinically insignificant association between anterior knee pain and patellofemoral lesions which are found incidentally.

Patellofemoral chondral lesions are frequently identified incidentally during the arthroscopic treatment of other knee pathologies. A role has been described for arthroscopic debridement of such lesions when symptoms are known to originate from pathology of the patellofemoral joint. However, it remains unclear how to manage lesions which are found incidentally whilst tackling other pathologies. The purpose of this study was to establish the strength of association between anterior knee pain and patellofemoral lesions identified incidentally in a typical arthroscopic population. A consecutive series of patients undergoing arthroscopy for a range of standard indications formed the basis of this cross section study. We excluded those with patellofemoral conditions in order to identify patellofemoral lesions which were solely incidental. Pre-operative assessments were performed on 64 patients, where anterior knee pain was sought by three methods: an annotated photographic knee pain map (PKPM), patient indication with one finger and by palpated tenderness. A single surgeon, who was blinded to previous recordings, performed standard arthroscopies and recorded patellofemoral lesions. Statistical correlations were performed to identify the association magnitude. Associations were identified between incidental patellofemoral lesions and tenderness palpated on the medial patella (P=0.007, χ2=0.32) and the quadriceps tendon (P=0.029, χ2=0.26), but these associations were at best fair, which could be interpreted as clinically insignificant. In which case incidental patellofemoral lesions are not necessarily associated with anterior knee pain, we suggest that they could be left alone. This recommendation is only applicable to patellofemoral lesions which are found incidentally whilst addressing other pathology

Simulating composite behaviour in SCL tunnels with sprayed waterproofing membrane interface : a state-of-the-art review

Introduction of sprayed waterproofing has led to innovation of composite sprayed concrete lined (SCL) tunnels, where placing the waterproofing between primary and secondary layers gives potential for composite structural action, by transmission of tension, compression and shear stresses across the interface. Numerical analysis is required to design such structures taking into account soil-structure interaction and staged construction, but there is currently very limited guidance on how to conduct such analyses. This paper reviews use of numerical analysis to simulate composite SCL tunnels, focussing on soft ground tunnelling. It introduces types of sprayed membrane, their benefits in design and current industry practice for simulating the sprayed membrane interface. Numerical strategies for simulating composite action and their verification against laboratory test data are then described. Recommendations are made of design principles to optimise design of SCL tunnels with spray-applied waterproofing. Further opportunities for research on this topic are discussed

Permutation Routing in the Hypercube and Grid Topologies

The problem of edge disjoint path routing arises from applications in distributed memory parallel computing. We examine this problem in both the directed hypercube and two-dimensional grid topologies. Complexity results are obtained for these problems where the routing must consist entirely of shortest length paths. Additionally, approximation algorithms are presented for the case when the routing request is of a special form known as a permutation. Permutations simply require that no vertex in the graph may be used more than once as either a source or target for a routing request. Szymanski conjectured that permutations are always routable in the directed hypercube, and this remains an open problem

Exact and approximate polynomial decomposition methods for signal processing applications

Signal processing is a discipline in which functional composition and decomposition can potentially be utilized in a variety of creative ways. From an analysis point of view, further insight can be gained into existing signal processing systems and techniques by reinterpreting them in terms of functional composition. From a synthesis point of view, functional composition offers new algorithms and techniques with modular structure. Moreover, computations can be performed more efficiently and data can be represented more compactly in information systems represented in the context of a compositional structure. Polynomials are ubiquitous in signal processing in the form of z-transforms. In this paper, we summarize the fundamentals of functional composition and decomposition for polynomials from the perspective of exploiting them in signal processing. We compare exact polynomial decomposition algorithms for sequences that are exactly decomposable when expressed as a polynomial, and approximate decomposition algorithms for those that are not exactly decomposable. Furthermore, we identify efficiencies in using exact decomposition techniques in the context of signal processing and introduce a new approximate polynomial decomposition technique based on the use of Structured Total Least Norm (STLN) formulation.Texas Instruments Leadership University Consortium ProgramBose (Firm