A Gettysburg Streetscape, North Washington Street in 1925

This paper explores life in Gettysburg on North Washington Street in 1925. It was the final project for Dr. Michael Birkner\u27s Spring 2017 Historical Methods class

TOWARDS AN UNDERSTANDING OF HOW TUBE INSERTS MITIGATE FOULING IN HEAT EXCHANGERS

A number of studies undertaken by Total have measured the improvement that can be expected when TurbotalTM inserts are installed in heat exchangers. These studies have fully established that TurbotalTM both improve heat transfer coefficient and mitigate fouling. It has been found that fouling levels vary with application. Consequently, economics of installing inserts are difficult to quantify. Gains must be estimated through specific tests. A model that predicts fouling development solves this problem. In this paper first steps towards the understanding of how TurbotalTM limits the fouling rate are described. Authors suggest that the calculation of both pressure drop and heat transfer coefficient in a tube equipped with insert can be used to extend the Ebert & Panchal fouling model to predict the fouling rate in tube equipped with TurbotalTM. This extension of the Ebert-Panchal Model requires adjustment of both the deposition term and the removal term. The deposition term can be adjusted by multiplying by the ratio of plain to enhanced heat transfer coefficients and the removal term can be based on the pressure drop imposed by the insert. This modified model is then compared with operating cases to verify its reliability. Further issues that require consideration are a mechanical effect that gives rise to limiting growth of the fouling deposit, and total suppression of fouling in parts of the exchanger into account

Micro-macro relationship between microstructure, porosity, mechanical properties, and build mode parameters of a selective-electron-beam-melted Ti-6Al-4V alloy

The performance of two selective electron beam melting operation modes, namely the manual mode and the automatic ‘build theme mode’, have been investigated for the case of a Ti-6Al-4V alloy (45–105 μ;m average particle size of the powder) in terms of porosity, microstructure, and mechanical properties. The two operation modes produced notable differences in terms of build quality (porosity), microstructure, and properties over the sample thickness. The number and the average size of the pores were measured using a light microscope over the entire build height. A density measurement provided a quantitative index of the global porosity throughout the builds. The selective-electron-beam-melted microstructure was mainly composed of a columnar prior β-grain structure, delineated by α-phase boundaries, oriented along the build direction. A nearly equilibrium α + β mixture structure, formed from the original β-phase, arranged inside the prior β-grains as an α-colony or α-basket weave pattern, whereas the β-phase enveloped α-lamellae. The microstructure was finer with increasing distance from the build plate regardless of the selected build mode. Optical measurements of the α-plate width showed that it varied as the distance from the build plate varied. This microstructure parameter was correlated at the sample core with the mechanical properties measured by means of a macro-instrumented indentation test, thereby confirming Hall-Petch law behavior for strength at a local scale for the various process conditions. The tensile properties, while attesting to the mechanical performance of the builds over a macro scale, also validated the indentation property measurement at the core of the samples. Thus, a direct correlation between the process parameters, microstructure, porosity, and mechanical properties was established at the micro and macro scales. The macro-instrumented indentation test has emerged as a reliable, easy, quick, and yet non-destructive alternate means to the tensile test to measure tensile-like properties of selective-electron-beam-melted specimens. Furthermore, the macro-instrumented indentation test can be used effectively in additive manufacturing for a rapid setting up of the process, that is, by controlling the microscopic scale properties of the samples, or to quantitatively determine a product quality index of the final builds, by taking advantage of its intrinsic relationship with the tensile properties

Integrative Whole Person Oncology Care in the UK

The term ‘whole person cancer care’ - an approach that addresses the needs of the person as well as treating the disease - is more widely understood in the UK than its synonym ‘integrative oncology”. The National Health Service (NHS), provides free access to care for all, which makes it harder to prioritise NHS funding of whole person medicine, where interventions may be multi-modal and lacking in cost-effectiveness data. Despite this, around 30% of cancer patients are known to use some form of complementary or alternative medicine (CAM). This is virtually never medically led, and usually without the support or even the knowledge of their oncology teams, with the exception of one or two large cancer centres. UK oncology services are, however, starting to be influenced from three sides; firstly, by well-developed and more holistic palliative care services; secondly, by directives from central government via the sustainable healthcare agenda; and thirdly, by increasing pressure from patient-led groups and cancer charities. CAM remains unlikely to be provided through the NHS, but nutrition, physical activity, mindfulness, and stress management are already becoming a core part of the NHS ‘Living With and Beyond Cancer’ agenda. This supports cancer survivors into stratified pathways of care, based on individual, self-reported holistic needs and risk assessments, which are shared between healthcare professionals and patients. Health and Wellbeing events are being built into cancer care pathways, designed to activate patients into self-management and support positive lifestyle change. Those with greater needs can be directed towards appropriate external providers, where many examples of innovative practice exist. These changes in policy and vision for the NHS present an opportunity for Integrative Oncology to develop further and to reach populations who would, in many other countries, remain underserved or hard-to-reach by whole person approaches

Using a whole person approach to support people with cancer: a longitudinal, mixed methods service evaluation

Introduction: Improved models of care are needed to meet all the support needs of people with cancer, which encompass psychological, emotional, physical, spiritual, sexual, occupational, social and existential needs. The aim of this paper is to (1) evaluate short and long-term impacts of using a whole person approach to support people with cancer on the Living Well with the Impact of Cancer Course (LWC); (2) use these data to inform strategic decisions about future service provision at Penny Brohn UK. Methods: Longitudinal mixed-methods service evaluation (n=135). Data collected included health related quality of life (HRQoL) (FACIT-SpEx); Concerns (types and severity - MYCaW); lifestyle behaviour (bespoke questionnaire) and participants’ experiences over 12 months post course. Results: Statistically and clinically significant improvements from baseline - 12 months in severity of MYCaW Concerns (n=64; p<0.000) and mean total HRQoL (n=66; p<0.000). The majority of MYCaW concerns were ‘psychological and emotional’ and about participants’ wellbeing. Spiritual, emotional and functional wellbeing contributed most to HRQoL improvements at 12 months. Barriers to maintaining healthy lifestyle changes included lack of support from family and friends, time constraints, and returning to work. 3-6 months post-course was identified as the time when more support was most likely to be needed. Conclusions: Using a whole person approach for the LWC enabled the needs of participants to be met, and statistically and clinically significant improvements in HRQoL and MYCaW Concerns were reported. Qualitative data analysis explored how experiencing whole person support enabled participants to make and sustain healthy lifestyle changes associated with improved survivorship. Barriers experienced to making health behaviour change were also identified. These data then informed wider and more person-centred clinical provision to increase the maintenance of positive long-term behaviour changes. Comparison of whole person approaches to cancer treatment and support and standard care are now urgently needed

Super Learner

Previous articles (van der Laan and Dudoit (2003); van der Laan et al. (2006); Sinisi et al. (2007)) advertised and theoretically validated the use of cross-validation to select among many candidate estimators to compute a so called super learner which outperforms any of the given candidate estimators. The theoretical basis was provided for this super learner based on oracle results for the cross-validation selector (e.g., van der Laan and Dudoit (2003); van der Laan et al. (2006)) and in Sinisi et al. (2007). In addition, these papers contained a practical demonstration of the adaptivity of this so called super learner in the context of prediction of the fitness of the HIV virus as a function of its mutations. This article proposes a fast algorithm for constructing a super learner in prediction which uses V-fold cross-validation to select a functional form of an initial set of candidate predictors according to a parametric or semi-parametric model, or possibly, data adaptively. The paper contains a proof that the resulting super learner performs asymptotically as well as the oracle selector among the continuum of estimators defined by the (semi-)parametric functional forms of the initial set of candidate estimators. This approach also yields a new class of cross-validation methods to select among a family of candidate estimators by formulating the minimization of the cross-validated risk over the family of candidate estimators as a new least squares regression problem which itself can be carried out with any type of parametric or nonparametric regression methodology (e.g. using cross-validation itself), thereby preventing over-fitting of the cross-validated risk. Simulations and data analysis suggest this new proposed super learner superior to competing methods. This approach for construction of a super learner generalizes to any parameter which can be defined as a minimizer of a loss function

Naturally acquired antibodies to polymorphic and conserved epitopes of Plasmodium falciparum merozoite surface protein 3

Many studies on the role of merozoite surface protein 3 (MSP3) in immunity against malaria have focused on a conserved section of MSP3. New evidence suggests that polymorphic sequences within MSP3 are under immune selection. We report a detailed analysis of naturally-acquired antibodies to allele-specific and conserved parts of MSP3 in a Kenyan cohort. Indirect and competition ELISA to heterologous recombinant MSP3 proteins were used for antibody assays, and parasites were genotyped for msp3 alleles. Antibody reactivity to allele-specific and conserved epitopes of MSP3 was heterogenous between individuals. Overall, the prevalence of allele-specific antibody reactivity was significantly higher (3D7-specific 54%, K1-specific 41%) than that to a recombinant protein representing a conserved portion of C-terminal MSP3 (24%, P < 0·01). The most abundant IgG subclass was IgG3, followed by IgG1. Allele-specific reactivity to the K1-type of MSP3 was associated with a lower risk of clinical malaria episodes during a 6-month follow-up in individuals who were parasitized at the start of the malaria transmission season (Relative risk 0·41 with 95% confidence interval 0·20–0·81, P = 0·011). The potential importance of allele-specific immunity to MSP3 should be considered in addition to immunity to conserved epitopes, in the development of an MSP3 malaria vaccine

C3–C4 composition and prior carbon dioxide treatment regulate the response of grassland carbon and water fluxes to carbon dioxide

During May, July and October 2000, we measured the effects of temporarily increasing or decreasing CO2 concentration by 150–200 μmol mol−1 on daytime net ecosystem CO2 exchange (NEE) and water flux (evapotranspiration, ET) of C3–C4 grassland in central Texas, USA that had been exposed for three growing seasons to a CO2 gradient from 200 to 560 μmol mol−1. Grassland grown at subambient CO2 (\u3c 365 μmol mol−1) was exposed for 2 days to an elevated CO2 gradient (\u3e 365 μmol mol−1). Grassland grown at elevated CO2 was exposed for 2 days to a subambient gradient. Our objective was to determine whether growth CO2 affected the amount by which grassland NEE and ET responded to CO2 switching (sensitivity to CO2)

Free HIV Antiretroviral Therapy Enhances Adherence among Individuals on Stable Treatment: Implications for Potential Shortfalls in Free Antiretroviral Therapy

Objective: To estimate the population-level causal effect of source of payment for HIV medication on treatment adherence using Marginal Structural Models. Methods: Data were obtained from an observational cohort of 76 HIV-infected individuals with at least 24 weeks of antiretroviral therapy treatment from 2002 to 2007 in Kampala, Uganda. Adherence was the primary outcome and it was measured using the 30-day visual analogue scale. Marginal structural models (MSM) were used to estimate the effect of source of payment for HIV medication on adherence, adjusting for confounding by income, duration on antiretroviral therapy (ART), timing of visit, prior adherence, prior CD4+ T cell count and prior plasma HIV RNA. Traditional association models were also examined and the results compared. Results: Free HIV treatment was associated with a 3.8% improvement in adherence in the marginal structural model, while the traditional statistical models showed a 3.1–3.3% improvement in adherence associated with free HIV treatment. Conclusion: Removing a financial barrier to treatment with ART by providing free HIV treatment appears to significantly improve adherence to antiretroviral therapy. With sufficient information on confounders, MSMs can be used to make robust inferences about causal effects in epidemiologic research

Net grassland carbon flux over a subambient to superambient CO2 gradient

Increasing atmospheric CO2 concentrations may have a profound effect on the structure and function of plant communities. A previously grazed, central Texas grassland was exposed to a 200-µmol mol-1 to 550 µmol mol-1 CO2 gradient from March to mid-December in 1998 and 1999 using two, 60-m long, polyethylene-covered chambers built directly onto the site. One chamber was operated at subambient CO2 concentrations (200-360 µmol mol-1 daytime) and the other was regulated at superambient concentrations (360-550 µmol mol-1). Continuous CO2 gradients were maintained in each chamber by photosynthesis during the day and respiration at night. Net ecosystem CO2 flux and end-of-year biomass were measured in each of 10, 5-m long sections in each chamber. Net CO2 fluxes were maximal in late May (c. day 150) in 1998 and in late August in 1999 (c. day 240). In both years, fluxes were near zero and similar in both chambers at the beginning and end of the growing season. Average daily CO2 flux in 1998 was 13 g CO2 m-2 day-1 in the subambient chamber and 20 g CO2 m-2 day-1 in the superambient chamber; comparable averages were 15 and 26 g CO2 m-2 day-1 in 1999. Flux was positively and linearly correlated with end-of-year above-ground biomass but flux was not linearly correlated with CO2 concentration; a finding likely to be explained by inherent differences in vegetation. Because C3 plants were the dominant functional group, we adjusted average daily flux in each section by dividing the flux by the average percentage C3 cover. Adjusted fluxes were better correlated with CO2 concentration, although scatter remained. Our results indicate that after accounting for vegetation differences, CO2 flux increased linearly with CO2 concentration. This trend was more evident at subambient than superambient CO2 concentrations