A Three-dimensional Printed Low-cost Anterior Shoulder Dislocation Model for Ultrasound-guided Injection Training.

Anterior shoulder dislocations are the most common, large joint dislocations that present to the emergency department (ED). Numerous studies support the use of intraarticular local anesthetic injections for the safe, effective, and time-saving reduction of these dislocations. Simulation training is an alternative and effective method for training compared to bedside learning. There are no commercially available ultrasound-compatible shoulder dislocation models. We utilized a three-dimensional (3D) printer to print a model that allows the visualization of the ultrasound anatomy (sonoanatomy) of an anterior shoulder dislocation. We utilized an open-source file of a shoulder, available from embodi3D® (Bellevue, WA, US). After approximating the relative orientation of the humerus to the glenoid fossa in an anterior dislocation, the humerus and scapula model was printed with an Ultimaker-2 Extended+ 3D® (Ultimaker, Cambridge, MA, US) printer using polylactic acid filaments. A 3D model of the external shoulder anatomy of a live human model was then created using Structure Sensor®(Occipital, San Francisco, CA, US), a 3D scanner. We aligned the printed dislocation model of the humerus and scapula within the resultant external shoulder mold. A pourable ballistics gel solution was used to create the final shoulder phantom. The use of simulation in medicine is widespread and growing, given the restrictions on work hours and a renewed focus on patient safety. The adage of see one, do one, teach one is being replaced by deliberate practice. Simulation allows such training to occur in a safe teaching environment. The ballistic gel and polylactic acid structure effectively reproduced the sonoanatomy of an anterior shoulder dislocation. The 3D printed model was effective for practicing an in-plane ultrasound-guided intraarticular joint injection. 3D printing is effective in producing a low-cost, ultrasound-capable model simulating an anterior shoulder dislocation. Future research will determine whether provider confidence and the use of intraarticular anesthesia for the management of shoulder dislocations will improve after utilizing this model

VarSight: prioritizing clinically reported variants with binary classification algorithms.

BackgroundWhen applying genomic medicine to a rare disease patient, the primary goal is to identify one or more genomic variants that may explain the patient's phenotypes. Typically, this is done through annotation, filtering, and then prioritization of variants for manual curation. However, prioritization of variants in rare disease patients remains a challenging task due to the high degree of variability in phenotype presentation and molecular source of disease. Thus, methods that can identify and/or prioritize variants to be clinically reported in the presence of such variability are of critical importance.MethodsWe tested the application of classification algorithms that ingest variant annotations along with phenotype information for predicting whether a variant will ultimately be clinically reported and returned to a patient. To test the classifiers, we performed a retrospective study on variants that were clinically reported to 237 patients in the Undiagnosed Diseases Network.ResultsWe treated the classifiers as variant prioritization systems and compared them to four variant prioritization algorithms and two single-measure controls. We showed that the trained classifiers outperformed all other tested methods with the best classifiers ranking 72% of all reported variants and 94% of reported pathogenic variants in the top 20.ConclusionsWe demonstrated how freely available binary classification algorithms can be used to prioritize variants even in the presence of real-world variability. Furthermore, these classifiers outperformed all other tested methods, suggesting that they may be well suited for working with real rare disease patient datasets

Continuum Limit of BKB_K from 2+1 Flavor Domain Wall QCD

We determine the neutral kaon mixing matrix element $B_K$ in the continuum limit with 2+1 flavors of domain wall fermions, using the Iwasaki gauge action at two different lattice spacings. These lattice fermions have near exact chiral symmetry and therefore avoid artificial lattice operator mixing. We introduce a significant improvement to the conventional NPR method in which the bare matrix elements are renormalized non-perturbatively in the RI-MOM scheme and are then converted into the MSbar scheme using continuum perturbation theory. In addition to RI-MOM, we introduce and implement four non-exceptional intermediate momentum schemes that suppress infrared non-perturbative uncertainties in the renormalization procedure. We compute the conversion factors relating the matrix elements in this family of RI-SMOM schemes and MSbar at one-loop order. Comparison of the results obtained using these different intermediate schemes allows for a more reliable estimate of the unknown higher-order contributions and hence for a correspondingly more robust estimate of the systematic error. We also apply a recently proposed approach in which twisted boundary conditions are used to control the Symanzik expansion for off-shell vertex functions leading to a better control of the renormalization in the continuum limit. We control chiral extrapolation errors by considering both the NLO SU(2) chiral effective theory, and an analytic mass expansion. We obtain B_K^{\msbar}(3 GeV) = 0.529(5)_{stat}(15)_\chi(2)_{FV}(11)_{NPR}. This corresponds to $\hat{B}_K = 0.749(7)_{stat}(21)_\chi(3)_{FV}(15)_{NPR}$. Adding all sources of error in quadrature we obtain $\hat{B}_K = 0.749(27)_{combined}$, with an overall combined error of 3.6%.Comment: 65 page

Models and metaphors: complexity theory and through-life management in the built environment

Complexity thinking may have both modelling and metaphorical applications in the through-life management of the built environment. These two distinct approaches are examined and compared. In the first instance, some of the sources of complexity in the design, construction and maintenance of the built environment are identified. The metaphorical use of complexity in management thinking and its application in the built environment are briefly examined. This is followed by an exploration of modelling techniques relevant to built environment concerns. Non-linear and complex mathematical techniques such as fuzzy logic, cellular automata and attractors, may be applicable to their analysis. Existing software tools are identified and examples of successful built environment applications of complexity modelling are given. Some issues that arise include the definition of phenomena in a mathematically usable way, the functionality of available software and the possibility of going beyond representational modelling. Further questions arising from the application of complexity thinking are discussed, including the possibilities for confusion that arise from the use of metaphor. The metaphor of a 'commentary machine' is suggested as a possible way forward and it is suggested that an appropriate linguistic analysis can in certain situations reduce perceived complexity

Lattice determination of the K→(ππ)I=2K \to (\pi\pi)_{I=2} Decay Amplitude A2A_2

We describe the computation of the amplitude A_2 for a kaon to decay into two pions with isospin I=2. The results presented in the letter Phys.Rev.Lett. 108 (2012) 141601 from an analysis of 63 gluon configurations are updated to 146 configurations giving Re$A_2=1.381(46)_{\textrm{stat}}(258)_{\textrm{syst}} 10^{-8}$ GeV and Im$A_2=-6.54(46)_{\textrm{stat}}(120)_{\textrm{syst}}10^{-13}$ GeV. Re$A_2$ is in good agreement with the experimental result, whereas the value of Im$A_2$ was hitherto unknown. We are also working towards a direct computation of the $K\to(\pi\pi)_{I=0}$ amplitude $A_0$ but, within the standard model, our result for Im$A_2$ can be combined with the experimental results for Re$A_0$, Re$A_2$ and $\epsilon^\prime/\epsilon$ to give Im$A_0/$Re$A_0= -1.61(28)\times 10^{-4}$ . Our result for Im\,$A_2$ implies that the electroweak penguin (EWP) contribution to $\epsilon^\prime/\epsilon$ is Re$(\epsilon^\prime/\epsilon)_{\mathrm{EWP}} = -(6.25 \pm 0.44_{\textrm{stat}} \pm 1.19_{\textrm{syst}}) \times 10^{-4}$.Comment: 59 pages, 11 figure

OSCE best practice guidelines—applicability for nursing simulations

Background: Objective structured clinical examinations (OSCEs) have been used for many years within healthcare programmes as a measure of students’ and clinicians’ clinical performance. OSCEs are a form of simulation and are often summative but may be formative. This educational approach requires robust design based on sound pedagogy to assure practice and assessment of holistic nursing care. As part of a project testing seven OSCE best practice guidelines (BPGs) across three sites, the BPGs were applied to an existing simulation activity. The aim of this study was to determine the applicability and value of the OSCE BPGs in an existing formative simulation. Methods: A mixed methods approach was used to address the research question: in what ways do OSCE BPGs align with simulations. The BPGs were aligned and compared with all aspects of an existing simulation activity offered to first-year nursing students at a large city-based university, prior to their first clinical placement in an Australian healthcare setting. Survey questions, comprised of Likert scales and free-text responses, used at other sites were slightly modified for reference to simulation. Students’ opinions about the refined simulation activity were collected via electronic survey immediately following the simulation and from focus groups. Template analysis, using the BPGs as existing or a priori thematic codes, enabled interpretation and illumination of the data from both sources.Results: Few changes were made to the existing simulation plan and format. Students’ responses from surveys (n = 367) and four focus groups indicated that all seven BPGs were applicable for simulations in guiding their learning, particularly in the affective domain, and assisting their perceived needs in preparing for upcoming clinical practice. Discussion: Similarities were found in the intent of simulation and OSCEs informed by the BPGs to enable feedback to students about holistic practice across affective, cognitive and psychomotor domains. The similarities in this study are consistent with findings from exploring the applicability of the BPGs for OSCEs in other nursing education settings, contexts, universities and jurisdictions. The BPGs also aligned with other frameworks and standards often used to develop and deliver simulations. Conclusions: Findings from this study provide further evidence of the applicability of the seven OSCE BPGs to inform the development and delivery of, in this context, simulation activities for nurses. The manner in which simulation is offered to large cohorts requires further consideration to meet students’ needs in rehearsing the registered nurse role

A <i>Herschel</i> and BIMA study of the sequential star formation near the W 48A H II region

We present the results of Herschel HOBYS (Herschel imaging survey of OB Young Stellar objects) photometric mapping combined with Berkeley Illinois Maryland Association (BIMA) observations and additional archival data, and perform an in-depth study of the evolutionary phases of the star-forming clumps in W 48A and their surroundings. Age estimates for the compact sources were derived from bolometric luminosities and envelope masses, which were obtained from the dust continuum emission, and agree within an order of magnitude with age estimates from molecular line and radio data. The clumps in W 48A are linearly aligned by age (east-old to west-young): we find a ultra-compact (UC) H II region, a young stellar object (YSO) with class II methanol maser emission, a YSO with a massive outflow and finally the NH2D prestellar cores from Pillai et al. This remarkable positioning reflects the (star) formation history of the region. We find that it is unlikely that the star formation in the W 48A molecular cloud was triggered by the UC H II region and discuss the Aquila supershell expansion as a major influence on the evolution of W 48A. We conclude that the combination of Herschel continuum data with interferometric molecular line and radio continuum data is important to derive trustworthy age estimates and interpret the origin of large-scale structures through kinematic information

Measurement of deep crustal resistivities

Thesis (M.S.)--Massachusetts Institute of Technology, Dept. of Geology and Geophysics, 1963.Includes bibliographical references (leaf 103).by Arthur M. Kelly.M.S

The TREAT-NMD advisory committee for therapeutics (TACT): an innovative de-risking model to foster orphan drug development

Despite multiple publications on potential therapies for neuromuscular diseases (NMD) in cell and animal models only a handful reach clinical trials. The ability to prioritise drug development according to objective criteria is particularly critical in rare diseases with large unmet needs and a limited numbers of patients who can be enrolled into clinical trials. TREAT-NMD Advisory Committee for Therapeutics (TACT) was established to provide independent and objective guidance on the preclinical and development pathway of potential therapies (whether novel or repurposed) for NMD. We present our experience in the establishment and operation of the TACT. TACT provides a unique resource of recognized experts from multiple disciplines. The goal of each TACT review is to help the sponsor to position the candidate compound along a realistic and well-informed plan to clinical trials, and eventual registration. The reviews and subsequent recommendations are focused on generating meaningful and rigorous data that can enable clear go/no-go decisions and facilitate longer term funding or partnering opportunities. The review process thereby acts to comment on viability, de-risking the process of proceeding on a development programme. To date TACT has held 10 review meeting and reviewed 29 program applications in several rare neuromuscular diseases: Of the 29 programs reviewed, 19 were from industry and 10 were from academia; 15 were for novel compounds and 14 were for repurposed drugs; 16 were small molecules and 13 were biologics; 14 were preclinical stage applications and 15 were clinical stage applications. 3 had received Orphan drug designation from European Medicines Agency and 3 from Food and Drug Administration. A number of recurrent themes emerged over the course of the reviews and we found that applicants frequently require advice and education on issues concerned with preclinical standard operating procedures, interactions with regulatory agencies, formulation, repurposing, clinical trial design, manufacturing and ethics. Over the 5 years since its establishment TACT has amassed a body of experience that can be extrapolated to other groups of rare diseases to improve the community's chances of successfully bringing new rare disease drugs to registration and ultimately to marke

Genomic, Pathway Network, and Immunologic Features Distinguishing Squamous Carcinomas

This integrated, multiplatform PanCancer Atlas study co-mapped and identified distinguishing molecular features of squamous cell carcinomas (SCCs) from five sites associated with smokin