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Inhaled epoprostenol is a selective pulmonary vasodilator that has shown a potentially broad number of applications in the management of critically ill patients. To date, the vast majority of the literature with regard to efficacy, indications for use, and adverse effects of inhaled epoprostenol is focused on use of this agent in critical care settings, with relatively little literature describing use of inhaled epoprostenol in the Emergency Department. This retrospective review sought to examine instances in which inhaled epoprostenol was administered in the Emergency Department of a tertiary-care, Level I trauma center following implementation of a clinical pathway for administration of this medication for cases of refractory hypoxemia, RV dysfunction, and refractory hypoxemia. Primary outcomes were monitoring for adverse effects (i.e. hypotension), trend in FiO2 requirement over time, and clinical indication for initiation of inhaled epoprostenol. An automated review was performed to query cases in which inhaled epoprostenol had been initiated in the Emergency Department following adoption of the inhaled epoprostenol clinical pathway. Cases were excluded if the medication was initiated in the prehospital setting, ordered but not administered, or administered for a period of <1 h. Vital signs and co-administration of vasopressors were followed before and following epoprostenol administration to assess for change over time. Clinical indication of epoprostenol administration was assessed via manual chart review. Inhaled epoprostenol was administered in 20 instances, with 15 cases ultimately meeting inclusion criteria. There were no cases of clinically significant hypotension (MAP <65) in any of the cases in which inhaled epoprostenol was administered in the Emergency Department, and mean vasopressor requirement did not increase over time. A majority of patients saw a reduction in FiO2 requirement following administration of inhaled epoprostenol. The most common indication for initiation of inhaled epoprostenol based on manual chart review was pulmonary embolism. In this review of cases in which inhaled epoprostenol was administered following adoption of a clinical pathway for medication administration, there were no cases of hypotension or other adverse effects that appear to be attributable to medication administration. Pulmonary embolism and refractory hypoxemia were the most common noted indications for administration of inhaled epoprostenol. Further research is warranted regarding development of clinical protocols for administration of inhaled pulmonary vasodilators in the Emergency Department setting.

\"For readers of Inside of a Dog and The Soul of an Octopus, a fascinating, charming, and revelatory look at the science behind why animals play that shows how life-at its most fundamental level-is playful. In Kingdom of Play, critically acclaimed science writer David Toomey takes us on a fast-paced and entertaining tour of playful animals and the scientists who study them. From octopuses on Australia's Great Barrier Reef to meerkats in the Kalahari Desert to brown bears on Alaska's Aleutian Islands, we follow adventurous researchers as they design and conduct experiments seeking answers to new, intriguing questions: When did play first appear in animals? How does play develop the brain, and how did it evolve? Are the songs and aerial acrobatics of birds the beginning of avian culture? Is fairness in dog play the foundation of canine ethics? And does play direct and possibly accelerate evolution? Monkeys belly-flop, dolphins tail-walk, elephants mud-slide, crows dive-bomb, and octopuses bounce balls. These activities are various, but all are play, and as Toomey explains, animal play can be seen as a distinct behavior-one that is ongoing and open-ended, purposeless and provisional-rather like natural selection. Through a close examination of both natural selection and play, Toomey argues that life itself is fundamentally playful. A globe-spanning journey and a scientific detective story filled with lively animal anecdotes, Kingdom of Play is an illuminating-and yes, playful-look at a little-known aspect of the animal kingdom\"-- Provided by publisher.

As digital pathology systems for clinical diagnostic work applications become mainstream, interoperability between these systems from different vendors becomes critical. For the first time, multiple digital pathology vendors have publicly revealed the use of the digital imaging and communications in medicine (DICOM) standard file format and network protocol to communicate between separate whole slide acquisition, storage, and viewing components. Note the use of DICOM for clinical diagnostic applications is still to be validated in the United States. The successful demonstration shows that the DICOM standard is fundamentally sound, though many lessons were learned. These lessons will be incorporated as incremental improvements in the standard, provide more detailed profiles to constrain variation for specific use cases, and offer educational material for implementers. Future Connectathon events will expand the scope to include more devices and vendors, as well as more ambitious use cases including laboratory information system integration and annotation for image analysis, as well as more geographic diversity. Users should request DICOM features in all purchases and contracts. It is anticipated that the growth of DICOM-compliant manufacturers will likely also ease DICOM for pathology becoming a recognized standard and as such the regulatory pathway for digital pathology products.

Integrating multidisciplinary perspectives on the relation of rhetoric, science, technology and public policy-making to the process and product of technical communication, this textbook reformulates the issues raised by science and technology studies (STS) within the context of technical communication.

Background: The magnitude of exercise-induced hypoalgesia (EIH) varies across individuals with knee osteoarthritis (OA). Impaired EIH may limit the pain-relieving effects of exercise and reduce exercise adherence. This study aimed to identify key factors associated with EIH in knee OA. Methods: This cross-sectional study included 119 participants (mean age 68 ± 10) with knee OA. Pre-exercise assessments, including validated questionnaires and quantitative sensory testing were undertaken. EIH was evaluated by measuring pressure pain thresholds (PPT) at the knee and forearm before and after quadriceps isometric resistance exercise. Linear regression and mixed models were used to identify factors associated with the magnitude of EIH and sources of variance in EIH. Results: EIH was greater at the knee compared to the forearm (p < 0.01), with considerable inter-individual variability. Older age, less anxiety, and expecting less exercise-induced pain were associated with increased EIH (all p < 0.05). However, all measured variables explained <20% of the variance in EIH, with unobserved between-participant factors estimated to account for ≥45% additional variance. Conclusions: Age, pre-exercise anxiety, and pain expectations are associated with the magnitude of EIH after resistance exercise in people with knee OA. However, the contribution of these factors was modest, with much of the inter-individual variance in EIH remaining unexplained.

Genome sequencing and bioinformatics have provided the full hypothetical proteome of many pathogenic organisms. Advances in microarray and mass spectrometry have also yielded large output datasets of possible target proteins/genes. However, the challenge remains to identify new targets for drug discovery from this wealth of information. Further analysis includes bioinformatics and/or molecular biology tools to validate the findings. This is time consuming and expensive, and could fail to yield novel drugs if protein purification and crystallography is impossible. To pre-empt this, a researcher may want to rapidly filter the output datasets for proteins that show good homology to proteins that have already been structurally characterised or proteins that are already targets for known drugs. Critically, those researchers developing novel antibiotics need to select out the proteins that show close homology to any human proteins, as future inhibitors are likely to cross-react with the host protein, causing off-target toxicity effects later in clinical trials. To solve many of these issues, we have developed a free online resource called Genomes2Drugs which ranks sequences to identify proteins that are (i) homologous to previously crystallized proteins or (ii) targets of known drugs, but are (iii) not homologous to human proteins. When tested using the Plasmodium falciparum malarial genome the program correctly enriched the ranked list of proteins with known drug target proteins. Genomes2Drugs rapidly identifies proteins that are likely to succeed in drug discovery pipelines. This free online resource helps in the identification of potential drug targets. Importantly, the program further highlights proteins that are likely to be inhibited by FDA-approved drugs. These drugs can then be rapidly moved into Phase IV clinical studies under 'change-of-application' patents.

Analysis of military campaigns through the use of computational models and simulations, is one of the fundamental methods used within defence Operational Analysis at the Defence Science and Technology Laboratory. It helps to develop understanding behind the value of investment so that an agile defence capability can be built and maintained; in order to face the challenges of an ever-changing world. However, many of these models have been used and adapted continuously over decades, resulting in code-bases that have become unmaintainable in the face of constrained budgets. To address this problem, a number of software modelling framework, based upon the reuse of code and concepts have been developed. However, many of these ultimately did not achieve their full potential, because they merely iterated upon the same software patterns which had been used to produce models to-date. The most recent attempt however, known as the Generic Aggregator Model Valuator, was very different in this regard, due to its exploitation of the emerging Object-Functional design paradigm. As an emerging design paradigm, Object-Functional is still to be more formally understood. There is currently a lack of widely accepted design patterns for the paradigm and explicitly acknowledged examples of its use in projects. This thesis examines the Object-Functional paradigm in greater detail, by performing a qualitative evaluation of defence models built using the paradigm compared to extant models that use other approaches such as Object-Orientation. The evaluation aims to answer two key questions: what benefits does the exploitation of this paradigm bring to defence modelling? But also, what challenges? The Generic Aggregator Model Valuator framework’s implementation of the paradigm is also presented in detail, illustrating the patterns it uses, standing as an example that can contribute to the further refinement of this paradigm in the future.

Healthcare waste is estimated at 30%, or $1 trillion, and it’s heavily influenced by the 300+% price variation amongst healthcare providers as well as the lack of some providers following evidence-based standards of care, resulting in unnecessary services. The efforts over the past 20 plus years around wellness, consumer-directed healthcare, and performance-based contracts have produced national healthcare costs 45% higher than Switzerland, the country with the second highest spend per capita. The initiative leverages the...

At Cambridge University Library, along with all the books, maps and manuscripts, there’s a child’s drawing that curators have titled “The Battle of the Fruit and Vegetable Soldiers.” [...]to foraging and hunting – behaviors with clearly defined goals – play is likewise undirected. [...]in the 1860s, Russian naturalist Pyotr Kropotkin’s observations of birds and fallow deer led him to conclude that many species were “the most numerous and the most prosperous” because natural selection also selects for cooperation. [...]since natural selection shares so many features with play, we may with some justification maintain that life, in a most fundamental sense, is playful.