Instructional texts rewritten by five expert teams: Revisions and retention improvements.

700 undergraduates were tested in 3 experiments on original or rewritten versions of 52 instructional texts about Army job tasks, general science, philosophy, and history. Five experts had rewritten various sets of the texts and stated hypotheses about the efficacious features of their revisions. We tested their hypotheses and several others. Recall and recognition tests were given immediately and after a 24-hr delay. Results showed that revisions made by 3 of the 5 experts improved retention of text information. The kind and number of revisions and improvements varied across the text sets. Most expert hypotheses were not supported, and they made many revisions they were declaratively unaware of. Some of our hypotheses about the revision features were supported, but different features were effective for different sets of texts. It was concluded that some experts have effective knowledge about improving instructional text, but it exists primarily in procedural form. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prevention of bleeding after cardiopulmonary bypass with high-dose tranexamic acid. Double-blind, randomized clinical trial

This prospective, double-blind, randomized trial assessed the effectiveness of high-dose tranexamic acid given in the preoperative period on blood loss in patients undergoing cardiopulmonary bypass. One hundred fifty patients scheduled to undergo cardiac operations with cardiopulmonary bypass were randomized into three groups of equal size. The first group received 10 gm of tranexamic acid intravenously over 20 minutes before sternotomy and a placebo infusion over 5 hours. The second group received 10 gm of tranexamic acid over 20 minutes and then another 10 gm infused intravenously over 5 hours. The control group received a placebo bolus and a placebo infusion over 5 hours (0.9% normal saline solution). The blood loss after the operation was measured at 6 hours and 24 hours. The homologous blood and blood products given during and up to 48 hours after operation were recorded. Eighteen percent of the control group patients shed more than 750 ml blood in 6 hours compared with only 2% in both tranexamic acid groups. Patients who shed more than 750 ml blood required 93% more red blood cell transfusions than patients without excessive bleeding. Tranexamic acid (10 gm) given intravenously in the period before cardiopulmonary bypass reduced blood loss over 6 hours by 50% and over 24 hours by 35%. Continued tranexamic acid infusion (10 gm over 5 hours) did not reduce bleeding further. There was no difference in the coagulation profile before operation between patients with and without excessive bleeding. However, coagulation tests done in the postoperative period indicated ongoing fibrinolysis and platelet dysfunction in patients with excessive bleeding.     

Offering customers direct access: Using choice to stimulate competition

The essential elements for a system of customer direct access to electricity supplies are already in place, with protocols for existing pool operation and inter-system coordination, as well as the Western System Power Pool market. Extending our experience with gas and electricity wholesale markets to direct access for large retail electricity customers, then to small customers, is achievable now.     

Modeling the glucose regulatory system in extreme preterm infants

Background

Premature infants represent a significant proportion of the neonatal intensive care population. Blood glucose homeostasis in this group is often disturbed by immaturity of endogenous regulatory systems and the stress of their condition. Hypo- and hyperglycemia are frequently reported in very low birth weight infants, and more mature infants often experience low levels of glycemia. A model capturing the unique fundamental dynamics of the neonatal glucose regulatory system could be used to develop better blood glucose control methods.

Methods

A metabolic system model is adapted from adult critical care to the unique physiological case of the neonate. Integral-based fitting methods were used to identify time-varying insulin sensitivity and non-insulin mediated glucose uptake profiles. The clinically important predictive ability of the model was assessed by assuming insulin sensitivity was constant over prediction intervals of 1, 2 and 4 h forward and comparing model-simulated versus actual clinical glucose values for all recorded interventions. The clinical data included 1091 glucose measurements over 3567 total patient hours, along with all associated insulin and nutritional infusion data, for N = 25 total cases. Ethics approval was obtained from the Upper South A Regional Ethics Committee for this study.

Results

The identified model had a median absolute percentage error of 2.4% [IQR: 0.9-4.8%] between model-fitted and clinical glucose values. Median absolute prediction errors at 1-, 2- and 4-h intervals were 5.2% [IQR: 2.5-10.3%], 9.4% [IQR: 4.5-18.4%] and 13.6% [IQR: 6.3-27.6%] respectively.

Conclusions

The model accurately captures and predicts the fundamental dynamic behaviors of the neonatal metabolism well enough for effective clinical decision support in glycemic control. The adaptation from adult to a neonatal case is based on the data from the literature. Low prediction errors and very low fitting errors indicate that the fundamental dynamics of glucose metabolism in both premature neonates and critical care adults can be described by similar mathematical models.     

Risk-based approach to developing a national residue sampling plan for testing under European Union regulation for veterinary medicinal products and coccidiostat feed additives in domestic animal production

A ranking system for veterinary medicinal products and coccidiostat feed additives has been developed as a tool to be applied in a risk-based approach to the residue testing programme for foods of animal origin in the Irish National Residue Control Plan (NRCP). Three characteristics of substances that may occur as residues in food are included in the developed risk ranking system: Potency, as measured by the acceptable daily intake assigned by the European Medicines Agency Committee for Medicinal Products for Veterinary Use, to each substance; Usage, as measured by the three factors of Number of Doses, use on Individual animals or for Group treatment, and Withdrawal Period; and Residue Occurrence, as measured by the number of Non-Compliant Samples in the NRCP. For both Number of Doses and Non-Compliant Samples, data for the 5-year period 2008–12 have been used. The risk ranking system for substances was developed for beef cattle, sheep and goats, pigs, chickens and dairy cattle using a scoring system applied to the various parameters described above to give an overall score based on the following equation: Potency × Usage (Number of Doses + Individual/Group Use + Withdrawal Period) × Residue Occurrence. Applying this risk ranking system, the following substances are ranked very highly: antimicrobials such as amoxicillin (for all species except pigs), marbofloxacillin (for beef cattle), oxytetracycline (for all species except chickens), sulfadiazine with trimethoprim (for pigs and chickens) and tilmicosin (for chickens); antiparasitic drugs, such as the benzimidazoles triclabendazole (for beef and dairy cattle), fenbendazole/oxfendazole (for sheep/goats and dairy cattle) and albendazole (for dairy cattle), the avermectin ivermectin (for beef cattle), and anti-fluke drugs closantel and rafoxanide (for sheep/goats); the anticoccidials monensin, narasin, nicarbazin and toltrazuril (for chickens). The risk ranking system described is a relatively simple system designed to provide a reliable basis for selecting the veterinary medicinal products and coccidiostat feed additives that might be prioritised for residue testing.     

Effects of 3‐D microwell culture on initial fate specification in human embryonic stem cells

Several studies have demonstrated that three‐dimensional (3‐D) culture systems influence human embryonic stem cell (hESC) phenotypes and fate choices. However, the effect that these microenvironmental changes have on signaling pathways governing hESC behaviors is not well understood. Here, a 3‐D microwell array was used to investigate differences in activation of developmental pathways between 2‐D and 3‐D cultures of both undifferentiated hESCs and hESCs undergoing initial differentiation in embryoid bodies (EBs). An increased induction into mesoderm and endoderm and differences in expression of genes from multiple signaling pathways that regulate development, including Wnt/β‐catenin, TGF‐β superfamily, Notch, and FGF during EB‐mediated differentiation were observed in 3‐D microwells as compared with the 2‐D substrates. In undifferentiated hESCs, differences in epithelial‐mesenchymal transition phenotypes and the TGFβ/BMP pathway between cultures in 3‐D and 2‐D were also observed. These results illustrate that 3‐D culture influences multiple pathways that may regulate the differentiation trajectories of hESCs. © 2014 American Institute of Chemical Engineers AIChE J, 60: 1225–1235, 2014     

Glycoalkaloid Concentrations in Aerial Tubers of Potato ( Solanum tuberosumL)

The total glycoalkaloid concentrations in aerial and subterranean tubers of 14 potato genotypes were measured using high-performance liquid chromatography immediately after harvest. Post-harvest, aerial tubers from all genotypes were exposed to 144 h continuous fluorescent light; additionally three genotypes (cvs Home Guard, Kerrs Pink and Desiree) were subjected to mechanical wounding prior to glycoalkaloid analysis. Variations in glycoalkaloid concentrations between aerial tubers taken from a single genotype (cv Kerrs Pink) were determined by analysis of eight aerial tubers formed in the second leaf axil, selected from separate individual plants. Irrespective of genotype, total and individual glycoalkaloid concentrations were higher in aerial than in subterranean tubers. The highest glycoalkaloid concentrations were found in aerial tubers of cv Kerrs Pink (1343·0 mg kg⁻¹ FW) and lowest in cv Lindsey (301·0 mg kg⁻¹ FW). Ratios of α-chaconine: α-solanine in aerial tubers differed significantly ( P< 0·05) from those in subterranean tubers of cv Cara, Golden Wonder, Home Guard, Lindsey, Maris Piper, Record and 8859 indicating that exposure to light during aerial tuber growth enhanced the synthesis of one glycoalkaloid to a greater degree than the other. In all cultivars except cv Maris Piper, exposure of aerial tubers to 144 h continuous fluorescent light post-harvest increased total and individual glycoalkaloids compared with dark-treated controls. However, the ratios of α-chaconine: α-solanine in all genotypes except cv Golden Wonder (decreased α-chaconine: α-solanine, P< 0·05) were not significantly altered in comparison with dark controls, indicating that light exposure of aerial tubers post-harvest fails to enhance selectively synthesis of individual glycoalkaloids in the majority of cultivars. Regardless of cultivar, total glycoalkaloid, α-solanine and α-chaconine concentrations were higher in wounded than unwounded aerial tubers. Wounding stimulated synthesis of α-solanine more than α-chaconine ( P< 0·05) in cv Home Guard and Desiree. Glycoalkaloid concentrations in aerial tubers varied widely from a minimum of 1010 mg kg⁻¹ to a maximum of 2520 mg kg⁻¹ FW when harvested from individual plants of cv Kerrs Pink but selected from equivalent positions on the plant. Throughout the experiments large, non-significant increases in total and individual glycoalkaloid concentrations were recorded following light and wounding treatments. The scientific implications of aerial tuber formation are discussed.     

Early inpatient rehabilitation after elective hip and knee arthroplasty

CONTEXT: Inpatient rehabilitation after elective hip and knee arthroplasty is often necessary for patients who cannot function at home soon after surgery, but how soon after surgery inpatient rehabilitation can be initiated has not been studied. OBJECTIVE: To test the hypothesis that high-risk patients undergoing elective hip and knee arthroplasty would incur less total cost and experience more rapid functional improvement if inpatient rehabilitation began on postoperative day 3 rather than day 7, without adverse consequences to the patients. DESIGN: Randomized controlled trial conducted from 1994 to 1996. SETTING: Tertiary care center. PARTICIPANTS: A total of 86 patients undergoing elective hip or knee arthroplasty and who met the following criteria for being high risk: 70 years of age or older and living alone, 70 years of age or older with 2 or more comorbid conditions, or any age with 3 or more comorbid conditions. Of the 86 patients, 71 completed the study. INTERVENTIONS: Random assignment to begin inpatient rehabilitation on postoperative day 3 vs postoperative day 7. MAIN OUTCOME MEASURES: Total length of stay and cost from orthopedic and rehabilitation hospital admissions, functional performance in hospitals using a subset of the functional independence measure, and 4-month follow-up assessment using the RAND 36-item health survey I and the functional status index. RESULTS: Patients who completed the study and began inpatient rehabilitation on postoperative day 3 exhibited shorter mean (+/-SD) total length of stay (11.7+/-2.3 days vs 14.5+/-1.9, P<.001), lower mean (+/-SD) total cost ($25891+/-$3648 vs $27762+/-$3626, P<.03), more rapid attainment of short-term functional milestones between days 6 and 10 (36.2+/-14.4 m ambulated vs 21.4+/-13.3 m, P<.001; 4.8+/-0.8 mean transfer functional independence measure score vs 4.3+/-0.7, P<.01), and equivalent functional outcome at 4-month follow-up. CONCLUSION: These data showed that high-risk individuals were able to tolerate early intensive rehabilitation, and this intervention yielded faster attainment of short-term functional milestones in fewer days using less total cost.     

Petri nets,event structures and domains,part I

The general aim of this paper is to find a theory of concurrency combining the approaches of Petri and Scott (and others).In part I we introduce our formalisms. To connect the abstract ideas of events and domains of information, we show how casual nets induce certain kinds of domains where the information points are certain sets of events. This allows translations between the languages of net theory and domain theory. Following the idea that events of causal nets are occurrences, we generalise causal nets to occurrence nets, by adding forwards conflict. Just as infinite flow charts unfold finite ones, so transition nets can be unfolded into occurrence nets. Next we extend the above connections between nets and domains to these new nets. Event structures which are intermediate between nets and domains play an important part in all our work. Finally, as an example of how concepts translate from one formalism to the other, we show how Petri's notion of confusion ties up with Kahn and Plotkin's concrete domains.In part II we shall continue the job of connecting up notions within net theory and the theory of domains. In particular, we shall examine the idea of states of computations.