Trauma Surgeons’ Perceptions of Resuscitating Lethally Injured Patients for Organ Preservation

Background Trauma surgeons face a challenge when deciding whether to resuscitate lethally injured patients whose organ donor status is unknown. Data suggests practice pattern variability in this setting, but little is known about why. Materials and Methods We conducted semi-structured interviews with trauma surgeons practicing in Level 1 or 2 trauma centers in Tennessee. Interviews focused on ethical dilemmas and resource constraints. Analysis was performed using inductive thematic analysis. Results Response rate was 73% (11/15). Four key themes emerged. All described resuscitating patients to buy time to collect more definitive clinical information and to identify family. Some acknowledged this served the secondary purpose of organ preservation. 11/11 participants felt a primacy of obligation to the patient in front of them even after it became apparent, they could not personally benefit. For 9/11 (82%), the moral obligation to consider organ preservation was secondary/balancing; 2/11 (18%) felt it was irrelevant/immoral. Resource allocation was commonly considered. All participants expressed some limitation to resources they would allocate. All participants conveyed clear moral agency in determining resuscitation extent when the goal was to save the patient’s life, however this was less clear when resuscitating for organ preservation. Across themes, perceptions of a “standard practice” existed but the described practices were not consistent across interviewees. Discussion Widely ranging perceptions regarding ethical and resource considerations underlie practices resuscitating toward organ preservation. Common themes suggest a lack of consensus. Despite expressed beliefs, there is no identifiable standard of practice amongst trauma surgeons resuscitating in this setting.

Going Beyond Rote Auditory Learning: Neural Patterns of Generalized Auditory Learning

The ability to generalize across specific experiences is vital for the recognition of new patterns, especially in speech perception considering acoustic–phonetic pattern variability. Indeed, behavioral research has demonstrated that listeners are able via a process of generalized learning to leverage their experiences of past words said by difficult-to-understand talker to improve their understanding for new words said by that talker. Here, we examine differences in neural responses to generalized versus rote learning in auditory cortical processing by training listeners to understand a novel synthetic talker. Using a pretest–posttest design with EEG, participants were trained using either (1) a large inventory of words where no words were repeated across the experiment (generalized learning) or (2) a small inventory of words where words were repeated (rote learning). Analysis of long-latency auditory evoked potentials at pretest and posttest revealed that rote and generalized learning both produced rapid changes in auditory processing, yet the nature of these changes differed. Generalized learning was marked by an amplitude reduction in the N1–P2 complex and by the presence of a late negativity wave in the auditory evoked potential following training; rote learning was marked only by temporally later scalp topography differences. The early N1–P2 change, found only for generalized learning, is consistent with an active processing account of speech perception, which proposes that the ability to rapidly adjust to the specific vocal characteristics of a new talker (for which rote learning is rare) relies on attentional mechanisms to selectively modify early auditory processing sensitivity.

Exploring the Dynamics of Week-to-Week Blood Pressure in Nursing Home Residents Before Death

BACKGROUND Aging is accompanied by an overall dysregulation of many dynamic physiologic processes including those related to blood pressure (BP). While year-to-year BP variability is associated with cardiovascular events and mortality, no studies have examined this trend with more frequent BP assessments. Our study objective is to take the next step to examine week-to-week BP dynamics—pattern, variability, and complexity—before death. METHODS Using a retrospective study design, we assessed BP dynamics in the 6 months before death in long-term nursing home residents between 1 October 2006 and 30 September 2017. Variability was characterized using SD and mean squared error after adjusting for diurnal variations. Complexity (i.e., amount of novel information in a trend) was examined using Shannon’s entropy (bits). Generalized linear models were used to examine factors associated with overall BP variability. RESULTS We identified 17,953 nursing home residents (98.0% male, 82.5% White, mean age 80.2 years, and mean BP 125.7/68.6 mm Hg). Despite a slight trend of decreasing systolic week-to-week BP over time (delta = 7.2 mm Hg), week-to-week complexity did not change in the 6 months before death (delta = 0.02 bits). Average weekly BP variability was stable until the last 3–4 weeks of life, at which point variability increased by 30% for both systolic and diastolic BP. Factors associated with BP variability include average weekly systolic/diastolic BP, days in the nursing home, days in the hospital, and changes to antihypertensive medications. CONCLUSIONS Week-to-week BP variability increases substantially in the last month of life, but complexity does not change. Changes in care patterns may drive the increase in BP variability as one approaches death.

USABLE SECURITY IN BIOMETRIC AUTHENTICATION SYSTEMS

We introduce the term usable security to refer to security systems, models, mechanisms and applications that have as the main goal usability. Secure systems cannot exist without secure authentication methods. Thus we outline biometric authentication methods and we focus on iris recognition because is the most reliable and accurate method for human identification]. The most important advantage of iris biometric over other biometrics is that irises have enormous pattern variability meaning that the variation between individual is almost maximum and variation for any person across time or conditions is minimum. Taking into consideration this observations, this survey covers researches in this field, methods of technical implementation and the usability of this method as an authentication system on iOS environment.

The Q-Pass Index: A Multifactorial IMUs-Based Tool to Assess Passing Skills in Basketball

Despite being a key sport-specific characteristic in performance, there is no practical tool to assess the quality of the pass in basketball. The aim of this study is to develop a tool (the quality-pass index or Q-Pass) able to deliver a quantitative, practical measure of passing skills quality based on a combination of accuracy, execution time and pass pattern variability. Temporal, kinematics and performance parameters were analysed in five different types of passes (chest, bounce, crossover, between-the-leg and behind-the-back) using a field-based test, video cameras and body-worn inertial sensors (IMUs). Data from pass accuracy, time and angular velocity were collected and processed in a custom-built excel spreadsheet. The Q-pass index (0–100 score) resulted from the sum of the three factors. Data were collected from 16 young basketball players (age: 16 ± 2 years) with high (experienced) and low (novice) level of expertise. Reliability analyses found the Q-pass index as a reliable tool in both novice (CV from 4.3 to 9.3%) and experienced players (CV from 2.8 to 10.2%). Besides, important differences in the Q-pass index were found between players’ level (p < 0.05), with the experienced showing better scores in all passing situations: behind-the-back (ES = 1.91), bounce (ES = 0.82), between-the-legs (ES = 1.11), crossover (ES = 0.58) and chest (ES = 0.94). According to these findings, the Q-pass index was sensitive enough to identify the differences in passing skills between young players with different levels of expertise, providing a numbering score for each pass executed.

R-BPMN for abstract modeling of business process patterns

PurposeThe authors use the extension mechanism provided by the Business Process Model and Notation (BPMN) to define roles, which allows roles to be fully aligned with the BPMN standard. The authors describe how a pattern can be defined in terms of roles and present the formal semantics of pattern realization and refinement to support systematic reuse of patterns in business process development.Design/methodology/approachIt is widely agreed that the use of business process patterns improves the efficiency and quality of business process development. However, few techniques are available to describe business process patterns at an appropriate level of abstraction to facilitate the reuse of patterns. To address this, this paper presents the role-based Business Process Model and Notation (R-BPMN), an extension of BPMN for abstract modeling of business process patterns based on a novel notion of role.FindingsThe authors apply R-BPMN in case studies for pattern realization and refinement and discuss tool support via an existing tool. The case studies demonstrate the practical benefits of R-BPMN in capturing pattern variability and facilitating pattern reuse.Practical implicationsThe findings imply a potential impact of R-BPMN on practical benefits when it is supported at the metamodel level in tool development.Originality/valueThis study addresses the need for abstract modeling of process patterns at the metamodel level, which facilitates the formalization of pattern variability and tool development to support various realizations of process patterns at the model level.

Back in time to unlock the future: tracing the type-specimens of Corallus hortulana (Linnaeus, 1758) (Serpentes: Boidae), with designation of a lectotype for the Amazon tree boa

Corallus hortulana presents a large array of tones and color pattern variability throughout its distribution (= polychromatism), which trigged the description of several taxa now considered to be primary synonyms. Linnaeus described two of these (Boa enydris and Boa hortulana) on the same page of the 10th Edition of the Systema Naturae. However, both names had been widely used in literature almost in an optional way, until their formal synonymization more than two centuries after the original description. Additionally, the type specimen of Boa hortulana was reported as missing since the late 19th century. These two factors may have enabled the unjustified switched association of types, which was perpetuated in the literature to the present day. Our main goals here were to trace the correct type specimens for each species through a literature review and specimen examination, and to amend the switched association of type material. We found two specimens in the collection of the Uppsala University that are unmistakably associated with Boa hortulana. Herein we designate one of them as its lectotype in order to promote nomenclatural stability considering its huge phenotypic variability and the future possibility of eventually splitting the species.

Autoimmune gastritis, with or without pernicious anemia: epidemiology, risk factors, and clinical management

Autoimmune gastritis (AIG) is a chronic immune-mediated, inflammatory condition that involves the destruction of the gastric oxyntic mucosa through the autoimmune-mediated loss of parietal cells, with replacement by atrophic and metaplastic tissue. Diagnosing AIG is important, given the need for ongoing clinical management and vigilance with respect to downstream complications, the most serious of which is gastric adenocarcinoma. Other clinical consequences include gastric neuroendocrine tumors, consequences related to decreased gastric acid and decreased intrinsic factor due to parietal cell destruction and antibodies against intrinsic factor (e.g. micronutrient deficiencies), as well as concomitant autoimmune disorders. Considering the prevalence of AIG and the potential for severe clinical outcomes, it is important to engage in efforts to reduce practice pattern variability related to diagnosis and management. Accordingly, herein, we review of the epidemiology, pathogenesis, clinical presentation of AIG, including both gastric and extragastric manifestations, and provide an overview of clinical management.