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OBJECTIVES/SPECIFIC AIMS: In patients with recurrent glioblastoma (GBM) who undergo a second surgery following standard chemoradiotherapy, histopathologic examination of the resected tissue often reveals a combination of viable tumor and treatment-related inflammatory changes. However, it remains unclear whether the degree of viable tumor Versus “treatment effect” in these specimens impacts prognosis. We sought to determine whether the percentage of viable tumor Versus “treatment effect” in recurrent GBM surgical samples, as assessed by a trained neuropathologist and quantified on a continuous scale, is associated with overall survival. METHODS/STUDY POPULATION: We reviewed the records of 47 patients with histopathologically confirmed GBM who underwent surgical resection as the first therapeutic modality for suspected radiographic progression following standard radiation therapy and temozolomide. The percentage of viable tumor Versus “treatment effect” in each specimen was estimated by one neuropathologist who was blinded to patient outcomes. RESULTS/ANTICIPATED RESULTS: After adjusting for other known prognostic factors in a multivariate Cox proportional hazards model, there was no association between the degree of viable tumor and overall survival (HR 0.83; 95% CI, 0.20–3.4; p=0.20). DISCUSSION/SIGNIFICANCE OF IMPACT: These results suggest that, in patients who undergo resection for recurrent GBM following standard first-line chemoradiotherapy, histopathologic quantification of the degree of viable tumor Versus “treatment effect” present in the surgical specimen has limited prognostic influence and clinical utility.
Introduction: Situational Awareness is the ability to identify, process, and comprehend the critical elements of information about the patient condition, stability, the operational environment and an appropriate clinical course. The Situational Awareness Global Assessment Tool (SAGAT) is a validated tool for measuring situational awareness. The SAGAT tool was measured during a series of standardized high fidelity advanced airway management simulations in multidisciplinary teams in New Brunswick Emergency Departments delivered by two simulation programs Methods: Thirty eight simulated emergency airway cases were performed in situ in Emergency Departments and in learning centers in Southern New Brunswick from September 2015 to October 2017. Eight standardized cases were used whose educational objectives were to develop the optimization of critically ill patients prior to induction, to deliver patient-centered anesthesia and to choose an appropriate airway strategy. Learner profiles collected. Cases were divided into two groups; those that contained critical errors and those that did not based on video assessment. Critical errors were defined as failure of 1) Oxygenation 2) Shock correction 3) Induction dose estimation 4) Choice of airway management paradigm. The SAGAT has a maximum score of 13 and was assessed by research nurses after each case for all participants. SAGAT scores were non-normally distributed, so results were expressed as medians with interquartile ranges. Mann Whitney U tests were used to calculate statistical significance. Results: Results. Of the 38 cases, 14 contained one more critical errors. The median SAGAT score in the group that contained critical errors was 8 +/− 2 (IQR). The median SAGAT Score in the group that contained no critical errors was 11 +/− 2 (IQR). The median scores we significantly different with a p-value of 0.02. Conclusion: In this study in simulated emergency cases, higher SAGAT scores were associated with teams leaders that did not commit safety critical errors. This work is the initial analysis to develop standards for Simulated team performance in Emergency Department teams.
Introduction: Situational awareness (SA) is the team understanding patient stability, presenting illness and future clinical course. Losing SA has been shown to increase safety-critical events in multiple industries. SA can be measured by the previously validated Situational Awareness Global Assessment Tool (SAGAT). Checklists are used in many safety-critical industries to reduce errors of omission and commission. An RSI checklist was developed from case review and published evidence.The New Brunswick Trauma Program supports an inter-professional simulation-based medical education program Methods: Simulations were facilitated in three hospitals in New Brunswick from April 2017 to October 2017. Learner profiles were collected. The SAGAT tool was completed by a research nurse at the end of each scenario. SAGAT scores were non-normally distributed, so results were expressed as medians and interquartile ranges. Mann Whitney U tests were used to calculate statistical significance. To understand the effect of the of an RSI checklist a comparison was made between SAGAT scores at baseline in scenario 1, and the same first scenario completed after a washout period. A Poisson regression analysis will be used to account for the effect of confounding variables in further analyses. Results: The group was composed of Registered Nurses (8), Physicians (7), and Respiratory Therapists (2). Situational awareness increased significantly with the use of an RSI checklist after 1 day of 4 simulations. The washout period ranged between 5 weeks and 8 weeks. The baseline situational awareness of the whole group during scenario 1 was 9 +/− 0.5 (median, IQR), and with the RSI checklist was 12 +/−1 (median, IQR). The difference was highly statistically significant, p=< 0.001. This level of situational awareness using checklist is comparable to the SAGAT scores after 10 scenarios. Conclusion: In this provisional analysis, the use of an RSI checklist was associated with an increase in measured situational awareness. Higher levels of situational awareness are associated with greater patient safety. A Poisson regression model will be used to understand the confounding effects of user expertise and the likely interaction with simulation exposure.
OBJECTIVES/SPECIFIC AIMS: Obesity is a rapidly growing epidemic and long-term interventions aimed to reduce body weight are largely unsuccessful due to an increased drive to eat and a reduced metabolic rate established during weight loss. Previously, our lab demonstrated that exercise has beneficial effects on weight loss maintenance by increasing total energy expenditure above and beyond the cost of an exercise bout and reducing the drive to eat when allowed to eat ad libitum (relapse). We hypothesized that exercise’s ability to counter these obesogenic-impetuses are mediated via improvements in skeletal muscle oxidative capacity, and tested this using a mouse model with augmented oxidative capacity in skeletal muscle. METHODS/STUDY POPULATION: We recapitulated the exercise-induced improvements in oxidative capacity using FVB mice that overexpress lipoprotein lipase in skeletal muscle (mLPL). mLPL and wild type (WT) mice were put through a weight-loss-weight-regain paradigm consisting of a high fat diet challenge for 13 weeks, with a subsequent 1-week calorie-restricted medium fat diet to induce a ~15% weight loss. This newly established weight was maintained for 2 weeks and followed with a 24-hour relapse. Metabolic phenotype was characterized by indirect calorimetry during each phase. At the conclusion of the relapse day, mice were sacrificed and tissues were harvested for molecular analysis. RESULTS/ANTICIPATED RESULTS: During weight loss maintenance, mLPL mice had a higher metabolic rate (p=0.0256) that was predominantly evident in the dark cycle (p=0.0015). Furthermore, this increased metabolic rate was not due to differences in activity (p=0.2877) or resting metabolic rate (p=0.4881). During relapse, mLPL mice ingested less calories and were protected from rapid weight regain (p=0.0235), despite WT mice exhibiting higher metabolic rates during the light cycle (p=0.0421). DISCUSSION/SIGNIFICANCE OF IMPACT: These results highlight the importance of muscular oxidative capacity in preventing a depression in total energy expenditure during weight loss maintenance, and in curbing overfeeding and weight regain during a relapse. Moreover, our data suggest that the thermic effect of food is responsible for the differences in metabolic rate, because no differences were found in activity or resting metabolic rate. Additional studies are warranted to determine the molecular mechanisms driving the ability of oxidative capacity to assist with weight loss maintenance.
Medieval English Theatre is the premier journal in early theatre studies. Its name belies its wide range of interest: it publishes articles on theatre and pageantry from across the British Isles up to the opening of the London playhouses and the suppression of the civic mystery cycles, and also includes contributions on European and Latin drama, together with analyses of modern survivals or equivalents, and of research productions of medieval plays. This volume includes essays on spectatorship, audience reception and records of early drama, especially in Scotland, besides engaging with the current interest in the Towneley Plays and the history of its manuscript.Editors: Sarah Carpenter, Pamela M. King, Meg Twycross, Greg Walker.
Volumes 37 and 38 of Medieval English Theatre offer a collection of essays to honour John McGavin. Written by his friends and colleagues, students and admirers, these all testify to the deep affection as well as the academic esteem in which John himself and his work across the discipline of early theatre are held. Many reflect his own particular interests in the early drama of England and, especially, of Scotland: its records and narratives, its spectators, its intellectual and affective strategies, and its cultural work. There are papers on many aspects of Scottish theatrical culture, from ceremonial (Williamson) to Sir David Lyndsay (Hadley Williams, Happé, and Walker); from foolery (Carpenter) to Dunbar's dramatic voice (Jack). John's abiding interest in spectatorship and audience reception is approached from different angles, in morality drama (Steenbrugge), dialogue (Bose), in the York Play (King), academic drama (Dutton), and theory (van Pelt). His authoritative work in the creative interpretation of records and narratives, of both dramatic and para-dramatic performance, is reflected in essays on coronation ceremony (Hunt), libel (Egan), and monastic crucifixion games (Klausner). His steering role in the project on Early Modern London Theatres is commemorated in the online Bear Hunt (MacLean and Hagen). Three essays engage with one of the central current concerns of early theatre study, the Towneley manuscript and its plays (Epp, Johnston, and Twycross), while two more address uniquely revealing single plays: the Digby Mary Magdalen (Godfrey), and the Welsh Troelus a Chresyd (Niebrzydowski).
John's work has indeed come to epitomise ‘the best pairt of our play’. The number of essays contributed to the collection, by scholars young and old across the whole field of early drama studies, shows the range of his influence on the discipline itself and on generations of those working within it. This collection is offered as a tribute both to his creative scholarship and his collegiality. There is no space here for all the many friends and colleagues who would like to salute him on this occasion; but we hope that the recollections of three voices, offering memories and appreciation from John's student days to the present, may speak for us all.
Medieval English Theatre Meeting 2015 Change of publication details
The 2015 METh meeting was held at the University of Southampton, hosted by John McGavin. His carefully timetabled proceedings were interrupted by the unscheduled (by him) presentation of a Festschrift in his honour. He holds the unique composite volume, but the articles it contains will be divided between this volume of METh (Part One), and Volume 38 (Part Two).
The rest of the day lived up to its festive beginning. A range of papers on the topic of ‘Paradigms Lost’ highlighted those once entrenched scholarly positions about which we have changed our minds. Pamela M. King, in ‘Medieval Drama Criticism before METh’, introduced the late nineteenth-century work of Adolphus William Ward; Garrett Epp, on ‘Things we can no longer say about the Towneley Plays’, gave an impressive PowerPoint show of deletions of accepted ‘facts’; while Meg Twycross summarised new evidence on the provenance of the manuscript (see this volume). Other speakers introduced new material which extends or changes our approach to well-worn topics: Lindsey Cox showed us the visual evidence for the portrait miniature in Wit and Science, and how the different parts of the audience might have perceived it, and Jason Burg sketched the changing patterns of performance in Lincoln Cathedral between 1309 and 1642. Nadia van Pelt reminded us of the necessity of looking at original manuscript sources rather than their calendared summaries by discussing the enigmatic detail of a letter from Chapuys which reports Henry VIII's visit to a St John's Day pageant showing him ‘cutting off the heads of the clergy’; while Greg Walker rounded off the day with a masterly summation of recent critical approaches to spectatorship, and where they fell short.
Elisabeth Dutton gave us our own spectatorly experience. Before lunch, James McBain and Stephanie Allen of the EDOX (Early Drama at Oxford University) project spoke about ‘Rehabilitating Academic Drama’, and just after lunch this was put to the test by an enthusiastic reading of the play of Narcissus originally mounted by the undergraduates of St John's College, Oxford, as a Christmas entertainment in 1602.
The transport of relativistic electron beam in compressed cylindrical targets was studied from a numerical and experimental point of view. In the experiment, cylindrical targets were imploded using the Gekko XII laser facility of the Institute of Laser Engineering. Then the fast electron beam was created by shooting the LFEX laser beam. The penetration of fast electrons was studied by observing Kα emission from tracer layers in the target.
Dietary assessment in older adults can be challenging. The Novel Assessment of Nutrition and Ageing (NANA) method is a touch-screen computer-based food record that enables older adults to record their dietary intakes. The objective of the present study was to assess the relative validity of the NANA method for dietary assessment in older adults. For this purpose, three studies were conducted in which a total of ninety-four older adults (aged 65–89 years) used the NANA method of dietary assessment. On a separate occasion, participants completed a 4 d estimated food diary. Blood and 24 h urine samples were also collected from seventy-six of the volunteers for the analysis of biomarkers of nutrient intake. The results from all the three studies were combined, and nutrient intake data collected using the NANA method were compared against the 4 d estimated food diary and biomarkers of nutrient intake. Bland–Altman analysis showed a reasonable agreement between the dietary assessment methods for energy and macronutrient intake; however, there were small, but significant, differences for energy and protein intake, reflecting the tendency for the NANA method to record marginally lower energy intakes. Significant positive correlations were observed between urinary urea and dietary protein intake using both the NANA and the 4 d estimated food diary methods, and between plasma ascorbic acid and dietary vitamin C intake using the NANA method. The results demonstrate the feasibility of computer-based dietary assessment in older adults, and suggest that the NANA method is comparable to the 4 d estimated food diary, and could be used as an alternative to the food diary for the short-term assessment of an individual's dietary intake.
The world’s climate is changing rapidly. In the last 50 years, global temperatures on land have risen by approximately 1°C, and over the next 100 years a further rise in temperatures of at least 2°C is expected (IPCC, 2007). This rise may not seem like much, but the rate of temperature change is unprecedented in recent history, and many animals and plants are struggling to keep pace (Chen et al., 2011). Wading birds (Charadrii) are particularly susceptible to climate change (Maclean & Wilson, 2011). Many species travel over large sections of the globe during the course of their annual cycle and use habitats in many different biomes and climate zones (Piersma & Lindstrom, 2004). The majority of waders breed in the high Arctic, a region warmer now than at any time in the last 125 000 years and undergoing further warming at a rate almost twice that of the global average. Other species breed in freshwater marshes, which are threatened by increased drought. During the winter periods, the majority of waders move to coastal habitats where they experience climate-related threats associated with the marine environment. Global sea level rose ~17 cm during the last century, but the rate in the last decade is nearly double that of the last century (Church & White, 2006). Significant habitat loss and change has occurred as a result, and even greater changes are expected in the future (Chu-Agor et al., 2010). The magnitude of future changes in sea level are very difficult to predict because of uncertainties associated with understanding the extent of polar ice sheet loss. However, the last time polar regions were significantly warmer than at present for an extended period, reductions in polar ice volume led to 4–6 m of sea level rise (IPCC, 2007). Marine invertebrate prey of waders are also susceptible to changes in ocean chemistry. Ocean acidity has increased by ~30% as a result of higher levels of dissolved carbon dioxide, with concomitant deleterious impacts on calcifying organisms (Orr et al., 2005). Moreover, temperature increases and changes in ocean circulation patterns have been linked with reductions in dissolved oxygen in coastal and marine systems, with extremely damaging consequences for the fauna associated with these habitats (Grantham et al., 2004). Many of these species are part of the food web on which waders rely.
This paper presents a motion planning method for a simple wheeled robot in two cases: (i) where translational and rotational speeds are arbitrary, and (ii) where the robot is constrained to move forwards at unit speed. The motions are generated by formulating a constrained optimal control problem on the Special Euclidean group SE(2). An application of Pontryagin's maximum principle for arbitrary speeds yields an optimal Hamiltonian which is completely integrable in terms of Jacobi elliptic functions. In the unit speed case, the rotational velocity is described in terms of elliptic integrals, and the expression for the position is reduced to quadratures. Reachable sets are defined in the arbitrary speed case, and a numerical plot of the time-limited reachable sets is presented for the unit speed case. The resulting analytical functions for the position and orientation of the robot can be parametrically optimised to match prescribed target states within the reachable sets. The method is shown to be easily adapted to obstacle avoidance for static obstacles in a known environment.
The density and species richness of bird communities in disturbed and undisturbed stands of papyrus Cyperus papyrus were compared. Point counts, corrected for different probabilities of detection in different swamps, suggested that the species richness of bird communities in stands of papyrus disturbed by burning, grazing or pollution was higher than in nearby stands that were not disturbed. However, there were fewer species and individuals of highly specialized birds or species characteristic of papyrus, in disturbed stands than in undisturbed swamps. At < 1 ha-1, the density of Papyrus Gonolek Laniarius mufumbiri in Ugandan swamps was, for example, significantly lower in polluted and burnt sites than in undisturbed papyrus where up to 13 ha-1 were recorded in the centre of swamps. White-winged Swamp Warbler Bradypterus carpalis was only recorded in undisturbed papyrus. In the papyrus that fringes Lake Naivasha in Kenya, outside the geographical range of species restricted to papyrus, disturbance in the form of grazing selects against species classified as swamp-reliant. Species classified as generalist users of papyrus were much less sensitive to disturbance than specialists. The density of swamp specialists was also lower near the edge of swamps, where total species richness was higher. These results are discussed in relation to conservation management of papyrus swamps in East Africa.