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To date, nearly 10,000 World Trade Center (WTC) responders have been diagnosed with at least one type of WTC-related cancer, and over 70 types of cancer have been related to WTC occupational exposure. Due to the observed latency period for malignancies, the WTC Health Program anticipates increases in rates of new cancer diagnoses. Given the growing number of cancer diagnoses in this population, there is an urgent need to develop a novel intervention to address the psychosocial needs of WTC responders with cancer. Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention originally developed to help patients with advanced cancer find and sustain meaning in life despite illness-related limitations. Existential distress and loss of meaning are critical and understudied elements of psychological health that have been widely overlooked among WTC responders with cancer.
We have adapted MCP for WTC responders (MCP-WTC) for the treatment of WTC responders who have been diagnosed with WTC-certified cancers. MCP-WTC aims to target the complex crisis in meaning faced by those responders who responded to the 9/11 attacks and subsequently were diagnosed with cancer as a result of their service.
We describe the adaptation of MCP-WTC and the application of this intervention to meet the unique needs of those exposed to the terrorist attacks of September 11, 2001 (9/11), participated in the rescue, recovery, and clean-up effort at Ground Zero, and were diagnosed with WTC-related cancer. We highlight the novel aspects of this intervention which have been designed to facilitate meaning-making in the context of the patient's response to 9/11 and subsequent diagnosis of cancer.
Significance of results
This work provides a rationale for MCP-WTC and the potential for this intervention to improve the quality of life of WTC responders and help these patients navigate life after 9/11 and cancer.
Atomistic simulations are employed to investigate the dynamical behavior of atoms in cubic silicon carbide (SiC) following a 5 keV radiation knock. Specifically, we have computed the time-resolved van Hove self-correlation function, Gs(r,t), separately for the silicon and carbon sub-lattices. Our goal is to probe the early radiation damage mechanisms using a dynamical methodology. The simulation results show that the carbon atoms engage in a dynamic hopping mechanism as the system recovers from the radiation knock. The silicon atoms, however, exhibit a strikingly different behaviour: the time variation of 4πr2Gs(r,t) indicates a dynamic tension between the crystalline and disordered regions of the Si sub-lattice. The power-law tail of the 4πr2Gs(r,t) correlation for silicon atoms suggests a scale-free self-organized critical (SOC) state – a possible precursor to the collapse of the Si sub-lattice.
Risk adjustment is needed to fairly compare central-line–associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes.
Using a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank.
Overall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51–0.59) for the ICU-type model and 0.64 (95% CI, 0.60–0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model.
Our risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals.
There is increasing emphasis on the need for effective ways of sharing knowledge to enhance environmental management and sustainability. Knowledge exchange (KE) are processes that generate, share and/or use knowledge through various methods appropriate to the context, purpose, and participants involved. KE includes concepts such as sharing, generation, coproduction, comanagement, and brokerage of knowledge. This paper elicits the expert knowledge of academics involved in research and practice of KE from different disciplines and backgrounds to review research themes, identify gaps and questions, and develop a research agenda for furthering understanding about KE. Results include 80 research questions prefaced by a review of research themes. Key conclusions are: (1) there is a diverse range of questions relating to KE that require attention; (2) there is a particular need for research on understanding the process of KE and how KE can be evaluated; and (3) given the strong interdependency of research questions, an integrated approach to understanding KE is required. To improve understanding of KE, action research methodologies and embedding evaluation as a normal part of KE research and practice need to be encouraged. This will foster more adaptive approaches to learning about KE and enhance effectiveness of environmental management.
This chapter provides an overview of Earth system models, the various model ‘flavours’, their state of development including model evaluation, benchmarking and optimization against observational data and their application to climate change issues.
The Earth system can be conceptualized as a suite of interacting physical, chemical, biological and anthropogenic processes that regulate the planet’s low of matter and energy. Earth system models (ESMs; Box 5.1 ) are built to mirror these processes. In fact, ESMs are the only tool available to the scientific community to investigate the system properties of the Earth, as we do not have an alternative planet to manipulate that could serve as a scientist’s laboratory.
The term ‘Earth system model’ is commonly used to describe coupled land–ocean–atmosphere models that include interactive biogeochemical components. Such models have developed progressively from the physical climate models first created in the 1960s and 1970s. Conventional climate models apply physical laws to simulate the general circulation of atmosphere and ocean. As our understanding of the natural and anthropogenic controls on climate has grown, and given the steady advances in computing power, global climate models have been extended to include more comprehensive representations of biological and geochemical processes, involving the addition of the various interacting components of the Earth system with their own feedback mechanisms. Figure 5.1 shows the conceptual differences between a conventional global coupled atmosphere–ocean general circulation model (AOGCM) and an ESM. In terms of the coupling between components, ESMs are more complex, and they have correspondingly higher computational demands.
The two main ways to search for information in electronic document
collections are by using free-text retrieval search engines
or browsing information that has been organized into predefined
organizational structures. However, each of these approaches
has limitations. Using word or phrase search, users are faced
with a compromise between overly broad searches returning an
excessive amount of information or overly narrow searches that
may fail to return relevant information. Browsing organizational
structures is dependent on the user's knowledge of the
structures, and a user may find it difficult to refine searches.
This paper introduces a user interface based approach to the
browsing of hierarchically organized information entities that
avoids these problems by allowing the incremental narrowing
down of a set of search results and by pruning the organizational
structure after each user selection to show the consequences
of the selection. The effect is to present to the user at all
times only that part of the organizational structure that will
lead to a nonnull selection. The approach is called no zero
match (NZM) browsing. The paper presents the computational basis
of NZM browsing before describing a trial implementation of
the approach and presenting three case studies, which represent
common search situations in an engineering context.
Osteoporosis is almost universal in very old age, and is a major cause of morbidity and mortality in the elderly of both sexes. Bone is lost at a rate of 0·2–0·5 %/year in both men and women after the age of 40–45 years. The causes of age-related changes in bone mass are multifactorial and include genetic predisposition, nutritional factors, endocrine changes, habitual exercise levels and body weight. Bone loss is accelerated to 2–5 % year immediately before and for up to 10 years post-menopause (Heaney, 1986). In women hormone-replacement therapy is effective in reducing the rate of bone loss caused by this peri-menopausal decrease in hormone levels (Smith & Studd, 1993); however, in men and older women (>10 years post-menopause) nutrition plays a key role in the rate of bone loss. One factor contributing to bone loss in the elderly may be a subclinical Zn and/or Cu deficiency, due to a reduced dietary intake of micronutrients and reduced absorption (Thomson & Keelan, 1986). Zn and Cu are essential cofactors for enzymes involved in the synthesis of various bone matrix constituents. Paradoxically, Ca supplementation may accentuate the problem of reduced Zn and Cu levels by impairing the absorption of simultaneously-ingested Zn and the retention of Cu (Snedeker et al. 1982; Grekas et al. 1988). The present paper will review the current literature on the potential benefits of Cu and Zn supplementation in reducing bone loss, and present new information on the effect of Ca supplementation on Zn and Cu status in post-menopausal women with osteoporosis.
Magnetization measurements, transmission electron microscopy (TEM), and high-resolution micro-x-ray fluorescence (μ-XRF) using a synchrotron radiation source (Advanced Photon Source) were used to examine Fe3O4 particle agglomerates of nominally 10-nm particles at low concentrations (down to 0.03%) in thick epoxy resin samples. The magnetization measurements showed that at low concentrations (<0.5%) the magnetite particles, although closely packed in the agglomerates, did not interact magnetically. Predicated on a 2-μm sample step scan, the μ-XRF results were compatible with the presence of spherical agglomerates due to magnetostatic attraction, and these ranged in size from 100 to several thousand nanometers, as observed in TEM measurements. At smaller step scans the resolution could be significantly improved. Thus, the synchroton μ-XRF method was very useful in detecting very small concentrations of particles in thick samples and could probably be used to detect particles in amounts as low as 10−16 g.
Third rather than lateral ventriculomegaly may be a more specific finding in psychosis. The relevance of ventricular abnormality remains unclear.
To investigate the developmental correlates of ventricular enlargement.
Information on childhood development and magnetic resonance images in 1.5-mm contiguous sections were collected on 21 patients experiencing a first episode of psychosis.
Patients (n=21) had significantly less whole brain volume and enlarged third and lateral ventricles compared to controls (n=25). Third ventricle (r=0.48, P < 0.03) and lateral ventricle (r=0.65, P < 0.01) volumes correlated with developmental score. Patients with developmental delay had significantly larger third and lateral ventricles than those without.
Enlargement of both third and lateral ventricles is found in first-episode psychosis and is related to developmental delay in childhood. Insult to periventricular areas is relevant to the neurobiology of the disease. These findings support the view that schizophrenia involves disturbance of neurodevelopmental processes in some patients.
A field study evaluated the effects of green kyllinga establishment method (seed vs. stolon), two mowing heights (2.5 and 5.0 cm), and three nitrogen (N) rates (0, 24, and 49 kg/ha/mo) on green kyllinga infestation in ‘Tifway’ bermudagrass turf. The study was initiated in vigorous and newly established or “weak” bermudagrass turf in May 1997 and continued until December 1998. The green kyllinga area was measured periodically each year and plant dry weight (g/500 cm2) was calculated in December 1997 and 1998. In 1997, stolon established green kyllinga plots were twice as large as seeded plots in vigorous turf and four times larger in weak turf. Method of establishment, however, was less important in 1998 as seedling populations became more established. In weak turf, increasing N rate to 49 kg/ha/mo decreased green kyllinga spread by 50% in 1997 and by 40% in 1998 compared to no N. In vigorous turf, mowing height influenced green kyllinga infestation more than N. Low mowing height (2.5 cm) increased green kyllinga infestations nearly twofold in vigorous turf in 1997 and more than fivefold in 1998. Golf course fairways are often maintained at clipping heights shorter than 2.5 cm, and green kyllinga is a prevalent weed at these sites. Green kyllinga may gain a competitive advantage in bermudagrass turf at lower mowing heights.