In lieu of an abstract, here is a brief excerpt of the content:Night ShiftCalvin R. GrossI don't like working at night anymore. Too much goes wrong when you're alone.I'm sitting at my desk in the middle of the cardiac intensive care unit, and it's far later than I'd like to be awake—two or three in the morning. Things are calm, almost pleasant. I can hear the occasional alarm going off—an imperfectly positioned blood pressure cuff, a pulse oximeter with a poor (...) waveform, a ventilator with secretions in it. The night's initial frenzied work is done; my new admissions are tucked away, and my overnight to-dos are completed. Now it's just time to sit and wait. I could sleep, but despite the calm, I'm too afraid to leave the unit to rest. The fellow has gone to bed hours ago, and now it's just me. Sure, I'm surrounded by experienced nurses who know their work well, but somehow, I'm the one in charge. A brand-new second-year resident, the only doctor there. I'm no intern, that's for sure, but I've never led a code before, and I've only ever placed one central line without supervision. As second years go, I'm as fresh as they come.The daytime, you see, is far different than nights. There's a large (and even bloated) team of two attendings, two fellows, two pharmacists, and more importantly, multiple other residents. When you don't know what to do for a patient, there's always someone there to bounce ideas off of. When something difficult or surprising happens, there are peers and mentors to process with. At night, it's the opposite—no peers, no mentors, only a group of experienced nurses, whose circle is closed to me, the outsider. I long to be a part of that large and bloated daytime team."Can you come into 23? I think his pupils are a different size."I'm startled out of my thoughts. 23 … All I can remember from sign-out that evening is that he's young, close to my age, and supposedly stable. I look at my notes, a catalogue of tragedies: early onset heart failure, multiple prior suicide attempts, intubated because of pulmonary edema, and a left-ventricular assist device (LVAD) that's malfunctioning. I walk over to the room and look at the nurse at the other side of the bed. She's in the early phases of her career too—less than a year on the job—but she's still more experienced than me. I take a flashlight, open his eyelids, and look at the pupils. Sure enough, one of them is much larger than the other. When I shine the light into each eye, the large one doesn't change. When I turn his head from side to side, his eyes stay fixed. We look [End Page 83] at each other, she and I. We both know something terrible is happening."Should we maybe wake the fellow up?" she asks tentatively.I nod my head in agreement, glad to have been offered a suggestion. It's the right thing to do. I walk to the fellow's call room, knock on the door, and wake him up. He's set to work 24 hours and would like nothing more than to keep resting. He sleepily comes with me to the bedside, looks at the pupils as well, and says, "With the sedation on, your exam isn't going to be the most accurate. We should start by scanning his head, and then go from there. Wake me back up if you need me, but I know you've got this one."I don't think that I deserve the confidence he has in me. I walk back to my desk, open the patient's chart, and place the order for an urgent CT scan. The machinery of the hospital starts to rumble as the imaging schedulers find a spot in the queue for the scan, the patient's nurse and respiratory therapist disconnect and reconnect cables and tubes, the technicalities of the scan are ironed out, and he is... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Full Collection of Personal NarrativesJake Beery, Neethi Pinto, Marcia King, Laura Wachsmuth, Alisha, Katie L. Gholson, T.S. Moran, Calvin R. Gross, Joanne Alfred, Cindy Bitter, Jenna Bennett, Nadia Khan, Clarice Douille, Kristen Carey Rock, Adrienne Feller Novick, Andrea Eisenberg, Japmehr Sandhu, Katherine Bakke, Heer Hendry, Karan K. Mirpuri, and Katerina V. Liong• Being the Difference• Grieving One More Time• Echoes of Grief: Tales from an Emergency Medicine and (...) Critical Care Nurse• Searching for Peace in Death• “I’d Love to go Off the Grid and Never Come Back”• “A Mother’s Love”• Tiny Person, Big Impact• Night Shift• Cracked Armor• Who Tells the Story• Navigating Hard Situations that Medical School Cannot Prepare You For• The Wish• Break• Five More Minutes• I Saw My Reflection• The Aftermath• Where the Journey Begins• Lessons Learned in Room 208• Joint and Grief Aches• My First Loss: Carrying His Legacy• Grieving the Loss of What Medicine Was Supposed to BeCopyright © 2024 Johns Hopkins University Press... (shrink)

Animals are hand-raised in a variety of contexts, including experimental research. This has been criticized frequently as producing animals with species-untypical behaviour. Here we compare life histories of 330 hand-raised and 631 gooseraised Greylag geese from a free-flying flock to determine whether hand-raising affected life history, reproductive variables and behaviour. We found little differences in life histories or reproductive variables of hand-raised and goose-raised geese. However, hand-raised females had lower life expectancies than goose-raised ones, mainly due to predation during breeding. (...) Hand-raised geese were stressed significantly less during social, handling and predator stress, were attacked less by conspecifics and were less vigilant than goose-raised geese. We conclude that hand-raising resulted in geese with species-typical life histories but reduced stress responses. This makes hand-raised geese cooperative partners for research, but also more vulnerable when exposed to predators. Keywords: hand-raising; greylag goose; Anser anser; life-history; reproductive success; stress. (shrink)

Using a parallel mixed-methods design, the current study examined university students’ perceptions of academic cheating through collecting and analyzing both the quantitative and qualitative data. Our quantitative findings corroborate previous research that male students have engaged more in academic cheating than females based on students’ self-reports, and that undergraduate students are less willing to discuss issues on academic cheating as compared with their graduate counterparts. Five themes emerged from the thematic analysis of the qualitative data: flexible definitions for cheating, environmental (...) promotion of cheating, the moral transgression of cheating, cheating as an ambiguous justification, and cheating as a conscious decision making process. The mixed-methods findings indicate that there is no relationship between students’ gender or classification and their endorsements of the qualitative themes. However, non-White students are more likely to endorse the theme “cheating as an ambiguous justification.” Implications for reducing and preventing academic cheating at the university level are discussed. (shrink)

This volume contains 17 articles on various aspects of Islamic thought in the Middle East and in Southeast Asia. The first 9 articles concentrate especially on the Qur’ān and its exegesis, Kalām and Sufism; the second 8 articles deal with Javanese Islam, and with Islam and modernity in Southeast Asia.

The apolipoprotein E gene plays an important role in the pathogenesis of Alzheimer's disease , and amyloid plaque comprised mostly of the amyloid-beta peptide ) is one of the major hallmarks of AD. However, the relationship between these two important molecules is poorly understood. We examined how A treatment affects APOE expression in cultured cells and tested the role of the transcription factor NF-B in APOE gene regulation. To delineate NF-B's role, we have characterized a 1098 nucleotide segment containing the (...) 5'-flanking region of the human APOE gene . Sequence analysis of this region suggests the presence of two potential NF-B elements. To demonstrate promoter activity, the region was cloned upstream of a promoterless luciferase gene. This segment was able to drive expression of luciferase in transient transfections of human fetal glial cells. Promoter activity was stimulated twofold by A treatment. Pretreatment with double-stranded DNA decoy oligonucleotides against NF-B reduced A stimulation. Deletion and mutagenetic analyses demonstrated that the distal NF-B element was functional and showed a strong DNA-protein complex band in gel shift analysis, similar to that from control NF-B consensus element. An anti-inflammatory and anti-NF-B drug, sodium salicylate, significantly blocked A-induced APOE promoter function. Our data provide evidence that upregulation of APOE by A in astroglial cells is mediated by an NF-B-element present in the 5'-flanking region of the APOE gene. (shrink)

We have conducted an experimental study of V-type electromagnetically induced transparency in sodium. Its principles are elucidated by a simple model. Measurements show decreased fluorescence and absorption depending on the detuning of the driving and probe fields, which is in agreement with the results of numerical simulation.

The tsunami effect of the COVID-19 pandemic is affecting many aspects of scientific activities. Multidisciplinary experimental studies with international collaborators are hindered by the closing of the national borders, logistic issues due to lockdown, quarantine restrictions, and social distancing requirements. The full impact of this crisis on science is not clear yet, but the above-mentioned issues have most certainly restrained academic research activities. Sharing innovative solutions between researchers is in high demand in this situation. The aim of this paper is (...) to share our successful practice of using web-based communication and remote control software for real-time long-distance control of brain stimulation. This solution may guide and encourage researchers to cope with restrictions and has the potential to help expanding international collaborations by lowering travel time and costs. (shrink)

Comparative Political Theory and Cross-Cultural Philosophy explores new forms of philosophizing in the age of globalization by challenging the conventional border between the East and the West, as well as the traditional boundaries among different academic disciplines. This rich investigation demonstrates the importance of cross-cultural thinking in our reading of philosophical texts and explores how cross-cultural thinking transforms our understanding of the traditional philosophical paradigm.

Background: We aimed to determine the smallest changes in health-related quality of life (HRQoL) scores in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 and the Brain Cancer Module (QLQ-BN20), which could be considered as clinically meaningful in brain cancer patients. Materials and methods: World Health Organisation performance status (PS) and mini-mental state examination (MMSE) were used as clinical anchors appropriate to related subscales to determine the minimal clinically important differences (MCIDs) in HRQoL (...) change scores (range 0-100) in the QLQ-C30 and QLQ-BN20. A threshold of 0.2 standard deviation (SD) (small effect) was used to exclude anchor-based MCID estimates considered too small to inform interpretation. Results: Based on PS, our findings support the following integer estimates of the MCID for improvement and deterioration, respectively: physical (6, 9), role (14, 12), and cognitive functioning (8, 8); global health status (7, 4(star)), fatigue (12, 9), and motor dysfunction (4(star), 5). Anchoring with MMSE, cognitive functioning MCID estimates for improvement and deterioration were (11, 2(star)) and for communication deficit were (9, 7). Estimates with asterisks were <0.2 SD and were excluded from our MCID range of 5-14. Conclusion: These estimates can help clinicians evaluate changes in HRQoL over time, assess the value of a health care intervention and can be useful in determining sample sizes in designing future clinical trials. (shrink)

Airway mucin secretion is important pathophysiologically and as a model of polarized epithelial regulated exocytosis. We find the trafficking protein, SNAP23, selectively expressed in secretory cells compared with ciliated and basal cells of airway epithelium by immunohistochemistry and FACS, suggesting that SNAP23 functions in regulated but not constitutive epithelial secretion. Heterozygous SNAP23 deletant mutant mice show spontaneous accumulation of intracellular mucin, indicating a defect in baseline secretion. However mucins are released from perfused tracheas of mutant and wild-type mice at the (...) same rate, suggesting that increased intracellular stores balance reduced release efficiency to yield a fully compensated baseline steady state. In contrast, acute stimulated release of intracellular mucin from mutant mice is impaired whether measured by a static imaging assay 5 min after exposure to the secretagogue ATP or by kinetic analysis of mucins released from perfused tracheas during the first 10 min of ATP exposure. Together, these data indicate that increased intracellular stores cannot fully compensate for the defect in release efficiency during intense stimulation. The lungs of mutant mice develop normally and clear bacteria and instilled polystyrene beads comparable to WT mice, consistent with these functions depending on baseline secretion that is fully compensated. (shrink)

Antonio R. Damasio , The Feeling of What Happens: Body and Emotion in the Making of Consciousness . This is clearly a must-read book for anyone wanting a neurologist's perspective on one of the greatest of the unsolved mysteries, human consciousness and the ways in which it exceeds that of the other apes. By the author of Descartes' Error.

© 2017. The American Astronomical Society. All rights reserved.We present new observations of the low-mass companion to HD 984 taken with the Gemini Planet Imager as a part of the GPI Exoplanet Survey campaign. Images of HD 984 B were obtained in the J and H bands. Combined with archival epochs from 2012 and 2014, we fit the first orbit to the companion to find an 18 au orbit with a 68% confidence interval between 14 and 28 au, an eccentricity (...) of 0.18 with a 68% confidence interval between 0.05 and 0.47, and an inclination of 119°with a 68% confidence interval between 114°and 125°. To address the considerable spectral covariance in both spectra, we present a method of splitting the spectra into low and high frequencies to analyze the spectral structure at different spatial frequencies with the proper spectral noise correlation. Using the split spectra, we compare them to known spectral types using field brown dwarf and low-mass star spectra and find a best-fit match of a field gravity M6.5 ±1.5 spectral type with a corresponding temperature of K. Photometry of the companion yields a luminosity of log=2.88 ± 0.07 dex with DUSTY models. Mass estimates, again from DUSTY models, find an age-dependent mass of 34 ±1 to 95 ±4 M Jup. These results are consistent with previous measurements of the object. (shrink)

Recording and manipulating neuronal ensemble activity is a key requirement in advanced neuromodulatory and behavior studies. Devices capable of both recording and manipulating neuronal activity brain-computer interfaces should ideally operate un-tethered and allow chronic longitudinal manipulations in the freely moving animal. In this study, we designed a new intracortical BCI feasible of telemetric recording and stimulating local gray and white matter of visual neural circuit after irradiation exposure. To increase the translational reliance, we put forward a Göttingen minipig model. The (...) animal was stereotactically irradiated at the level of the visual cortex upon defining the target by a fused cerebral MRI and CT scan. A fully implantable neural telemetry system consisting of a 64 channel intracortical multielectrode array, a telemetry capsule, and an inductive rechargeable battery was then implanted into the visual cortex to record and manipulate local field potentials, and multi-unit activity. We achieved a 3-month stability of the functionality of the un-tethered BCI in terms of telemetric radio-communication, inductive battery charging, and device biocompatibility for 3 months. Finally, we could reliably record the local signature of sub- and suprathreshold neuronal activity in the visual cortex with high bandwidth without complications. The ability to wireless induction charging combined with the entirely implantable design, the rather high recording bandwidth, and the ability to record and stimulate simultaneously put forward a wireless BCI capable of long-term un-tethered real-time communication for causal preclinical circuit-based closed-loop interventions. (shrink)

High turnover rate is one of the striking features of the hotel industry and one of the most significant challenges. High turnover rate causes substantial costs for recruitment, selection and training in hotels, on the other hand, it also leads to negative consequences such as the decline of organizational performance and service quality. Thus, it is necessary to search for the root causes of turnover and put forward solutions. This study was designed to examine the impact of psychological capital, organizational (...) commitment, and job satisfaction on turnover intention among hotel employees. Additionally, it aimed to test the mediating roles of job satisfaction and organizational commitment. The data were obtained from 228 hotel customer-contact employees with a time lag of two weeks in three waves in Kuala Lumpur based on convenience sampling. A series of structural equation modeling analyses were utilized to investigate hypothesized relationships. The results reveal that there exists a significant and negative impact of PsyCap on employees’ turnover intention and this correlation is partially mediated through two job attitudes. That is to say, to retain hotel talents, five-star hotel management should take proper measures to help employees obtain and maintain positive psychological resources such as PsyCap, on the other hand, how to cultivate positive job attitudes and strengthen their sense of identification and belonging for their organizations is supposed to be more focused on. (shrink)

Truth and correspondence, by G.J. Warnock.--Some exercises in epistemic logic, by A.N. Prior.--Symposium: Meaning and speech acts, by J.R. Searle.--Comments, by Zeno Vendler.--Comments, by Paul Benacerraf.--Rejoinders, by J.R. Searle.--Symposium: Wittgenstein on criteria, by Newton Garver.--Commments, by Carl Ginet.--Comments by F.A. Siegler.--Comments, by Paul Ziff.--Rejoinders, by Newton Garver.--Symposium: The private-language argument, by H-N. Castañeda.--Comments, by V.C. Chappell.--Comments, by J.F. Thomson.--Rejoinders, by H-N. Castañeda.

Introduction While quizzing during informed consent for research to ensure understanding has become commonplace, it is unclear whether the quizzing itself is problematic for potential participants. In this study, we address this issue in a multinational HIV prevention research trial enrolling injection drug users in China and Thailand. Methods Enrolment procedures included an informed consent comprehension quiz. An informed consent survey followed. Results 525 participants completed the informed consent survey (Heng County, China=255, Xinjiang, China=229, Chiang Mai, Thailand=41). Mean age was (...) 33 and mean educational level was 8 yrs. While quizzing was felt to be a good way to determine if a person understands the nature of clinical trial participation (97%) and participants did not generally find the quiz to be problematic, minorities of respondents felt pressured (6%); anxious (5%); bored (5%); minded (5%); and did not find the questions easy (13%). In multivariate analysis, lower educational level was associated with not minding the quizzing (6–10 yrs vs 0–5 yrs: OR=0.27, p=0.03; more than 11 yrs vs 0–5 yrs: OR=0.18, p=0.03). There were also site differences (Heng County vs Xinjiang) in feeling anxious (OR=0.07; p=<0.01), not minding (OR=0.26; p=0.03), being bored (OR=0.25; p=0.01) and not finding the questions easy (OR=0.10; p=<0.01). Conclusions Quizzing during the informed consent process can be problematic for a minority of participants. These problems may be associated with the setting in which research takes place and educational level. Further research is needed to develop, test and implement alternative methods of ensuring comprehension of informed consent. Trial Registration clinicaltrials.gov number NCT00270257. (shrink)

Longitudinal diagnostic classification models (DCMs) with hierarchical attributes can characterize learning trajectories in terms of the transition between attribute profiles for formative assessment. A longitudinal DCM for hierarchical attributes was proposed by imposing model constraints on the transition DCM. To facilitate the applications of longitudinal DCMs, this paper explored the critical topic of the Q-matrix design with a simulation study. The results suggest that including the transpose of the R-matrix in the Q-matrix improved the classification accuracy; ten-item tests measuring three (...) linear attributes across three time points provided satisfactory classification accuracy for low-stakes assessment. Educational implications and future directions were discussed. (shrink)