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Anderson LC, Jacobson T. Providing the choice of in-person or videoconference attendance in a clinical physiology course may harm learning outcomes for the entire cohort. Adv Physiol Educ 2023; 47:548-556. [PMID: 37318999 DOI: 10.1152/advan.00160.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 06/17/2023]
Abstract
Clinical Physiology 1 and 2 are flipped classes in which students watch prerecorded videos before class. During the 3-h class, students take practice assessments, work in groups on critical thinking exercises, work through case studies, and engage in drawing exercises. Due to the COVID pandemic, these courses were transitioned from in-person classes to online classes. Despite the university's return-to-class policy, some students were reluctant to return to in-person classes; therefore during the 2021-2022 academic year, Clinical Physiology 1 and 2 were offered as flipped, hybrid courses. In a hybrid format, students either attended the synchronous class in person or online. Here we evaluate the learning outcomes and the perceptions of the learning experience for students who attended Clinical Physiology 1 and 2 either online (2020-2021) or in a hybrid format (2021-2022). In addition to exam scores, in-class surveys and end of course evaluations were compiled to describe the student experience in the flipped hybrid setting. Retrospective linear mixed-model regression analysis of exam scores revealed that a hybrid modality (2021-2022) was associated with lower exam scores when controlling for sex, graduate/undergraduate status, delivery method, and the order in which the courses were taken (F test: F = 8.65, df1 = 2, df2 = 179.28, P = 0.0003). In addition, being a Black Indigenous Person of Color (BIPOC) student is associated with a lower exam score, controlling for the same previous factors (F test: F = 4.23, df1 = 1, df2 = 130.28, P = 0.04), albeit with lower confidence; the BIPOC representation in this sample is small (BIPOC: n = 144; total: n = 504). There is no significant interaction between the hybrid modality and race, meaning that BIPOC and White students are both negatively affected in a hybrid flipped course. Instructors should consider carefully about offering hybrid courses and build in extra student support.NEW & NOTEWORTHY The transition from online to in-person teaching has been as challenging as the original transition to remote teaching with the onset of the pandemic. Since not all students were ready to return to the classroom, students could choose to take this course in person or online. This arrangement provided flexibility and opportunities for innovative class activities for students but introduced tradeoffs in lower test scores from the hybrid modality than fully online or fully in-person modalities.
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Affiliation(s)
- Lisa Carney Anderson
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, Minnesota, United States
| | - Tate Jacobson
- Department of Statistics, University of Minnesota, Minneapolis, Minnesota, United States
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Ware J, Boughton CK, Allen JM, Wilinska ME, Tauschmann M, Denvir L, Thankamony A, Campbell FM, Wadwa RP, Buckingham BA, Davis N, DiMeglio LA, Mauras N, Besser REJ, Ghatak A, Weinzimer SA, Hood KK, Fox DS, Kanapka L, Kollman C, Sibayan J, Beck RW, Hovorka R, Hovorka R, Acerini CL, Thankamony A, Allen JM, Boughton CK, Dovc K, Dunger DB, Ware J, Musolino G, Tauschmann M, Wilinska ME, Hayes JF, Hartnell S, Slegtenhorst S, Ruan Y, Haydock M, Mangat J, Denvir L, Kanthagnany SK, Law J, Randell T, Sachdev P, Saxton M, Coupe A, Stafford S, Ball A, Keeton R, Cresswell R, Crate L, Cripps H, Fazackerley H, Looby L, Navarra H, Saddington C, Smith V, Verhoeven V, Bratt S, Khan N, Moyes L, Sandhu K, West C, Wadwa RP, Alonso G, Forlenza G, Slover R, Towers L, Berget C, Coakley A, Escobar E, Jost E, Lange S, Messer L, Thivener K, Campbell FM, Yong J, Metcalfe E, Allen M, Ambler S, Waheed S, Exall J, Tulip J, Buckingham BA, Ekhlaspour L, Maahs D, Norlander L, Jacobson T, Twon M, Weir C, Leverenz B, Keller J, Davis N, Kumaran A, Trevelyan N, Dewar H, Price G, Crouch G, Ensom R, Haskell L, Lueddeke LM, Mauras N, Benson M, Bird K, Englert K, Permuy J, Ponthieux K, Marrero-Hernandez J, DiMeglio LA, Ismail H, Jolivette H, Sanchez J, Woerner S, Kirchner M, Mullen M, Tebbe M, Besser REJ, Basu S, London R, Makaya T, Ryan F, Megson C, Bowen-Morris J, Haest J, Law R, Stamford I, Ghatak A, Deakin M, Phelan K, Thornborough K, Shakeshaft J, Weinzimer SA, Cengiz E, Sherr JL, Van Name M, Weyman K, Carria L, Steffen A, Zgorski M, Sibayan J, Beck RW, Borgman S, Davis J, Rusnak J, Hellman A, Cheng P, Kanapka L, Kollman C, McCarthy C, Chalasani S, Hood KK, Hanes S, Viana J, Lanning M, Fox DS, Arreaza-Rubin G, Eggerman T, Green N, Janicek R, Gabrielson D, Belle SH, Castle J, Green J, Legault L, Willi SM, Wysham C. Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial. Lancet Digit Health 2022; 4:e245-e255. [PMID: 35272971 DOI: 10.1016/s2589-7500(22)00020-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 12/10/2021] [Accepted: 01/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population. METHODS In a multicentre, multinational, parallel randomised controlled trial, participants aged 6-18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbA1c levels between 53 and 86 mmol/mol (7·0-10·0%). Using block randomisation and central randomisation software, we randomly assigned participants to either closed-loop insulin delivery (closed-loop group) or to usual care with insulin pump therapy (control group) for 6 months. Randomisation was stratified at each centre by local baseline HbA1c. The Cambridge closed-loop algorithm running on a smartphone was used with either (1) a modified Medtronic 640G pump, Medtronic Guardian 3 sensor, and Medtronic prototype phone enclosure (FlorenceM configuration), or (2) a Sooil Dana RS pump and Dexcom G6 sensor (CamAPS FX configuration). The primary endpoint was change in HbA1c at 6 months combining data from both configurations. The primary analysis was done in all randomised patients (intention to treat). Trial registration ClinicalTrials.gov, NCT02925299. FINDINGS Of 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbA1c was 8·2% (SD 0·7) in the closed-loop group and 8·3% (0·7) in the control group. At 6 months, HbA1c was lower in the closed-loop group than in the control group (between-group difference -3·5 mmol/mol (95% CI -6·5 to -0·5 [-0·32 percentage points, -0·59 to -0·04]; p=0·023). Closed-loop usage was low with FlorenceM due to failing phone enclosures (median 40% [IQR 26-53]), but consistently high with CamAPS FX (93% [88-96]), impacting efficacy. A total of 155 adverse events occurred after randomisation (67 in the closed-loop group, 88 in the control group), including seven severe hypoglycaemia events (four in the closed-loop group, three in the control group), two diabetic ketoacidosis events (both in the closed-loop group), and two non-treatment-related serious adverse events. There were 23 reportable hyperglycaemia events (11 in the closed-loop group, 12 in the control group), which did not meet criteria for diabetic ketoacidosis. INTERPRETATION The Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX. FUNDING National Institute of Diabetes and Digestive and Kidney Diseases.
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Bhatt D, Brinton E, Miller M, Steg P, Jacobson T, Ketchum S, Juliano R, Jiao L, Doyle R, Granowitz C, Busch R, Tardif J, Ballantyne C. SUBSTANTIAL CARDIOVASCULAR RISK REDUCTION WITH ICOSAPENT ETHYL REGARDLESS OF DIABETES STATUS OR BMI: REDUCE-IT BMI. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Nguyen M, Jacobson T, Torres J, Wann A. Potential reduction of hospital stay length with outpatient management of low-risk febrile neutropenia in a regional cancer center. Cancer Rep (Hoboken) 2021; 4:e1345. [PMID: 33635593 PMCID: PMC8222550 DOI: 10.1002/cnr2.1345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 11/28/2022] Open
Abstract
Background Febrile neutropenia is a serious complication of chemotherapy. The Multinational Association for Supportive Care in Cancer (MASCC) risk index score identifies patients at low risk of serious complications. Outpatient management programs have been successfully piloted in other Australian metropolitan cancer centers. Aim To assess current management of febrile neutropenia at our regional cancer center and determine potential impacts of an outpatient management program. Method We performed a retrospective review of medical records for all patients admitted at our regional institution with febrile neutropenia between 1 January 2016, and 31 December 2018. We collected information regarding patient characteristics, determined the MASCC risk index score, and if low risk, we determined the eligibility for outpatient care and potential reduction in length of stay and cost benefit. Results A total of 98 hospital admissions were identified. Of these, 66 had a MASCC low‐risk index score. Fifty‐eight patients met the eligibility criteria for outpatient management. Seventy‐one percent were female. The most common tumor type was breast cancer. Forty‐eight percent were treated with curative intent. The median length of stay was 3 days. The median potential reduction in length of stay for each admission was 2 days. The total potential reduction in length of stay was 198 days. No admission resulted in serious complications. Conclusion This review demonstrates a significant number of hospital admission days can be avoided. We intend to conduct a prospective pilot study at our center to institute an outpatient management program for such low‐risk patients with potential reduction in hospital length of stay. This will have significant implications on health resource usage, service provision planning, and patient quality of life.
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Affiliation(s)
- Mike Nguyen
- Medical Oncology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Tate Jacobson
- Department of Medicine, Peninsula Health, Frankston, Victoria, Australia
| | - Javier Torres
- Medical Oncology, Goulburn Valley Health, Shepparton, Victoria, Australia
| | - Alysson Wann
- Medical Oncology, Goulburn Valley Health, Shepparton, Victoria, Australia
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Johnson A, Hughes R, Jacobson T, Brown D. Nutritional Outcomes and Efficacy of Palliative Chemoradiation for Patients with Metastatic Esophageal Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.1391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Steber C, Hughes R, Jacobson T, Farris M. Association between Dose to Normal Lung Outside the Planning Target Volume and Disease Recurrence after SBRT for Early-Stage Non-small Cell Lung Cancer. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Bhatt D, Steg P, Miller M, Brinton E, Jacobson T, Ketchum S, Juliano R, Jiao L, Doyle R, Granowitz C, Tardif J, Verma S, Ballantyne C. SIGNIFICANT CARDIOVASCULAR BENEFITS OF ICOSAPENT ETHYL FROM REDUCE-IT. Can J Cardiol 2020. [DOI: 10.1016/j.cjca.2020.07.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jung A, Paterson E, Bowler T, Miller B, McLindon LA, Jacobson T, Wynn-Williams M. 1410 Contained Vaginal Morcellation at Laparoscopic Hysterectomy – Safe, Efficient, Effective. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Steber C, Hughes R, Soike M, Wheless W, Blackstock A, Leyrer M, McTyre E, Ververs J, Prajapati S, Jacobson T, Farris M. Local Control after 50 Gy Delivered in 5 Fractions Versus 10 Fractions for Primary and Metastatic Lung Tumors. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Nguyen M, Jacobson T, Tamjid B, Torres J, Sahu A, Wann A. Potential length of stay reduction with outpatient management of low risk febrile neutropenia in a regional cancer centre. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e18000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18000 Background: Febrile neutropenia is a serious complication of chemotherapy. The Multinational Association for Supportive Care in Cancer (MASCC) risk index score can reliably identify patients with febrile neutropenia at low risk of serious complications. Outpatient management programs utilising protocol based risk stratification, daily ambulatory nursing visits, telephone follow up and early outpatient review have been successfully piloted in other Australian cancer treatment centres. Methods: We performed a retrospective review of medical records for all patients admitted at our institution with febrile neutropenia between January 1 2016 and December 31 2018. We collected information regarding patient characteristics, cancer diagnosis and treatment, determined the MASCC risk index score, and if low risk, we determined the potential eligibility for outpatient care and potential reduction in length of stay. Results: A total of 98 hospital admissions with febrile neutropenia were analysed. Of these, 66 were determined to have a MASCC low risk index score. 58 patients met the eligibility criteria for outpatient management. The median age was 67 years. 71% were female. The most common tumour type was breast cancer. 52% were treated with palliative intent. The median length of stay was 3 days. The median potential reduction in length of stay for each admission was 2 days. The total potential reduction in length of stay was 198 days. No admission resulted in serious complications indicating the safety of outpatient care. Conclusions: Febrile neutropenia is a common complication of chemotherapy and a leading cause of hospital admission. This review demonstrates a significant number of hospital admission days can be avoided with outpatient care. We intend to conduct a prospective pilot study at our centre to institute an outpatient febrile neutropenia program for such low risk groups with potential reduction in hospital bed length of stay. This has significant implications on health resource usage, service provision planning and patient quality of life.
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Affiliation(s)
- Mike Nguyen
- Goulburn Valley Health, Shepparton, Australia
| | | | | | | | - Arvind Sahu
- Goulburn Valley Health, Shepparton, Australia
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Eckel S, Kumar A, Jacobson T, Spielman IB, Campbell GK. A rapidly expanding Bose-Einstein condensate: an expanding universe in the lab. Phys Rev X 2018; 8:10.1103/PhysRevX.8.021021. [PMID: 31275731 PMCID: PMC6605088 DOI: 10.1103/physrevx.8.021021] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We study the dynamics of a supersonically expanding ring-shaped Bose-Einstein condensate both experimentally and theoretically. The expansion redshifts long-wavelength excitations, as in an expanding universe. After expansion, energy in the radial mode leads to the production of bulk topological excitations - solitons and vortices - driving the production of a large number of azimuthal phonons and, at late times, causing stochastic persistent currents. These complex nonlinear dynamics, fueled by the energy stored coherently in one mode, are reminiscent of a type of "preheating" that may have taken place at the end of inflation.
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Affiliation(s)
- S Eckel
- Joint Quantum Institute, National Institute of Standards and Technology and University of Maryland, Gaithersburg, Maryland 20899, USA
| | - A Kumar
- Joint Quantum Institute, National Institute of Standards and Technology and University of Maryland, Gaithersburg, Maryland 20899, USA
| | - T Jacobson
- Department of Physics, University of Maryland, College Park, Maryland 20742, USA
| | - I B Spielman
- Joint Quantum Institute, National Institute of Standards and Technology and University of Maryland, Gaithersburg, Maryland 20899, USA
| | - G K Campbell
- Joint Quantum Institute, National Institute of Standards and Technology and University of Maryland, Gaithersburg, Maryland 20899, USA
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Peyton PJ, Wu C, Jacobson T, Hogg M, Zia F, Leslie K. The effect of a perioperative ketamine infusion on the incidence of chronic postsurgical pain-a pilot study. Anaesth Intensive Care 2017; 45:459-465. [PMID: 28673215 DOI: 10.1177/0310057x1704500408] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Chronic postsurgical pain (CPSP) is a common and debilitating complication of major surgery. We undertook a pilot study at three hospitals to assess the feasibility of a proposed large multicentre placebo-controlled randomised trial of intravenous perioperative ketamine to reduce the incidence of CPSP. Ketamine, 0.5 mg/kg pre-incision, 0.25 mg/kg/hour intraoperatively and 0.1 mg/kg/hour for 24 hours, or placebo, was administered to 80 patients, recruited over a 15-month period, undergoing abdominal or thoracic surgery under general anaesthesia. The primary endpoint was CPSP in the area of the surgery reported at six-month telephone follow-up using a structured questionnaire. Fourteen patients (17.5%) reported CPSP (relative risk [95% confidence interval] if received ketamine 1.18 [0.70 to 1.98], P=0.56). Four patients in the treatment group and three in the control group reported ongoing analgesic use to treat CPSP and two patients in each group reported their worst pain in the previous 24 hours at ≥3/10 at six months. There were no significant differences in adverse event rates, quality of recovery scores, or cumulative morphine equivalents consumption in the first 72 hours. Numeric Rating Scale pain scores (median [interquartile range, IQR]) for average pain in the previous 24 hours among those patients reporting CPSP were 17.5 [0 to 40] /100 with no difference between treatment groups. A large (n=4,000 to 5,000) adequately powered multicentre trial is feasible using this population and methodology.
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Affiliation(s)
- P J Peyton
- Associate Professor, Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, University of Melbourne, Associate Professor, Department of Surgery, Austin Health, University of Melbourne, Head of Research, Dept of Anaesthesia, Austin Health, Melbourne, Victoria
| | - C Wu
- Anaesthetic Registrar, Department of Anaesthesia, Austin Health, Melbourne, Victoria
| | - T Jacobson
- Medical student, University of Melbourne, Austin Health Medical Education, Melbourne, Victoria
| | - M Hogg
- Head of Pain Services, Melbourne Health, Melbourne, Victoria
| | - F Zia
- Staff Anaesthetist, Ballarat Health Services, Department of Anaesthesia, Ballarat, Victoria
| | - K Leslie
- Honorary Professorial Fellow, Anaesthesia, Perioperative and Pain Medicine Unit, Melbourne Medical School, and Department of Pharmacology and Therapeutics, University of Melbourne; Honorary Adjunct Professor, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria
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Johnston H, Jacobson T, Gu X, Jiang S, Stojadinovic S. SU-E-T-184: Clinical VMAT QA Practice Using LINAC Delivery Log Files. Med Phys 2015. [DOI: 10.1118/1.4924545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Jacobson T, Murphy M. MO-F-BRA-03: NURBS-Based Deformable Image Registration. Med Phys 2012. [DOI: 10.1118/1.4735822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Jacobson T, Murphy M. TU-C-211-10: Optimized Knot Placement for B-Splines in Deformable Image Registration. Med Phys 2011. [DOI: 10.1118/1.3613157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Thurn J, Jacobson T, Crossley K. P29.13 Effect of a national control program on the proportions of MRSA infections contributed by specific ward types in a us veterans affairs medical center. J Hosp Infect 2010. [DOI: 10.1016/s0195-6701(10)60275-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Jacobson T, Murphy M. SU-GG-I-117: NURBS-Based Deformable Image Registration. Med Phys 2010. [DOI: 10.1118/1.3468151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Abstract
Constraints on possible Lorentz symmetry violation (LV) of order E/M(Planck) for electrons and photons in the framework of effective field theory (EFT) are discussed. Using (i) the report of polarized MeV emission from GRB021206 and (ii) the absence of vacuum Cerenkov radiation from synchrotron electrons in the Crab Nebula, we improve previous bounds by 10(-10) and 10(-2), respectively. We also show that the LV parameters for positrons and electrons are different, discuss electron helicity decay, and investigate how prior constraints are modified by the relations between LV parameters implied by EFT.
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Affiliation(s)
- T Jacobson
- Department of Physics, University of Maryland, College Park, Maryland 20742-4111, USA
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Jacobson T, Liberati S, Mattingly D. A strong astrophysical constraint on the violation of special relativity by quantum gravity. Nature 2003; 424:1019-21. [PMID: 12944959 DOI: 10.1038/nature01882] [Citation(s) in RCA: 205] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2003] [Accepted: 06/27/2003] [Indexed: 11/09/2022]
Abstract
Special relativity asserts that physical phenomena appear the same to all unaccelerated observers. This is called Lorentz symmetry and relates long wavelengths to short ones: if the symmetry is exact it implies that space-time must look the same at all length scales. Several approaches to quantum gravity, however, suggest that there may be a microscopic structure of space-time that leads to a violation of Lorentz symmetry. This might arise because of the discreteness or non-commutivity of space-time, or through the action of extra dimensions. Here we determine a very strong constraint on a type of Lorentz violation that produces a maximum electron speed less than the speed of light. We use the observation of 100-MeV synchrotron radiation from the Crab nebula to improve the previous limit by a factor of 40 million, ruling out this type of Lorentz violation, and thereby providing an important constraint on theories of quantum gravity.
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Affiliation(s)
- T Jacobson
- Department of Physics, University of Maryland, College Park, Maryland 20742-4111, USA.
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Risk D, Verpy D, Conley JD, Jacobson T, Sawyer TW. Volatile anesthetics give a false-positive reading in chemical agent monitors in the "H" mode. Mil Med 2001; 166:708-10. [PMID: 11515322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023] Open
Abstract
Chemical agent monitors (CAMs) are routinely used by the armed forces and emergency response teams of many countries for the detection of the vesicant sulfur mustard (HD) and the G series of organophosphate nerve agents. Ambient operating room isoflurane levels were found to produce strong positive signals in the "H" mode when the CAM was used to monitor the efficacy of decontamination procedures during routine surgical procedures on HD-poisoned animals requiring up to 8 hours of general anesthesia. Subsequent testing showed that isoflurane, as well as desflurane, sevoflurane, halothane and methoxyflurane, produce two ionization peaks in the CAM response. One of these peaks is interpreted by the CAM processing software as HD, resulting in a CAM "H" mode bar response. No interference was encountered with isoflurane, desflurane, and sevoflurane when the CAM was set to the "G" mode, although extremely high (nonclinical) concentrations of halothane and methoxyflurane yielded a weakly positive bar response. These findings have potentially serious ramifications for the medical management of patients resulting from terrorist, military, or chemical agent decommissioning activity when concomitant chemical injuries are also possible.
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Affiliation(s)
- D Risk
- Therapy Group, Chemical Biological Defence Section, Defence Research Establishment Suffield, Box 4000, Medicine Hat, Alberta, Canada T1A 8K6
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Abstract
In Sweden, milk and milk products are important sources of daily energy intake but the role of milk with preschool lunch meals has been debated frequently and water is often alternatively given today. We studied the effects of milk or water on lunch energy intake. Water or milk alternatively was served in a controlled, within-subject design on 12 occasions to 36 children aged 4-6 years, and energy intake was analysed at an individual level in three typical preschool lunches with a varying degree of preference among the children. When milk was given with the meals, a mean additional energy intake of 17% (p<0.0001) was found. The pattern was similar among boys and girls and irrespective of the lunch dish served. However, for the least preferred dish (fish with potatoes) milk helped to increase the energy intake by 26%. Physical activity measured as MET units (energy expenditure/body weight), atmosphere at the table as registered by a three-graded scale, and meal duration did not differ with meals or milk/water. Milk with preschool lunch meals seems to be a significant source of energy to achieve nutritional goals for this group of children.
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Affiliation(s)
- A Hägg
- Obesity Unit and Health Behaviour Research, Karolinska and Huddinge University Hospitals
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Westra BL, Holland DE, Aufenthie J, Cullen L, Finley J, Griebenow L, Hess G, Jacobson T, Kennebek S, McHale J, McMyler E, Ohland J, Ryan S, Wollan P. Testing the Uniform Needs Assessment Instrument for hospital discharge planning with older adults. J Gerontol Nurs 1998; 24:42-6. [PMID: 9735731 DOI: 10.3928/0098-9134-19980501-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The Uniform Needs Assessment Instrument (UNAI) was developed to systematically assess the continuing care needs of high-risk older adults in response to the 1986 Omnibus Budget Reconciliation Act. Based on previous studies, a revised UNAI was tested with 103 hospitalized older adults, comparing usual discharge planning with the UNAI. High interrater reliability was obtained. The UNAI had high (> or = 85%) sensitivity and specificity when comparing needs identification on the UNAI with subjects' reported needs at 10 to 14 days after discharge. Overall, the UNAI was more effective (sensitive and specific).
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Affiliation(s)
- B L Westra
- Clinical Services, Epsilon Systems, Inc., New Brighton, Minnesota, USA
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Jacobson T. Stricture and pouchitis after ileal pouch-anal anastomosis. J Wound Ostomy Continence Nurs 1997; 24:295-301. [PMID: 9407824 DOI: 10.1016/s1071-5754(97)90133-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Ileal pouch-anal anastomosis is a surgical procedure used for the treatment of people with chronic ulcerative colitis and familial adenomatous polyposis. The surgery is intended to preserve anal sphincter function, but it carries a risk for certain complications, including pouchitis and anastomotic stricture. The purpose of this article is to review the clinical manifestations, causes, and treatment of anastomotic stricture and pouchitis after ileal pouch-anal anastomosis.
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Affiliation(s)
- T Jacobson
- Mayo Medical Center, Rochester Methodist Hospital, MN 55902, USA
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Jacobson T. Standardized ET nursing database: imagine the possibilities. J Wound Ostomy Continence Nurs 1996; 23:5-9. [PMID: 8704851 DOI: 10.1016/s1071-5754(96)90109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
A national database of the components of ET nursing practice currently does not currently exist. Justification for ET nurse services requires hard data that demonstrate quality and cost-effectiveness of care. Lacking hard data, the value of the services provided by ET nurses remains difficult to quantify. The Nursing Minimum Data Set is the first step in building a nursing database. The purpose of this article is to familiarize ET nurses with the concepts of nursing information systems, the Nursing Minimum Data Set, and classification systems. Implications for ET nursing practice are also presented.
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Carling K, Jacobson T. Modeling unemployment duration in a dependent competing risks framework: identification and estimation. Lifetime Data Anal 1995; 1:111-122. [PMID: 9385087 DOI: 10.1007/bf00985262] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Three Mixed Proportional Hazard models for estimation of unemployment duration when attrition is present are considered. The virtue of these models is that they take account of dependence between failure times in a multivariate failure time distribution context. However, identification in dependent competing risks models is not straightforward. We show that these models, independently derived, are special cases of a general frailty model. It is also demonstrated that the three models are identified by means of identification of the general model. An empirical example illustrates the approach to model dependent failure times.
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Affiliation(s)
- K Carling
- Department of Statistics, Uppsala University, Sweden
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Abstract
PURPOSE To evaluate the hypocholesterolemic effects of long-term treatment (36 to 51 weeks) with a mixture of dietary fibers (guar gum, pectin, soy, pea, corn bran) administered twice a day. PATIENTS AND METHODS Fifty-nine subjects with moderate hypercholesterolemia who completed a 15-week, placebo-controlled study with the dietary fiber were treated for an additional 36 weeks with 20 g/day of fiber. Subjects were counseled and monitored on a National Cholesterol Education Program (NCEP) Step-One Diet before starting and during treatment. Analyses of changes in lipoprotein values during the additional 36 weeks of treatment took into account changes in weight, diet, and other variables that might have affected the response to treatment. RESULTS There were no significant effects on the levels of either triglycerides or high-density lipoprotein cholesterol (HDL-C). Levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) and the LDL/HDL ratio were significantly reduced during treatment. The mean percentage reductions from baseline after 51 weeks of treatment were approximately 5% for TC, 9% for LDL-C, and 11% for the LDL/HDL ratio. Changes were apparent after 3 weeks of treatment, with the maximum reductions occurring by the 15th week of treatment. CONCLUSIONS For subjects on a Step-One Diet who complied with the treatment regimen, the moderate cholesterol-lowering effects of the fiber persisted throughout the 36-to-51 week treatment period.
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Affiliation(s)
- D B Hunninghake
- Heart Disease Prevention Clinic, University of Minnesota, Minneapolis
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Jacobson T. Note on Hartle-Hawking vacua. Phys Rev D Part Fields 1994; 50:R6031-R6032. [PMID: 10017640 DOI: 10.1103/physrevd.50.r6031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Abstract
Sympathomimetic drug use or abuse in a thyrotoxic individual can be clinically devastating as a result of enhanced cellular sensitivity to adrenergic stimulation. Thus, it is critical to recognize thyrotoxicosis in a patient with coexistent sympathomimetic drug abuse. This case report describes a patient with Graves' disease and severe hyperadrenergic symptomatology that was thought to result from sympathomimetic drug abuse.
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Affiliation(s)
- T Jacobson
- University of Nevada School of Medicine, Las Vegas
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Abstract
The relationship between both the quantity and perceived quality of social support and suicidal risk was examined in a sample of 50 adolescents whose ages ranged from 16 to 20 years. A multiple regression analysis was performed, using scores from Cull and Gill's 1983 Suicide Probability Scale as the criterion measure along with the predictor variables of quantity and quality of experienced social support as measured by the 1983 Social Support Questionnaire of Sarason, Levine, Basham, and Sarason. Analysis showed the social support variables accounted for over 52% of the variance in suicide potential. The greatest proportion of the variance in suicide risk was attributable to the quality of the perceived social support. Adolescents at greater risk for suicide were significantly less satisfied with the quality of their social support.
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Affiliation(s)
- J P D'Attilio
- Department of Psychology, Nova University, Fort Lauderdale, FL 33314
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Abstract
Eighteen patients with 20 symptomatic hips underwent lengthening of the iliopsoas tendon for persistent painful snapping of this "internal" variety of snapping hip. We referred to the pathologic, painful snapping of the iliopsoas in the deep anterior groin as the "internal" snapping hip. This is in contrast to the more common and better-known "external" snapping that involves the greater trochanter and its overlying soft tissues. The results of our iliopsoas lengthening procedure are presented here. Lengthening of the iliopsoas tendon was accomplished by step cutting of the tendinous portion of the iliopsoas. The pathoanatomy of this poorly understood symptom complex was described in 1984 paper from this institution and is reviewed here. Iliopsoas bursography demonstrated a sudden jerking movement of the iliopsoas tendon between the anterior inferior iliac spine and iliopectineal eminence, synchronous with the patient's pain and often accompanied by an audible snap. The average preoperative duration of symptoms was 2.9 years, and the average length of postoperative followup was 25 months. All patients, except one, had a marked reduction in the frequency of snapping after tendon lengthening, and 14 of 20 hips had no snapping postoperatively. Of the six patients who had recurrence of snapping, all but one stated that this occurred much less frequently and was much less painful compared to the preoperative state. Two hips required reoperation. Postoperatively, only three patients complained of subjective weakness, and most patients were unlimited in physical activity with return to activities such as competitive football, pole vaulting, and long-distance running.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- T Jacobson
- University of Missouri Health Sciences Center, Division of Orthopaedic Surgery, Columbia 65212
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Jacobson T, Tsamis NC, Woodard RP. Tachyons and perturbative unitarity. Phys Rev D Part Fields 1988; 38:1823-1834. [PMID: 9959332 DOI: 10.1103/physrevd.38.1823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
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Jacobson T. [Management assistance in the nursing department]. Tidskr Sver Sjukskot 1966; 33:367-9. [PMID: 5177946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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