Placement Criteria Research Articles

Where Are the African American Males? Enrollment Criteria and the Placement of African American Males in Advanced Placement Courses

This qualitative study was a critical race analysis of Advanced Placement criteria and under-enrollment of African American males in two midwestern urban high schools. Analysis of faculty interviews and documents generated four themes. AP criteria and enrollment were implemented through formal and informal practices, and key roles of individual faculty and collaboration with faculty and families supported AP structures. However, assumptions about African American males, and color and gender-blind dialogue contributed to disproportionate African American male enrollment in AP courses.

Protocolized Based Management of Cerebrospinal Fluid Drains in Thoracic Endovascular Aortic Aneurysm Repair Procedures

Spinal cord ischemia (SCI) resulting in paraplegia is a devastating complication associated with thoracic endovascular aortic aneurysm repair (TEVAR) whose incidence has significantly declined over time. In this review, we present our experience with a multidisciplinary clinical protocol for cerebrospinal fluid (CSF) drain management in patients undergoing TEVAR. Furthermore, we aimed to characterize complications of CSF drain placement in a large, single center experience of patients who underwent TEVAR. This retrospective review is of patients undergoing TEVAR with and without CSF drain placement between January 2014 and December 2019 at a single institution. Patient demographics, hospital course, and drain-related complications were analyzed to assess the incidence of CSF drain-related complications. A total of 235 patients were included in this study, of which 85 received CSF drains. Eighty patients (94.1%) were placed by anesthesiologists, while 5 (5.9%) were placed under fluoroscopic guidance by interventional neurosurgery. The most common level of placement was L3-L4 in 38 (44.7%) cases followed by L4-L5 in 36 (42.4%) cases. The mean duration of CSF drain was 1.9±1.4days. Complications due to CSF drainage occurred in 5 (5.9%) patients and included partial retainment of catheter, subdural edema, epidural hematoma, headache, and bleeding near the drain site. The overall 30-day mortality rate was 5.5% and did not differ between those who received a CSF drain and those who did not (P=0.856). The overall incidence of SCI resulting in paraplegia was 1.7% in the studied patients. A protocol-based CSF drainage program for spinal cord protection involves a multifaceted approach in identification and selection of patients meeting criteria for prophylactic drain placement, direct closed loop communication, and perioperative management by an experienced team. Despite the inherent advantages of CSF drain placement, it is not without complications, thus risk and benefit need to be weighed in context of the procedure and the patient with close communication and team approach.

How Patient Centered Are Addiction Treatment Intake Processes?

The substance use disorder (SUD) treatment field has conducted significant research on creating intake tools and processes that best match patients to the most appropriate treatment setting, but less research has been conducted on how those tools impact the patient experience. The study took advantage of a natural experiment in California to evaluate whether the implementation of American Society of Addiction Medicine (ASAM) assessment criteria and a computer-facilitated intake assessment based on the ASAM criteria affects patient experiences and patient-centeredness during intake relative to patients receiving intake assessments not based on ASAM criteria. We analyzed surveys completed by 851 patients covered by Medi-Cal who were receiving specialty SUD treatment at 33 providers across 10 California counties about their experiences and perceptions of the intake assessment process. To account for differences in patient mix, we used inverse-probability weighting and computed differences in the weighted means for patients across non-ASAM, ASAM, and computerized-ASAM patients. We have found that patients who underwent intake based on ASAM assessment criteria or computerized ASAM assessment experienced a more patient-centered intake. We also found that patients who received ASAM-based assessments were more satisfied with their choice of treatment setting. This evidence is encouraging for the SUD treatment field, especially considering that many Medicaid programs are adopting ASAM or similar patient placement criteria and multidimensional assessments. Future research should consider whether increases in the patient-centeredness of assessments are associated with increased retention in SUD treatment and other positive treatment outcomes.

Liver transplantation for alcoholic hepatitis in the United States: Excellent outcomes with profound temporal and geographic variation in frequency.

Medical-refractory severe alcoholic hepatitis (AH) has a high mortality. The national frequency, longer term outcomes and regional practices of AH liver transplantation (LT) in the United States are not well described, despite the increasing mortality from alcohol-associated liver disease. We analyzed the trends in frequency and outcomes of UNOS data on 39455 adult patients who underwent LT from 2014 to 2019, including AH LT recipients. LTs for AH increased 5-fold, from 28 in 2014 to 138 in 2019, varying 8-fold between UNOS regions. Three transplant centers accounted for 50%-90% of AH LTs within each region. The number of transplant centers performing AH LTs increased from 14 in 2014 to 47 in 2019. AH patients were younger (mean=39.4years), had higher MELD scores (mean=36.8), and were more often on dialysis (46.0%) and in ICU (38.4%), compared to other indications (all P<.05). One- and 5-year graft survivals for AH LT recipients were 91.7% and 81.9%, respectively. The frequency of AH LT is increasing rapidly, with excellent medium-term outcomes. An impact of AH recurrence on patient or graft survival is not apparent in this national analysis. There are marked geographic variations in practices, highlighting the lack of selection criteria standardization.

Regional oxygen saturation change rate for detection of leg ischemia in minimally invasive cardiac surgery.

The criteria for placement of distal perfusion cannulas vary among reports. This cohort study aimed to establish a reproducible method to monitor critical leg ischemia during minimally invasive cardiac surgery. We included 121 patients who underwent minimally invasive cardiac surgery via right thoracotomy with right femoral arterial cannulation from 2015 to 2018. The change rate of regional oxygen saturation (ΔrSO2) was calculated as follows: rSO2 (baseline) - rSO2 (actual number)/rSO2 (baseline). Patients were divided into Group N (ΔrSO2 < 40%): 100/121 (83%) and Group H (ΔrSO2 > 40%, <10 minutes if >40%): 21/121 (17%). A distal perfusion cannula was placed when ΔrSO2 was >40% over 10 minutes. No patients experienced significant leg ischemia. Significantly longer cardiopulmonary bypass and aortic cross-clamp times were observed in Group H than in Group N (cardiopulmonary bypass time, 129 ± 36 minutes (Group N) vs. 151 ± 34 minutes (Group H), p = 0.01). ΔrSO2 correlated positively with plasma creatine phosphokinase elevation (R = 0.40, p < 0.001) on postoperative day 1. Serum lactate on intensive care unit admission showed a significant positive correlation (R = 0.40, p < 0.001) with ΔrSO2. ΔrSO2 measurement by near-infrared spectroscopy can facilitate distal leg perfusion monitoring and assist surgeons in preventing critical leg ischemia during minimally invasive cardiac surgery.

Desired Trajectory following by Feedforward Anticipation

This work presents a tracking method that is easy to design and implement. In particular, it is considered the tracking of a predefined trajectory whose temporal derivatives are known. This anticipated information of the desired reference signal allows, by employing a guaranteed dominant pole placement criterion, the formulation of a control law that uses the conventional feedback error compensation together with the anticipated knowledge of the derivatives of the reference signal. This provides substantial improvements in the closed-loop behavior of the system, impossible to achieve using only the feedback compensation. A numerical example, the steering of a ship and a real application, the control of a rotary flexible joint, show the effectiveness of the proposed method

An Optimal Placement Model for Electric Springs in Distribution Networks

The electric spring (ES) is a type of demand-response technology that improves the voltage quality of critical loads (CLs) in a distribution network. This paper, proposes an optimal placement model to determine the optimal placement locations and power ratings of ESs in a radial distribution network. The total voltage deviations with respect to the buses are proposed as the placement criteria. The non-critical loads (NCLs) with ESs are extended to power-electronics-based loads, and they are modeled as constant-power-type loads. The operation characteristics of the individual ESs are investigated and linearized. On the basis of the linearized Distflow equations, an optimal placement model is proposed for ESs in a radial distribution network. The proposed model is solved as a mixed integer linear program problem. As per the case-study results, the installation locations and power ratings of the ESs are mainly associated with the network topology, weight coefficients of the voltage deviations on different buses, and bus loads in the radial distribution network.

Optimal Vibration Control of Membrane Structures with In-Plane Polyvinylidene Fluoride Actuators

Different kinds of membrane structures have been proposed for future space exploration and earth observation. However, due to the low stiffness, high flexibility, and low damping properties, membrane structures are likely to generate large-amplitude (compared to the thickness) vibrations, which may lead to the degradation of their working performance. In this work, the governing equations are established at first, taking into account the modal control force induced by the polyvinylidene fluoride (PVDF) actuator. The optimal vibration control of the membrane structure is explored subsequently. A square PVDF actuator is attached on the membrane to achieve the vibration suppression. The influence of actuator position and control gains on the vibration control performance are studied. The optimal criteria for actuator placement and energy allocation are developed. Several case studies are numerically simulated to demonstrate the validity of the proposed optimization criteria. The analytical results in this study can serve as guidelines for optimal vibration control of membrane structures. Additionally, the proposed optimization criteria can be applied to active control of different flexible structures.

An optimal sensor placement strategy for reliable expansion of mode shapes under measurement noise and modelling error

Modal expansion techniques are typically used to expand the experimental modal displacements at sensor positions to all unmeasured degrees of freedom. Since in most cases, sensors can be attached only at limited locations in a structure, an expansion is essential to determine mode shapes, strains, stresses, etc. throughout the structure which can be used for structural health monitoring. Conventional sensor placement algorithms are mostly aimed to make the modal displacements at sensor positions of different modes as linearly independent as possible. However, under the presence of modelling errors and measurement noise, an optimal location based on this criterion is not guaranteed to provide an expanded mode shape which is close to the real mode shape. In this work, the expected value of normal distance between the real mode shape and the expanded mode shape is used as a measure of closeness between the two entities. Optimal sensor locations can be determined by minimizing this distance. This new criterion is applied on a simple cantilever beam and an industrial milling tower. In both cases, by using an exhaustive search of all possible sensor configurations it was possible to find sensor locations which resulted in a significant reduction in the distance when compared to a conventional optimal sensor placement strategy. Sufficiently accurate sub-optimal sequential sensor placement algorithm is also suggested as an alternative to the exhaustive search which is then compared with a genetic algorithm-based search. The efficiency of this new sensor placement criterion is further verified using Monte Carlo simulations for some realistic modelling error conditions.

Increasing Cervidae populations have variable impacts on habitat suitability for threatened forest plant and lichen species

Large herbivores play a key role in temperate and boreal forest ecosystems. Cervidae (deer) population densities and community structure have undergone drastic changes in many parts of the world over the past decades, often with deer populations increasing. Many studies show impacts of Cervidae on multiple ecosystem properties, including vegetation and biodiversity, at local spatial scales. At larger spatial scales, however, impacts of changing Cervidae populations on forest ecosystems are less known. Although both abiotic and biotic dimensions contribute to shaping species’ niches, abiotic variables are generally given prominence when modelling species habitats and ranges. This is despite biotic changes, including changes in trophic structure, being an important component of global environmental change. In this study, we examined the potential contribution of Cervidae densities to the habitat suitability for rare plant and lichen species across the temperate and boreal forests of Norway, where cervid densities have increased over the past 60 years. We also examined how these changes in herbivore communities may have shaped habitat suitability for rare lichens and plants and discuss the results in light of continuing shifts in herbivore assemblages. We ran habitat suitability models for 47 species of rare plants and lichens, which were selected based on herbivory reported as a criterion for placement on the national red list for species. Climate (temperature and precipitation), forest (forest type and productivity), soil pH and Cervidae densities (moose Alces alces, red deer Cervus elaphus and roe deer Capreolus capreolus) were used as independent variables. Densities of one or more of the three Cervidae species were inferred to be associated with the distribution of 14 (ten lichen, one bryophyte and three vascular plant species) of these 47 species. We found a range of habitat suitability associations with Cervidae densities, including positive, negative and hump-backed responses. Increases in Cervidae densities over the past 60 years may have led to different spatial trends in habitat suitability across the 14 species. Our results suggest that Cervidae densities are associated with the distribution of rare forest plant and lichen species differently at large spatial scales; experimental studies should test the causality of these associations. If causal, this implies that Cervidae management should find a balance between high and low densities to conserve several plant and lichen species. The preponderance of epiphytic lichens species, for which habitat suitability was associated with Cervidae densities, calls for field studies to focus on Cervidae impacts on forest lichens.

Abstract A36: Impact of feeding tube use on swallowing-related quality of life and weight in oropharyngeal cancer

Abstract Purpose: This study investigated differences in swallowing-related quality of life (QoL) and weight outcomes in patients treated for oropharyngeal cancer (OPC) based on feeding tube (FT) use. Methods: A retrospective chart review of OPC patients treated with definitive radiotherapy (± chemotherapy) was performed. Swallowing QoL and weight outcomes were collected from electronic medical records for patients seen at a single regional cancer center between January 2013 and December 2015. M.D. Anderson Dysphagia Inventory (MDADI) composite scores, Performance Status Scale for Head and Neck Cancer (PSS-HN) Normalcy of Diet scores, and weight measurements were gathered at baseline and at 3, 6, and 12 months post-treatment. Patients were grouped based on FT use. Bivariate associations were evaluated using the chi-square test and change over time was analyzed by group using a linear mixed effects analysis. The proportion of patients with clinically meaningful change was also determined. Results: Of 126 eligible patients, 46 (36.5%) received a reactive gastrostomy or gastro-jejunostomy FT (FT group). Compared to baseline, MDADI composite scores were significantly lower at 3 and 6 months (p &amp;lt; .001) for those who did not receive a FT (NFT group), while no significant change occurred in the FT group over time. No significant change was noted in PSS-HN scores for either group. Significant decreases in weight occurred in both groups at 3 and 6 months, and at 12 months for the NFT group alone (p &amp;lt; .001). Clinically meaningful decreases in MDADI composite scores at 3, 6, and 12 months were observed in 53%, 43%, and 29% of FT patients and 45%, 44%, and 33% of NFT patients, respectively. Clinically meaningful decreases in weight were observed at 3, 6, and 12 months in 30%, 23%, and 13% of FT patients and for 50%, 44%, and 40% of NFT patients, respectively. There was no significant association between FT use and clinically meaningful decreases in either MDADI composite scores or weight. Conclusions: Despite selective use of enteral feeding for nutritional support in patients at risk, the impact of FT utilization on functional outcomes is not well understood. Statistically significant decreases in short-term swallowing-related QoL were noted preferentially in patients without FTs, and there was a concerning trend for NFT patients to not return to baseline weight by 12 months post-treatment. However, this study also identified that patients in both groups experienced clinically meaningful decreases in swallowing-related QoL and weight in the first year post-treatment irrespective of FT use. Based on this evidence, it is prudent to monitor weight change closely, particularly in patients who do not meet initial risk criteria for reactive FT placement. Understanding the potential for clinically meaningful change in swallowing QOL and weight will contribute to improved patient monitoring and intervention, and may ultimately lead to better outcomes for those with OPC. Citation Format: Nedeljko Jovanovic, Colleen Dreyer, Sarah Hawkins, Kendra Thouless, David Palma, Philip C. Doyle, Julie A. Theurer. Impact of feeding tube use on swallowing-related quality of life and weight in oropharyngeal cancer [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Optimizing Survival and Quality of Life through Basic, Clinical, and Translational Research; 2019 Apr 29-30; Austin, TX. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(12_Suppl_2):Abstract nr A36.

Time delay handling in dominant pole placement with PID controllers to obtain stability regions using random sampling

This paper proposes a new formulation of proportional–integral–derivative (PID) controller design using the dominant pole placement method for handling second-order-plus-time-delay (SOPTD) systems. It transforms the transcendental exponential delay term of the plant into finite number of discrete-time poles by a suitable choice of the sampling time. The PID controller has been discretised using Tustin’s method and the controller gains are obtained using the dominant pole placement criterion where the plant is discretized using the pole-zero matching method. Random search and optimisation have been used to obtain the stability region in the desired closed loop parameters space by minimising the integral squared error (ISE) criterion by randomly sampling from the stabilizable region. Then these closed loop parameters are mapped on to the PID controller gains. Effectiveness of the proposed methodology is shown for nine test-bench plants with different lag to delay ratios, open loop damping, and sampling times.

The Impact of Medicaid Reimbursement on Rates of Postpartum LARC Uptake [27J

INTRODUCTION: There are many barriers to immediate postpartum long acting reversible contraception (LARC) placement, including lack of knowledge, restrictive placement criteria, inadequate reimbursement, and policies banning reimbursement for placement during an inpatient hospitalization. We aimed to determine the impact of a policy change by Missouri Medicaid in October of 2016 allowing reimbursement of immediate postpartum LARC placement. METHODS: We completed a retrospective cohort study comparing patients who delivered at Barnes Jewish Hospital (BJH) one year before (September, 2015-September 2016) and after (November, 2016-November, 2017) the Medicaid LARC immediate postpartum reimbursement policy change. Patients who had a contraindication to LARC placement were excluded. The primary outcome was immediate postpartum LARC placement. Demographic characteristics were compared using chi-square and Fisher’s exact test, as appropriate. Pertinent confounders were controlled for using logistic regression and the analysis was stratified by insurance type. RESULTS: A total of 6,233 women were included with 3,105 delivering before the postpartum LARC policy change and 3,128 delivering after. Immediate postpartum LARC uptake increased from 0.5% (n=16) to 7.3% (n=229) after the policy change (adjusted odds ratio (aOR) 15.4; 95% CI 9.3-25.8). In stratified analysis, postpartum LARC uptake increased in both women enrolled in Medicaid (0.7% to 9.6%; aOR 14.8; 95% CI 8.6-25.9) and private insurance (0.2% to 2.9%; aOR 13.3; 95% CI 3.2-55.9). CONCLUSION: Medicaid reimbursement for inpatient postpartum LARC is associated with an increased uptake among women with both Medicaid and private insurance. This policy change is an important step in reducing the burden of unintended pregnancies.

Academic Tracking of English Learners With Disabilities in Middle School

Despite increased attention to the academic progress of English learners (ELs) with disabilities as a result of the Every Student Succeeds Act of 2015, research has yet to investigate the educational opportunities of these students in secondary grades. This qualitative embedded case study examined the curricular access of 10 ELs with disabilities in middle school. Utilizing deficit thinking for its theoretical underpinnings, the analysis illuminated that ELs with disabilities were consistently placed in lower academic tracks through a number of mutually reinforcing institutional and perceptual factors. The findings have exigent implications for expanding opportunities to learn of ELs with disabilities through reform to placement criteria and provision of special education and linguistic support across a range of academic tracks.

Hate to Burst Your Balloon: Successful REBOA Use Takes More Than a Course.

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is emerging as a viable intervention for hemorrhagic shock. Training surgeons to place the device is only part of the process. We hypothesize that implementation challenges extend beyond surgical skills training and initial REBOA use should not be expected to mirror published success. All REBOA placements from January 2016 to February 2017 at a level 1 trauma center were reviewed for opportunities for improvement. From September 2016 to February 2017, all patients meeting highest trauma activation criteria were reviewed against our REBOA algorithm to identify patients meeting criteria for REBOA placement but not undergoing the procedure. REBOA was introduced at our institution in September 2015, with the first placement in January 2016. Trauma surgery, emergency department, and operating room staff underwent training. Nine patients had REBOA placed with six survivors. One patient underwent an unsuccessful REBOA attempt and died. Four patients had complications from REBOA. Eight additional patients met indications but did not undergo REBOA. Successful REBOA use requires more than teaching surgeons indications and techniques. For a successful REBOA program, system factors must be addressed. System processes must ensure equipment and procedures are standardized and familiar to all involved. Complications should be expected.

How the Implementation of a Battlefield Clinical Practice Guideline Affects Documentation Practice and Informs Future Research Initiatives: Spinal Injuries and Cervical Collars

In 2010, the Joint Trauma System published a clinical practice guideline (CPG) for providing care to patients with suspicion of spinal cord injury. The CPG advocated for liberal use of cervical collars and adequate documentation of the practice. This performance improvement project examined C-spine CPG adherence in both the prehospital and military treatment facility (MTF) settings. Understanding challenges in CPG adherence facilitates evaluation of future CPGs and their success at implantation of the clinical guidance. The Department of Defense Trauma Registry was used to identify US Military casualties meeting the criteria for cervical collar placement between January 1, 2007 and December 31, 2018. Criteria for cervical collar placement were defined as any patient who experienced a mechanism of injury relating to an explosion, fall, or motor-vehicle-related injury. Any patients with an AIS severity score greater than 1 to the head or having any ICD injury codes related to either upper spinal cord or head injury were also considered for inclusion. Adherence of cervical collar placement was defined by documented ICD codes or prehospital documentation of cervical collar placement as captured in the registry. A total of 14,837 patients were identified for possible cervical collar placement and 3,317 had verifiable documentation of having a C-collar placed. Documented C-collar placement was higher after the publication of the clinical practice guideline in 2010 (29% vs. 15%, p<0.0001). CPG publication was associated with cervical collar application (odds ratio: 2.50, 95% CI: 2.29-2.72). Application of cervical collars has increased significantly, since the initial publication of the spine injury CPG. Current gaps include valid and reliable identification of patients warranting specific clinical interventions and documentation of patient care. Currently, lack of documentation is reported as nonadherence, but it remains unknown if these missing clinical data accurately portray nonadherence or adherence with lack of documentation. Future research and resources would benefit and expand the results collected in this paper, and cement the importance of CPG publication and adherence.

Social Communication Skills’ Criteria for Placement of Student with Disabilities in Inclusive Program

Social Communication Skills’ Criteria for Placement of Student with Disabilities in Inclusive Program

Occipital Condyle Screw Placement in Patients with Chiari Malformation: A Radiographic Feasibility Analysis and Cadaveric Demonstration

Patients who undergo decompression surgery for Chiari malformation frequently require occipitocervical fixation. This is typically performed with occipital plates, which may cause intracranial injuries due to multiple fixation points. We undertook this study to assess the feasibility of occipital condyle (OC) screw placement as an alternative method of occipitocervical fixation in this patient population. Using a cadaveric model with navigational assistance, we performed the complete surgical procedure for occipitocervical fixation with OC screws. We then performed a morphometric analysis using measurements from computed tomography scans of 49 patients (32 adult, 17 pediatric) who had undergone occipitocervical fusion with instrumentation following decompression surgery for Chiari malformation. Bilateral morphometric data were analyzed for the adult and pediatric subgroups separately, as well as for the overall group. The surgical procedure was successfully performed in the cadaveric model, demonstrating the feasibility of the proposed method. Ninety-eight OCs were studied in the morphometric analysis, and 80 (81.6%) met our eligibility criteria for OC screw placement. However, in 14.1% of adult OCs and 26.5% of pediatric OCs studied, placement of condylar screws would have been challenging or unsafe, according to our criteria. Our findings suggest that OC screws provide a useful option for occipitocervical fixation in a substantial proportion of patients with Chiari malformation. However, rigorous preoperative analysis would be essential to identify appropriate candidates for this technique and exclude those in whom it should not be attempted. Additional study is warranted.

Lengthy unpaid placements in social work: exploring the impacts on student wellbeing

ABSTRACT In Australia, there are 130,000 students studying social work across 30 universities. The Australian Association of Social Workers (AASW) mandates the completion of at least 1,000 hours of field education for qualification, across at least two placements in different fields of practice. This means a full-time social work placement at 7.5 hours per day is typically just under 3.5 months’ duration. Yet, recent Australian research has demonstrated that students experience significant levels of financial and other stress during lengthy, unpaid placements. In response to this, we surveyed Bachelor of Social Work (BSW) students who were currently undertaking or had recently undertaken (n = 60) their first or second field placement at Victoria University, in Australia to elicit their feedback on their experiences of lengthy unpaid placements. The descriptive survey was completed anonymously online and consisted of 38 short answer questions that elicited demographic information and respondents’ opinions on key field placement criteria. The results of this study have important implications for field education, as it adds to the existing calls for a reworking of the AASW accreditation standards to address this issue. Future research could incorporate feedback from field liaisons, and field directors.

Assessing connectivity and the contribution of private lands to protected area networks in the United States.

Current targets for protected area network coverage call for increased protection but lack specificity in terms of criteria for parcel type, placement, and landscape connectivity. We assessed land conservation achieved by protected area networks in the contiguous United States, and assessed whether private lands contributed substantially to network coverage and connectivity given species dispersal abilities. On average, states have 4.1% (range: 0.2% to 15.8%, n = 48) protected area coverage with connectivity ≤10 km. Terrain ruggedness, percent farmland, and population density are the primary determinants of protected area placement, leading to biased representation of land features currently under protection. On average, private protected areas contribute <1.1% (range 0.0% to 9.2%) to current protected area coverage across the United States. We conclude that current levels of protection and connectivity are inadequate to support a functional protected area network, and that increased and strategic selection of private protected areas is necessary to meet conservation planning goals.