Multiphase Approach Research Articles

Molecular characterization, virulence and antimicrobial and biocidal susceptibility of selected bacteria isolated from the cloaca of nestling ospreys (Pandion haliaetus) from Mono Lake, California, USA.

In the present study, the presence of the Enterobacterales, Staphylococcus spp., Mammaliicoccus spp., and Enterococcus spp. in cloacal samples of nestling ospreys (Pandion haliaetus), a fish-eating specialist, from Mono Lake, California, USA was examined by a multiphasic approach, including antimicrobial and biocide susceptibility testing, genotyping, and whole genome sequencing of selected isolates. The most commonly detected species was Escherichia coli, followed by Mammaliicoccus sciuri, Staphylococcus delphini, Enterococcus faecalis, Enterococcus faecium, Hafnia alvei, Klebsiella pneumoniae, Citrobacter braakii and single isolates of Edwardsiella tarda, Edwardsiella albertii, Klebsiella aerogenes, Plesiomonas shigelloides and Staphylococcus pseudintermedius. Multi-drug resistance (MDR) was observed in two E. coli isolates and in an Enterococcus faecium isolate. The MDR blaCTX-M-55-positive E. coli belonged to the pandemic clone ST58. The results of the present study suggest that nestling ospreys are exposed to MDR bacteria, possibly through the ingestion of contaminated fish. Ospreys may be good biosentinels for the presence of these microorganisms and antibiotic resistance in the local environment and the risk for other wildlife, livestock and humans.

Programmatic Efforts to Provide Progressively Autonomous Clinical Education Experiences

Context In previous research, athletic trainers (ATs) have identified the formal coursework and clinical experiences of their professional program as contributing to preparedness for autonomous practice. However, new graduates have reported a perceived lack of skills necessary for practicing autonomously. Objective The purpose of this study was to evaluate how programs provide progressively autonomous clinical education experiences and the role of these experiences in preparing future ATs. Design Qualitative study. Setting Virtual interviews. Patients or Other Participants A sample of 17 program administrators (program directors = 12, coordinators of clinical education = 5) representing 16 master of science in athletic training programs participated in this study. Main Outcome Measure(s) Each program completed a virtual interview guided by a semistructured interview protocol. A 3-person data analysis team identified emerging domains and categories through a multiphase approach. Member checking, multiple researcher triangulation, and auditing were used to establish trustworthiness. Results Four domains emerged from participant responses: (1) curricular design, (2) preparatory experience and outcomes, (3) preceptor role, and (4) assessments. We found that intentionality in curricular design to promote progressive autonomy was beneficial in facilitating transition to practice through improved knowledge, skills, and confidence. Due to the importance of clinical education in AT preparation, preceptors played a critical role in creating opportunities for learning in the clinical environment. However, the degree to which experiences were autonomous and the effectiveness of the student in those encounters were rarely measured. Limitations outlined by participants included accreditation and program length. Conclusions The development of knowledge, skills, and confidence through intentionally selected clinical experiences and guided by preceptor feedback are critical to establishing an autonomous practitioner. However, the program’s evaluations were predominantly traditional practice assessments and informal feedback, instead of an assessment of readiness for practice.

Development and evaluation of a scale to measure nurses’ unsafe driving behaviour while commuting

Driving is the most prevalent form of commuting for most workers but is also perhaps the most hazardous mode of travel with unsafe driving contributing significantly to road traffic accidents. Despite nurses having been reported as being at higher risk of commuter-related accidents over the last three decades, little is known about unsafe driving behaviours among nurses while commuting, which is unique from other driving routines. Additionally, the lack of appropriate tools to measure such behaviours is apparent. This study aims i) to identify unsafe driving behaviours among nurses while commuting and ii) to develop a scale to assess nurses' unsafe commuting driving behaviours. The study employed a multiphase and multimethod approach to develop the scale, which was subject to stringent validation and evaluation. Themes were specified via the Nominal Group Technique (NGT). Six themes were identified namely: i) violations and reckless driving, ii) negative emotions, iii) drowsy driving iv) mind wandering, v) error and vi) carelessness. Content and face validity were sought through expert review. A total of 442 nurses’ data were collected across multisite hospitals for evaluation. Exploratory factor analysis (EFA) resulted in recovered structure and was confirmed through Confirmatory Factor Analysis (CFA) with structural equation analyses being conducted to test predictive validity. All constructs met adequate validity and reliability. Nurses' unsafe driving behaviours while commuting were identified with a novel scale to assess them being both developed and validated. The resulting MyUDWC scale is a suitable tool for measuring nurses' unsafe driving behaviours while commuting.

Developing a Model to Enhance Junior High School Teacher 21st Century Learning Management Competencies

This study pursues a comprehensive tripartite agenda: firstly, to investigate the essential requisites for formulating a model geared towards augmenting teachers’ 21st century learning management competencies; secondly, to design a tailored model aligned with these competencies; and thirdly, to scrutinize the tangible impact of model implementation. Employing a multi-phased approach involving meticulous need analysis, model development, and real-world implementation, this study navigated a dynamic educational landscape. Phase 1 involved 353 participants, collectively shaping the foundation for subsequent phases. Phase 2 harnessed the expertise of five seasoned educators and scholars to collaboratively refine and assess the model. Phase 3 expanded the scope to encompass 24 junior high school teachers and 36 educational stakeholders, further validating the model’s utility. The outcomes highlight a model encompassing curriculum development, learner-centered active learning strategies, media and technology integration, authentic learning assessment, and conducting research for learner development. This comprehensive model was fashioned as a dynamic workshop, integrating face-to-face training, coaching training, and online modules, thereby catering to diverse learning preferences. Remarkably, the model’s implementation elicited substantial benefits: significant enhancements were observed in teachers’ 21st century learning management skills, while students’ 21st century skills also experienced discernible progress. Notably, the model’s overall quality, rigorously evaluated through the CIPPIEST model, reaffirms its excellence and potential for sustainable educational advancement.

PATHway: Intervention optimization of a prevention program for adolescents at–risk for depression in the primary care setting

With as many as 13% of adolescents diagnosed with depressive disorders each year, prevention of depressive disorders has become a key priority for the National Institute of Mental Health (NIMH). Currently, we have no widely available interventions to prevent these disorders. To address this need, we developed a multi-health system collaboration to develop and evaluate the primary care based technology “behavioral vaccine,” Competent Adulthood Transition with Cognitive-Behavioral Humanistic and Interpersonal Therapy (CATCH-IT). The full CATCH-IT program demonstrated evidence of efficacy in prevention of depressive episodes in clinical trials. However, CATCH-IT became larger and more complex across trials, creating issues with adherence and scalability.We will use a multiphase optimization strategy approach to optimize CATCH-IT. The theoretically grounded components of CATCH-IT include: behavioral activation, cognitive-behavioral therapy, interpersonal psychotherapy, and parent program. We will use a 4-factor (2x2x2x2) fully crossed factorial design with N = 16 cells (25 per cell, after allowing 15% dropout) to evaluate the contribution of each component. Eligible at-risk youth will be high school students 13 through 18 years old, with subsyndromal symptoms of depression. The study design will enable us to eliminate non-contributing components while preserving efficacy and to optimize CATCH-IT by strengthening tolerability and scalability by reducing resource use. By reducing resource use, we anticipate satisfaction and acceptability will also increase, preparing the way for an implementation trial.

Updated recommendations on measures for clinical trials in pediatric chronic pain: a multiphase approach from the Core Outcomes in Pediatric Persistent Pain (Core-OPPP) Workgroup.

Many gaps remain in finding effective, safe, and equitable treatments for children and adolescents with chronic pain and in accessing treatments in different settings. A major goal of the field is to improve assessment of pain and related experience. Valid and reliable patient-reported outcome measures are critical for advancing knowledge of clinical interventions for pediatric chronic pain. Building on the work of the Ped-IMMPACT group, we previously updated a core outcome set (COS) for pediatric chronic pain clinical trials using stakeholder feedback from providers, youth, and parents. The new COS includes 3 mandatory domains: pain severity, pain-related interference with daily living, and adverse events and 4 optional domains: overall well-being, emotional functioning, physical functioning, and sleep quality. The aim of this study was to use a multiphased approach to recommend specific measures for each of the 7 domains identified in our new COS for pediatric chronic pain. We synthesized evidence through conducting the following: (1) a Delphi study of experts to identify candidate measures for the new COS domains, (2) a review phase to gather evidence for measurement properties for candidate measures, and (3) an expert consensus conference to reach agreement on measurement recommendations. Final recommendations included 9 patient-reported measures. Important contextual considerations are discussed, and guidance is provided regarding strengths and limitations of the recommendations. Implementation of these recommendations may be enhanced by widespread dissemination and ease of access to measurement tools.

Advective gas flow in bentonite: Development and comparison of enhanced multi-phase numerical approaches

Understanding the impact of repository gas, generated from degradation of waste and its interaction with the host rock, is essential when assessing the performance and safety function of long-term disposal systems for radioactive waste. Numerical models based on conventional multi-phase flow theory have historically been applied to predict the outcome and impact of gas flow on different repository components. However, they remain unable to describe the full complexity of the physical processes observed in water-saturated experiments (e.g., creation of dilatant pathways) and thus, the development of novel representations for their description is required when assessing fully saturated clay-based systems. This was the primary focus of Task A within the international cooperative project DECOVALEX-2019 (D-2019) and refinement of these approaches is the primary focus of this study (Task B in the current phase of DECOVALEX-2023).This paper summarises development of enhanced numerical representations of key processes and compares the performance of each model against high-quality laboratory test data. Experimental data reveals that gas percolation in water-saturated compacted bentonite is characterised by four key features: (i) a quiescence phase, followed by (ii) the gas breakthrough, which leads to a (iii) peak value, which is then followed by (iv) a negative decay. Three models based on the multiphase flow theory have been developed. These models can provide good initial values and reasonable responses for gas breakthrough (although some of them still predict a too-smooth response). Peak gas pressure values are in general reasonably well captured, although maximum radial stress differences are observed at 48 mm from the base of the sample. Here, numerical peak values of 12.8 MPa are predicted, whereas experimental values are about 11 MPa. These models are also capable of providing a reasonable representation of the negative pressure decay following peak pressure. However, other key specific features (such as the timing of gas breakthrough) still require a better representation. The model simulations and their comparison with experimental data show that these models need to be further improved with respect to model parameter calibration, the numerical representation of spatial heterogeneities in material properties and flow localisation, and the upscaling of the related physical processes and parameters. To further understand gas flow localisation, a new conceptual model has been developed, which shows that discrete channels can possibly be induced through the instability of gas-bentonite interface during gas injection, thus providing a new perspective for modeling gas percolation in low-permeability deformable media.

A Review on Online Pharmacy

The Internet has revolutionized the way in which ordinary people conduct their everyday business. People can bank pays bills, manage investments, order various products, and gain information on an bottomless number of motifs online. It isn't surprising that such an invention would give a vehicle for the minister to educate them and guide the direction of their health. Nor is it surprising that the healthcare assiduity would seize this occasion to contemporize a commonplace function — tradition division. numerous internet apothecaries offer overnight shipping, allowing guests to avoid the detention of regular correspondence. Internet apothecaries can offer sequestration that's frequently lacking in a traditional drugstore. still, there's need to consider critically the ethical principles in the use of cyber drug. The development of online apothecaries has urged nonsupervisory and covering conduct at the civil, state, and professional association situations. The trade of online specifics in the transnational system is potentially dangerous and requires transnational regulation. Then's an overview of online apothecaries, their implicit benefits, the associations involved in regulating these spots, and the major difficulties girding online apothecaries. The ideal is to identify the position of web operation security vulnerabilities in online apothecaries and the common types of excrescencies, therefore expanding on previous studies. Technical, directorial and legal recommendations on how to alleviate security issues are presented. system. The proposed four- step system first consists of choosing an online testing tool. The coming way involve choosing a list of 60 online drugstore spots to test, and also running the software analysis to collect a list of excrescencies. Eventually, an in- depth analysis is performed on the types of web operation vulnerabilities. Results. The maturity of spots had serious vulnerabilities, with the maturity of excrescencies being cross-site scripting or old performances of software that have not been streamlined. Conclusions. A system is proposed for the securing of web apothecary spots, using a multiphase approach of technical and managerial ways together with a thorough understanding of public legal conditions for securing systems (1) The COVID- 19 epidemic demanded academic institutions to snappily transition to online knowledge and make changes to assessment procedures. This study examines how a academy of drugstore creatively approached the challenge of online assessment while maintaining the norms necessary to prepare practice-ready pupil druggists. To conduct traditional examinations, preceptors stationed two different types of styles using testing software a videotape conferencing technology approach which mimicked pre- pandemic, on- lot proctored examinations; or open- book, internet access- enabled examinations that assured academic integrity and rigor through colorful testing strategies. To assess scholars’ clinical chops, faculty used a combination of ways similar as physical to understand the pupil experience with these assessments, scholars were surveyed using a 12- item questionnaire. Overall, online videotape proctoring maintained thickness in test structure and administration, but needed expansive instruction for both scholars and proctors. scholars preferred unproctored open- book, internet access- enabled, standard time examinations versus proctored, unrestricted- book, internet- access impaired, extended time examinations. Changes to testing procedures, whether with proctored or unproctored styles, appeared to increase pupil stress (2).

Cancer patients’ needs for volunteer services during Covid-19: a mixed-method exploratory study

IntroductionTo date, there are no known studies that have investigated the new need for volunteer services among cancer patients during the Covid-19 pandemic. However, it is essential for volunteer associations to heighten such knowledge to best guide their offer in this challenging period.AimThe present study aims to provide a mapping of the cancer patients’ needs for volunteer services followed at Istituto Nazionale dei Tumori in Milan (Italy) during the Covid-19 pandemic. Since there are no specific questionnaires for this purpose, we created an ad hoc tool for which we report the preliminary result.MethodWe used a mixed-method multiphase approach. Phase I: in April-May 2020 40 ad hoc paper questionnaires were distributed at the entrance of the aforementioned hospital, with the aim of investigating patients’ needs through two open-ended questions then analyzed through thematic analysis. Phase II: the contents that emerged from Phase I were transformed into items and submitted to the judgment of a small group of “peers” (patients) and “experts” (professionals) in November-December 2020 to evaluate their comprehensiveness, representativeness and intrusiveness. Phase III: in January-February 2021 paper questionnaires, containing the items reviewed in Phase II, were distributed within the hospital to a representative sample of cancer patients. We applied descriptive statistics, Exploratory Factor Analysis (EFA) and Cronbach’s Alpha.Results32 patients completed Phase I, 3 “peers” and 9 “experts” participated in Phase II, 214 patients completed the questionnaire in Phase III. EFA highlights five kinds of needs during the Covid-19 pandemic, in order of priority: (1) need to be supported at the hospital; (2) need for emotional support; (3) need for daily errands; (4) need for practical support to family members; (5) need to share free time. Preliminary results on the tool are encouraging, although further studies are needed. These results will allow local volunteer associations to adapt their services during the pandemic.

Reflections from the 'Hold the door open' project: Inviting older adults across the UK to shape dissemination of health research findings.

This project sought to expand patient and public involvement (PPI) practices to the development of research finding dissemination with people aged 55+ years. The project is innovative due to its UK-wide approach and use of PPI to plan better ways to share findings of health research with older adults, extending PPI beyond research project initiation to support dissemination activities. The aim of this study is to understand how to develop effective public engagement activities with older adults to disseminate findings of health research. We hope to promote greater inclusivity and advance our understanding of this demographic. This project combined three approaches: (i) an online questionnaire to ask what activities older adults enjoy; (ii) online planning workshops seeking public contributors'input in event planningand (iii) community events to share research findings and raise awareness of PPI. Activities were carried out in Cardiff, Belfast, Glasgow and Tewkesbury. The planning workshops clarified that in-person activities and offering options for activities were important. Based on feedback from our contributors, all our events focused around a talk and questionand answersession. Other short activities included light exercise and a writing activity. Our multiphase approach helped us develop informative activities that reflected the questionnaire results and the feedback from the workshops, as we tailored our events to each location. A phased approach allowed both researchers and contributors to gradually deepen their understanding. Further awareness raising is needed to develop the role older adults currently hold in health research activities. Working closely with existing communities can help broaden diversity. Thirty-three public contributors helped facilitate this project. Two of these also contributed to this article by writing a reflection of their experiences, one of whom also provided feedback for the article.

The Development of the RA-VING Self-Trust Instrument (RSTI) across Three National Samples of Adults in the United States

Objective The purpose of this study was to begin developing and validating an instrument to measure self-trust in adults. Method Using a multi-phased and mixed methods approach to instrument development, the RSTI scores were tested across three samples reflecting national demographics of adults in the United States (n = 157, n = 692, n = 261). The 3 studies included construct conceptualization, development and pilot testing of initial items, exploration of factor structure through EFA and parallel analysis, confirmation of factor structure using CFA, and assessment of reliability and validity evidence. Results The RSTI was composed of 26 items extracted into five factors, which demonstrated largely adequate model fit, good internal consistency, and adequate validity. Conclusion This research provided an operational definition of self-trust, a new measure self-trust in adults, and a framework for counselors to investigate the role of self-trust in client conceptualization and treatment.

Beyond the Ballot: A Comparative Analysis of Political Microtargeting Practices and Regulations in Kenya and Nigeria

Technological advancements have significantly impacted the political world. Unlike the traditional means of conducting campaigns, technology makes it possible to conduct data-driven campaigns on a larger scale and with high levels of specificity. For political parties, better clarity leads to hyper-individualized communication in a process known as microtargeting. Critics argue that political microtargeting can directly manipulate and suppress voters, exacerbate polarization, perpetuate misinformation, and indirectly lead to long-term effects by encouraging political parties to ignore individuals whom they deem unlikely to vote or those who are digitally excluded. This paper studies political microtargeting in Kenya and Nigeria because of data-driven campaigns that have been observed in these jurisdictions in the past and due to the increased reliance on social media platforms that political actors are utilizing to influence voters. It argues that political microtargeting is an issue of concern and therefore, using Kenya and Nigeria, it pushes the agenda that countries in the Global South should implement policies and regulations to curtail the negative impact of the practice. To examine the extent of political microtargeting in both Kenya and Nigeria, this paper employs a multi-phase approach that involves an analysis of paid Facebook advertisements in both countries during the past election periods.

Addressing complexity when developing an education program for the implementation of a stroke Electronic Medical Record (EMR) enhancement

BackgroundDigital interventions in health services often fail due to an underappreciation of the complexity of the implementation. This study develops an approach to address complexity through an evidenced-based, theory-driven education and implementation program for an Electronic Medical Record (EMR) digital enhancement for acute stroke care.MethodsAn action research approach was used to design, develop, and execute the education and implementation program over several phases, with iterative changes over time. The study involved collaboration with multiple statewide and local key stakeholders and was conducted across two tertiary teaching hospitals and a regional hospital in Australia.ResultsInsights were gained over five phases. Phase 1 involved a review of evidence that supported blended learning strategies for the education and training of staff end-users. In Phase 2, contextual assessment was conducted via observation of study sites, providing awareness of local context variability and insight into key implementation considerations. The Non-adoption, Abandonment, Scale-Up, Spread and Sustainability (NASSS) framework assisted in Phase 3 to identify and manage the key domains of complexity. Phase 4 involved the design of the program which included group-based training and an e-learning package, endorsed and evaluated by key leaders. Throughout implementation in Phase 5, further barriers were identified, and iterative changes were tailored to each context.ConclusionsThe NASSS framework, combined with a multi-phased approach employing blended learning techniques, context evaluations, and iterative modifications, can serve as a model for generating theory-driven and evidence-based education strategies that adresss the complexity of the implementation process and context.

Thailand’s innovative agritourism in the post COVID-19 new normal: A new paradigm to achieve sustainable development goals

Before the COVID-19 crisis, Thailand’s tourism industry, which is critical to the economy, relied on global tourists. The Thai government initiated a policy reform to stimulate domestic focus on the agricultural sector as the key occupation for income distribution, which involved changing tourist behavior from urban to local tourism. This study integrates quantitative and qualitative multiphase approaches to obtain reliable research results from six regions of Thailand. The travel behaviors of Thai tourists engaged in agritourism did not show a statistically significant difference. The paradigm was intercorrelated with variables of the entry mode, comprising internal and external factors that influence the decision to enter the agritourism business. An agritourism entrepreneur must perceive risks and benefits, and adjust and return to the homecoming of offspring. Thailand’s agritourism can contribute to achieving the Sustainable Development Goals (SDGs), resulting in economic growth based on sustainable domestic dependency.

Reduction of acute kidney injury in pediatric patients after bone marrow transplant: A prospective analysis after quality improvement implementation.

371 Background: Hematopoietic cell transplantation (HCT) is a curative therapy for malignant and non-malignant diseases. Acute kidney injury (AKI) is a common complication after HCT secondary to use of nephrotoxic medications (NTMx) prescribed for conditioning and prophylaxis. A recently published meta-analysis estimates the incidence of AKI after HCT to be 55.1%, with Stage 3 occurring in 8.3% of patients. Nephrotoxic medication–associated AKI (NAKI) affects 19%–31% of children who receive an intravenous aminoglycoside, with NAKI rates doubling with receipt of ≥ 3 nephrotoxic medications on the same day. We hypothesized that reducing NTMx exposure in pediatric HCT patients would be associated with lower all causes AKI incidence in the HCT unit. Methods: Single-center harm-preventing measures have been implemented at our center since 2019 to 2023. A multi-phased approach was used to increase education and recognition surrounding NTMx exposures in the HCT unit and role in subsequent AKI. We identified champions in the Pediatric HCT and Infectious Disease Host Defense teams. Five educational sessions took place from November 2022-June 2023 and an informational handout was created and distributed to HCT providers. Notifications to attending physicians of patients meeting NTMx exposure criteria, with acceptable alternatives to commonly used nephrotoxic drugs, and suggestions for AKI monitoring took place during daily rounds by the clinical pharmacist. Data on exposures and NAKIs’ was collected and reviewed every 3 months. Results: The cohort included 79 unique patients with 3547 patient days admitted to the HCT unit at Nationwide Children’s Hospital between January 1 2022 and March 31 2023. A total of 210 NTMx exposures were identified and resulted in 22 NAKI events. We reduced the rates of nephrotoxic medication exposure by 51% from 14.36 to 7 per month per 1000 patient days and NAKIs by 21% from to 1.27 to 1 per month per 1000 patient days since the start of our interventions. Conclusions: Successful interventions to decrease AKI in patients admitted to the HCT unit require a multi-disciplinary, iterative, and continuous approach, including recurrent education efforts to providers and pharmacy-driven daily physician alerts. Organizational implementation of these interventions is still ongoing.

Social media usage and students’ social anxiety, loneliness and well-being: does digital mindfulness-based intervention effectively work?

BackgroundThe increasing integration of digital technologies into daily life has spurred a growing body of research in the field of digital psychology. This research has shed light on the potential benefits and drawbacks of digital technologies for mental health and well-being. However, the intricate relationship between technology and psychology remains largely unexplored.PurposeThis study aimed to investigate the impact of mindfulness-based mobile apps on university students' anxiety, loneliness, and well-being. Additionally, it sought to explore participants' perceptions of the addictiveness of these apps.MethodThe research utilized a multi-phase approach, encompassing a correlational research method, a pretest–posttest randomized controlled trial, and a qualitative case study. Participants were segmented into three subsets: correlations (n = 300), treatment (n = 60), and qualitative (n = 20). Data were gathered from various sources, including the social anxiety scale, well-being scale, social media use integration scale, and an interview checklist. Quantitative data was analyzed using Pearson correlation, multiple regression, and t-tests, while qualitative data underwent thematic analysis.ResultsThe study uncovered a significant correlation between social media use and the variables under investigation. Moreover, the treatment involving mindfulness-based mobile apps led to a reduction in students' anxiety and an enhancement of their well-being. Notably, participants held various positive perceptions regarding the use of these apps.ImplicationsThe findings of this research hold both theoretical and practical significance for the field of digital psychology. They provide insight into the potential of mindfulness-based mobile apps to positively impact university students' mental health and well-being. Additionally, the study underscores the need for further exploration of the intricate dynamics between technology and psychology in an increasingly digital world.

A Computational Study of the Influence of Drag Models and Heat Transfer Correlations on the Simulations of Reactive Polydisperse Flows in Bubbling Fluidized Beds

In this work, the influence of gas–solid drag and heat transfer coefficient models on the prediction capacity of the Euler–Euler approach to simulate reactive bubbling fluidized bed flows is studied. Three different cases are considered, a non-reactive bidisperse bubbling fluidized bed flow (Case 1), and two reactive polydisperse flows in bubbling fluidized beds, one for biomass gasification (Case 2), and the other for biomass pyrolysis (Case 3). The Gidaspow, Syamlal–O’Brien, and BVK gas–solid drag models and the Gunn, Ranz–Marshall, and Li–Mason gas–solid heat transfer correlations are investigated. A Eulerian multiphase approach in a two-dimensional Cartesian domain is employed for the simulations. Computational results for the three cases are compared with experimental data from the literature. The results obtained here contribute to a better understanding of the impacts of such closure models on the prediction ability of the Euler–Euler approach to simulate reactive flows. The results indicate that, for the simulation of reactive flows in bubbling fluidized bed reactors, the kinetic modeling of the reactions has a global effect, which superposes with the influence of the drag and heat transfer coefficient models. Nevertheless, local parameters can be noticeably affected by the choice of the interface closure models. Finally, this work also identifies the models that lead to the best results for the cases analyzed here, and thus proposes the use of such selected models for gasification and pyrolysis processes occurring in bubbling fluidized bed reactors.

Building Complex Autologous Breast Reconstruction Program: A Preliminary Experience

Autologous breast reconstruction is an increasingly popular method of reconstruction for breast cancer survivors. While deep inferior epigastric perforator (DIEP) flaps are the gold standard, not all patients are ideal candidates for DIEP flaps due to low BMI, body habitus, or previous abdominal surgery. In these patients, complex autologous breast reconstruction can be performed, but there is a limited number of programs around the world due to high technical demand. Given the increased demand and need for complex autologous flaps, it is critical to build programs to increase patient access and teach future microsurgeons. In this paper, we discuss the steps, pearls, and preliminary experience of building a complex autologous breast reconstruction program in a tertiary academic center. We performed a retrospective chart review of patients who underwent starting the year prior to the creation of our program. Since the start of our program, a total of 74 breast mounds have been reconstructed in 46 patients using 87 flaps. Over 23 months, there was a decrease in median surgical time for bilateral reconstruction by 124 min (p = 0.03), an increase in the number of co-surgeon cases by 66% (p < 0.01), and an increase in the number of complex autologous breast reconstruction by 42% (p < 0.01). Our study shows that a complex autologous breast reconstruction program can be successfully established using a multi-phase approach, including the development of a robust co-surgeon model. In addition, we found that a dedicated program leads to increased patient access, decreased operative time, and enhancement of trainee education.

CFD simulation of geometrical parameters effects on the hydrodynamic characteristics and CO2 absorption efficiency of Arc-RPB

The Computational Fluid Dynamics (CFD) technique was used to study the effect of the geometrical parameters on the intensification of hydrodynamic parameters and Carbon dioxide (CO2) absorption efficiency by Mono-Ethanol-Amine (MEA) solution in a novel Arc-blade Rotating Packed Bed reactor (Arc-RPB). The VOF multiphase approach and RNGk-ε turbulent model were used to study the multiphase and turbulent behavior of the flow field in the computational domain, respectively. The effects of liquid flow rate, the bed wire mesh diameter, and number of the mesh layers were studied on the liquid holdup (αL), gas-liquid interfacial area (Aint) and liquid dispersion index (Id). Considering the Arc-RPB bed wire mesh diameter from 0.2 mm to 1.6 mm showed that αL, Aint and Id decrease 20%, 29% and 11%, respectively. By examining the effect of the bed layers enhancement, the liquid holdup αL decreased by about 36% but, Aint and Id reached a maximum value at 16 bed layers. Finally, with study the effect of the bed geometrical parameters on CO2 absorption efficiency, results showed the efficiency reduces about 7.5% with increase in the bed mesh diameter and shows a maximum at 16 bed layers.

Smartphone Apps Targeting Youth Tobacco Use Prevention and Cessation: An Assessment of Credibility and Quality.

The goals of this study were to identify smartphone apps targeting youth tobacco use prevention and/or cessation discussed in the academic literature and/or available in the Apple App Store and to review and rate the credibility of the apps. We took a multiphase approach in a non-systematic review that involved conducting parallel literature and App Store searches, screening the returned literature and apps for inclusion, characterizing the studies and apps, and evaluating app quality using a standardized rating scale. The negative consequences of youth tobacco use initiation are profound and far-reaching. Half of the youth who use nicotine want to quit, but quit rates are low. The integration of smartphone apps shows promise in complementing and enhancing evidence-based youth tobacco prevention and treatment methods. Consistent with prior reviews, we identified a disconnect between apps that are readily accessible and those that have an evidence base, and many popular apps received low quality scores. Findings suggest a need for better integration between evidence-based and popular, available apps targeting youth tobacco use.