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Elevation in White Blood Cell Count After Corticosteroid Use in Noninfected Hospitalized Patients
No full textBackground: It is widely accepted that corticosteroids cause leukocytosis. Clinicians must decide whether a rise in white blood cell (WBC) count is due to steroids versus other processes like developing infection. Objective: The objective of this study is to measure the increase in white blood cell count after corticosteroid administration in hospitalized patients without malignancy, infection, or immune dysfunction. Methods: This is a retrospective cohort study from 2017 to 2018 in a single large healthcare system. We analyzed the trajectory of WBC count stratified by steroid dose. The study included nonsurgical patients admitted with at least two complete blood count measurements. Patients were excluded if they had immunosuppression, infection, malignancy, or steroid use within 2 weeks before admission. The main outcome was mean WBC count by day following corticosteroid administration. Results: Our sample included 28,425 patients with at least two WBC measurements, 1608 (5.7%) of which received steroids. WBC response peaked at 48 h after steroid administration with a mean increase of 2.4 × 10⁹/L WBCs. In all patients on steroids, across doses, the mean increase was 0.3 × 10⁹/L WBCs, 1.7 × 10⁹/L WBCs, and 4.84 × 10⁹/L WBCs in low, medium, and high dose groups, respectively. For patients not on steroids, the mean WBC count decreased during hospitalization. Conclusions: When interpreting WBC counts after initiating steroids, increases of up to 4.84 × 10⁹/L cells may be seen within 48 h after high-dose steroids. Larger increases, and any increase after low-dose steroids, suggest other causes of leukocytosis
Development of a Self-Management Tool for Individuals with Seizure Clusters: Trial Design and Methodological Report
No full textBackground: Despite advances in anti-seizure medications (ASMs) for people with epilepsy (PWE), adverse outcomes, negative health events (NHEs), and breakthrough seizures remain common. Rescue medication (RM) can better manage repetitive seizures, but barriers to RM use persist. Self-management for PWE and a history of NHEs (SMART) is an evidence-based epilepsy self-management program aimed at reducing barriers and maximizing facilitators to self-care in high-risk PWE. Methods: This 2-phase, ongoing clinical trial adapts SMART to integrate RM support for PWE with repetitive seizures. Phase 1, now completed, used input from an advisory board (AB) of PWE, caregivers, and clinicians to adapt the SMART curriculum to include diazepam nasal spray, an RM. Phase 2 will test the adapted curriculum (SMART-RM) in a 6-month prospective trial among adult PWE, measuring seizure counts from baseline to 6-month follow-up. Secondary outcomes include changes in quality of life, NHEs, functional status, and depression severity. Results: The AB for Phase 1 enrolled 6 individuals: 2 PWE, 2 caregivers, and 2 clinicians. Participants endorsed the need for evidence-based epilepsy self-management curricula that include RM support and positively reviewed the SMART curriculum\u27s format and duration. Additional content requests included: 1) A seizure action plan with RM, 2) RM education for caregivers, 3) Customized care plans for PWE to support caregivers, 4) An RM-specific goal template, and 5) A template for RM-related discussion topics with care providers. Conclusions: Integrating RM into an evidence-based epilepsy self-management curriculum offers a comprehensive care package with potential to improve care for PWE with seizure clusters
Centering Justice: The role of women\u27s centers in advancing reproductive justice and gender equity
Full text linkAn overview of how women\u27s and gender equity centers play a role in doing reproductive justice work.https://commons.case.edu/mathercenter-briefs/1009/thumbnail.jp
Improving Employee Turnover Intention: Outsourced Human Resources vs. In-house Human Resources
Full text linkSmall business research has neglected comparing employees’ perceptions on variables related to in-house human resources (HRI) vs. outsourced human resources (HRO) in small businesses. We used a mixed methods research design to study this issue. The first study consisted of 11 in-depth interviews. The qualitative insights we gained helped to guide survey construction for the second quantitative survey-based study. For the survey, 101 HRI U.S. employees and 97 HRO U.S. employees filled out a survey. Results from the HRI and HRO samples were equivalent in terms of participants’ years of work experience, work schedule, gender, company size, company age, perceived timely HR response to a concern/issue, average HR response time, and turnover intention. However, the HRO sample had higher perceived employee engagement and organizational culture (OC). Subsequent hierarchical regression analyses comparing the two samples showed that although OC was a common correlate for explaining the outcome of turnover intention in both samples, employee engagement, timely HR response, and average HR response time were significant correlates of turnover intention only for the HRI sample
The Democratization of Coaching and Development Through Peer Coaching in Groups
Full text linkPeople want and need development at work and in life. The cost of typical development activities limits access to those in powerful or higher status positions. In addition, the efficacy of training programs in organizations and higher education as developmental activities have shown relatively poor results in terms of sustained, desired change. The effects of coaching seem more promising, but it is highly labor intensive and therefore costly. Peer coaching in groups (PCGs) offers a potentially efficacious developmental activity at no or very low cost to organizations or individuals. PCGs can be used throughout the world and invite participation regardless of occupational status, even to those without jobs or literacy. PCGs can be a democratizing force for development. The needs for future research and possible applications are examined
Breaking New Ground: Division Directly in Memory
Full text linkIn-memory computing (IMC) has emerged as a promising paradigm for overcoming the limitations of traditional von Neumann architectures by reducing data movement and enhancing computational efficiency. Despite significant advancements in this area, implementing complex arithmetic operations, such as division, directly within memory has remained an elusive challenge. This paper introduces a pioneering technique for performing division operations directly in memory, representing the first successful integration of such functionality into the IMC framework. Our approach leverages an innovative circuit based on an unconventional model of computing–stochastic computing (SC). Our technique extends the computational capabilities of IMC systems and paves the way for lightweight division operations
A Tolerated Terror: Rahmah bin Jabir and the Age of Revolutions in the Gulf, 1760-1830
No full textRahmah bin Jabir (c. 1760-1826) is one of the most frequently mentioned persons in British sources from the Gulf in the first decades of the nineteenth century. He is also found throughout important Arabic-language chronicles. Despite his prominence in the sources, however, scholars have paid him relatively little attention, in either English or in Arabic. Though often cast as a pirate, this article argues that Rahmah bin Jabir was a political entrepreneur critical to shaping the international order of the Gulf in the first half of the nineteenth century. Reading against the grain of the colonial archive and synthesizing British sources with Arab chronicles, this article brings to life a textured political imaginary of the Gulf in the global age of revolutions, using Rahmah to weave overlapping political agendas between different emerging states, including the Omanis, the Saudi-Wahhabis, the Bahrainis, the Qataris, and the British. I suggest that Rahmah stands as one figure through whom historians can continue piecing together an age of revolutions in the Gulf that is more than Europe’s emergence into modernity, one that highlights a complex and vibrant history of negotiation, endurance, and resiliency
Preoperative Hypoalbuminemia Predicts 30-day Complications in Head and Neck Microvascular Surgery
No full textIntroduction: Hypoalbuminemia, a marker for poor nutritional status, has been associated with postoperative complications, including head and neck cancer surgery. This study investigates the impact of hypoalbuminemia on head and neck microvascular free tissue transfer reconstruction. Methods: This retrospective cohort study queried the 2005–2021 American College of Surgeons National Surgical Quality Improvement Program databases. Reconstructive cases performed by otolaryngologists (CPT: 15756, 15757, 15758, 15842, 20955, 20956, 20957, 20962, 20969, 20970, 20972, 20973, 43116, 43496, 49006, and 49906) with available preoperative albumin, BMI, and age were included. Hypoalbuminemia was defined as a preoperative albumin \u3c 3.5 g/dL. Univariate and multivariable logistic regression were performed. Results: A total of 3,886 cases met the inclusion criteria, of which 835 (21.5%) had hypoalbuminemia. The hypoalbuminemia cohort was older, had lower BMI, had higher ASA classification, and had worse functional health status. Adjusted multivariable logistic regression showed that hypoalbuminemia was associated with unplanned return to the operating room within 30 days (OR: 1.36, p \u3c 0.01), unplanned reoperation (OR: 1.36, p \u3c 0.01), any complication (OR: 1.77, p \u3c 0.01), surgical complications (OR: 1.94, p \u3c 0.01), and medical complications (OR: 1.34, p = 0.01). Hypoalbuminemia was correlated with a longer hospital stay, superficial surgical site infection, wound dehiscence, transfusion, deep vein thrombosis, and acute renal failure. Conclusion: Hypoalbuminemia is a risk factor for postoperative complications after microvascular free tissue transfer for head and neck reconstruction. This study suggests that preoperative optimization of hypoalbuminemia may be beneficial for these patients. Level of Evidence: 3 Laryngoscope, 135:648–656, 2025
Role of Fluid-Structure Interactions in Mechanosensation During Hovering Flapping Flight
No full textInsect wings, known for their intricate structure and function, inherently deform during flapping motion. These deformations can be classified into chordwise cambering, spanwise bending, and root-to-tip twisting, arising from non-uniform venation distribution, aerodynamic loading, and wing inertia. Crucially, such deformations play a vital role in enhancing both aerodynamic performance and mechanosensory function. To investigate the complex interplay between wing structure, unsteady aerodynamics, and mechanosensation, we developed a fully coupled three-dimensional fluid-structure interaction (FSI) solver. This framework integrates an in-house Navier-Stokes equations solver for resolving the flow field with the open-source Vega FEM code to solve the solid structure dynamics. Our FSI simulations reveal that venation structures significantly enhance aerodynamic efficiency by enabling complex deformation patterns. Wings with moderate stiffness (reduced stiffness K = 3.94) values strike an optimal balance between lift generation and energy efficiency, outperforming both rigid and excessively flexible configurations (6 % higher lift generation and 89 % higher power efficiency, compared to rigid wings). In contrast with uniform wings, at K = 3.94, wings with venation structure generate 8 % less lift but the power efficiency is 25 % higher. Additionally, the time history of strain energy density closely mirrors the trend of aerodynamic forces, suggesting that local strain energy sensed by embedded mechanosensors could potentially predict aerodynamic forces. This finding highlights a direct functional link between unsteady aerodynamics and sensory feedback in insect wings. These results underscore the critical roles of wing stiffness, venation structures, and unsteady aerodynamics in shaping both the aerodynamic and sensory performance of insect-inspired wings. By elucidating how insects derive aerodynamic and sensory benefits from wing flexibility, this study provides valuable insights into insect flight mechanisms and offers inspiration for the design of efficient and adaptive flapping-wing Micro Air Vehicles
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