Jones International University

Delayed cerebral ischemia remains one of the principal therapeutic targets after aneurysmal subarachnoid hemorrhage. While large vessel vasospasm may contribute to ischemia, increasing evidence suggests that physiological impairment through disrupted impaired cerebral autoregulation (CA) and spreading depolarizations (SDs) also contribute to delayed cerebral ischemia and poor neurological outcome. This study seeks to explore the intermeasure correlation of different measures of CA, as well as correlation with SD and neurological outcome. Simultaneous measurement of 7 continuous indices of CA was calculated in 19 subjects entered in a prospective study of SD in aneurysmal subarachnoid hemorrhage undergoing surgical aneurysm clipping. Intermeasure agreement was assessed, and the association of each index with modified Rankin Scale score at 90 days and occurrence of SD was assessed. There were 4102 hours of total monitoring time across the 19 subjects. In time-resolved assessment, no CA measures demonstrated significant correlation; however, most demonstrate significant correlation averaged over 1 hour. Pressure reactivity (PRx), oxygen reactivity, and oxygen saturation reactivity were significantly correlated with modified Rankin Scale score at 90 days. PRx and oxygen reactivity also were correlated with the occurrence of SD events. Across multiple CA measure reactivity indices, a threshold between 0.3 and 0.5 was most associated with intervals containing SD. Different continuous CA indices do not correlate well with each other on a highly time-resolved basis, so should not be viewed as interchangeable. PRx and oxygen reactivity are the most reliable indices in identifying risk of worse outcome in patients with aneurysmal subarachnoid hemorrhage undergoing surgical treatment. SD occurrence is correlated with impaired CA across multiple CA measurement techniques and may represent the pathological mechanism of delayed cerebral ischemia in patients with impaired CA. Optimization of CA in patients with aneurysmal subarachnoid hemorrhage may lead to decreased incidence of SD and improved neurological outcomes. Future studies are needed to evaluate these hypotheses and approaches.

A goal of the Precision Medicine Initiative All of Us Research Program (AoURP) is recruitment of participants who reflect the diversity of the US. Recruitment from among blood bank donors, which may better reflect the demographic makeup of local communities, is one proposed strategy. We evaluated this strategy by analyzing the results of a survey of San Diego Blood Bank donors conducted in November2015. Whites were more likely than nonwhites to respond to the survey (7.1percent versus 3.9percent). However, race was not a significant predictor of interest in participating in precision medicine research. Using census data linked to donors' ZIP codes, we also found that people who indicated interest in research participation were more likely to come from regions with higher educational attainment. Although blood banks represent a viable recruitment strategy for AoURP, our findings indicate that bias toward inclusion of whites and more highly educated people persists.

With her first baby, while breastfeeding at 2 weeks postpartum, the skin on Amanda’s (not her real name) face, trunk, and back became marred with subcutaneous cysts. She described the cysts as quarter-sized blisters that would weep yellow fluid and then scab over. She consulted her obstetrician, dermatologist, and acupuncturist, but none were able to find a treatment solution. I met her 2 days after the birth of her second baby. She was worried her skin eruptions would happen again. After discharge from the hospital, we communicated via email. Her skin did develop cysts, although not as severe as with her first baby. Although advised to see an endocrinologist, she declined. She weaned her baby well before her breastfeeding goal was reached.

In preparing students for employment in commerce, the student needs to be aware of many aspects not necessarily included in business programs. In recognizing students often have no or limited exposure to foreign environments, the authors developed an electronic exchange between students in Canada and Kazakhstan. In this exchange, students not only learned about foreign marketplaces but were able to integrate classroom teachings and text knowledge into their actions. This approach resulted in enhanced learning for students through double-loop processes and development in their other courses.

Results of a preliminary feasibility study on a new concept for a highly compact space reactor power systems are presented. Notwithstanding the preliminary nature of the present study, the results which include a new space reactor configuration and its associated technologies indicate promising avenues for the devleopment of highly compact space reactors. The calculations reported in this study include a neutronic design trade‐off study using a two‐dimensioinal neutron transport model, as well as a simplified one‐dimensional thermal analysis of the reactor core. In arriving at the most desirable configuration, various options have been considered and analyzed, and their advantages/disadvantages have been compared. However, because of space limitation, only the most favorable reactor configuration is presented in this summary.Ongoing studies on potential future space missions indicates that extremely compact nuclear reactor systems with low specific mass will be required to provide power in the tens to hundreds of kWe range. Therefore, it is the intent of this study to examine all available technologies that could potentially result in highly compact space reactor configurations in the desired power range.