cssi/SciSciGPT-SciSciNet huggingface dataset:
Less is more in the difficult gallbladder: recent evolution of subtotal cholecystectomy in a single HPB unit

Subtotal cholecystectomy (SC) is a technique to manage the difficult gallbladder and avoid hazardous dissection and biliary injury. Until recently it was used infrequently. However, because of reduced exposure to open total cholecystectomy in resident training, we recently adopted subtotal cholecystectomy as the bail-out procedure of choice for resident teaching. This study reports our experience and outcomes with subtotal cholecystectomy in the years immediately preceding adoption and since adoption. A retrospective analysis was conducted of patients undergoing SC from July 2010 to June 2019. Outcomes, including bile leak, reoperation and need for additional procedures, were analyzed. Complications were graded by the Modified Accordion Grading Scale (MAGS). 1571 cholecystectomies were performed of which 71 were SC. Subtotal cholecystectomy patients had several indicators of difficulty including prior attempted cholecystectomy and previous cholecystostomy tube insertion. The most common indication for SC was marked inflammation in the hepatocystic triangle (51%). As our experience increased, fewer patients required open conversion to accomplish SC and SC was completed laparoscopically, usually subtotal fenestrating cholecystectomy (SFC). Most patients (85%) had a drain placed and 28% were discharged with a drain. The highest MAGS complication observed was grade 3 (11 patients, 15%). Six patients had a bile leak from the cystic duct resolved by ERCP. At mean follow-up of about 1 year no patient returned with recurrent symptoms. Subtotal fenestrating cholecystectomy is a useful technique to avoid biliary injury in the difficult gallbladder and can be performed with very satisfactory rates of bile fistula, ERCP, and reoperation.
Measurements of the Ka Band opacity of sulfuric acid vapor with application towards radio occultations of Venus

Abstract Radio occultation experiments are capable of providing insight into the properties of the Venus atmosphere at the boundary between the upper and lower atmosphere. To retrieve vertical profiles of atmospheric gases from Venus radio occultation experiments, accurate models for the absorption of these gases are necessary. New laboratory measurements have been made of the microwave opacity of H2SO4 vapor at Ka Band (30–45 GHz, 6.5–10 mm) in mixtures containing up to 3 bars of CO2 at temperatures ranging from 550 to 585 K, simulating the conditions of the lower atmosphere of Venus. The results of these measurements and prior microwave and millimeter-wavelength laboratory studies have been used to derive a model for H2SO4 vapor opacity valid from 1 to 150 GHz. This model is incorporated into a microwave radiative transfer model of the Venus atmosphere, which has been used to predict the penetration depth of a radio occultation signal at 32 GHz and determine the contributions of atmospheric gases to 32 GHz opacity. These results can be used to interpret signal attenuation profiles for future Ka Band radio occultations of Venus.
Concurrent Velocimetry and Flash X-ray Characterization of Impact and Penetration in an Armor Ceramic☆

We present a methodology for concurrent Photon Doppler Velocimetry (PDV) and in-situ flash X-ray imaging during ballistic impact of metallic penetrators into monolithic armor grade ceramic targets. Tungsten heavy alloy long rod penetrators were launched from a smooth bore cannon into silicon carbide targets at velocities of 0.753 and 1.403 mm/μs. Penetrator lengths and penetration depths were measured as a function of time using an array of four 450 kV flash X-ray sources and digital film. A four channel PDV system coupled to a 16 GHz oscilloscope was used to measure the velocity history of the penetrator and at three positions on the back surface of the target. This experimental technique shows great promise for measurements of the dwell time, penetration velocity, and the time of final break-out from the back of the target.
Improved Superheat Control of Variable-Speed Vapor Compression Systems in Provision of Fast Load Balancing Services

Abstract Utilization of renewable energy resources, such as solar and wind, has seen rapid growth on the power grid worldwide. To mitigate the adverse impact of these volatile generation on the reliability of the power grid, fast balancing services are increasingly procured by system operators from various resources, such as flexible air-conditioning and space heating loads. Recent work of the authors has demonstrated technical feasibility and various benefits of using variable-speed vapor compression equipment for two fast load balancing services, namely frequency regulation and solar photovoltaic power smoothing. A major control issue was also identified in prior experimental tests: the drastic changes of the compressor speed for fast load balancing have caused severe superheat regulation issues including oscillations and even wet compression. To this end, a gain-scheduled feedforward and proportional integral (PI) controller is proposed and presented in this paper, which uses the real-time compressor speed in determining compensating control actuation of the expansion valve to mitigate the disturbance effect. Both simulation and experimental validations of the proposed control strategy were carried out with a 3-ton variable-speed heat pump. Test results have shown that the proposed controller is effective in improving the superheat regulation performance for three load balancing scenarios, i.e., compressor speed step changes, frequency regulation and photovoltaic smoothing. The demonstrated performance gains include fast post-disturbance recovery of the superheat with the settling time shortened by 63% to 83%, complete avoidance of wet compression and enhanced transient energy efficiency.
Duality in Analytic Number Theory

In this stimulating book, aimed at researchers both established and budding, Peter Elliott demonstrates a method and a motivating philosophy that combine to cohere a large part of analytic number theory, including the hitherto nebulous study of arithmetic functions. Besides its application, the book also illustrates a way of thinking mathematically: historical background is woven into the narrative, variant proofs illustrate obstructions, false steps and the development of insight, in a manner reminiscent of Euler. It is shown how to formulate theorems as well as how to construct their proofs. Elementary notions from functional analysis, Fourier analysis, functional equations and stability in mechanics are controlled by a geometric view and synthesized to provide an arithmetical analogue of classical harmonic analysis that is powerful enough to establish arithmetic propositions until now beyond reach. Connections with other branches of analysis are illustrated by over 250 exercises, structured in chains about individual topics.
Osteoprotegerin (OPG) gene therapy in animal models of osteoarticular disease

The soluble decoy receptor osteoprotegerin (OPG) regulates bone resorption by inhibiting osteoclast formation, function and survival. We investigated OPG gene therapy as a means of ameliorating chronic osteoarticular disease using a mouse ovariectomy (OVX) model of estrogen deficiency-induced osteoporosis (Mol Ther 2001, 3:1–9). Young adult female mice injected once with an adenoviral (Ad) vector carrying a human fusion protein combining the OPG ligand-binding and immunoglobulin constant domains (hOPG-Fc) developed serum OPG levels that exceeded the threshold needed for efficacy (as assessed by a marked increase in bone density) for over 12 months. The extent of OPG production and skeletal enhancement was titer-dependent. Mice subjected to OVX or sham surgery and then treated with Ad-hOPG-Fc had significantly more bone volume and fewer osteoclasts in axial and appendicular bones after 4 weeks. In contrast, animals given OVX and either a control vector expressing β-galactosidase or vehicle had significantly less bone than did comparably treated, sham-operated mice. This study confirms that a single Ad gene transfer can produce persistent high-level OPG expression and shows that OPG gene therapy may prove useful in treating osteoporosis. We anticipate that OPG gene therapy will offer similar promise as a bone-sparing agent in chronic arthritis since we have shown previously that injected OPG significantly inhibits skeletal erosion in the Lewis rat model of mycobacterial-induced adjuvant arthritis (Nature 1999, 402:304–309).
Personalizing Behavioral Interventions Through Single‐Patient (N‐of‐1) Trials

Behavioral interventions are typically studied with the use of a conventional between-subject randomized controlled trial (RCT) design. In this design, the effect of an intervention on one group of patients is compared with the effect of a control condition on another group of patients, such that a between-subject change is tested. A between-subject design has an underlying assumption that there is a homogenous treatment effect for a behavioral intervention, drug or psychotherapy, and that the way the intervention operates in the study that will tend to operate in the same way in many other patients. We review some of the philosophical and practical problems with the use of this design when a clinician is attempting to decide on a course of behavioral treatment aimed at within-subject change in patients who are likely to have heterogeneous or unique responses to behavioral treatment. We also review the biases inherent in our current clinical practice model, which does not use any empirical data collection or design for testing if a treatment is useful, and also in the conventional between-subject personalized medicine RCT designs. We propose increased use of single-patient (also known as N-of-1) trials that employ within-subject designs, in cases where treatment response is heterogeneous-as is the case for most psychological and behavioral treatments. Limitations of such designs include that they can only be used when the treatment is potentially reversible, the patient can act as their own control, and the outcome can be measured repeatedly. Increased use of within-subject trials may address in many more instances the more clinically relevant question of how a specific patient will respond to a specific treatment, and could introduce a more harmonious scientific approach into the way we treat our patients. We have incorporated a case presentation that illustrates the complexities of applying evidence drawn from these different designs to selecting and evaluating treatments for the behavioral issues commonly faced by clinicians and patients.
Recent developments of human‐computer interfaces

Proposes ways to improve human‐computer interaction by presenting system information to users in ways which conform to their own learning models. First, describes problems of novice users and makes recommendations for addressing their difficulties, then relates types of computer presentation media to users′ learning styles. Concludes that some problems encountered by novice users can be overcome by presenting information in ways that users easily understand.
How Spiritual Are Social Workers? An Exploration of Social Work Practitioners' Personal Spiritual Beliefs, Attitudes, and Practices

Utilizing a national random sample of 225 members of the National Association of Social Workers (NASW), this study examined practitioners' personal spiritual beliefs, their attitudes regarding the role of religion and spirituality in social work, and factors that might predict practitioners' use of religious and spiritual interventions. Findings suggest religion and spirituality plays an important role in respondents' personal and professional lives. A multiple regression analysis indicates that older respondents, with a stronger positive attitude regarding the role of religion and spirituality in social work practice were more likely to utilize spiritual practices or interventions.
Length of second stage of labor and preterm birth in a subsequent pregnancy.

Background During the second stage of labor, it is plausible that the pressure of the fetal head against a completely dilated cervix may lead to changes in the cervical integrity and cervical strength lending it susceptible to premature dilation in a subsequent pregnancy. Therefore, a prolonged second stage of labor has been hypothesized to be a risk factor for cervical insufficiency and spontaneous preterm birth (sPTB). Objective We sought to evaluate the effect that the length of second stage of labor in one pregnancy has on the risk of sPTB in a subsequent pregnancy. Study Design This was a planned secondary analysis of a large retrospective cohort study of women with 2 consecutive deliveries at our institution from 2005 through 2010. Women with a term pregnancy that reached the second stage were included; women with a prior sPTB were excluded. The primary outcome was sPTB Results In all, 757 women were included. The overall length of the second stage ranged from 0-7.3 hours. The sPTB rate in a subsequent pregnancy was 8.7%. There was no association between length of second stage (hours) as a continuous variable and sPTB after adjusting for confounders (adjusted odds ratio, 0.83; [95% CI 0.58-1.20]). A prolonged second stage ≥3 hours occurred in 48 (6.3%) women. Women with a second stage ≥3 hours were older, less likely to be African American, and were less likely to be overweight or obese as compared to women with a second stage P = .5. The sPTB risk was, however, modified by mode of delivery in the second stage. There was no difference in sPTB rate among women with a vaginal delivery when comparing those with and without a prolonged second stage (7.4 vs 7.8%, P = .9). There also was no difference among women with a cesarean when comparing those with and without a prolonged second stage (11.8 vs 14.3%, P = .8). While not statistically significant, the absolute risk of a subsequent sPTB after a cesarean delivery with a second stage ≥3 hours is twice as high as the risk of a sPTB after a vaginal delivery with a second stage ≥3 hours (adjusted odds ratio, 2.08; [0.32-13.78]). Conclusion A prolonged second stage of labor alone does not increase the risk of sPTB in a subsequent pregnancy. Cesarean delivery after a prolonged second stage of labor may confer a possible increased risk. It is important to continue to evaluate potential risk factors for sPTB. If these risk factors are confirmed in future studies, it will aid in the counseling of women and may open the door for therapeutic strategies to be studied among these newly identified at-risk women.
Biochemical mutants of bacterial viruses.

We wish to report some observations on the mutability of phage T4 with respect to cofactor requirements, and on certain features throwing additional light on the mechanism of cofactor action.
Patient-centered physical activity coaching in COPD (Walk On!): A study protocol for a pragmatic randomized controlled trial

Abstract Background Physical inactivity is significantly associated with more frequent hospitalizations and increased mortality in COPD even after adjusting for disease severity. While practice guidelines recommend regular physical activity for all patients with COPD, health systems are challenged in operationalizing an effective and sustainable approach to assist patients in being physically active. Methods A pragmatic randomized controlled trial design was used to determine the effectiveness of a 12-month home and community-based physical activity coaching intervention (Walk On!) compared to standard care for 1650 patients at high risk for COPD exacerbations from a large integrated health care system. Eligible patients with a COPD-related hospitalization, emergency department visit, or observational stay in the previous 12 months were automatically identified from the electronic medical records (EMR) system and randomized to treatment arms. The Walk On! intervention included collaborative monitoring of step counts, semi-automated step goal recommendations, individualized reinforcement from a physical activity coach, and peer/family support. Results The primary composite outcome included all-cause hospitalizations, emergency department visits, observational stays, and death in the 12 months following randomization. Secondary outcomes included COPD-related utilization, cardio-metabolic markers, physical activity, symptoms, and health-related quality of life. With the exception of patient reported outcomes, all utilization and clinical variables were automatically captured from the EMR. Conclusions If successful, findings from this multi-stakeholder driven trial of a generalizable and scalable physical activity intervention, carefully designed with sufficient flexibility, intensity, and support for a large ethnically diverse sample could re-define the standard of care to effectively address physical inactivity in COPD.
Performance on an Alzheimer-Selective Odor Identification Test in Patients with Parkinson’s Disease and Its Relationship with Cerebral Dopamine Transporter Activity

Abstract Background Previous studies have shown selective deficits of odor identification in both Parkinson's disease (PD) and Alzheimer's disease (AD). Brief, selective AD smell screening tests have been developed to identify subjects at risk of AD. The disease specificity of such screening tests has not been formally evaluated. Objective To evaluate the performance of an Alzheimer-selective odor identification test in patients with PD and its relationship with cerebral dopamine transporter (DAT) activity. Methods PD patients (n = 44; Hoehn and Yahr stages I–III; 13f/31 m; mean age 59.3 ± 10.1) and 44 controls matched for gender and age completed the University of Pennsylvania Smell Identification Test (UPSIT). All patients had PD duration > 1 year and none had evidence of dementia. Using the UPSIT, we calculated performance on the 10 odors previously reported to be selective for AD risk (UPSIT-AD10). A subset of 29 PD patients also underwent brain DAT [11C]β-CFT (2-β-carbomethoxy-3β-(4-fluorophenyl) tropane) PET imaging. DAT binding was assessed in the hippocampus, amygdala, ventral and dorsal striatum. Results UPSIT-AD10 scores were significantly lower in the patient (5.8 ± 2.1) compared to the control group (8.6 ± 2.4) (t = 5.8, P Conclusions Hyposmia in PD and AD overlap and supposed Alzheimer-selective smell screening tests may not be specific for AD. However, the supposed AD-selective hyposmia scores in PD did not correlate with cerebral DAT binding and may reflect a non-dopaminergic olfactory mechanism.
IL-1β induces an exaggerated pro- and anti-inflammatory response in peritoneal macrophages of children compared with adults

Children have a lower incidence of acute lung injury (ALI) compared with adults. Because ALI appears to be the end result of systemic hyperinflammation, children may either have 1) an attenuated pro-inflammatory response or 2) an augmented anti-inflammatory response compared with adults. The purpose of this study was to determine the IL-1-induced pro- and anti-inflammatory response of pediatric vs. adult peritoneal macrophages (PMs). We hypothesized that pediatric PMs would have an enhanced anti-inflammatory response compared with adult PMs. Human PMs were collected during elective laparoscopic procedures, cultured, and stimulated with IL-1β. IL-6, IL-8, IL-10, and TNFα production were determined by ELISA. Statistical analyses were by ANOVA; a P <0.05 was significant. Our results showed that IL-1β induced an 11-fold increase in IL-10 production in pediatric PMs (659±103 vs. 60±25 control, P <0.05). There was no IL-10 production in IL-1β-stimulated adult PMs. IL-1β-induced TNF production was greater in children compared with adults (2152±166 vs. 592±188, P <0.05). Similarly, IL-1β-induced IL-6 production was greater in pediatric PMs compared with adults (532±3 vs. 444±52, P <0.05). There was no difference in IL-1β-induced IL-8 production in children compared with adults. The IL-10:TNFα ratio after IL-1β stimulation was 0.306±0.056 in pediatric macrophages and 0.020±0.015 in adult macrophages ( P <0.01). In conclusion, IL-1β-induced IL-6 and TNFα production were greater in pediatric than adult PMs. Furthermore, pediatric PMs had an 11-fold increase in IL-1β-induced IL-10 production, while adult PMs did not produce IL-10. Therefore, IL-1β induces both a pro- and an anti-inflammatory response in pediatric PMs, whereas adult PMs produce only pro-inflammatory cytokines in response to IL-1β. The exaggerated anti-inflammatory IL-10 response in children may be an important factor in the observed differences in ALI between children and adults.
Parathyroidectomy in Maryland: effects of an endocrine center.

Background. Surgery for hyperparathyroidism is associated with high cure rates and low morbidity and mortality when performed by experienced surgeons. We wanted to determine whether referral of patients with hyperparathyroidism to an endocrine surgery center has an impact on patient outcomes and costs. Method. Data from 901 patients who underwent parathyroidectomy recorded in the Maryland inpatient discharge database between 1990 and 1994 at 52 hospitals were compared with 169 consecutive patients who underwent surgical exploration by one surgeon (R.U.) at the Johnts Hopkins Hospital. Results. Although in 47 of 52 hospitals fewer than 10 parathyroidectomies were performed each year, in these hospitals four of five related deaths occurred before patient discharge. The percentage of parathyroidectomies in Maryland performed by one endocrine surgeon has increased from 8% in 1990 to 21% in 1994 and is associated with a 97% cure rate and no mortality. Moreover, while hospital length of stay (LOS) in the state has decreased from 7 to 3.1 days, LOS for the high-volume provider has declined to a mean of 1.3 days. Conclusions. Patients with hyperparathyroidism are increasingly referred to an endocrine surgery center, which results in a high cure rate, low morbidity, no mortality, and a shorter LOS. Improved surgical outcomes and lower costs depend on an experienced surgeon and argue for the referral of these patients to endocrine surgery centers.
Spectral reflectance and emittance of particulate materials. 2: application and results.

Experimental data on the spectral emittance of particulate minerals, obtained using a Michelson interferometer operating between 300 cm−1 and 1400 cm−1 are compared with the results of a new theory of the spectral reflectance (emittance) of such materials. The comparisons show that the theory predicts the infrared spectra of minerals quite well both for single substances and mixtures, over the wide particle size range between 0.3 μ and 330 μ. The good agreement suggests that the theory can be used in the application of remote infrared spectroscopy to such problems as the compositional analysis of the surface of a planet.
Inhibitory control effects in adolescent binge eating and consumption of sugar-sweetened beverages and snacks

Inhibitory control and sensitivity to reward are relevant to the food choices individuals make frequently. An imbalance of these systems can lead to deficits in decision-making that are relevant to food ingestion. This study evaluated the relationship between dietary behaviors - binge eating and consumption of sweetened beverages and snacks - and behavioral control processes among 198 adolescents, ages 14 to 17. Neurocognitive control processes were assessed with the Iowa Gambling Task (IGT), a generic Go/No-Go task, and a food-specific Go/No-Go task. The food-specific version directly ties the task to food cues that trigger responses, addressing an integral link between cue-habit processes. Diet was assessed with self-administered food frequency and binge eating questionnaires. Latent variable models revealed marked gender differences. Inhibitory problems on the food-specific and generic Go/No-Go tasks were significantly correlated with binge eating only in females, whereas inhibitory problems measured with these tasks were the strongest correlates of sweet snack consumption in males. Higher BMI percentile and sedentary behavior also predicted binge eating in females and sweet snack consumption in males. Inhibitory problems on the generic Go/No-Go, poorer affective decision-making on the IGT, and sedentary behavior were associated with sweetened beverage consumption in males, but not females. The food-specific Go/No-Go was not predictive in models evaluating sweetened beverage consumption, providing some initial discriminant validity for the task, which consisted of sweet/fatty snacks as no-go signals and no sugar-sweetened beverage signals. This work extends research findings, revealing gender differences in inhibitory function relevant to behavioral control. Further, the findings contribute to research implicating the relevance of cues in habitual behaviors and their relationship to snack food consumption in an understudied population of diverse adolescents not receiving treatment for eating disorders.
Oculocutaneous Albinoidism as a Manifestation of Reduced Neural Crest Derivatives in the Prader-Willi Syndrome

Nine patients with Prader-Willi syndrome (five female and four male; one Oriental and eight white), all of whom had interstitial deletions of the proximal long arm of one chromosome 15 (q11-q13) were found to have decreased tyrosinase activity in isolated hair bulbs. As infants, all patients had light hair and skin coloring, both of which darkened with age. Light and electron microscopic analysis of skin and hair bulbs disclosed a reduced number of melanocytes in the basal epidermis and hair bulbs. Each patient demonstrated decreased pigmentation of the iris stroma, which was accentuated peripherally and manifested clinically as iris translucency. There was no foveal hypoplasia, nystagmus, or photophobia, and ocular function was normal. Oculocutaneous albinoidism is thus a component of del(15q) Prader-Willi syndrome with reduction of melanocytes of neural crest origin (skin, hair, and iris stroma) and retention of normal retinal and iris pigment epithelia of neuroectodermal origin.
Parental psychiatric illness associated with schizophrenia in the siblings of schizophrenics

Abstract The diagnostic boundaries of schizophrenia remain controversial. Although there may be little disagreement about classifying process schizophrenia as schizophrenia, the inclusion of good-prognosis schizophrenia, 1 borderline syndromes, or nonpsychotic conditions has engendered more debate. The issue regarding good-prognosis schizophrenia has been clarified by a number of studies 2–6 indicating that this group has clinical and family differences from process schizophrenia. Progress in classifying borderline syndromes and nonpsychotic conditions has not been as great. As we have previously stated, 7 the reasons seem to be difficulty in defining these disorders as well as a lack of data regarding their occurrence in the general population. Because of this impasse, we have looked for indirect ways of defining the boundaries of schizophrenia. One approach has been to compare positive family history schizophrenics with negative family history schizophrenics on the assumption that schizophrenics with a loaded family history for process schizophrenia should also have a loaded family history for other disorders that are related to schizophrenia. The frequency of other psychiatric disorders in these two groups were not significantly different; 8 thus failing to support the extension of the concept of schizophrenia to include such nonpsychotic conditions as neuroses or personality disorder. Because there is a positive association between schizophrenia in the siblings of schizophrenics and parental schizophrenia, 9 the present report makes the following assumption: If there are borderline or nonpsychotic psychiatric illnesses that are genetically related to schizophrenia, their occurrence in parents should be associated with schizophrenia in the siblings of schizophrenics. Conversely, if there are parental illnesses that are distinct from schizophrenia, they should be associated with other illnesses in the siblings because most mental disorders, regardless of their etiology, have been shown to run in families. 1
Tbx18 Targets Dermal Condensates for Labeling, Isolation, and Gene Ablation during Embryonic Hair Follicle Formation

How cell fate decisions of stem and progenitor cells are regulated by their microenvironment or niche is a central question in stem cell and regenerative biology. Although functional analysis of hair follicle epithelial stem cells by gene targeting is well established, the molecular and genetic characterization of the dermal counterpart during embryonic morphogenesis has been lacking because of the absence of cell type–specific drivers. Here, we report that T-box transcription factor Tbx18 specifically marks dermal papilla (DP) precursor cells during embryonic hair follicle morphogenesis. With Tbx18LacZ, Tbx18H2BGFP, and Tbx18Cre knock-in mouse models, we demonstrate LacZ and H2BGFP (nuclear green fluorescent protein) expression and Cre activity in dermal condensates of nascent first-wave hair follicles at E14.5. As Tbx18 expression becomes more widespread throughout the dermis at later developmental stages, we use tamoxifen-inducible Cre-expressing mice, Tbx18MerCreMer, to exclusively target DP precursor cells and their progeny. Finally, we ablate Tbx18 in full knockout mice, but find no perturbations in hair follicle formation, suggesting that Tbx18 is dispensable for normal DP function. In summary, our study establishes Tbx18 as a genetic driver to target for the first time embryonic DP precursors for labeling, isolation, and gene ablation that will greatly enhance investigations into their molecular functions during hair follicle morphogenesis.
Four-Part Fractures Require Replacement: Once Is Enough—Affirms

The optimal treatment of four-part proximal humerus fractures is yet undetermined. Although recent advances in locked plate technology have led to increased interest in humeral head preservation, results are inconsistent and complication rates remain high. Hemiarthroplasty is a durable option for the management of these fractures, especially in patients with underlying osteopenia. With proper adherence to key surgical principles, hemiarthroplasty can predictably restore function and produce satisfactory results in a high percentage of patients. Because the academic literature has reliably demonstrated pain relief and consistent functional results, humeral head replacement should be considered as a primary management strategy for four-part proximal humerus fractures.
Modern aerial gamma-ray spectrometry and regional potassium map of the conterminous United States

Abstract Aerial gamma-ray surveys of the natural environment measure the flux of gamma rays produced by the radioactive decay of 40K, 214Bi, and 208Tl in the upper 10–20 cm of surface materials. 40K is a radioactive potassium isotope which can be used to estimate the total amount of potassium in the soils and rocks. 214Bi is a decay product of the 238U radioactive decay series and is used to estimate the uranium concentrations, and 208Tl, a decay product of the 232Th radioactive decay series, is used to estimate thorium concentrations. Aerial gamma-ray data covering the 48 contiguous states of the United States have been compiled to produce maps showing the distributions of equivalent uranium, equivalent thorium, and potassium. This compilation involved processing the aerial survey data from about 470 1° × 2° quadrangle maps.
Tolerance of rat testis to graded periods of total circulatory isolation

Infertility because of testicular damage is a distressing problem for survivors of cancer chemotherapy. We have previously described a cytoprotective effect of temporary testicular circulatory isolation (TCI) during doxorubicin administration in the rat. In this report we define the relationship between duration of TCI and testicular ischemic injury, using paired groups of animals with normothermic TCI and hypothermic TCI. Sixty rats were used and received TCI for varying lengths of time up to 180 minutes, with or without hypothermia. On day 56 +/- 4, all rats were killed and necropsied. Testicular injury was evaluated qualitatively by histology and quantitatively by testicular weight, sperm head count, repopulation index, and epididymal index. Warm TCI for up to 60 minutes induced modest damage to germ cells, while injury was greater with cold TCI. Leydig cells and vascular tissues were essentially unaffected by TCI, although Sertoli cell abnormalities were noted in rats receiving a long duration of TCI.
Multiple Sclerosis Is an Inflammatory T-cell-mediated Autoimmune Disease

T HE ETIOLOGY AND pathogenesis of multiple sclerosis (MS) have been much debated during the past 50 years. It is now recognized that MS is a complex disease with different clinical and pathological phenotypes, perhaps reflecting different pathways to tissue injury. Thus, MS may not be a single disease entity. Nonetheless, with recent advances in immunology and magnetic resonance imaging and the demonstration that immunomodulatory treatment can have an ameliorating effect on the disease process, it is now clear that the core process in MS is inflammatory, with T cells and their mediators triggering injury of axons and their myelin sheaths through a complex sequence of events. The Tcell–mediated inflammation is driven by an autoimmune process, which in turn can trigger a degenerative phase that is immune independent. As described below, a large body of evidence suggests there is a Th1-type bias in MS (interferon [IFN] gamma, interleukin [IL]12, IL-18, and osteopontin) and that factors associated with Th2-type (IL-4 and IL-10) or Th3-type (transforming growth factor ) responses are beneficial in MS. Immune abnormalities in MS include activated T cells in the blood and cerebrospinal fluid, T-cell reactivity to myelin antigens, Th1-type inflammation in the brain (IL-12 and chemokine expression), local central nervous system (CNS) immune reaction (Ig-G), linkage of immune abnormalities to clinical course and magnetic resonance imaging, and major histocompatibility complex linkage.
Development of an Objective Structured Clinical Examination (OSCE) for Practicing Substance Abuse Intervention Competencies: An Application in Social Work Education

ABSTRACT The substance abuse skills OSCE (Objective Structured Clinical Examination) was developed by an interdisciplinary faculty team at New York University from 2001 to 2003. The aims of the project were to teach medical, nursing, and social work students screening and brief intervention skills, provide a practice opportunity and feedback to students on their ability to demonstrate substance abuse skills, and to expose students to interdisciplinary collaboration. After students were educated and participated in the OSCE, the mean score on their substance abuse knowledge questionnaires increased from 6.24 (SD = 1.522) at pretest to 8.06 (SD = 1.600) at post test (t (16) = −6.080, p <.002). According to the faculty observer performance checklists, students manifested the fifteen competencies on the checklist at an average rate of 79.0%. Students rated the overall experience of participating in the OSCE highly favorably, at 4.9 on a five-point scale. While the OSCE proved to be highly compatible with the ...
Pathogenesis of the complete androgen insensitivity syndrome (AIS) with normal dihydrotestosterone (DHT) receptor binding

This study was designed to find out if qualitative abnormalities of the DHT-receptor of patients with AIS and normal binding could account for their androgen resistance. DHT-receptors in sex skin fibroblasts from 2 unrelated patients were compared to the DHT-binding proteins from normal subjects. Bmax and Kd in AIS were at the upper limit for the normal range. Sucrose density gradients showed similar peaks of DHT-receptor complexes. Degradation and dissociation rates of DHT from the receptor suggested a more rapid inactivation and turn-over rate of the AIS receptor. In competition studies of 3H-DHT from receptors with unlabelled steroids, Ki in AIS was greater for DHT and smaller for progesterone. In conclusion, small but definite differences in characteristics of receptors from normals and AIS fibroblasts were observed. These differences suggest that the androgen resistance of these patients is related to a structural abnormality of the receptor which in turn results in an abnormal interaction of the DHT-receptor complex with its specific acceptor site on chromatin.
Postscript to “The background of Kummer's proof ...”

This article contains additional comments and further data related to my article “The Background of Kummer's Proof of Fermat's Last Theorem for Regular Primes” (this journal, vol. 14, pp. 219–236). The principal addition is the publication of the full text of the paper, referred to in Appendix II of “Background”, which Kummer submitted for publication, and then withdrew, in 1844.
Multidetector CT of the heart: spectrum of benign and malignant cardiac masses

Recent innovations in multidetector 3D CT have improved the spatial and temporal resolution of cardiac computed tomography (CT), which results in greater frequency of mass lesion identification and provides a new opportunity for more precise characterization. Although cardiac masses are rare entities, patients with cardiac masses may present with acute symptoms and may be encountered by emergency radiologists. The objectives of this article are to review the CT appearance of cardiac masses and the role of volumetric MDCT with 3D rendering to define characteristic features and provide a practical approach to formulating a differential diagnosis.
The isotopic signature of fallout plutonium in the North Pacific

Abstract Plutonium analyses of a dated coral record from the French Frigate Shoals in the central North Pacific indicate that there are two major sources of Pu in this basin: close-in (tropospheric) fallout from nuclear weapons testing at the Pacific Proving Grounds in the Marshall Islands in the 1950s and global (stratospheric) fallout which peaked in 1962. Furthermore, the 240 Pu 239 Pu atom ratio of fallout from the Pacific Proving Grounds is characteristically higher (0.24) than that of global fallout Pu (0.18–0.19). Seawater and sediment samples from the North Pacific exhibit a wide range of 240 Pu 239 Pu values (0.19–0.34), with a trend towards higher ratios in the subsurface waters and sediment. Deep water 240 Pu 239 Pu ratios are higher in the vicinity of the Marshall Islands relative to stations further from this close-in fallout source. These preliminary data suggest that fallout Pu from the Pacific Proving Grounds is more rapidly removed from the surface waters than is global fallout Pu. Plutonium geochemistry appears to be related to the physical/chemical form of Pu-bearing particles generated by different fallout sources.
Passiflora linda, a new species from southern Ecuador

A new species ofPassiflora subgenusTacsonia from the province of Zamora-Chinchipe, Ecuador, is described. The species is illustrated and its affinities to other species within the subgenus are discussed.
Postimmunization Clearance of Liposome Entrapped Adenovirus Type 5 Hexon

AbstractClearance rates of 125I-hexon administered in three different forms from injection sites were assessed in animals. Aqueous and liposome-entrapped hexons following parental administration were cleared in linear fashion with half-lives that ranged from 1.5 to 4 and 30 to 45 hr, respectively. In contrast, hexons emulsified in complete Freund's adjuvant were cleared in a biphasic manner and tended to remain localized with 23 to 55% persisting after 16 days. No significant antigen accumulation in blood or any internal organs was detected following the three modes of immunization. These data suggest that formation of a transient antigen “depot” at injection sites may contribute to the adjuvant effect of liposomes but the complete resolution of this “depot” may avoid significant local reactogenicity.
Non-Monotonic Radio-Sensitivity over Tumor Volumes on Adjuvant Radio Therapy A New Insight on Cell Killing and Modeling

Adjuvant Radiotherapy (RT) after surgical removal of tumors proved beneficial in long-term tumor control and treatment planning. For many years, it has been well concluded that radio-sensitivities of tumors upon radiotherapy decrease according to the sizes of tumors and RT models based on Poisson statistics have been used extensively to validate clinical data. We found that Poisson statistics on RT is actually derived from bacterial cells despite of many validations from clinical data. However cancerous cells do have abnormal cellular communications and use chemical messengers to signal both surrounding normal and cancerous cells to develop new blood vessels and to invade, to metastasis and to overcome intercellular spatial confinements in general. We therefore investigated the cell killing effects on adjuvant RT and found that radio-sensitivity is actually not a monotonic function of volume as it was believed before. We present detailed analysis and explanation to justify above statement. Based on Niemierko's EUD, we present an equivalent radio-sensitivity model. We conclude that radio sensitivity is a sophisticated function over tumor volumes, since tumor responses upon radio therapy also depend on cellular communications.
Forage systems for beef production from conception to slaughter: III. Finishing systems.

Fall-weaned Angus calves grazed or were fed different forages during winter followed by 1) N-fertilized tall fescue (Festuca arundinacea Schreb.) grazed alone, 2) bluegrass (Poa pratensis L.)-white clover ( Trifolium repens L. ) sequence grazed with tall fescue-red clover (Trifolium pratense L.), or 3) bluegrass-white clover sequence grazed with alfalfa (Medicago sativa L.)-orchardgrass (Dactylis glomerata L.). Heifers were supplemented with grain at 1% of BW from April until slaughter in July. One-half of steers were supplemented with grain at 1% of BW from July until slaughter in October. Remaining steers were fed no grain but were finished on corn silage supplemented with.9 kg of soybean meal per steer daily, from October until slaughter in late January. Including alfalfa-orchardgrass in systems during the finishing phase resulted in higher daily and total gains during the grazing period, and carcasses had more marbling and higher USDA quality grades at slaughter compared with carcasses of cattle on systems using fescue-red clover. Correlation of final weight with carcass characteristics was low (r <.5). Performance and carcass characteristics were influenced as much or more by forage consumed during the previous wintering phase as by forage fed during the finishing phase. Wintering cattle on stockpiled fescue-alfalfa or alfalfa-orchardgrass hay generally resulted in higher BW at slaughter and more desirable carcass characteristics than systems using tall fescue alone or in combination with red clover. This was particularly notable in steers that grazed without grain until October and were finished on corn silage plus supplement. Final BW and carcass characteristics in all cattle were improved by full season grazing followed by feeding corn silage, compared with cattle finished with grain on pasture.
Patient desire to be involved in medication treatment decisions.

Objectives To identify unmet needs of patients taking medications for chronic health conditions and identify medication-related services that patients with chronic health conditions would desire. Design Descriptive, exploratory, nonexperimental study. Setting Large midwestern state in spring 2010. Participants 465 patients 45 years or older taking one or more prescriptions for chronic health problems. Intervention Cross-sectional survey. Main outcome measures Patient-reported usefulness of, satisfaction with, and intention to use medication-related services. Results Respondents wanted to be highly involved in treatment decisions but found medication information they received to be moderately useful and satisfactory. Medication-related services fell into three groups based on reported intention to use: therapy advice, cost advice, and medication organization. Desire to be involved in treatment decisions was a key factor in predicting reported intention to use therapy advice and cost advice services. The perceived affordability of medications was another important factor in patients' intention to use cost advice and medication organization services. Age, chronic conditions, number of prescription drugs, and the cost of therapy were not important in predicting the intention to use medication-related services in this population. Conclusion Patient desire to be involved in treatment decisions was a key factor in explaining intention to use medication-related services. Identifying individuals with desire for involvement in treatment decisions may increase medication therapy management (MTM) participation. Strategies to provide personalized MTM services to these individuals should be developed and evaluated.
Have I Got Something to Tell You Ideational Dynamics and Message Production

People think of things to say that they have never thought (or heard, or seen) before. Ideational dynamics is concerned with the processes that give rise to the ideas that shape overt verbal and nonverbal behavior. The focus of this article is on three specific problems of ideational dynamics: How do message-content ideations arise? What is the nature of these ideations as cognitive entities? and How do these ideations come to be manifested in overt behavior? This article overviews the implications of one particular theory, second generation action assembly theory (AAT2), for addressing these problems. AAT2 suggests that message-content ideations need not be propositional, that the abstract conceptions one is conscious of may not be related to the propositional content of his or her speech, that abstract conceptions need not be conscious to impact overt behavior, that message-relevant ideations may fail to be expressed in actual behavior, and that message-relevant ideations are malleable on a time scale s...
Solvation Structure in the Time Resolved Stokes Shift and Adiabatic Electron Transfer

Abstract There is an important connection between the time resolved Stokes shift of a chromophore in a polar solvent and the dynamical contribution to electron transfer reactions. We present a microscopic theory of the time resolved Stokes shift of a chromophore in a polar solvent which incorporates both non-Debye dielectric relaxation and solvation shell structure, then apply it to the Sparpaglione-Mukamel theory of electron transfer reactions. We find that molecular effects can dramatically affect the rate of reaction. Moreover, we find that when translational motion is fast compared to rotational motion, dielectric continuum theory gives a good approximation to the reaction rate.
Hepatitis C: IIb (IV) or not IIb (IV) that is the question

Objective: To analyze the distribution of hepatitis C virus (HCV) genotypes among patients positive for antibody to HCV (anti-HCV) according to age, severity of liver disease, and duration of infection; to investigate the influence of HCV genotypes on response to interferon-α therapy; and to study HCV viremia levels in relation to genotypes and severity of liver disease. Design: Cross-sectional study. Setting: 3 university hospitals and 2 research units. Patients: 3 groups of French and Italian patients with chronic HCV infection and detectable serum HCV RNA: Group 1 included 35 patients with hepatocellular carcinoma; group 2, 71 patients with cirrhosis who did not have hepatocellular carcinoma; and group