cssi/SciSciGPT-SciSciNet huggingface dataset:
Machen Sie dem MÄrchen vom Linksgewinde ein Ende

Sowohl die Geschichte vom Rechts-/oder Linksgewinde als auch die diversen Geheimtipps von Olivenol bis Klebstoff sollten Sie Ihren Patienten ausreden. ErklAren Sie WaldlAufern, GArtnern und Hundebesitzern zudem, worauf sie nach einem Zeckenstich achten mussen. Vor allem muss der Blutsauger moglichst schnell entfernt werden. Denn je kurzer die Saugzeit, desto geringer ist die Chance fur die infizierte Zecke, die Borrelien weiterzugeben.
Topics in Model Order Reduction with Applications to Circuit Simulation

When integrating several components on a chip, one may be faced with the task of combining parts which were not manufactured in house. Oftentimes, no accurate model is available for these constituents. In this scenario, one may perform measurements of each device in the frequency range of interest. This information can then be employed to construct a reduced order model which can be used in a simulator which integrates the behaviour of each component and analyzes the entire chip. This paper addresses the problem of modeling a system based on measurements of its frequency response using the concept of tangential interpolation, together with the tool of the Loewner matrix pencil. This concept is particularly useful in the context of modeling components with a large number of input and output ports. After a thorough theoretical analysis which motivates the approach and makes connections to system theory, we present two numerical results which show its applicability to different systems arising in circuit simulation.
What do you mean when you say "urban"? Divergence between everyday language and Northern analytical vocabularies in South African Cities

The everyday meanings of key words about urban topics in South Africa differ markedly from their received definitions in much of the international geographic literature. Terms such as urban , city , rural , modern , and developed are used in everyday settings to represent concepts that are sometimes subtly and in other cases markedly in contrast with Global North norms, and embody problematic racialized values and histories. This article briefly describes the authors’ experiences of the everyday meanings of these key terms through engagement with South African students and research participants. We suggest research tactics that may enable better understandings of implicit urban concepts used in South Africa and (potentially) elsewhere in the Global South. This is particularly important for understanding urban participants’ reactions to and narratives about rapidly evolving patterns of development in postcolonial contexts.
Directing the Wandering Mind

Mind wandering—a mental phenomenon characterized by the spontaneous shift of attention away from external stimulation toward self-generated thought—has been consistently shown to have a negative im...
Estimating ambient ozone effect of kansas rangeland burning with receptor modeling and regression analysis

Prescribed rangeland burning in April is a long-standing practice in the Flint Hills region of eastern Kansas to maintain the tallgrass prairie ecosystem. The smoke plumes originating from these fires increases ambient PM2.5 concentrations and potentially contributes to ozone (O3) exceedances in downwind communities. Source apportionment research using Unmix modeling has been utilized to estimate contributions of Kansas rangeland burning to ambient PM2.5 concentrations. The objective of this study was to investigate the potential correlations between O3 and various sources of PM2.5 that are derived from receptor modeling, and then to specifically estimate contributions of Kansas rangeland burning to ambient O3 concentrations through regression analysis. Various daily meteorological data were used as predictor variables. Multiple regression models were developed for the eight-hour daily maximum O3 as well as the daily contributions of the five PM2.5 source categories that were derived from receptor modeling. Cross correlation was analyzed among residuals of the meteorological regression models for O3 and the daily contributions of the five PM2.5 source categories in order to identify the potential hidden correlation between O3 and PM2.5. The model including effects of meteorological variables and episodic contributions from fire and industrial emissions can explain up to 78% of O3 variability. For non-rainy days in April, the daily average contribution from prescribed rangeland burning to O3 was 1.8 ppb. On 3% of the days in April, prescribed rangeland burning contributed over 12.7 ppb to O3; and on 7% of the days in April, burning contributed more than 7.2 ppb to O3. When the intensive burning activities occur in days with high O3 background due to high solar radiation or O3 carryover from the previous day, the contributions from these episodic fire emissions could result in O3 exceedances of the National Ambient Air Quality Standards (NAAQS). The regression models developed in this study demonstrated that the most valuable predictors for O3 in the Flint Hills region include the O3 level on the previous day, total solar radiation, difference between daily maximum and minimum air temperature, and levels of episodic fire and industrial emissions. The long term goal is to establish an online O3 forecasting tool that can assist regulators and land managers in smoke management during the burning season so that the intensive burning activities can be planned to avoid forecasted high O3 days and thus prevent O3 exceedance.
Predictors and outcomes of lead extraction requiring a bailout femoral approach: Data from 2 high-volume centers

Background Lead extraction (LE) infrequently requires the use of the "bailout" femoral approach. Predictors and outcomes of femoral extraction are not well characterized. Objective The aim of this study was to determine the predictors of need for femoral LE and its outcomes. Methods Consecutive patients who underwent LE at our centers were identified. Baseline demographic characteristics, procedural outcomes, and clinical outcomes were ascertained by medical record review. Patients were stratified into 2 groups on the basis of the need for femoral extraction. Results A total of 1080 patients underwent LE, of whom 50 (4.63%) required femoral extraction. Patients requiring femoral extraction were more likely to have leads with longer dwell time (9.5 ± 6.0 years vs 5.7 ± 4.3 years; P Conclusion In this study, femoral extraction was needed in ~5% of LEs. Longer lead dwell time, higher number of leads extracted per procedure, and the presence of infection predicted the need for femoral extraction. Procedural success of femoral extraction was low, highlighting the fact that this approach is mostly used as a bailout strategy and thus selects for more challenging cases.
Unearthing the Polynesian Past: Explorations and Adventures of an Island Archaeologist: Unearthing the Polynesian Past: Explorations and Adventures of an Island Archaeologist. By Patrick Vinton Kirch. University of Hawaii Press, Honolulu. 2015. ISBN 978-0-8248-5345-7 (Hardcover US $45.00), 379 pp.

Unearthing the Polynesian Past: Explorations and Adventures of an Island Archaeologist is a book of memoirs by Patrick Vinton Kirch, recently retired from University of California, Berkeley. The bo...
Botulinum Toxin Injection

Expansion of onabotulinumtoxinA (BoNT-A) application has revolutionized the treatment algorithms associated with idiopathic and neurogenic lower urinary tract symptoms. Dominant to this increased utilization is the relative ease of administration and low complication profile. However, concerns for systemic spread and local ramifications such as infection and retention mandate exceptional vigilance from the treating urologist. Careful attention to the potential sequela of BoNT-A therapy will insure patient outcomes more closely match expectations.
Pneumocystis carinii Pneumonia*: The Time Course of Clinical and Radiographic Improvement

Objectives The purpose of this study was to compare the time course of clinical and radiographic improvement in patients with Pneumocystis carinii pneumonia (PCP), and evaluate the usefulness of early follow-up chest radiographs (CXRs) in these patients. Design Retrospective, chart review. Methods The medical records of 36 episodes of confirmed PCP among 28 patients were reviewed. Clinical parameters of improvement were defined as follows: (1) a decrease in temperature by 0.5°C, (2) a decrease in respiratory rate by 25%, and (3) a 2% improvement in arterial oxygen saturation, as measured by pulse oximetry, in the setting of an unchanged amount of supplemental oxygen or a reduction in supplemental oxygen. A patient was defined as clinically improving when all three of these criteria were met. All CXRs were graded by radiologists, specifically for the study, as normal or abnormal and improved, worsened, or unchanged from the initial CXR. Results Clinical improvement was noted during 30 of 36 episodes of PCP (83%) at a mean of 4.5 ± 2.5 days (± SD). There was improvement in the CXR finding during the hospital stay during 15 of 36 episodes (42%), at a mean of 7.7 ± 4.5 days. Radiographic resolution preceded clinical resolution in only four cases (11%). Excluding seven patients who received ventilatory support, the median number of CXRs per patient was four (range, two to nine CXRs). Conclusion We conclude that radiographic improvement of PCP lags behind clinical improvement.
Intraoperative Radiation Exposure During Hip Arthroscopy.

Background:The frequency of hip arthroscopy for the treatment of acute and chronic chondrolabral pathology and femoroacetabular impingement (FAI) has increased exponentially over the past decade. W...
Targeting the IDO1/TDO2–KYN–AhR Pathway for Cancer Immunotherapy – Challenges and Opportunities

Indoleamine 2,3-dioxygenase 1 (IDO1) and tryptophan 2,3-dioxygenase 2 (TDO2) catalyze the commitment step of the kynurenine (KYN) metabolic pathway. Traditionally the immunosuppressive effect of IDO1 has been attributed mainly to reduced levels of tryptophan, which activates the kinase general control nonderepressible 2 (GCN2). Emerging data have shed light on an unexpected role of the ligand-activated transcription factor aryl hydrocarbon receptor (AhR) in transducing the tumor immune escape function imparted by IDO1 and TDO2. AhR activation by the IDO1/TDO2 product KYN leads to the generation of immune-tolerant dendritic cells (DCs) and regulatory T cells, which collectively foster a tumor immunological microenvironment that is defective in recognizing and eradicating cancer cells. Multiple IDO1 inhibitors have been evaluated in clinical trials. There are novel modalities downstream of IDO1/TDO2 for pharmacological interventions. We review recent progress and future perspectives in targeting the IDO1/TDO2-KYN-AhR signaling pathway for the development of novel cancer immunotherapies.
Intent-aware Query Obfuscation for Privacy Protection in Personalized Web Search

Modern web search engines exploit users' search history to personalize search results, with a goal of improving their service utility on a per-user basis. But it is this very dimension that leads to the risk of privacy infringement and raises serious public concerns. In this work, we propose a client-centered intent-aware query obfuscation solution for protecting user privacy in a personalized web search scenario. In our solution, each user query is submitted with l additional cover queries and corresponding clicks, which act as decoys to mask users' genuine search intent from a search engine. The cover queries are sequentially sampled from a set of hierarchically organized language models to ensure the coherency of fake search intents in a cover search task. Our approach emphasizes the plausibility of generated cover queries, not only to the current genuine query but also to previous queries in the same task, to increase the complexity for a search engine to identify a user's true intent. We also develop two new metrics from an information theoretic perspective to evaluate the effectiveness of provided privacy protection. Comprehensive experiment comparisons with state-of-the-art query obfuscation techniques are performed on the public AOL search log, and the propitious results substantiate the effectiveness of our solution.
The Healing Process for the Multidisciplinary Team: Recovering Post-Inpatient Suicide

1. With an inpatient suicide, the staff may experience grief for a variety of reasons. The staff member's perception of self as a competent mental health care provider may be destroyed. The caregiver may grieve the loss of an ideal. Some inpatient staff members mistakenly believe that suicide can always be prevented and that the multidisciplinary team can accurately assess all patients. 2. To successfully mourn a loss, Worden (1982) identified four tasks of grieving that must be completed: accept the reality of the loss; experience the pain of grief; adjust to an environment in which the deceased or lost object is missing; and withdraw emotional energy and reinvest it in another relationship. 3. Interventions to promote healing post-inpatient suicide must be aimed at individual caregivers and the multidisciplinary team. Individual caregivers will differ in their responses based on experiences, beliefs, values, and culture. Language: en
Wave Absorption in Piezoceramic-Polymer Composites

As new materials have become more difficult and expensive to develop, composites have received increased interest because they provide fewer development problems and often display better properties than single phased materials. Proper design of a composite involves several considerations and principles: properties of the constituents, connectivity of the individual phases, general phase connectivity, and possible cross-coupled properties. In the past, these principles have been profitably applied to optimizing electrical flux patterns and mechanical stress distributions to improve the hydrostatic strain and voltage coefficients of piezoelectric composites.
Drift Shells and the Second and Third Adiabatic Invariants

This chapter defines the fundamental concept of trapped particle drift shells. Two additional field-geometric concepts are introduced and added to the concept of guiding center: the guiding field line and the guiding drift shell. All this leads to the definition of the second adiabatic invariant and several related simplified expressions thereof valid for some special cases. The conservation of the second invariant is demonstrated (in Sect. A.2). Using this theorem, it is possible to trace drift shells in general fields and some practical recipes are given for numerical methods to accomplish this. The concepts of shell splitting and pseudo-trapping in azimuthally asymmetric fields are discussed, and consequences for particle trapping and diffusion are mentioned. Several examples are analyzed in detail and analytical expressions for near-equatorial particles are given. A special look is taken at the dipole field as a first approximation of the geomagnetic field. Old but still much used quantities are introduced and discussed, such as the L-value and the system of invariant coordinates. We examine the situation of near-equatorial particles (pitch angles near 90∘), for whose drift orbits analytical relationships can be written down for first-order magnetospheric field approximations. The last part of this chapter deals with slowly time-varying fields and the resulting effects on drift shells. We introduce the third adiabatic invariant, a purely field-geometric quantity (the magnetic flux enclosed by a drift shell), and demonstrate (in Sect. A.3) its constancy under adiabatic conditions. The process during the adiabatic change is examined “under a microscope”, showing that adiabatic constancy is not absolute but valid only when averaged over a drift period: under time-dependent conditions, identical particles on the same drift shell share a common drift shell only at times that are integer multiples of their drift period. Without proof, we mention that this really is also true for the other two adiabatic invariants and their related periodicities. A generalized L-parameter, or “L-star” is introduced, and a general method for its calculation is presented.
A NOTE ON MEASURES OF SINGLE TIMESERIES ACTIVITY IN RESTING-STATE FMRI STUDIES

In statistics, signal processing and mathematical finance, a time series is a sequence of data points, measured typically at successive times spaced at uniform time intervals. Here, I only focus on the discrete time series. The motivation of writing this methodology note is to clarify the relationship between the measures to quantify activity of an observed timeseries. Particularly, focus one several measures used in recently emerged field of resting-state fMRI studies. Although all these measures have been extensively developed in EEG or other timeseries studies, many researchers focusing on various applications in or new comers to this new field need to know existed measures and the relationships among these measures.
Welcoming Comments to the Conference on Science and the Information Onslaught

Publisher Summary This chapter focuses on the goals of the Conference on Science and the Information Onslaught. There are four general goals for the conference. The first is to provide a basis for assessing the extent of the information onslaught. There are signs that a consensus is emerging about the seriousness of the problem. The second goal of the conference is to provide a forum for learning of the advances that have been made in many disciplines to improve the use of vast amounts of new data. It is unlikely that any single person will be aware of work done in all the other disciplines that are relevant to the problems addressed at the conference. The third goal is to identify the most fruitful areas for new scientific work. The fourth goal of the conference is to identify some of the next steps that would be appropriate for organizing some of the scientific work that needs to be done.
Dehalogenation of Organohalide Pollutants by Bacterial Enzymes and Coenzymes

Organohalides are widespread environmental pollutants which typically contain a carbon-halogen bond. The halogen substituent can be fluorine, chlorine, bromine, or iodine but chlorine is most common. The environmental fate of organohalides is dominated by the chemistry of the carbon-halogen bond of particular compounds. For example, fluorocarbons are particularly inert. This is due in large measure to the high bond dissociation energy of the carbon-fluorine bond which ranges from 106–115 Kcal/mol (Reinecke, 1984). Chlorinated compounds differ markedly in their environmental persistence. Generally, aryl and alkenyl chlorides decompose much more slowly than alkyl chlorides. The former compounds undergo hydrolytic and photolytic cleavage of the carbon-halogen bond much less readily. Environmental organohalides often derive from industrial sources, but many halogenated organic natural products are known as well. Commodity organic chemicals that contain chlorine include vinyl chloride, trichloroethylene, dichloromethane, 1, 2-dichloroethane, and chlorobenzene. Each of these compounds are used by United States industries at levels exceeding ten million pounds annually (Hutzinger & Veerkamp, 1981). Several natural products such as methyl chloride (Wuosmaa & Hager, 1990) and tribromomethane (Gschwend, et al., 1985) are released into the environment at comparable levels on a global scale by fungi and algae, respectively. As an illustration of the complexity of this group of compounds, over 700 halogenated natural products have been identified (Neidleman & Geigert, 1986).
Navigating the maze: the impact of configurability in bioinformatics software

The bioinformatics software domain contains thousands of applications for automating tasks such as the pairwise alignment of DNA sequences, building and reasoning about metabolic models or simulating growth of an organism. Its end users range from sophisticated developers to those with little computational experience. In response to their needs, developers provide many options to customize the way their algorithms are tuned. Yet there is little or no automated help for the user in determining the consequences or impact of the options they choose. In this paper we describe our experience working with configurable bioinformatics tools. We find limited documentation and help for combining and selecting options along with variation in both functionality and performance. We also find previously undetected faults. We summarize our findings with a set of lessons learned, and present a roadmap for creating automated techniques to interact with bioinformatics software. We believe these will generalize to other types of scientific software.
Role of cell-to-cell communication in cancer: New features, insights, and directions

The current special issue entitled "Role of tunneling nanotubes (TNTs) in carcinogenesis" was designed to discuss the role of cell-to-cell communication, especially TNTs, in cancer pathogenesis. In addition, we discuss the exploitation of TNTs as a potential therapeutic target to prevent and reduce cancer incidence. It is accepted that cell-to-cell communication is essential for the development of multicellular systems, and it is coordinated by soluble factors, associated membrane proteins, exosomes, gap junction channels, and TNTs. An old belief in the cancer field is that cancer cells are "disconnected" from healthy cells, resulting in loss of cell-to-cell communication and neighbor control. However, recent data obtained from different kind of tumors indicate that TNTs and others forms of communication (exosomes and localized cell-to-cell communication) are highly expressed and functional during tumor development . In physiological conditions, TNTs are expressed by few cells, and their main function is to coordinate long-distance signaling. However, upon carcinogenesis, TNTs proliferate and provide an alternative route of communication to enable the transfer of several signaling molecules and organelles to spread disease and toxicity. We propose that TNTs and their cargo are an attractive therapeutic target to reduce or prevent cancer development. All these unique aspects of cell-to-cell diffusion and organelle sharing will be discussed in this special issue.
Tracing gypsiferous White Sands aerosols in the shallow critical zone in the northern Sacramento Mountains, New Mexico using Sr/Ca and 87Sr/86Sr ratios

Abstract White Sands (New Mexico, USA) emits gypsum dust with a unique chemical and mineralogical signature, providing an opportunity to investigate its loading and regional movement. This study tracked White Sands dust input to montane soils downwind in the northern Sacramento Mountains, and provided better understanding of the effects of gypsum dust on sources of bioavailable plant nutrients in an active critical zone. Four soil profiles were collected over bedrocks of different weatherabilities, from the most reactive limestone, mixed limestone, diorite, to the least reactive sandstone, as well as different atmospheric end-members (rain, regional dust, and White Sands gypsum). Annual dry deposition rate observed at the Sacramento Mountains was approximately at 11 g m−2 yr−1, up to an order of magnitude lower than those at the Chihuahuan Desert basins upwind and closer to dust sources at lower elevations. Elemental chemistry, Ca/Sr and 87Sr/86Sr of bulk soils were mostly controlled by those of bedrocks and modified by chemical weathering over carbonate substrates, whereas the atmospheric input was only detectable in shallow soils over the least reactive sandstone through addition profiles of Ca, Sr and Na. Although only making up a small portion of a bulk soil in mass, White Sands dust, along with wet deposition, dominantly controlled the Ca/Sr and 87Sr/86Sr ratios of plants and the water leachable fraction of the soils. Particles from White Sands, predominantly gypsum, were very soluble, and dissolved quickly in soils of the Sacramento Mountains but re-precipitated at the impermeable bedrock-soil interface. Although absolute concentrations of Ca and Sr in plants differed widely among four sites and among different local plant types, Sr/Ca ratios were largely controlled by plant type, and thus the rooting depth. This study highlighted the importance of regional dust and rainfall in loading nutrients even in a semi-humid environment.
A Multi Theory-Based Investigation of College Students' Underlying Beliefs About Local Food Consumption.

Abstract Objective To identify college students’ perceptions of local food on the basis of a multi-theory model. Design Semistructured individual interviews were conducted. The Theory of Planned Behavior and Health Belief Model extended with self-congruity were used as a framework. Setting A university in the southeast region of the US. Participants A total of 30 college students, including in-state, out-of-state, and international. Main Outcome Measures Behavioral beliefs, normative beliefs, control beliefs, perceived threats, self-congruity, cues to action, and definitions regarding local food. Analysis Interviews were audio-recorded and transcribed verbatim. A hybrid inductive and deductive content analysis was used to analyze transcriptions. Results Health benefits, supporting local, less processing, freshness, and trustworthiness were identified as advantages of consuming local food. Perceived disadvantages included limited variety and higher prices. Major themes related to normative beliefs included approval of family members and friends. Perceived barriers included lack of information, lack of availability, and inconvenience. Perceived facilitators included availability and clear advertisement. Poor dietary quality was a major threat. Local food consumers were identified as health conscious. Potentially effective cues to action were also identified. Emotion emerged as a new theme. Conclusions and Implications The identified themes could be further explored for promotion of local food consumption among this population.
Returning to the digital world: Digital technology use and privacy management of women transitioning from incarceration:

Based on interviews with 75 women transitioning from incarceration, our research identifies technology access and skills barriers facing this population and their underlying concerns and motivation...
Non-invasive brain stimulation as a tool to decrease chronic pain in current opiate users: A parametric evaluation of two promising cortical targets

Abstract Background Poorly controlled chronic pain can lead to non-prescription use of opiates, which is a growing crisis in our communities. Transcranial magnetic stimulation (TMS) is a non-invasive therapeutic tool which has emerged as a potential treatment option for these patients. It is still unclear, however, if the dorsolateral prefrontal cortex (DLPFC) or the motor cortex (MC) is a more effective treatment location. The purpose of this study was to directly compare the effects of DLPFC versus MC TMS on pain severity and the urge to use opiates among chronic pain patients. Methods Twenty-two individuals with chronic pain currently using prescription opiates were randomized to receive 10, 3000 pulse sessions of 10 Hz repetitive TMS (rTMS) to the left DLPFC (110% resting motor threshold) or left MC (90% resting motor threshold). Multivariate linear models were used to evaluate the effect of TMS on pain and opiate use, including items from the Brief Pain Inventory (BPI) as well as subjective ratings of pain, distress, and the urge for opiates. Results Twenty participants (91%) completed all 10 treatment sessions and follow up visits. There was a main effect of stimulation site (F7,210 = 3.742, p = 0.001), wherein MC stimulation decreased pain interference significantly more than DLPFC stimulation (F1,216 = 8.447, p = 0.004). While both sites had comparable effect sizes on stress, pain, and discomfort, MC stimulation had larger effects on pain interference (Cohen’s d: 0.7) and urge to use opiates (Cohen’s d: 0.5) than DLPFC stimulation. Conclusion These data suggest that the MC may be a promising target for decreasing opiate dependence and pain interference among chronic pain patients.
Praxis and Paradox: Inside the Black Box of Eviction Court

In the American legal system, we typically conceive of legal disputes as governed by specific rules and procedures, resolved in a formalized court setting, with lawyers shepherding both parties through an adversarial process involving the introduction of evidence and burdens of proof. The often-highlighted exception to this understanding is the mass, assembly-line processing of cases, whether civil or criminal, in large, urban, lower-level courts. The gap left unfilled by either of these two narratives is how “court” functions for the average, unrepresented litigant in smaller and non-urban jurisdictions across the United States. For many tenants facing eviction, elements of the “typical” formal legal process are absent, resulting in an experience that only loosely resembles what is taught in law school. This Article is based on a first-of-its-kind interdisciplinary, multi-year, mixed-methods study of suburban and rural dispossessory (eviction) courts in Georgia that aims to contribute to the knowledge gap described above. Through detailed quantitative analysis of case files and qualitative data gleaned from court observation and stakeholder interviews, and its unique focus on courts outside of a major city, it provides a clearer picture of how eviction court in such jurisdictions operates in practice and what resulting variations in process mean for case outcomes. Ultimately, the Article demonstrates that while one set of laws may govern throughout the state, the process for applying and enforcing those laws is highly localized, dependent on the nature of place and the attitudes of the stakeholders involved. While smaller, lower-volume courts have fewer caseload pressures and appear to prioritize procedural justice, the process they conduct functions less like a traditional legal proceeding and more as a vehicle for rent collection. Paradoxically, elements typically associated with fair process—like the opportunity to respond to legal claims through filing an answer or the scheduling of a hearing on the merits—do not always manifest in substantively improved outcomes for tenants, given the structure of the underlying law. The Article concludes by reflecting on what these observations suggest about the limitations and effectiveness of different forms of legal assistance and how court processes, regardless of their locale and the people who operate within them, can maximize access to justice.
Should One Kind of Freedom Be Restricted to Promote Another

Due to restraints' consequences for personal liberty and dignity, the threshold to apply restraints is understandably high and heavily regulated. However, there can be clinical scenarios in which restraint use can facilitate a patient's freedom. This article considers such a case and examines conditions under which using restraints offers therapeutic benefit for patients with traumatic brain injuries.
Introducing clinical pharmacy specialists into interprofessional primary care teams: Assessing pharmacists' team integration and access to care for rural patients

ABSTRACT Clinical pharmacy specialists (CPS) were deployed nationally to improve care access and relieve provider burden in primary care.The aim of this study was to assess CPS integration in primary care and the Clinical Pharmacy Specialist Rural Veteran Access (CRVA) initiative's effectiveness in improving access.Concurrent embedded mixed-methods evaluation of participating CRVA CPS and their clinical team members (primary care providers, others).Health care providers on primary care teams in Veterans Health Administration (VHA).Perceived CPS integration in comprehensive medication management assessed using the MUPM and semi-structured interviews, and access measured with patient encounter data.There were 496,323 medical encounters with CPS in primary care over a 3-year period. One hundred twenty-four CPS and 1177 other clinical team members responded to a self-administered web-based questionnaire, with semi-structured interviews completed by 22 CPS and clinicians. Survey results indicated that all clinical provider groups rank CPS as making major contributions to CMM. CPS ranked themselves as contributing more to CMM than did their physician team members. CPS reported higher job satisfaction, less burn out, and better role fit; but CPS gave lower scores for communication and decision making as clinic organizational attributes. Themes in provider interviews focused on value of CPS in teams, relieving provider burden, facilitators to integration, and team communication issues.This evaluation indicates good integration of CPS on primary care teams as perceived by other team members despite some communication and role clarification challenges. CPS may play an important role in improving access to primary care.
Associations of amyloid and neurodegeneration plasma biomarkers with comorbidities

Introduction Blood-based biomarkers of amyloid pathology and neurodegeneration are entering clinical use. It is critical to understand what factors affect the levels of these markers. Methods Plasma markers (Aβ42, Aβ40, NfL, T-tau, Aβ42/40 ratio) were measured on the Quanterix Simoa HD-1 analyzer for 996 Mayo Clinic Study of Aging (MCSA) participants, aged 51 to 95 years. All other data were collected during in-person MCSA visits or abstracted from the medical record. Results Among cognitively unimpaired (CU) participants, all plasma markers correlated with age. Linear regression models revealed multiple relationships. For example, higher Charlson Comorbidity Index and chronic kidney disease were associated with higher levels of all biomarkers. Some relationships differed between mild cognitive impairment and dementia participants. Discussion Multiple variables affect plasma biomarkers of amyloid pathology and neurodegeneration among CU in the general population. Incorporating this information is critical for accurate interpretation of the biomarker levels and for the development of reference ranges.
Pleasure and Displeasure: Thunderclap Headache in a 13-Year-Old Boy:

Primary headache associated with sexual activity (PHASA) is a rare headache syndrome characterized by an acute, maximally intense headache during sexual activity and/or orgasm. While rare, it is a ...
Turkey's Entente with Israel and Azerbaijan: State Identity and Security in the Middle East and Caucasus

1. The Entente of Turkey, Israel and Azerbaijan: The New Type of an Alliance in the Post-Cold War Era 2. State Identities as Building Blocs of the Relationship, 1992-1999 3. The Military- Security Stranglehold: State Agents as Drivers of the Triple Entente 4. Foreign Policy and its Discontents in the Age of Globalisation: Informal Networks and Transnational Levers 5. The Heart of Entente: Security Dimension of the Relationship 6. Fluctuating Zones of Influence: Involution of the Alignment, 2000-2005 7. Conclusion
Modification and Refinement of Cast Al‐Si Alloys

In the Al-Si system, minor additions of metallic impurities, Na, Sr and others, modify the micro-structure of eutectic and primary silicon by inducing a high twin density, causing a morphological transition from flake-like to fibrous or spherical shapes. This modification should be distinguished from the inoculation or refining effects of other minor impurities, notably of phosphorous. The modified structural transition can be entirely explained in terms of growth kinetics modified by impurity induced twinning for the silicon phase and numerical modelling of the cooling curves shows that there need be no change in the nucleation behavior. The presence of elements such as phosphorous complicates the picture because in contrast to the former growth controlled process, the latter probably do alter the nucleation kinetics.
Gas exchange and water relations of two Rocky Mountain shrub species exposed to a climate change manipulation

Gas exchange and water relations responses to warming were compared for two shrub species, Artemisia tridentata spp. vaseyana (Asteraceae), a widely distributed evergreen species of the Great Basin and the western slope of the Rocky Mountains, and Pentaphylloides floribunda (Rosaceae), a deciduous shrub limited in distribution to moist, high-elevation meadows. Plants were exposed to an in situ infrared (IR) climate change manipulation at the Rocky Mountain Biological Laboratory, near Crested Butte, CO. Measurements of gas exchange and water relations were made on the two species in July and August, 1993 from plants growing in situ in infrared-heated and control plots. Carbon dioxide uptake, water loss, leaf temperature, water use efficiency, and water potential were compared to test the hypothesis that leaf and soil responses to IR will cause leaf level changes in photosynthesis. Photosynthetic CO2 uptake and water use efficiency increased for A. tridentata (2.9 vs. 1.9 μmol m−2 s−1 and 1.2 vs. 0.7 mmol C/mol H2O) in the heated plots compared to the controls, while water potential was significantly lower in the heated plots (−1.1 vs. −0.5 MPa). The heating treatment decreased rates of photosynthesis for P. floribunda, but not significantly so. For A. tridentata, the results are consistent with the community-level changes observed with heating. Taken together, the evidence suggests that global warming is likely to result in increasing dominance of A. tridentata in subalpine meadow habitat now dominated by forbs.
The influence of HOPE VI neighborhood revitalization on neighborhood-based physical activity: A mixed-methods approach.

Abstract Objectives This study uses a mixed methods approach to 1) identify surrounding residents' perceived expectations for Housing Opportunities for People Everywhere (HOPE VI) policy on physical activity outcomes and to 2) quantitatively examine the odds of neighborhood-based physical activity pre-/post-HOPE VI in a low socioeconomic status, predominantly African American community in Birmingham, Alabama. Methods To address aim one, we used group concept mapping which is a structured approach for data collection and analyses that produces pictures/maps of ideas. Fifty-eight residents developed statements about potential influences of HOPE VI on neighborhood-based physical activity. In the quantitative study, we examined whether these potential influences increased the odds of neighborhood walking/jogging. We computed block entry logistic regression models with a larger cohort of residents at baseline (n = 184) and six-months (n = 142, 77% retention; n = 120 for all informative variables). We examined perceived neighborhood disorder (perceived neighborhood disorder scale), walkability and aesthetics (Neighborhood Environment Walkability Scale) and HOPE VI-related community safety and safety for physical activity as predictors. Results During concept mapping, residents generated statements that clustered into three distinct concepts, “Increased Leisure Physical Activity,” “Safe Play Areas,” and “Generating Health Promoting Resources.” The quantitative analyses indicated that changes in neighborhood walkability increased the odds of neighborhood-based physical activity (p = 0.04). When HOPE VI-related safety for physical activity was entered into the model, it was associated with increased odds of physical activity (p = 0.04). Walkability was no longer statistically significant. Conclusions These results suggest that housing policies that create walkable neighborhoods and that improve perceptions of safety for physical activity may increase neighborhood-based physical activity. However, the longer term impacts of neighborhood-level policies on physical activity require more longitudinal evidence to determine whether increased participation in physical activity is sustained.
The Superbugs Are Coming

Because the media has stolen all the catchy names—MRSA, VRSA, VRE, C Diff et al—I’d like to be the first to coin the term “PREC” (penicillin-resistant E. coli). * ### The study. This was a retrospective examination of pediatric urine culture isolates from clinical laboratories collected in a variety of inpatient and outpatient settings across the United States in 2009. The aim was to compare antibiotic resistance patterns among common uropathogens obtained for outpatients and inpatients. ### The key findings. The authors identified 5560 inpatient and 25 418 outpatient urinary isolates. Here’s their table on prevalence of common species: View this table: You’ll have to check the article to see all the resistance patterns that were measured, but suffice it to say that inpatient resistance rates frequently exceeded outpatient resistance rates, particularly for third-generation cephalosporins and ciprofloxacin. Most notably (in my opinion anyway) was Escherichia coli resistance to ampicillin in the outpatient and inpatient settings (45% vs 55%, P < .001). #### Why do we care? This article substantiates the claim previously suggested by single-center studies that resistance patterns for uropathogens differ in the outpatient and inpatient settings. Thus, we should likely be using separate inpatient- and outpatient-based antibiograms to optimize effective empirical antibiotic use for treatment of urinary tract infection. That said, it is probably worth pointing out that there is site-to-site variability in determining who gets admitted for urinary tract infections (UTI), and this study was not designed to address this confounder or, more specifically, to account for severity of illness. #### Words from a hospitalist . . . “The common, often reflexive, empiric inpatient UTI management is getting a little trickier thanks …
E-Selectin Gene Expression in Vascular Smooth Muscle Cells: Evidence for a Tissue-Specific Repressor Protein

E-Selectin is an inducible, endothelium-specific, cell surface adhesion molecule that mediates inflammatory responses in the vasculature. Nonendothelial cell types such as cultured human aortic smooth muscle cells (HASMCs) lack the ability to express E-selectin. We tested the hypothesis that HASMCs express a negative regulatory factor that inhibits E-selectin gene expression. E-Selectin mRNA and gene transcription were not detected in HASMCs after treatment with tumor necrosis factor-alpha (TNF-alpha) by Northern and nuclear runoff analyses, respectively. However, both E-selectin mRNA and gene transcription were dramatically induced by TNF-alpha in the same cells pretreated with the protein synthesis inhibitor cycloheximide. Lipopolysaccharide demonstrated similar effects. Furthermore, E-selectin was detected on the cell surface of HASMCs after washing out of cycloheximide. Cycloheximide pretreatment enabled immortalized human dermal microvascular endothelial cells that have lost the ability to express E-selectin to induce both E-selectin mRNA and gene transcription in response to TNF-alpha. Induction of E-selectin mRNA by lipopolysaccharide one an TNF-alpha in cycloheximide-treated HASMCs was inhibited by the antioxidant pyrrolidinedithiocarbamate and the serine protease inhibitor N alpha -L-tosyl-L-phenylalanine chloromethyl ketone, suggesting that a nuclear factor-kappa B-like mechanism may play an important role in E-selectin gene expression in HASMCs. These data strongly suggest that a labile repressor protein(s) plays an important role in inhibiting E-selectin gene expression in HASMCs likely at the level of gene transcription. Except for this repressor, HASMCs and endothelial cells may share similar regulatory mechanisms for controlling E-selectin expression.
Studies in absorption of ragweed antigen following the injection of alum-precipitated pyridine-ragweed complex in man

Abstract 1. 1. By means of the reverse passive transfer technique it was not possible to demonstrate the absorption of free ragweed antigen from the site of injection of alum-precipitated pyridine-ragweed complex (APPR) in nonatopic subjects. 2. 2. Direct skin tests with a strong ragweed extract in subjects injected with APPR failed to reveal induced sensitivity to ragweed antigen, as evidenced by the absence of delayed or immediate skin reactions. 3. 3. Direct tests on specific ragweed serum-sensitized sites with APPR were negative, whereas tests with aqueous ragweed extract in comparable concentrations were strongly positive. 4. 4. Skin sites in nonatopic subjects sensitized with a potent ragweed reagin-containing serum failed to detect free ragweed antigen following the injection with APPR.
Impact of geopolitical crises on the formation or maintenance of multicultural counseling relationships: Insights from case studies

This article draws attention to the impact of geopolitical crises on multicultural counseling. It acknowledges that counselors may listen to news about these conflicts on radios and televisions without realizing the multicultural counseling implications. It puts these crises in socio-psychological perspective and raises, explains, and discusses the concepts of vicarious gain, lack, and loss of credibility as experienced by counselors due to these crises. Illustrative cases are used to show how vicarious gain, lack, and loss of credibility can inhibit the development and/or maintenance of healthy multicultural counseling relationships. Finally, ways to deal effectively with these problems are presented.
Neuropathology of pediatric brain tumors

Pediatric central nervous system neoplasms include a spectrum of both glial and nonglial tumors that differ significantly in location and biological behavior from those of adults. Brain tumors in infants and children most often arise from central neuroepithelial tissue, whereas a significant number of adult tumors arise from central nervous system coverings (eg, meningioma), adjacent tissue (eg, pituitary adenoma), or metastases. Most adult the cerebellar primitive neuroectodermal tumor (medulloblastoma). This article reviews neuropathological characteristics of the more common pediatric brain tumors. Entities, such as the brainstem glioma, and less common neoplasms like the desmoplastic infantile ganglioglioma and the central nervous system atypical teratoid/rhabdoid tumor are reviewed because they occur almost exclusively in children. Known cytogenetic and molecular characteristics of childhood brain tumors are also reviewed.
Temporal bone anatomy: comparison of computed tomography and complex motion tomography.

Specially reconstructed 1.5-mm thick CT scans and complex motion tomograms of the temporal bones were compared with anatomic sections of the same bones. Computed tomography demonstrated sloping bone surfaces and soft tissues better than tomography, whereas standard complex motion tomography produced a slightly thinner section with better spatial resolution. The advantages of computed tomography will probably make it the preferred radiologic study for many abnormalities of the temporal bone.
Mixed Mode Contributions to Absorption in CO(2) at 10.6micro.

A rise of temperature in a molecular system causes the higher energy levels to become more populated. For the case of CO(2) absorption (or, in a lasing medium, gain) calculations based only on single line considerations are sometimes inappropriate as the contributions from some higher energy levels can be appreciable. This paper summarizes this effect for 10.4micro band of CO(2) . The calculations are compared with the experimental measurements of others.
A review of data mining techniques

Terabytes of data are generated everyday in many organizations. To extract hidden predictive information from large volumes of data, data mining (DM) techniques are needed. Organizations are starting to realize the importance of data mining in their strategic planning and successful application of DM techniques can be an enormous payoff for the organizations. This paper discusses the requirements and challenges of DM, and describes major DM techniques such as statistics, artificial intelligence, decision tree approach, genetic algorithm, and visualization.
Structure of Global Supply Chains: The Design and Location of Sourcing, Production and Distribution Facility Networks for Global Markets

The Structure of Global Supply Chains: The Design and Location of Sourcing, Production, and Distribution Facility Networks for Global Markets