cssi/SciSciGPT-SciSciNet huggingface dataset:
Phytoliths, pollen, and microcharcoal from the Baringo Basin, Kenya reveal savanna dynamics during the Plio-Pleistocene transition

Abstract As part of the Hominin Sites and Paleolakes Drilling Project (HSPDP), phytoliths, pollen, and microcharcoal were examined from the 228 m (3.29 to 2.56 Ma) Baringo-Tugen Hills-Barsemoi drill core (BTB13). A total of 652 samples were collected at ~10 to 32 cm intervals, corresponding to sub-millennial to millennial scale temporal resolution. Microcharcoal was well-preserved throughout the core and often peaked in abundance ~5 kyr before and after insolation peaks. Phytolith preservation varied between excellent to total dissolution in alternating intervals throughout the core. Pollen was rarely preserved. These combined datasets indicate that prior to ~3.1 Ma, woody cover fluctuated between open savanna ( 80% cover) at typically precessional (19–23 kyr) periodicities. During the mid-Piacenzian Warm Period (MPWP; 3.26–3.01 Ma), intervals with exceptionally high microcharcoal abundance suggest that regional turnover from wooded to open habitats was driven in part by fire. After ~3.1 Ma, low-elevation woody cover likely never exceeded 40%, with oscillations between mesic tall-grass vs. xeric short-grass savanna at precessional periodicities. Mesic C4 tall-grass (Panicoideae) peaked in abundance during insolation maxima, whereas xeric C4 short-grass (Chloridoideae) peaked during insolation minima. The onset of Northern Hemisphere glaciation (NHG) at ~2.75 Ma coincided with the appearance of deep lake phases and increases in grass density and fire frequency. Spectral analysis and intervals with well-preserved phytoliths indicate that precession and interhemispheric insolation gradients influenced vegetation via their effects on equatorial precipitation and fire. This study fills a crucial gap in Pliocene vegetation reconstructions from the East African Rift Valley and its associated hominin localities. It also provides orbitally resolved regional vegetation data useful in paleodata–model comparisons for the onset of the MPWP (which is often used as an analog for future warming) and NHG.
Data and debriefing observations on healthcare simulation to prepare for the COVID-19 pandemic

Abstract We report on data and debriefing observations in the context of an immersive simulation conducted to (a) train clinicians and (b) test new protocols and kits, developed in table-top exercises without prior clinical experience to fit anticipated clinical encounters in the setting of the rapidly expanding COVID-19 pandemic. We simulated scenarios with particular relevance for anesthesiology, perioperative and critical care, including (1) cardiac arrest, (2) emergency airway management, (3) tele-instruction for remote guidance and supervision, and (4) transporting an intubated patient. Using a grounded theory approach, three authors (MHA, DLR, EHS) developed emergent themes. First alone and then together, we sought consensus in uncovering overarching themes and constructs from the debriefings. We thus performed an informal qualitative thematic analysis based in a critical realist epistemological position - the understanding that our findings, while real, are affected by situational variables and the observer's perspective[ 1 , 2 ]. We compared data from videos and triangulated the data by member checking. All participants and course instructors volunteered to participate in this educational project and contributed as co-authors to this manuscript. During debriefing, we applied crisis resource management concepts including situation awareness, prioritization of tasks, and clear communication practices, conducting the debriefing with emphasis on current TeamStepps 2.0 terminology and concepts. [ 3 , 4 ] In addition, we re-evaluated formerly familiar processes, as shortcomings of protocols, kits, and interdisciplinary cooperation became apparent. The data provide detailed observations on how immersive simulation and debriefing among peers mitigated the unfamiliarity of individual clinicians and the organization at large with the demands of an unprecedented healthcare crisis. We also observed and report on the anxiety caused by resource constraints, risk to clinicians in the face of limited personal equipment, and the overall uncertainty surrounding COVID-19. We began to summarize, interpret, critique, and discuss our data and debriefing observations in a rapid co-publication in the Journal of Clinical Anesthesia. [Healthcare Simulation to Prepare for the COVID-19 Pandemic] [5]
Anti-Vascular Endothelial Growth Factor and Panretinal Photocoagulation Use after Protocol S for Proliferative Diabetic Retinopathy.

Purpose To characterize the rates of panretinal photocoagulation (PRP) and anti–vascular endothelial growth factor (VEGF) medications before and after publication of the Diabetic Retinopathy Clinical Research Network protocol S. Design A retrospective, cross-sectional study from January 2012, through September 2019, using a nationally representative claims-based database, Clinformatics Data Mart Database (OptumInsight, Eden Prairie, MN). Participants Eyes newly diagnosed with proliferative diabetic retinopathy (PDR), continuous enrollment, and no prior treatment with PRP or anti-VEGF agents. Methods Interrupted time series regression analysis was performed to identify the annual change in treatment rates before and after the publication of Protocol S (November 2015). Main Outcome Measures Annual rates of anti-VEGF or PRP treatments per 1000 treated eyes with PDR. Results From 2012 through 2019, 10 035 PRP or anti-VEGF treatments were administered to 3685 PDR eyes. Of these, 63.6% (n = 6379) were anti-VEGF agents, and 36.4% (n = 3656) were PRP treatments. Throughout treatment, 88.7% of eyes treated with anti-VEGF received the same agent and 7.7% were treated with both PRP and anti-VEGF agents. Panretinal photocoagulation rates declined from 784/1000 treated eyes in 2012 to 566/1000 in 2019 (pre-Protocol S: β = –32 vs. post-Protocol S: –77; P = 0.005), whereas anti-VEGF rates increased from 876/1000 in 2012 to 1583/1000 in 2019 (β = –48 vs. 161, respectively; P = 0.001). Panretinal photocoagulation rates in diabetic macular edema (DME) eyes did not significantly differ from 474/1000 in 2012 to 363/1000 in 2019 (β = –9 vs. –58 respectively; P = 0.091), and anti-VEGF rates increased from 1533/1000 in 2012 to 2096/1000 in 2019 (β = –57 vs. 187; P = 0.043). In eyes without DME, PRP use declined from 1017/1000 in 2012 to 707/1000 in 2019 (β = –31 vs. –111, respectively; P Conclusions Following the publication of Protocol S, PRP rates decreased, while anti-VEGF rates increased. Panretinal photocoagulation rates did not significantly change among eyes with DME. Our findings indicate the impact that randomized controlled trials can have on real-world practice patterns.
Respiratory Sound Classification Using Long-Short Term Memory.

Developing a reliable sound detection and recognition system offers many benefits and has many useful applications in different industries. This paper examines the difficulties that exist when attempting to perform sound classification as it relates to respiratory disease classification. Some methods which have been employed such as independent component analysis and blind source separation are examined. Finally, an examination on the use of deep learning and long short-term memory networks is performed in order to identify how such a task can be implemented.
Medical Student Involvement in a Human Rights Program: Impact on Student Development and Career Vision.

Background: There is consensus among many medical school deans that exposure to human rights is a necessary component of physician training [7, 8], however little is known about the impact of engagement in human rights programs on students’ personal and professional development [15–28]. Objective: This study aimed to examine medical students’ experiences in the Mount Sinai Human Rights Program (MSHRP), their motivations for involvement, and the possible influence of engagement on their professional identities, personal growth, and career choices. Methods: Through semi-structured interviews, this qualitative study gathered the experiences of 15 fourth year and recently graduated medical students who participated in the comprehensive training, research, and direct service opportunities provided by the program. Responses were coded using a content analysis approach. Findings: The results of this research highlight the motivations behind students’ involvement in a medical human rights program, as well as the challenges they experienced engaging with this work. The study captured students’ perceptions of the role of the program on their personal growth, clinical skills, and career vision. Nearly all the students interviewed indicated they developed important, clinically applicable skills that enhanced their traditional medical education. Students indicated that their participation directly influenced their professional identities and future career directions by reinforcing previous interests in human rights and social justice work, impacting medical specialty and residency program selections and fostering commitment to working with immigrant populations. Conclusions: The results of this study indicate that longitudinal involvement with the MSHRP contributed to the acquisition of important clinical skills that were not otherwise attained in students’ early medical education. Findings suggest that there is significant opportunity for clinical and leadership development outside the traditional preclinical and clinical setting, and that exposure to human rights education shapes students’ professional identities and career paths. Finally, the findings highlight the essential role of human rights and social justice in medical education.
Sulfate import in Salmonella Typhimurium impacts bacterial aggregation and the neutrophil respiratory burst

Abstract During enteric salmonellosis, neutrophil generated reactive oxygen species alter the gut microenvironment favoring survival of Salmonella Typhimurium. While the type-3 secretion system-1 (T3SS-1) and flagellar motility are potent Salmonella Typhimurium agonists of the neutrophil respiratory burst in vitro, neither of these pathways alone are responsible for stimulation of a maximal respiratory burst. In order to identify Salmonella Typhimurium genes that impact the magnitude of the neutrophil respiratory burst, we performed a two-step screen of defined mutant libraries in co-culture with neutrophils. We first screened Salmonella Typhimurium mutants lacking defined genomic regions, followed by the individual mutants mapping to genomic regions under selection. Mutants in four genes, STM1696 (sapF), STM2201 (yeiE), STM2112 (wcaD), and STM2441 (cysA), induced an attenuated respiratory burst. We linked the altered respiratory burst to reduced T3SS-1 expression and/or altered flagellar motility for two mutants (ΔSTM1696 and ΔSTM2201). The ΔSTM2441 mutant, defective for sulfate transport, formed aggregates in minimal media and adhered to surfaces in rich media, suggesting a role for sulfur homeostasis in regulation of aggregation/adherence. We linked the aggregation/adherence phenotype of the ΔSTM2441 mutant to biofilm-associated protein A and flagellins and hypothesize that aggregation caused the observed reduction in the magnitude of the neutrophil respiratory burst. Our data demonstrate that Salmonella Typhimurium has numerous mechanisms to limit the magnitude of the neutrophil respiratory burst. These data further inform our understanding of how Salmonella may alter neutrophil antimicrobial defenses.
Assessing Association Between Team Structure and Health Outcome and Cost by Social Network Analysis.

Background/objective To assess the impact of team structure composition and degree of collaboration among various providers on process and outcomes of primary care. Design Cross-sectional study. Setting Data from 20% randomly selected primary care service areas in the 2015 Medicare claims were used to identify primary care practices. Participants 449,460 patients with diabetes, heart failure, or chronic obstructive pulmonary disease cared for by the identified primary care practices. Measurements Social network analysis measures, including edge density, degree centralization, and betweenness centralization for each practice. Results When compared with practices with MDs and nurse practitioners (NPs) or/and physicians assistants (PAs), the practices with MDs had only lower degree of centralization and higher MD-to-MD connectedness. Within the primary care practices comprising MDs, NPs, or/and PAs, the nonphysician providers were more connected (measured as edge density) to all providers in the practice but with higher degree of centralization compared with the MDs in the practice. After adjusting for patient characteristics and type of practice, higher edge density was associated with lower odds of hospitalization (odds ratio (OR) = 0.89, 95% confidence interval (CI) = 0.79-0.99), emergency department (ER) admission (OR = 0.80, 95% CI = 0.70-0.92), and total spending (cost ratio (CR) = 0.86, standard error of the mean (SE) = 0.038). Conversely, higher degree centralization was associated with higher rates of hospitalization (OR = 1.15, 95% CI = 1.03-1.28), ER admission (OR = 1.23, 95% CI = 1.08-1.40), and total spending (CR = 1.14, SE = 0.037). However, higher degree centralization was associated with lower rates of potentially inappropriate medications (OR = 0.90, 95% CI = 0.81-0.99). Team leadership by an NP versus an MD was similar in the rate of ER admissions, hospitalizations, or total spending. Conclusion Our findings showed that highly connected primary care practices with high collaborative care and less top-down MD-centered authority have lower odds of hospitalization, fewer ER admissions, and less total spending; findings likely reflecting better communication and more coordinated care of older patients.
Opioid use in pregnant women with mental health-related disabilities.

The purpose of this study was to examine associations between opioid use and the degree of mental health-related disability due to emotional/behavioral problems as measured by the World Health Organization Disability Assessment Schedule (WHODAS) instrument in a national sample of pregnant women. We used data from the National Survey on Drug Use and Health 2014–2017 which included 2,888 pregnant women 18 years or older. The WHODAS instrument was utilized to measure disability as the degree of functional impairment due to emotional/behavioral problems experienced by the respondent. Multinomial logistic regression models were built to assess the magnitude and direction of the association between severity of mental health-related disability with opioid use and abuse/dependency in the past year. Approximately 30% of pregnant women suffered from moderate/severe mental health-related disability, and 2% reported opioid abuse/dependency. Compared to those with no opioid use, the odds of opioid use in the past year for individuals with moderate/severe mental health-related disability were 1.73 (95% CI 1.36, 2.21) times higher than those with no/mild disability. Similarly, the odds of opioid abuse/dependency were at least three times higher (OR 3.51; 95% CI 1.80, 6.84) among those with moderate/severe mental health-related disability relative to pregnant women with no/mild disability. Clinicians should consider screening for both opioid use and mental health conditions and related disabilities using screening tools such as the WHODAS during the initial prenatal visits.
Chile's Natural Experiment in Criminal Law Reform: Conversion from an Inquisitorial to Adversarial System

Between 2001 and 2005, Chile significantly transformed its criminal law system from inquisitorial to adversarial. The reforms led to greater rights for defendants and victims, the establishment of a modern prosecutors and public defenders' office, and a more open and transparent system. It also allowed judges to focus on adjudicating cases rather than conducting investigations as they had done under the former system. This paper examines the impact of the reform on legal variables dealing with case adjudication and processing times. Preliminary fixed effects results show that converting Chile's system has decreased slightly apprehension and conviction rates, and has had a mixed effect on case processing times. Reform in areas with indigenous populations of greater than or equal to 10% of the entire population has resulted in statistically lower conviction rates and higher acquittal rates and has had no significant effect on processing times. Reforms in the two most urban regions of metropolitan Santiago and Valparaiso, have resulted in lower apprehension and acquittal rates, but higher conviction rates.
Thermal-Aware Design Space Exploration of 3-D Systolic ML Accelerators

Machine learning (ML) accelerators have a broad spectrum of use cases that pose different requirements on accelerator design for latency, energy, and area. In the case of systolic array-based ML accelerators, this puts different constraints on processing element (PE) array dimensions and SRAM buffer sizes. The 3-D integration packs more compute or memory in the same 2-D footprint, which can be utilized to build more powerful or energy-efficient accelerators. However, 3-D also expands the design space of ML accelerators by additionally including different possible ways of partitioning the PE array and SRAM buffers among the vertical tiers. Moreover, the partitioning approach may also have different thermal implications. This work provides a systematic framework for performing system-level design space exploration of 3-D systolic accelerators. Using this framework, different 3-D-partitioned accelerator configurations are proposed and evaluated. The 3-D-stacked accelerator designs are modeled using the hybrid wafer bonding technique with a 1.44- $\mu \text{m}$ pitch of 3-D connection. Results show that different partitioning of the systolic array and SRAM buffers in a four-tier 3-D configuration can lead to either 1.1– $3.9\times $ latency reduction or 1– $3\times $ energy reduction compared to the baseline design of the same 2-D area footprint. It is also shown that by carefully organizing the systolic array and SRAM tiers using logic over memory, the temperature rise with 3-D across benchmarks can be limited to 6 °C.
Abstract P1-11-01: Patients' perspectives on using a genomic test for their breast cancer treatment decisions: Disparities in information exchange

Research Objective Genomic tests predicting tumor recurrence risk may help inform treatment decisions and improve quality of care. Yet differences in information exchange and patient decision style about genomic tests may further exacerbate disparities in care, particularly if recommendations conflict with patients’ preferences or other prognostic information. This study looks at the information exchange between patients and physicians and patients’ preferences in decision-making in the context of receiving a genomic test for early-stage breast cancer. Study Design Retrospective study of women covered by a large national health insurer, who had received the most common, commercial genomic test for early-stage breast cancer prognosis. All eligible minority women (n=705) and a random sample of eligible white women (n=719) matched by age category, geography and diagnosis year, were invited to a mailed survey later linked to claims data. We used random-effects logistic regression models (cluster=state) to examine the association of patient self-reported race/ethnicity with 3 outcomes: 1) knowledge of being tested; 2) patient decision style (assessed with the Control Preference Scale and categorized as active (patient-based), shared, or passive (physician-based); 3) amount of information received on the test. Models were adjusted by patient age, education, income, family structure/support, year of testing, and plan type. Population Studied Privately insured women aged 64 years old or less, enrolled for at least 9 continuous months, with an insurance claim for the genomic test in 2009–2012. Principal Findings The 62% response rate yielded 896 respondents, including 108 Hispanics, 112 Black, 97 Asians, and 549 whites. 10% of the respondents were unaware that they had received the genomic test, with significant differences in this knowledge by race/ethnicity after controlling for age, education and income (OR= 3.8 for Hispanic and OR = 2.7 for Black women compared to White, both p Conclusions While most women reported more active styles of decision-making, we found significant differences in information exchange that may lower the odds of a well-informed decision for minority patients. Variation in patient reports may reflect variation in understanding and retaining information about the genomic test, or in information delivery by physicians. Citation Format: Catherine Chanfreau-Coffinier, Ninez A Ponce, Patricia A Ganz, Michele Toscano, Joanne Armstrong, Jennifer S Haas. Patients9 perspectives on using a genomic test for their breast cancer treatment decisions: Disparities in information exchange [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-01.
Filling of solvent shells about ions: Part 3. Isomeric clusters of (HCN)n(NH3)mH+

Abstract Clustering enthalpies of (HCN) n (NH 3 ) m H + ions have been studied via high pressure mass spectrometry and ab initio calculations. Fully optimized geometries have been obtained for n + m ⩽ 5 at the HF/6–31G ∗ level of calculation. Five isomeric forms of the (HCN) n (NH 3 ) m H + ions have been considered. All of the complexes were found to contain an NH + 4 core ion. One isomer has all of the ligands bound to the NH + 4 ion whereas the other four have one of the ligands bound to another ligand. The former isomer is the most stable for all clusters; however, the latter isomers containing an NCH ⋯ NH 3 or an NCH ⋯ NCH hydrogen bond become competitive in stability as n + m increases. MP2/6–31 + G(2d,2p)//HF/6-31G ∗ stabilization enthalpies adjusted for BSSE have been compared to the experimental values. With two exceptions the values agree to within ± kJmol −1 . The agreement between the calculated and experimental Δ S ° and Δ G ° values is less good at ± 27 J K −1 mol −1 and ± 12 kJ mol −1 , respectively. The smooth decrease with n in the plot of -Δ H n −1 °, n vs. n for (HCN) n (NH 3 )H + and the ab initio results for (HCN) n (NH 3 )H + and (HCN)(NH 3 ) m H + suggest that mixtures of isomeric clusters may be present at equilibrium when n and m are ⩾ 4.
When Dreams Came True: Classical Fairy Tales and Their Tradition

For centuries fairy tales have been a powerful mode of passing cultural values onto our children, and for many these stories delight and haunt us from cradle to grave. But how have these stories become so powerful and why? In When Dreams Came True, Jack Zipes explains the social life of the fairy tale, from the sixteenth century on into the twenty-first. Whether exploring Charles Perrault or the Brothers Grimm, Hans Christian Andersen or The Thousand and One Nights, The Happy Prince or Pinocchio, L. Frank Baum or Hermann Hesse, Zipes shows how the authors of our beloved fairy tales used the genre to articulate personal desires, political views, and aesthetic preferences within particular social contexts. Above all, he demonstrates the role that the fairy tale has assumed in the civilizing process—the way it imparts values, norms, and aesthetic taste to children and adults. This second edition of one of Jack Zipes’s best-loved books includes a new preface and two new chapters on J.M. Barrie’s Peter Pan and E.T.A. Hoffman’s The Nutcracker and the Mouse King.
Dopamine D2 receptors mediate two-odor discrimination and reversal learning in C57BL/6 mice

Dopamine modulation of neuronal signaling in the frontal cortex, midbrain, and striatum is essential for processing and integrating diverse external sensory stimuli and attaching salience to environmental cues that signal causal relationships, thereby guiding goal-directed, adaptable behaviors. At the cellular level, dopamine signaling is mediated through D1-like or D2-like receptors. Although a role for D1-like receptors in a variety of goal-directed behaviors has been identified, an explicit involvement of D2 receptors has not been clearly established. To determine whether dopamine D2 receptor-mediated signaling contributes to associative and reversal learning, we compared C57Bl/6J mice that completely lack functional dopamine D2 receptors to wild-type mice with respect to their ability to attach appropriate salience to external stimuli (stimulus discrimination) and disengage from inappropriate behavioral strategies when reinforcement contingencies change (e.g. reversal learning). Mildly food-deprived female wild-type and dopamine D2 receptor deficient mice rapidly learned to retrieve and consume visible food reinforcers from a small plastic dish. Furthermore, both genotypes readily learned to dig through the same dish filled with sterile sand in order to locate a buried food pellet. However, the dopamine D2 receptor deficient mice required significantly more trials than wild-type mice to discriminate between two dishes, each filled with a different scented sand, and to associate one of the two odors with the presence of a reinforcer (food). In addition, the dopamine D2 receptor deficient mice repeatedly fail to alter their response patterns during reversal trials where the reinforcement rules were inverted. Inbred C57Bl/6J mice that develop in the complete absence of functional dopamine D2 receptors are capable of olfaction but display an impaired ability to acquire odor-driven reinforcement contingencies. Furthermore, the ability of dopamine D2 receptor deficient mice to adjust their responding to a previously reinforced stimulus when unexpected outcomes are encountered is significantly impaired. These findings suggest that signaling mediated by the dopamine D2 receptor is important for regulating associative and reversal learning and may have implications for the treatment of human attention disorders.
The dynamic behavior of charged aerosols: II. Numerical solution by the sectional method

Abstract A general sectional method for computation of the size-charge distribution of coagulating charged particles is developed. The physical phenomena taken into account are coagulation, electrostatic dispersion, particle production, and removal. The sectional equations are based on a general moment conservation that includes as particular cases the principles of volume and charge conservation.
Cyclic Adenosine 3',5'-Monophosphate in Guinea Pig Cerebral Cortical Slices II. THE ROLE OF PHOSPHODIESTERASE ACTIVITY IN THE REGULATION OF LEVELS OF CYCLIC ADENOSINE 3',5'-MONOPHOSPHATE

Abstract Elevated levels of cyclic adenosine 3',5'-monophosphate (cyclic AMP) in guinea pig cerebral cortical slices after incubations with histamine, histamine-norepinephrine, adenosine, and combinations of adenosine and biogenic amines rapidly return to basal levels (t½ l 10 min) during subsequent incubations in control medium. Elevated intracellular levels return only slowly to basal levels after stimulation with the depolarizing agent, veratridine. The rate of apparent degradation of cyclic AMP may be somewhat limited by the rate of diffusion of stimulatory test agents out of the brain slices. The time courses for the diappearance of total cyclic AMP and of radioactive cyclic AMP, the latter derived from intracellular radioactive nucleotides labeled by a prior incubation with radioactive adenine, follow similar patterns. The phosphodiesterase inhibitors, papaverine and isobutylmethylxanthine, potentiate the accumulation both of total and of radioactive cyclic AMP elicited by histamine or by histamine-norepinephrine and in addition decrease the rate of degradation of cyclic AMP after removal of the stimulatory agents. Isobutylmethylxanthine potentiates the histamine-elicited accumulation of total cyclic AMP to a greater extent than the accumulation of radioactive cyclic AMP. The potentiative effects of papaverine and isobutylmethylxanthine on accumulations of cyclic AMP are not additive. Papaverine and isobutylmethylxanthine have either no effect or antagonize the accumulations of cyclic AMP evoked by adenosine, adenosine-biogenic amine combinations, or veratridine-histamine, and in addition they do not retard degradation of total and of radioactive cyclic AMP after a prior stimulation by adenosine-histamine-norepinephrine. N,O-Dibutyryl cyclic AMP potentiates the accumulation of radioactive cyclic AMP elicited by histamine or histamine-norepinephrine. The effects of adenosine on cyclic AMP levels are blocked by theophylline and nonpolar analogs, and to a lesser extent by a polar analog, 7-(2'-diethylmethyl-ammoniumethyl)theophylline iodide. Theophylline either has no effect or inhibits the accumulation of cyclic AMP elicited by biogenic amines.
Curiouser and curiouser: the link between incompressibility and complexity

This talk centers around some audacious conjectures that attempt to forge firm links between computational complexity classes and the study of Kolmogorov complexity. More specifically, let R denote the set of Kolmogorov-random strings. Let $\mbox{\rm BPP}$ denote the class of problems that can be solved with negligible error by probabilistic polynomial-time computations, and let $\mbox{\rm NEXP}$ denote the class of problems solvable in nondeterministic exponential time. Conjecture 1. $\mbox{\rm NEXP} = \mbox{\rm NP}^R$. Conjecture 2. $\mbox{\rm BPP}$ is the class of problems non-adaptively polynomial-time reducible to R. These conjectures are not only audacious; they are obviously false! R is not a decidable set, and thus it is absurd to suggest that the class of problems reducible to it constitutes a complexity class. The absurdity fades if, for example, we interpret "$\mbox{\rm NP}^R$" to be "the class of problems that are $\mbox{\rm NP}$-Turing reducible to R, no matter which universal machine we use in defining Kolmogorov complexity". The lecture will survey the body of work (some of it quite recent) that suggests that, when interpreted properly, the conjectures may actually be true.
Synthesis of imagery with high spatial and spectral resolution from multiple image sources

We demonstrate how a realistic scene with high spatial and spectral resolution can be synthesized from color aerial photography and AVIRIS hyperspectral imagery. A review of techniques for image fusion is first presented. Image processing techniques were developed to extract a digital elevation model from stereo aerial photography in order to correct temporal shading differences between two image sets and to fuse aerial photography with AVIRIS imagery. A unique contribution is the explicit inclusion of corrections for topography and differing solar angles in the fusion process. Color infrared photography and an AVIRIS image from a site near Cuprite, Nevada, were used as a test of an improved high-frequency modulation (HFM) technique for the creation of hybrid images. Comparison of spectra extracted from the synthesized image with library spectra demonstrated that our methodology successfully preserved the spectral signatures of the ground surface.
Capsule commentary on Tukey et al., the impact of a medical procedure service on patient safety, procedure quality and resident training opportunities.

Medical procedure services (MPS) were developed to achieve several aims: 1) train residents in the performance of bedside procedures, 2) routinely provide attending supervision, 3) improve procedural success while reducing complications, and 4) offset resident workload in the era of duty hours restrictions.1–3 The study by Tukey et al.4 examines the impact of a MPS on trainee engagement and procedural safety. They found that resident participation in procedures did not differ when performed by the MPS versus the primary team. Procedures performed by the MPS were more likely to use ultrasound guidance, be supervised by an attending, and were more likely to be completed successfully. However, there was no difference in the primary outcome of overall or individual procedure complication rates. This is not the first study that has failed to show a difference in complications.3 Similar to previous studies, the inability to measure differences in patient outcomes may be the result of selection bias: more procedural referrals to the MPS from inexperienced residents or referrals for more complex procedures that in other hands may have resulted in complications. What does it mean that, when studied rigorously, a MPS does not achieve all desired aims? Perhaps we can draw an analogy between MPS and Rapid Response Teams (RRTs). Both are resource-rich innovations that provide valuable support to hospital providers, but have not yet consistently demonstrated benefits in patient outcomes.5 Like RRTs, hospitals may decide the benefits of a MPS—namely, enhanced resident experience and comfort, improved educational outcomes, and low rates of complications1–3—offset the as yet unproven outcome improvements. The truth is that alternatives are lacking. It is no longer practical or feasible to ensure all Internal Medicine (IM) residents are competent to perform procedures during training. Fewer IM faculty feel comfortable training residents in bedside procedures; they have neither the opportunity nor demand to maintain their skills. The need for safe and timely bedside procedures, however, still exists. MPS offer dedicated experience and training for IM residents, while providing safe and successful procedures for residents and other attendings, who often lack the time and expertise for procedures.
Time-resolved X-ray spectroscopy of deeply buried tracer layers as a density and temperature diagnostic for the fast ignitor

The fast ignitor concept for inertial confinement fusion relies on the generation of hot electrons, produced by a short-pulse ultrahigh intensity laser, which propagate through high-density plasma to deposit their energy in the compressed fuel core and heat it to ignition. In preliminary experiments designed to investigate deep heating of high-density matter, we used a 20 joule, 0.5–30 ps laser to heat solid targets, and used emission spectroscopy to measure plasma temperatures and densities achieved at large depths (2–20 microns) away from the initial target surface. The targets consisted of an Al tracer layer buried within a massive CH slab; H-like and He-like line emission was then used to diagnose plasma conditions. We observe spectra from tracer layers buried up to 20 microns deep, measure emission durations of up to 200 ps, measure plasma temperatures up to Te=650 eV, and measure electron densities above 1023 cm−3. Analysis is in progress, but the data are in reasonable agreement with heating simulations when space-charge induced inhibition is included in hot-electron transport, and this supports the conclusion that the deep heating is initiated by hot electrons.
Shear creep recovery behavior of IUPAC low‐density polyethylenes

Shear creep and creep recovery measurements were carried out on three low-density polyethylenes that were the object of extended investigations of the International Union of Pure and Applied Chemistry Working Party on the Structure and Properties of Commerical Polymers. The measurements were carried out in torsion at 130° and 153°C using a frictionless apparatus with a magnetic levitation bearing. The three samples were found to be experimentally the same at short deformation times and a high shear rates. Larger nonlinear recoverable compliances were exhibited by one of the samples, which is suspected of containing a high molecular weight tail, possibly microgel, at long times and low creep stresses.
Measurement of tissue optical properties by time-resolved detection of laser-induced transient stress.

We report on a technique utilizing time-resolved detection of laser-induced stress transients for the measurement of optical properties in turbid media specifically suitable for biological tissues. The method was tested initially in nonscattering absorbing media so that it could be compared with spectrophotometry. The basis of this method is provided by the conditions of temporal stress confinement in the irradiated volume where the pressure generated in tissues heated instantly by laser pulses is proportional to the absorbed laser energy density, and the exponential profile of the initial stress distribution in the irradiated volume corresponds to thez-axial distribution of the absorbed laser fluence. Planar thermoelastic waves can propagate in water-containing media with minimal distortion, and their axial profiles can be detected by an acoustic transducer with sufficient temporal resolution. The acoustic waves induced by14-ns laser pulses in nonscattering media, turbid gels, and tissues were measured by a piezoelectric transducer with a 3-ns response time. Temporal profiles of stress transients yielded z-axial distributions of the absorbed laser energy in turbid and opaque media, provided that the speed of sound in these media was known. The absorption and effective scattering coefficients of beef liver, dog prostate, and human aortic atheroma at three wavelengths, 1064 nm (in near infrared), 532 nm(visible), and 355 nm (near UV), were deduced from laser-induced stress profiles with additional measurements of total diffuse reflectance.
Dosimetric effects of rotational offsets in stereotactic body radiation therapy (SBRT) for lung cancer.

Abstract To quantitatively evaluate dosimetric effects of rotational offsets in stereotactic body radiation therapy (SBRT) for lung cancer. Overall, 11 lung SBRT patients (8 female and 3 male; mean age: 75.0 years) with medially located tumors were included. Treatment plans with simulated rotational offsets of 1°, 3°, and 5° in roll, yaw, and pitch were generated and compared with the original plans. Both clockwise and counterclockwise rotations were investigated. The following dosimetric metrics were quantitatively evaluated: planning target volume coverage (PTV V100%), max PTV dose (PTV Dmax), percentage prescription dose to 0.35 cc of cord (cord D0.35 cc), percentage prescription dose to 0.35 cc and 5 cc of esophagus (esophagus D0.35 cc and D5 cc), and volume of the lungs receiving at least 20 Gy (lung V20). Statistical significance was tested using Wilcoxon signed rank test at the significance level of 0.05. Overall, small differences were found in all dosimetric matrices at all rotational offsets: 95.6% of differences were
Fluoroscopic percutaneous lumbar zygapophyseal joint cyst rupture: a clinical outcome study.

Abstract Background context Lumbar zygapophyseal joint (Z-joint) synovial cysts can cause low back pain (LBP), spinal stenosis, and lower extremity radiculopathy. In the literature, there are several minimally invasive techniques described with mixed results. Typical recommended treatment is surgical resection of the cyst. Currently, there is little information available concerning the efficacy and outcome with treatment of Z-joint synovial cyst by percutaneous, fluoroscopic, contrast-enhanced distention, and rupture. Purpose To evaluate the therapeutic value and safety of Z-joint cyst rupture in symptomatic patients. Study design/setting Retrospective cohort study in an academic outpatient physiatric spine practice. Patient sample Thirty-two patients with moderate-to-severe LBP and leg pain (18 women and 14 men with an age range of 46–86 y; mean age, 66 y) with an average preprocedure symptom duration of 5 months. The patient's clinical symptoms correlated with magnetic resonance imaging studies documenting the presence of a synovial cyst at the corresponding level and side of symptoms. Patients had at least 6 months follow-up (range, 6–24). Outcome measures Numerical Pain Rating Scale, Roland-Morris Disability Questionnaire, North American Spine Society four-point patient satisfaction survey, recurrence of synovial cyst requiring repeat rupture, and need for surgical intervention. Methods Patients with symptomatic lumbar Z-joint synovial cyst were identified and their charts were reviewed. Patients included in the study either had symptomatic lumbar LBP or LBP with associated lower extremity radiculopathy. All patients in the study had magnetic resonance imaging's documenting Z-joint synovial cyst that corresponded with the patients' clinical symptoms. All patients received fluoroscopically guided, contrast-enhanced, percutaneous facet cyst distention and rupture followed by an intra-articular facet joint injection of 1 cc kenalog and 1 cc of 1% lidocaine. Seventeen of the patients also received a transforaminal epidural steroid injection just before facet cyst rupture. Telephone follow-up was conducted on all patients. Results Excellent long-term (average follow-up 1 y; range, 6–24 mo) pain relief was achieved in 23 (72%) of 32 patients undergoing facet cyst rupture. Twelve patients (37.5%) had synovial cyst recurrence and 11 chose to undergo repeat rupture, which resulted in 5 patients (45%) obtaining complete relief of symptoms and 6 patients (55%) requiring surgical intervention for cyst removal. Fisher exact test demonstrated that all patients who did not have a cyst recurrence were a success and obtained complete relief of symptoms (p Conclusions Fluoroscopic percutaneous Z-joint cyst rupture appears to be a safe and effective minimally invasive treatment option. This procedure should be considered before surgical intervention.
Dysphonia Following Nonsurgical Management of Advanced Laryngeal Carcinoma

Traditionally, laryngectomy has been the medical treatment of choice for patients with advanced cancer of the larynx, and voice clinicians have been largely concerned, not with these patients’ dysp...
Candidacy and management of assistive listening devices: special needs of the elderly.

The listening needs of older individuals cannot be successfully addressed with hearing aids alone. Assistive listening devices and systems (ALDs). either solely or in conjunction with the use of personal hearing aids, can facilitate listening in various acoustic environments, especially those in which excessive noise, reverberation and distance exist between the listener and sound source. Listening situations that are especially problematic, even with hearing aids, such as listening in large groups, on the telephone, in restaurants and at concerts and movies are ideally suited for ALD use. ALDs can reduce the impact of hearing loss and also ensure safety for older individuals. Owing to a variety of age-related factors, candidacy for ALD use among older individuals must be carefully considered. In addition, several issues related to the interaction between the older adult and the devices, the compatibility of the devices and hearing aids, as well as professional issues, complicate the fitting of ALDs. The ...
Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons

The efficacy of highly active antiretroviral therapy (HAART) is dependent upon moderately high levels of adherence; however, predicting adherence before HAART initiation can be difficult. We conducted a prospective, longitudinal study among 350 HIV-infected adults attending a HIV clinic in San Diego, CA (USA) from January 2010 to December 2011 to examine both established and novel predictors of adherence, including religious practices and beliefs. Statistically significant (p < .05) variables identified in bivariate analyses were included in multivariate analyses predicting ≥90% adherence. Higher annual household income (p = .004) and religious affiliation (p = .031) were predictive of greater adherence. Participants who said their beliefs gave meaning to their lives, made them feel they had a connection with a higher being, were influential during their recovery, and helped them feel connected to humanity were more likely to be ≥90% adherent (p < .015). Conversely, participants who believed God created all things in the universe; that God will not turn his back on them; and those who regularly attended religious services, participated in religious rituals, and prayed and meditated to get in touch with God were less likely to be ≥90% adherent (p ≤ .025). Results indicate that a patient's religious beliefs and practices may predict medication adherence. Interventions should be designed to emphasize the use of positive religious coping strategies and address the adverse implications of religious fatalism.
On laminar flame quenching and its application to spark ignition engines

Analyses are made of flame quenching in flows both perpendicular and parallel to a heat sink. A fundamental question is raised about the characteristic length over which a flame in a tube loses heat. Two possibilities are examined, the radius and the flame thickness. By using a functional form prescribed by the theoretical analyses a correlation of laminar flame speed, quenching diameter, and lean limit flame temperature is developed. The correlation suggests that the characteristic length for heat loss is the flame thickness. Laminar flame speeds of isooctane and propane have been correlated and used to compute quench distances in an engine. The agreement is reasonable and leads to speculation that quenching in an engine is basically laminar and dependent upon the free stream unburned gas temperature rather than the wall temperature.
Hybrid Simulations: Theory, Applications, and Future Directions

Hybrid simulation is a testing method for examining the seismic response of structures using a hybrid model comprised of both physical and numerical substructures. Because of the unique feature of the method to combine physical testing with numerical simulations, it provides an opportunity to investigate the seismic response of structures in an efficient and economically feasible manner. It is this feature of the method which made it gain widespread use in recent years. This paper presents the theory of the method including an overview of the previous research related to various aspects of the method, an overview of two hybrid simulation applications, and the future directions for transforming the method to its next generation.
Different computer tasks affect the exposure of the upper extremity to biomechanical risk factors

In order to determine differences in biomechanical risk factors across computer tasks, a repeated measures laboratory experiment was completed with 30 touch-typing adults (15 females and 15 males). The participants completed five different computer tasks: typing text, completing an html-based form with text fields, editing text within a document, sorting and resizing objects in a graphics task and browsing and navigating a series of intranet web pages. Electrogoniometers and inclinometers measured wrist and upper arm postures, surface electromyography measured muscle activity of four forearm muscles and three shoulder muscles and a force platform under the keyboard and force-sensing computer mouse measured applied forces. Keyboard-intensive tasks were associated with less neutral wrist postures, larger wrist velocities and accelerations and larger dynamic forearm muscle activity. Mouse-intensive tasks (graphics and intranet web page browsing) were associated with less neutral shoulder postures and less variability in forearm muscle activity. Tasks containing a mixture of mouse and keyboard use (form completion and text editing) were associated with higher shoulder muscle activity, larger range of motion and larger velocities and accelerations of the upper arm. Comparing different types of computer work demonstrates that mouse use is prevalent in most computer tasks and is associated with more constrained and non-neutral postures of the wrist and shoulder compared to keyboarding.