cssi/SciSciGPT-SciSciNet huggingface dataset:
Causation as a Structure of the Lebenswelt

Whatever radical insights existentialism and phenomenology have occasioned in philosophy as well as in science, an implicit consequence of their intellectual vitality is the question they raise regarding the nexus between philosophy and science. Nowhere is this question more clearly found than in contemporary psychiatry. The recent stir in many quarters over existential psychoanalysis is only the surface disturbance of a much deeper problem, for underlying the publicity that has attended this movement is the more important, more insistent issue of the relationship between philosophical viewpoints and systems and the role of psychiatric theory in the matrix of knowledge. What is at issue, ultimately, is the very meaning of theory itself. I am interested in exploring theory in terms of a particular perspective, that of a fundamental problem for all science, the problem of causation. In a way, the choice of causation is less than necessary, for I could as well turn to the status of “fact” or “law” or “hypothesis” as a way into the difficulties I wish to engage. But if “causation” is a half-arbitrary choice, it is no less the case that it will do very well for the purposes at hand. Causation, I trust, will prove to be the threshold to the domain of theory as well as a clue to the meaning of the contribution of existential and phenomenological philosophy to science in general and to psychiatry in particular.
MY APPROACH to a patient with atrial fibrillation and dementia.

Atrial fibrillation (AF) is associated with multiple forms of dementia, including Alzheimer's disease. Although, on the surface, this association may seem an epiphenomenon derived from two diseases of aging, in our prior studies the youngest groups studied, who developed AF had the higher risks for cognitive impairment [1]. In addition, we found that the combined disease state of dementia and AF harbors a significant increased risk for all-cause mortality. As such, defining mechanisms that underlie the association as a means to explore therapeutic strategies of prevention, disease management, and risk reduction is essential. When I encounter a patient, who has AF and is experiencing early cognitive decline or has dementia, my clinical approach reflects our research into the disease states' association.
Politics, Adaptation and Change in Corporate Law

Berle & Means observed that US corporate structure was inefficient because shareholders owned too little of their firms to monitor effectively. This leaves ultimate control with non-owner managers. But many have argued that firm structure adapts efficiently to transaction cost problems. A necessary corollary of this view is that corporate law is efficient. Mark Roe has forcefully challenged this view. He suggests that US laws created corporations with weak, dispersed owners and strong managers. But I argue that, even if US corporate structure has been shaped by history and politics, the survival of this structure may be some evidence of efficiency if both laws and firms were under significant competitive pressure to change over time. This theory provides a basis for comparing the efficiency of the corporate law and structure of different countries. The more a country's corporate law and structure is subject to competitive forces, and thereby "market tested," the closer it will come to a first-best adjustment to inherent transaction costs. The US is a dynamic system that facilitates challenges to attempted political wealth transfers. There is less such testing in other countries, including Japan, Germany and New Zealand. Under this theory, the US weak-owner model looks better than under Roe's analysis.
The wireless network jamming problem subject to protocol interference

We study the following questions related to wireless network security: Which jammer placement configuration during a jamming attack results in the largest degradation of network throughput? and Which network design strategies are most effective in mitigating a jamming attack? Although others have studied similar jammer placement problems, this article is the first to optimize network throughput subject to radio wave interference. We formulate this problem as a bi-level mixed-integer program, and solve it using a cutting plane approach that is able to solve networks with up to 81 transmitters, which is a typical size for studies in wireless network optimization. Experiments with the algorithm also yielded the following insights into wireless network jamming: (1) increasing the number of channels is the best strategy for designing a network that is robust against jamming attacks, and (2) increasing the range of the jammer is the best strategy for the attacker. © 2015 Wiley Periodicals, Inc. NETWORKS, 2015
The Effects of Boating Safety Policies in the United States

This paper presents an analysis of the effects of boating safety policies on accidents involving pleasure boats on state waterways. We focus on the impacts of law enforcement and youth certification policies, using ordinary least squares and negative binomial estimators that control for select demographic and geographical variables. Estimates from the negative binomial model are used in policy simulations to predict the outcomes of proposed boating safety policies. Our findings suggest that substantial reductions in accidents and property damages could be achieved through the uniform application of law enforcement and youth certification programs across the United States. The paper extends existing studies on automobile safety and demonstrates the usefulness of a maximum likelihood estimator for policy analysis.
Multiplication and cytopathogenicity of Simian vacuolating virus 40 in cultures of human tissues.

SummaryMultiplication of SV40 virus has been demonstrated in primary cultures of several human tissues. The virus multiplied without cytopathic effect during the first passage in these systems. In subsequent passages in kidney cell cultures, CPE was noted which included nuclear changes, increased cell proliferation and necrosis.
Basic Time-Stepping Schemes

Generally, methods for the time integration of differential equations falls within two broad categories: (1) implicit and (2) explicit. In order to clearly delineate between the two approaches, we first study a generic equation of the form (\({\emph \bf U}\)=unknown variable)
Coronary artery bypass graft or percutaneous coronary interventions in patients with diabetes: another nail in the coffin or “too close to call?”∗

Percutaneous coronary intervention (PCI) was introduced by Gruentzig as an alternative to bypass surgery and was originally applied for symptomatic patients with single-vessel disease. As technology advanced, angioplasty became a therapy for the more usual forms of multivessel disease. Randomized
Household Saving in the USSR

Soviet household saving is examined in the context of the life cycle model of saving. The institutional features of the Soviet economy which one would expect systematically to affect saving patterns are described. Empirical work on the determinants of Soviet household saving is summarised and interpreted in the context of the life cycle model. Despite the limited data, the evidence suggests that Soviet household saving displays problems familiar in the West and which can be explained quite satisfactorily in the life cycle hypothesis framework.
Altered Gene Expression Following Cardiopulmonary Bypass and Circulatory Arrest

This study investigated the effects of normothermic cardiopulmonary bypass (CPB) and circulatory arrest (DHCA) on expression of specific genes in neonatal piglet brain. CPB was performed through the chest at 100 ml/kg/min for 2 hrs at 37°C. In the second group of animals, CPB was begun as described above and then animals were cooled to a nasopharyngeal/brain temperature of 18°C. When the brain temperature reached I8°C, the CPB circuit was turned off. After 60 min of circulatory arrest (DHCA), CPB was resumed at 100 ml/kg/min, and the piglets were rewarmed to a temperature of 36°C. In both groups, the animals remain sedated, paralyzed, mechanically ventilated, and continuously monitored throughout a four hour study period after CPB. Oxygen pressure in the microvasculature of the cortex was measured by oxygen dependent quenching of phosphorescence. The aRNA technique was used to assess mRNA steady-state levels in the brain tissue.
Ammonia activation at a metal

Although ammonia (NH3) is made on a vast scale for use in fertilizers, its use as a chemical feedstock or as an energy carrier is much more limited. Many reactions that occur easily with its substitution products (amines) are sluggish for NH3, in part because of the difficulty of activating the N-H bond. For fuel cells, NH3 is attractive because it does not generate greenhouse gases, as do methanol and methane ( 1 ), and is more easily stored than hydrogen (H2). Amine-containing organic molecules are used in pharmaceutical and materials applications, and accessing these structures directly from ammonia could limit the generation of by-products during their synthesis ( 2 ). Bringing NH3 up to speed for these applications will require both the development of catalysts that can activate the strong N–H bond of ammonia and a fundamental understanding of the N–H bond cleavage step. On page 730 of this issue, Bezdek et al. ( 3 ) report a molybdenum complex capable of weakening the N–H bond of NH3 and releasing a H atom to generate H2 under mild conditions.
If You Want to Make an Important Discovery, Listen to Your Patients

No one knows more about certain aspects of a disease than the patient who has it. So, listen to your patients and they may lead you in a direction in which no one else is going.
Toward a Measure of Communicative Participation for Children with Developmental Speech Disorders

The general lack of assessment tools that adequately measure communicative participation has been well documented in the adult literature. However, there has been no systematic attempt to document the availability of these assessment tools in pediatric populations. The purpose of this literature review was to investigate the availability of patient-reported outcome (PRO) tools that measure communicative participation in children. Results indicate that there are no such tools that measure communicative participation in children at this time. In an effort to inspire researchers to develop these tools, the following guidelines for the development of pediatric PRO tools are discussed: (1) consider age-based criteria for tool development and administration, (2) design and format the tool specifically for the target age group, (3) establish content validity, (4) determine whether a parent proxy-report tool is necessary, and (5) consider cross-cultural issues.
Event-Based Model Simulating the Change in DDoS Attack Trends After P/DIME Events

This paper describes the methods for creating an event-based simulation used to predict DDoS attacks against countries following international events. The model uses various parameters for an event and generates time series DDoS attack data for the two countries over one week. The simulation uses a weighted, tit-for-tat approach in determining retaliation. The model was evaluated using attack data of actual events provided by Arbor Networks consisting of a two-week interval plus a day, centered around the start of the events. The model was sufficient in predicting the change in frequency of DDoS attacks following hostile diplomatic events, but it was unsuccessful at simulating attacks following friendly, military, and economic events. Overall, the resulting simulation was a successful baseline for future work in the field.
Librarian Outreach as a Critical Element That Impacts Patient Outcomes

Marketing and promoting library services can be a full-time job. In order to maintain a high profile in the hospital community, librarians serve on committees as contributing members (1). This allo...
Calculation of voltage gain transfer functions using Trajectance analysis

Numerator of the voltage gain transfer functions is directly derived with Trajectance analysis in this paper. Denominator of the voltage gain transfer functions is directly calculated by Suspendance analysis that was explained in prior publications. The voltage gain numerator is obtained by i) identifying all paths that connect the input node to output node of the circuit through sequential passive components and dependent active sources, ii) calculating the Suspendance of each path when the path segments are shorted to ground and iii) adding the products of path Trajectance and Suspendance together. The voltage gains of a four-node active MOSFET inductor are extracted and compared with numerical plots from Spice simulator to demonstrate the effectiveness of the Trajectance analysis.
On the Melting Curve of Sulfur Hexafluoride

A previous correlation for the melting curve of sulfur hexafluoride (SF6) is inconsistent with the thermodynamic slope at the triple point derived from the Clapeyron equation. It is shown that this is probably due to the previous authors combining an accurate measurement of the triple point with melting-curve data that were distorted by impurities. A new equation is proposed that is consistent with the Clapeyron slope.
WTO Compliance and Domestic Farm Policy Change

The establishment of the WTO in 1995 posed a challenge for the conduct of domestic farm policies. Both the levels of support and the instruments used were constrained by the Agreement on Agriculture and other parts of the Uruguay Round Agreement. This chapter explores the experience of the period since 1995 to see to what extent the WTO commitments have shaped domestic farm policies, particularly in the United States and the European Union. This influence can come about either through the negotiated constraints on policy outcomes or through the litigation of complaints by other countries. Notifications of domestic support levels show little direct impact on US farm policy but the outcome of litigation has had some influence on policy choices. In the European Union, the reform of the CAP has been much more influenced by WTO subsidy constraints but somewhat less by litigation.
The Associations between Self-Reported Exposure to the Chernobyl Nuclear Disaster Zone and Mental Health Disorders in Ukraine.

Abstract Background: In 1986, Reactor 4 of the Chernobyl nuclear power plant near Pripyat, Ukraine exploded, releasing highly-radioactive materials into the surrounding environment. Although the physical effects of the disaster have been well-documented, a limited amount of research has been conducted on association of the disaster with long-term, clinically-diagnosable mental health disorders. According to the diathesis-stress model, the stress of potential and unknown exposure to radioactive materials and the ensuing changes to one’s life or environment due to the disaster might lead those with previous vulnerabilities to fall into a poor state of mental health. Previous studies of this disaster have found elevated symptoms of stress, substance abuse, anxiety, and depression in exposed populations, though often at a subclinical level. Materials and methods: With data from The World Mental Health Composite International Diagnostic Interview, a cross-sectional large mental health survey conducted in Ukraine by the World Health Organization, the mental health of Ukrainians was modeled with multivariable logistic regression techniques to determine if any long-term mental health disorders were association with reporting having lived in the zone affected by the Chernobyl nuclear disaster. Common classes of psychiatric disorders were examined as well as self-report ratings of physical and mental health. Results: Reporting that one lived in the Chernobyl-affected disaster zone was associated with a higher rate of alcohol disorders amongst men and higher rates of intermittent explosive disorders amongst women in a prevalence model. Subjects who lived in the disaster zone also had lower ratings of personal physical and mental health when compared to controls. Discussion: Stress resulting from disaster exposure, whether or not such exposure actually occurred or was merely feared, and ensuing changes in life circumstances is associated with to increased rates of mental health disorders. Professionals assisting populations that are coping with the consequences of disaster should be aware of possible increases in psychiatric disorders as well as poorer perceptions regarding personal physical and mental health.
A Miniaturized Reconfigurable CRLH Leaky-Wave Antenna Using Complementary Split-Ring Resonators

Composite Right-/Left-Handed (CRLH) Leaky-Wave Antennas (LWAs) are a class of radiating elements characterized by an electronically steerable radiation pattern. The design is comprised of a cascade of CRLH unit cells populated with varactor diodes. By varying the voltage across the varactor diodes, the antenna can steer its directional beam from broadside to backward and forward end-fire directions. In this paper, we discuss the design and experimental analysis of a miniaturized CRLH Leaky-Wave Antenna for the 2.4 GHz WiFi band. The miniaturization is achieved by etching Complementary Split-Ring Resonator (CSRR) underneath each CRLH unit cell. As opposed to the conventional LWA designs, we take advantage of a LWA layout that does not require thin interdigital capacitors; thus we significantly reduce the PCB manufacturing constraints required to achieve size reduction. The experimental results were compared with a nonminiaturized prototype in order to evaluate the differences in impedance and radiation characteristics. The proposed antenna is a significant achievement because it will enable CRLH LWAs to be a viable technology not only for wireless access points, but also potentially for mobile devices.
Bilingual Children: Active Language Learners as Language Brokers

All children are active language learners, including those learning more than one language. Growing up bilingual offers children particular cognitive strengths and helpful patterns of interaction, along with some cognitive, perceptual, and academic challenges, particularly for children in families of low socioeconomic status. Many immigrants in the USA face language and cultural barriers in gaining access to resources. To overcome those barriers, families often engage in “language brokering,” in which children act as interpreters and translators between parents and US society. Parent–child interaction during language brokering resembles “dialogic reading” prompts and questioning strategies that have been successfully used to support vocabulary development among young children. This chapter outlines bilingual children’s active engagement with language in challenging cognitive and social situations, and describes promising innovations to promote bilingual language learning.
Seeking outlying subsets under star-contoured errors

Given observations {Yi; 1 ≤ i ≤ n{ with dispersion matrix Σ, a pervading issue is whether shifts have occurred in designated subsets of the observations. Early work on single shifts used order statistics or the R-Student ti statistics as diagnostics, initially derived under i.i.d. Gaussian assumptions. These diagnostics recently have been shown to remain exact in level and power under equicorrelation and more general dispersion structures, and under star-contoured mixtures supplanting Gaussian errors, with an accounting for irregularities engendered by shifts at other than the designated cases. Extensions here pertain to outlying subsets using the R-Fisher diagnostics FI, showing invariance of its distribution and of related diagnostics under more general dispersion structures and mixtures over these. Shifts occurring at cases other than those designated induce doubly noncentral F distributions. These elicit profound disturbances in operating characteristics of the diagnostics, serving in turn to explain masking and swamping, and the discovery of hidden “regression effects” among outliers. Evidence for anomalies arising from denominator noncentralities rests on two-sided rejection rules to be given. Numerical studies serve to illuminate the essence of the findings in practice.
Local and Regional Comparisons of Gravity and Magnetic Fields

A long recognized connection between the gravitational gradients of the Earth’s crust and its magnetic anomalies, known as Poisson’s relationship, is the object of investigation in this paper. We develop the mathematical and theoretical basis of this relationship in both the space and frequency domains. Anomalies of the magnetic field thus implied by the gravitational gradients (or other derivatives of the gravitational potential) are called pseudo-magnetic anomalies; and, they assume a linear relationship between the mass density of the source material and its magnetization induced by the Earth’s main magnetic field. Tests in several regions of the U.S. that compare gravitational gradients derived from the high-resolution model, EGM08, and a continental magnetic anomaly data base reveal that the correlation implied by Poisson’s relationship is not consistent. Some areas exhibit high positive correlation at various frequencies, while others have even strong negative correlation. Therefore, useful applications of Poisson’s relationship depend on the validity of the underlying assumptions that, conversely, may also be investigated and studied using a combination of gradiometric and magnetic data.
Creating a Policy Environment for Sustainable Water use

Water resources have been the source of environmental services and economic benefit for millennia. Water provides multiple benefits, in both consumptive and non-consumptive uses. Consumptive uses include things like drinking water and agricultural production, while non-consumptive uses include water recreation and habitat provision for aquatic species. Historically, an adequate supply of water has not been a constraint in many locations, and institutions and policies have been established to encourage utilization of water use. Governments who were rich in resources, but poor in capital, established systems that gave away water rights to the first person to use the water beneficially. Under this type of system, water is not used where it provides the greatest benefit. Increasing population growth, combined with growing concern for environmental quality, as well as financial constraints, are leading to the realization that water use has to be curtailed and water has to be managed in a sustainable manner for the long run. As the word ‘sustainable’ can be ambiguous, its meaning in this context should be explained. It requires that water use and resource development take into account the limitations of natural systems, and that the existing stock of the resource not be depleted. Surface water sources are replenished regularly, but the amount of water provided is limited and subject to variability. Groundwater aquifers provide another source of fresh water. While some groundwater aquifers are replenished, others are non-renewable and their use should be carefully monitored. These supply constraints need to be recognized in any sustainable water management plan. A key element in
Virtual-worlds research at the University of North Carolina at Chapel Hill as of February 1992

This paper gives a very brief look at the origins of virtual-worlds research, defines the major challenges in this field, and gives an overview of the current state of virtualworlds research at the University of North Carolina, work that has been going on for over two decades. This paper is an update of [Holloway 91].
On the measurement of strain in the hostile environment of high-pressure water (80 MPa): A newly developed self-pressure-compensating technique and two new chemical sealants for use with strain gages subjected to pressurized water environment are presented

The measurement of strain on a structural member in the presence of high-pressure water environment requires waterproofing of the gages as well as understanding of the pressure effect on the foil gages. Two new waterproofing methods are developed to protect the gage under these extremely high pressures. This study has resulted in a new compensating method which eliminates the effects of temperature and pressure simultaneously. The waterproofing materials studied during this investigation are superior to other earlier techniques reported in literature since they provide protection up to 11,500 psi (80 MPa) while previously existing techniques failed before this pressure. Also, these studies on the pressure effect deal with the realistic situation of coated strain gages in a water environment, as compared to previous studies which dealt with uncoated strain gages in an oil environment.
Strain enhancement of the electro-optical response in BaTi O 3 films integrated on Si ( 001 )

We discuss the possibility of significantly enhancing the nonlinear electro-optical response in strained perovskite $\mathrm{BaTi}{\mathrm{O}}_{3}$. First-principles calculations predict the enhancement for both compressive and tensile strain. The physical origin can be traced to strain-induced phonon softening that results in diverging first-order susceptibility. Within the Landau-Ginzburg-Devonshire formalism we demonstrate how, in turn, this divergence results in a diverging second-order susceptibility and Pockels coefficient. Our results suggest a way to optimize $\mathrm{BaTi}{\mathrm{O}}_{3}$ films for use in silicon nanophotonics.
Lattice Thermal Conductivity Reduction Due to Diffusive Boundary Scattering in Nanowires

Diffusive Boundary scattering of phonons due to rough surfaces was investigated for silicon nanowire structures. The roughness of the surface was modeled as a Gaussian distribution. The effects of surface roughness, incident phonon wavelength and angle were taken into account by employing the Bechmann-Kirchhoff (BK) surface scattering model for Electromagnetic waves. The BK model is more accurate than conventional approaches, where surface roughness (SR) are usually modeled based on experimental fitting parameters or only phonon wavelength. The SR model is implemented within a particle based Monte Carlo phonon transport simulator to calculate the thermal conductivity of different nanowire structures. The simulation results are benchmarked against experimental data. The reduction of thermal conductivity as a function of the degree of roughness and its dependence on temperature and phonon wavelength has been discussed. It is found that for a 70-nm width, $6-\mu \mathrm{m}$ long silicon structure, using 2.3-nm SR height and 8.9-nm SR correlation length, an 89% reduction in thermal conductivity occurs at 300K. These observations can be useful in designing materials with low thermal conductivity for thermoelectric cooling purpose.
The Number of Instanton Parameters

The main object of this chapter is to calculate the number of parameters on which the general q-instanton solution on the sphere S 4 depends. But since most of our reasoning is valid for an arbitrary compact Riemannian manifold M,we start with this general situation.
Human-Derived Brain Models: Windows Into Neuropsychiatric Disorders and Drug Therapies.

Human-derived neurons and brain organoids have revolutionized our ability to model brain development in a dish. In this review, we discuss the potential for human brain models to advance drug discovery for complex neuropsychiatric disorders. First, we address the advantages of human brain models to screen for new drugs capable of altering CNS activity. Next, we propose an experimental pipeline for using human-derived neurons and brain organoids to rapidly assess drug impact on key events in brain development, including neurite extension, synapse formation, and neural activity. The experimental pipeline begins with automated high content imaging for analysis of neurites, synapses, and neuronal viability. Following morphological examination, multi-well microelectrode array technology examines neural activity in response to drug treatment. These techniques can be combined with high throughput sequencing and mass spectrometry to assess associated transcriptional and proteomic changes. These combined technologies provide a foundation for neuropsychiatric drug discovery and future clinical assessment of patient-specific drug responses.
Modeling Tree Canopy Signal Power Path Loss (SPPL) for Deployment of Wireless Communication Systems (WCS) Using Point Cloud and Sensor Fusion

Deployment of WCS in different areas requires an expensive and tedious process in terms of obtaining reliable coverage and connectivity. The current random deployment strategies still face some challenges that are related to the complex structure of the environment such as areas covered with tree canopies and hills. These type of structures do not only cause unpredictable shadowing effects through scattering and absorption but also cause faulty tolerances and short network lifespans. Furthermore, the current empirical deployment approaches depended on predefined parameters like path loss exponents and random variable $X_{\sigma }$ with $N(\sigma,~\mu =0)$ which are available only for a limited number of environments. In other words, the empirical approaches are not versatile enough to be used for any environment. In this paper, we propose a solution for the challenges caused by tree canopies and hills using point cloud and computer vision techniques. We fuse Light Detection and Ranging (LiDAR) data with the satellite imagery to acquire information about the location, separation, and the size of the tree canopies. The tree canopies on the line of sight direction (LOS) are determined by the local maximum method and median filter. As a result, we achieved a significant improvement over the existing empirical methods in approximating the SPPL.
Socioeconomic status and race are correlated with affective symptoms in multiple sclerosis.

Abstract Objective: Investigate the relationship between socioeconomic status (SES) and race with self-reported fatigue, depression, and anxiety levels in multiple sclerosis (MS). Methods: Cross-sectional review of the MS Partners Advancing Technology and Health Solutions (MS PATHS) database for adults with MS in the United States. We evaluated race and socioeconomic status (available markers: insurance, employment status, or level of education) as predictors of fatigue, depression, and anxiety sub-scores of the Neuro-QoL (Quality of life in neurological disorders), with particular interest between Caucasians/whites (CA) and African Americans/blacks (AA). Multivariate linear regression models included as covariates age, sex, disability status, smoking status, body mass index, and disease-modifying therapy. Results: 7,430 individuals were included; compared to CA, AA tended to be younger, more female-predominant, and had a higher level of disability. AA had completed slightly less education, had a higher level of Medicaid coverage or uninsured status, and had higher rates of unemployed or disabled status. In the univariate model, markers of lower SES, by whichever definition we used, correlated with worse affective symptoms. In the multivariate model stratified by race, CA showed similar trends. In contrast, in AA, only lower SES by employment status was correlated with worse affective symptoms. In both CA and AA, moderate and severe level of disability correlated with worse affective symptoms. Conclusion: SES and race may influence affective symptoms reported by individuals with MS. The reasons for the correlation are likely multifactorial. Longitudinal studies should strive to identify factors associated with risk of affective symptoms in MS that may be modifiable.
Cognitive Flexibility Matters: The Role of Multilevel Positive Affect and Cognitive Flexibility in Shaping Victims’ Cooperative and Uncooperative Behavioral Responses to Trust Violations:

Despite a significant growth in the scholarly literature in the area of trust violations and repair in the last decade, extant work has largely ignored the complex and socially competent responses ...
Neonatal diet alters fecal microbiota and metabolome profiles at different ages in infants fed breast milk or formula.

Background Neonatal diet has a large influence on child health and might modulate changes in fecal microbiota and metabolites. Objectives The aim is to investigate fecal microbiota and metabolites at different ages in infants who were breastfed (BF), received dairy-based milk formula (MF), or received soy-based formula (SF). Methods Fecal samples were collected at 3 (n = 16, 12, and 14, respectively), 6 (n = 20, 19, and 15, respectively), 9 (n = 12, 11, and 12, respectively), and 12 mo (n = 14, 14, and 15, respectively) for BF, MF, and SF infants. Infants that breastfed until 9 mo and switched to formula were considered as no longer breastfeeding at 12 mo. Microbiota data were obtained using 16S ribosomal RNA sequencing. Untargeted metabolomics was conducted using a Q-Exactive Hybrid Quadrupole-Orbitrap mass spectrometer. The data were analyzed using R (version 3.6.0) within the RStudio (version 1.1.463) platform. Results At 3, 6, and 9 mo of age BF infants had the lowest α-diversity, SF infants had the highest diversity, and MF was intermediate. Bifidobacterium was 2.6- to 5-fold lower in SF relative to BF infants through 1 y of life. An unidentified genus from Ruminococcaceae higher in the SF (2%) than in the MF (0.4%) and BF (0.08%) infants at 3 mo of age was observed. In BF infants higher levels of butyric acid, d-sphingosine, kynurenic acid, indole-3-lactic acid, indole-3-acetic acid, and betaine were observed than in MF and SF infants. At 3 mo Ruminococcaceae was positively correlated to azelaic, gentisic, isocitric, sebacic, and syringic acids. At 6 mo Oscillospira was negatively correlated with 3-hydroxybutyric-acid, hydroxy-hydrocinnamic acid, and betaine whereas Bifidobacterium was negatively associated with 5-hydroxytryptamine. At 12 mo of age, Lachnospiraceae was negatively associated with hydroxyphenyllactic acid. Conclusions Infant diet has a large impact on the fecal microbiome and metabolome in the first year of life.This study was registered at clinicaltrials.gov as NCT00616395.
The impact of the depth-dependence of in-situ stresses on the effectiveness of stacked caprock reservoir systems for CO2 storage

Abstract A candidate reservoir deep enough for CO2 storage might still be unsuitable if it carries a low minimum horizontal stress (Shmin) that limits its storage capacity, due to a higher risk of fracturing. This study investigated the impact that depth variations in the magnitude of in-situ stresses of a stacked caprock reservoir system have on the geomechanical response to CO2 injection. While geological and fluid flow properties (e.g., caprock permeability) are typically considered to be the main factors preventing CO2 leakage, this work investigates the importance of considering the stress variation across formations as an impeding factor that prevents CO2 leakage. The study employed well log, core sample, and field tests data from one such system in the Appalachian basin, where the target storage formations have low Shmin, but are overlain/underlain by formations with larger Shmin. Two coupled fluid flow – geomechanical models were constructed (1: vertically heterogeneous but laterally homogeneous 2: both vertically and laterally heterogeneous) for this investigation. Modeling results suggest that variations in the in-situ Shmin along the vertical profile of the stacked system are effective in containing the risks of fracturing to only those zones with the lowest Shmin. Furthermore, results suggest that inducing fractures – typically considered undesirable for CO2 storage – may in fact enhance injectivity without compromising the integrity of the storage system. While incorporating 3-dimensional mechanical heterogeneity results in stochastic locations of induced fractures, the estimated injectivity is slightly different from the laterally homogeneous model. The variability of stresses in a stacked caprock reservoir system merits detailed investigation as an entire system (rather than an isolated zone) in order to fully characterize the geomechanical responses to injection. As demonstrated in this work, stress changes across caprock-reservoir formations in the Appalachian basin is an essential factor preventing CO2 leakage.
Grown Unschooling Outcomes

This chapter provides an answer to the question “What happens to unschoolers when they grow up?” Research focused on unschooled adults’ feelings about the unschooling experience is considered. Unschooled adult outcomes regarding higher education, careers, financial independence, and future plans are reviewed. The chapter concludes with an in-depth profile of a grown unschooler.
The improvement in post-operative mortality following pancreaticoduodenectomy between 2006 and 2016 is associated with an improvement in the ability to rescue patients after major morbidity, not in the rate of major morbidity.

Abstract Background The postoperative mortality rate of pancreaticoduodenectomy is decreasing over time. It is unknown whether this is related to reduction in incidence of major morbidity or failure to rescue. We aimed to make this determination. Methods ACS-NSQIP was retrospectively reviewed from 2006 to 2016. Comparisons were assessed with Spearman's rank-order correlation test, chi-square test with linear-by-linear association, and multivariable hierarchical logistic regression. Results Mortality decreased significantly from 2.9% to 1.5% (p Conclusion There has been a sizeable reduction in the mortality rate after pancreaticoduodenectomy from 2006 to 2016. This predominantly results from a reduction in failure to rescue rate rather than a decrease in incidence of major morbidity.
Optimizing the Selection of Patients for Simultaneous Liver-Kidney Transplant.

Simultaneous liver-kidney transplantation has increased significantly in the Model for End Stage Liver Disease era. The transplantation policy has evolved significantly since the implementation of allocation based on the Model for End Stage Liver Disease. Current policy takes into account the medical eligibility criteria for simultaneous liver-kidney transplantation listing. It also provides a safety net option and prioritizes kidney transplant after liver transplant recipients who are unlikely to recover their renal function within 60 to 365 days after liver transplant alone. This review seeks to understand the underlying challenges in carefully selecting the candidates while optimizing the patient selection.
Technological change, relative wages, and unemployment

This paper examines the effect of skilled-biased technological shocks on the structure of wages and the composition of employment in a two-sector economy with a heterogeneous work force. Efficiency wage considerations, turnover costs and minimum wage legislation lead to labor market segmentation and equilibrium unemployment. The analysis focuses on the effects of a technological shock that raises the demand for skilled labor and reduces the demand for unskilled labor, in such a way that the total demand for labor in the primary (high wage) sector remains constant at initial wages. The presence of efficiency considerations implies that such a shock tends to reduce total employment in that sector, as the equilibrium increase in skilled labor employment is smaller than the drop in the employment of unskilled labor. Efficiency factors and initial unemployment are shown to magnify the adverse employment effects of pro-skilled technological progress.
Predictive value of direct disk diffusion testing from positive blood cultures in a children’s hospital and its utility in antimicrobial stewardship

Background Accurate and early susceptibility results could reduce overuse of broad-spectrum antibiotics for empiric treatment of bacteremia. Direct disk diffusion testing (dDD) using non-standardized inocula directly from blood cultures could facilitate earlier narrowing of antibiotics. Methods To determine the predictive value of dDD compared with standardized antimicrobial susceptibility testing (AST), we performed a retrospective cohort study of 582 blood cultures from 495 pediatric patients with bacteremia. Positive and negative predictive value (PPV: number of isolates susceptible by both dDD and AST divided by the total number of isolates susceptible by dDD; NPV: number of isolates not susceptible [either intermediate or resistant] by both dDD and AST divided by the total number of isolates not susceptible by dDD), sensitivity, specificity, and 95% confidence interval were calculated for each bacterium-antibiotic combination. We evaluated the Antibiotic Spectrum Index of prescribed antibiotics to assess change in antibiotic prescribing after availability of Gram stain, dDD, and AST results. Results dDD results were available a median of 21 hours before AST results. dDD had PPVs of ≥96% for most organism-antibiotic pairs, including 100% (CI 96-100%) for Staphylococcus aureus and oxacillin and 99% (CI 93%-100%) for Enterobacterales and ceftriaxone. NPVs of dDD were variable and frequently lower than PPV. Very major errors and major errors occurred in 31/5454 (0.6%) and 231/5454 (4.2%) organism-antibiotic combinations, respectively. Antibiotics were narrowed in 30% of cases after dDD result and a further 25% of cases after AST result. Conclusions dDD is highly predictive of susceptibility for many common organism-antibiotic combinations and provides actionable information one day earlier than standard susceptibility approaches. dDD has the potential to facilitate earlier de-escalation to narrow-spectrum antibiotic treatment.
Functional 4-D clustering for characterizing intratumor heterogeneity in dynamic imaging: evaluation in FDG PET as a prognostic biomarker for breast cancer

Probe-based dynamic (4-D) imaging modalities capture breast intratumor heterogeneity both spatially and kinetically. Characterizing heterogeneity through tumor sub-populations with distinct functional behavior may elucidate tumor biology to improve targeted therapy specificity and enable precision clinical decision making. We propose an unsupervised clustering algorithm for 4-D imaging that integrates Markov-Random Field (MRF) image segmentation with time-series analysis to characterize kinetic intratumor heterogeneity. We applied this to dynamic FDG PET scans by identifying distinct time-activity curve (TAC) profiles with spatial proximity constraints. We first evaluated algorithm performance using simulated dynamic data. We then applied our algorithm to a dataset of 50 women with locally advanced breast cancer imaged by dynamic FDG PET prior to treatment and followed to monitor for disease recurrence. A functional tumor heterogeneity (FTH) signature was then extracted from functionally distinct sub-regions within each tumor. Cross-validated time-to-event analysis was performed to assess the prognostic value of FTH signatures compared to established histopathological and kinetic prognostic markers. Adding FTH signatures to a baseline model of known predictors of disease recurrence and established FDG PET uptake and kinetic markers improved the concordance statistic (C-statistic) from 0.59 to 0.74 (p = 0.005). Unsupervised hierarchical clustering of the FTH signatures identified two significant (p < 0.001) phenotypes of tumor heterogeneity corresponding to high and low FTH. Distributions of FDG flux, or Ki, were significantly different (p = 0.04) across the two phenotypes. Our findings suggest that imaging markers of FTH add independent value beyond standard PET imaging metrics in predicting recurrence-free survival in breast cancer and thus merit further study.
Social-Ecological Predictors of Opioid Use Among Adolescents With Histories of Substance Use Disorders.

Adolescent opioid misuse is a public health crisis, particularly among clinical populations of youth with substance misuse histories. Given the negative and often lethal consequences associated with opioid misuse among adolescents, it is essential to identify the risk and protective factors underlying early opioid misuse to inform targeted prevention efforts. Understanding the role of parental risk and protective factors is particularly paramount during the developmental stage of adolescence. Using a social-ecological framework, this study explored the associations between individual, peer, family, community, and school-level risk and protective factors and opioid use among adolescents with histories of substance use disorders (SUDs). Further, we explored the potential moderating role of poor parental monitoring in the associations between the aforementioned risk and protective factors and adolescent opioid use. Participants included 294 adolescents (Mage = 16 years; 45% female) who were recently discharged from substance use treatment, and their parents (n = 323). Results indicated that lifetime opioid use was significantly more likely among adolescents endorsing antisocial traits and those whose parents reported histories of substance abuse. Additionally, adolescents reporting more perceived availability of substances were significantly more likely to report lifetime opioid use compared to those reporting lower perceived availability of substances. Results did not indicate any significant moderation effects of parental monitoring on any associations between risk factors and lifetime opioid use. Findings generally did not support social-ecological indicators of opioid use in this high-risk population of adolescents, signaling that the social-ecological variables tested may not be salient risk factors among adolescents with SUD histories. We discuss these findings in terms of continuing care options for adolescents with SUD histories that target adolescents' antisocial traits, perceived availability of substances, and parent histories of substance abuse, including practical implications for working with families of adolescents with SUD histories.
Antiarrhythmic drugs

Both supraventricular and ventricular arrhythmias are associated with increased mortality and morbidity. Numerous antiarrhythmics have been developed in an attempt to decrease the frequency of these arrhythmias, hoping to improve survival and improve quality of life. Antiarrhythmic agents are a diverse group of drugs that affect various cardiac ionic channels and block specific arrhythmias. However, despite the suppression of these potentially lethal cardiac arrhythmias, only the β blockers have been shown to reduce sudden arrhythmic death, especially in patients with prior myocardial infarction or heart failure. Some antiarrhythmic agents can also worsen the index arrhythmia and caution must be used especially in the compromised patient. A simple guideline is as follows: For conversion of atrial fibrillation or flutter to sinus rhythm, in the absence of structural heart disease, intravenous ibutilide or oral propafenone or flecainide are good choices. For maintenance of sinus rhythm, propafenone or flecainide are logical choices. In the presence of structural heart disease, amiodarone, dofetilide, or dl sotalol are preferred. In heart failure, dofetilide or amiodarone are the logical choices. The role of antiarrhythmic therapy for ventricular arrhythmias is questionable and may be contraindicated, except for the use of β blockers. The implantable cardioverter-defibrillator is often used in patients at high risk. At times, the addition of an antiarrhythmic agent such as amiodarone may be justified.
Effects of Different Rest Period Durations Prior to Blood Pressure Measurement: The Best Rest Trial.

A rest period of 3 to 5 minutes before blood pressure (BP) measurement is recommended in hypertension guidelines but can be challenging to implement. We conducted a randomized trial to determine th...
Vaginal Vault Prolapse Surgery

Multiple techniques are available for restoration of vaginal vault support. The primary challenge is identification of prolapse of the vaginal vault in women with advanced degrees of prolapse. The surgical approach is then individualized based on the patient’s anatomy, visceral function, age, health status, and additional required procedures. Success rates of more than 95% are reported for all the mentioned techniques.