cssi/SciSciGPT-SciSciNet huggingface dataset:
Nonpharmacological Interventions to Prevent Delirium: An Evidence-Based Systematic Review

Development of delirium in critical care patients is associated with increased length of stay, hospital costs, and mortality. Delirium occurs across all inpatient settings, although critically ill patients who require mechanical ventilation are at the highest risk. Overall, evidence to support the use of antipsychotics to either prevent or treat delirium is lacking, and these medications can have adverse effects. The pain, agitation, and delirium guidelines of the American College of Critical Care Medicine provide the strongest level of recommendation for the use of nonpharmacological approaches to prevent delirium, but questions remain about which nonpharmacological interventions are beneficial.
Functional brain imaging using a blood oxygenation sensitive steady state.

Blood oxygenation level dependent (BOLD) functional MRI (fMRI) is an important method for functional neuroimaging that is sensitive to changes in blood oxygenation related to brain activation. While BOLD imaging has good spatial coverage and resolution relative to other neuroimaging methods (such as positron emission tomography (PET)), it has significant limitations relative to other MRI techniques, including poor spatial resolution, low signal levels, limited contrast, and image artifacts. These limitations derive from the coupling of BOLD functional contrast to sources of image degradation. This work presents an alternative method for fMRI that may over-come these limitations by establishing a blood oxygenation sensitive steady-state (BOSS) that inverts the signal from deoxygenated blood relative to the water signal. BOSS fMRI allows the imaging parameters to be optimized independently of the functional contrast, resulting in fewer image artifacts and higher signalto-noise ratio (SNR). In addition, BOSS fMRI has greater functional contrast than BOLD. BOSS fMRI requires careful shim
Treatment of childhood sexual abuse in anorexia nervosa and bulimia nervosa: A feminist psychodynamic approach

In this article a parallel is drawn between the psychological problems experienced by victims of childhood sexual abuse and by clients with eating disorders. In particular, we describe how sexual abuse has a significant and lasting effect on body image, identity, self-regulation, and interpersonal functioning. Treatment issues are outlined including the nature of the healing relationship, assessment of abuse, development of capacity for self-soothing, techniques for assisting in memory recall, sculpting of images, description and reenactment of abuse, dealing with shame, and ending the cycle of repeated victimization.
Crossing the Boundary and Becoming a Jew

Who was a Jew in antiquity? How was “Jewishness” defined? How did a non-Jew become a Jew, and how did a Jew become a non-Jew? In their minds and actions the Jews erected a boundary between themselves and the rest of humanity, the gentiles, but the boundary was always crossable and not always clearly marked. A gentile might associate with Jews and observe Jewish practices, or might “convert” to Judaism and become a proselyte. A Jew might avoid contact with Jews and cease to observe Jewish practices, or might deny Judaism outright and become an “apostate.” Or the boundary could be blurred through the marriage of a Jew with a gentile.
Hospital-acquired hyponatremia—why are hypotonic parenteral fluids still being used?

Hospital-acquired hyponatremia can be lethal. There have been multiple reports of death or permanent neurological impairment in both children and adults. The main factor contributing to the development of hospital-acquired hyponatremia is routine use of hypotonic fluids in patients in whom the excretion of free water, which is retained in response to excess arginine vasopressin (AVP), might be impaired. The practice of administering hypotonic parental fluids was established over 50 years ago, before recognition of the fact that there are numerous potential stimuli for AVP production in most hospitalized patients. Virtually all neurological morbidity resulting from hospital-acquired hyponatremia has been associated with administration of hypotonic fluids. Multiple prospective studies have shown that 0.9% NaCl is effective prophylaxis against hyponatremia. There is not a single report in the literature of neurological complications resulting from the use of 0.9% NaCl in non-neurosurgical patients. Patients at greatest risk of developing hyponatremic encephalopathy following hypotonic fluid administration are children, premenopausal females, postoperative patients, and those with brain injury or infection, pulmonary disease or hypoxemia. When hyponatremic encephalopathy develops, immediate administration of 3% NaCl is essential. In this Review, we discuss the question of why administering hypotonic fluids is unphysiologic and potentially dangerous, the settings in which isotonic fluids should be administered to prevent hyponatremia, and the appropriate treatment of hyponatremic encephalopathy.
TPL2 mediates autoimmune inflammation through activation of the TAK1 axis of IL-17 signaling

Development of autoimmune diseases, such as multiple sclerosis and experimental autoimmune encephalomyelitis (EAE), involves the inflammatory action of Th1 and Th17 cells, but the underlying signaling mechanism is incompletely understood. We show that the kinase TPL2 is a crucial mediator of EAE and is required for the pathological action of Th17 cells. TPL2 serves as a master kinase mediating the activation of multiple downstream pathways stimulated by the Th17 signature cytokine IL-17. TPL2 acts by linking the IL-17 receptor signal to the activation of TAK1, which involves a dynamic mechanism of TPL2–TAK1 interaction and TPL2-mediated phosphorylation and catalytic activation of TAK1. These results suggest that TPL2 mediates TAK1 axis of IL-17 signaling, thereby promoting autoimmune neuroinflammation.
Apicoaortic Conduit: A Simple Solution to a Difficult Problem

Apicoaortic conduit is a nonanatomic method of providing forward flow from the left ventricle. It is used as an alternative to aortic valve replacement in patients with comorbid factors that preclude a safe approach via median sternotomy. Our patient had undergone aortic and mitral valve replacements with bileaflet mechanical prostheses. After almost a decade, he started to experience recurrent episodes of congestive heart failure requiring hospitalization. Preoperative transesophageal echocardiography and computed tomography of the chest were done for evaluation. The 21-mm Carbomedics bileaflet aortic prosthesis (Sorin Group USA Inc, Arvada, CO) provided an effective orifice area index of 0.58 cm2/m2, leading to severe patient-prosthesis mismatch.1 A compounding factor was significant subvalvar stenosis (Panel A, arrows) due to the hypertrophied small left ventricle and the abnormal axis of the mechanical mitral valve (Panel A, asterisk). The ascending aorta measured 2.5 cm at the sinotubular junction, which is also smaller than normal (2.1-3.4 cm).2 The small hypertrophied left ventricle (LV) (Panel A, arrows) had a high end-diastolic pressure as demonstrated by the dilated left atrium (Panel A, LA). The multiple levels of left ventricular outflow tract obstruction made a corrective procedure via median sternotomy very high risk. Because of the abnormal placement of the mitral valve (Panel A, asterisk), we did not feel that we would be able to relieve the subvalvar stenosis even with myectomy. An apicoaortic conduit (Panel C, arrow) was constructed between the left ventricular apex (LVA) and the descending thoracic aorta (DTA) via a left thoracotomy. Normothermic cardiopulmonary bypass was achieved by cannulation of the left common femoral artery and vein. The left ventricle was small and hypertrophied with a very small cavity. Two separate pieces of a 16-mm Dacron tube graft (Medtronic, Inc, Minneapolis, MN) were anastomosed to the left ventricular apex (LVA) and the descending thoracic aorta (DTA) (Panel B, white arrows). A 20-mm Dacron graft was interposed between these 2 grafts (Panel B, gray arrow), and a 17-mm bileaflet mechanical valve (St. Jude Medical, St. Paul, MN) was interposed between these conduits. Hence, the combined effective orifice area index was 1.11 cm2/m2. The patient experienced marked symptomatic improvement at dismissal and was counseled regarding strict adherence to therapeutic anticoagulation, as he had 3 mechanical valves in situ. We demonstrate that this procedure is useful for the management of patients with complex left ventricular outflow tract obstruction. It avoids the high risks involved in repeated median sternotomy approach.
Effect of the Thermostatic Expansion Valve Characteristics on the Stability of a Refrigeration System: Part II

The combination of increased power dissipation and increased packaging density has led to substantial increases in chip and module heat flux in high-end computers. The challenge has been to limit the rise in chip temperature. In the past virtually all-commercial computers were designed to operate at temperatures above the ambient. However researchers have identified the advantages of operating electronics at low temperatures. The current research focuses on IBM’s mainframe, which uses a conventional refrigeration system to maintain chip temperatures below that of comparable air-cooled systems, but well above cryogenic temperatures. An experimental bench was built to study the effect of variation of evaporator outlet superheat on system performance. Three different types of thermostatic expansion valves were tested in order to verify that the bulb size and bulb location have significant effect on the transient behavior of the system. Bulbs of each of the three thermostatic expansion valves were mounted at five different locations on the suction line. It was observed that the overall system stability increases as we move closer to the evaporator exit. It was also observed that there exists a region in the suction line at which the superheat variation is the least and placing the bulb at this region gives maximum stable operation of the system. This region can be defined as the minimum stable superheat point. Tests were conducted at five different load conditions 1000W, 750W, 500W, 250W and no load condition. It was observed that the system was the most stable at full load condition for all three types of valves and system stability consistently decreased as the load was decreased.Copyright © 2003 by ASME
Tale of the Tape: International Teaching Assistant Noticing during Videotaped Classroom Observations.

International teaching assistants face challenges in learning the norms for teaching in American universities. In order to address this learning curve this article describes a qualitative study of twenty international teaching assistants that examined how these participants viewed observations as part of their professional development. The study explored the noticing practices of international teaching assistants who participated in an initial interview, followed by a classroom observation so that the ITAs could notice their own teaching practices in the classroom. After examining the ITAs’ noticing of events during observations, the article will conclude with general recommendations for effective use of observations as part of the training of international instructors.
he Global Impact Of Chinas Currency Policy: U.S. And Beyond

Since the yuan is pegged to the dollar, the U.S. and Chinese economies have become inter-connected in a myriad of ways. This study examines the global implications of this relationship.
Growth of Micrococcus lysodeikticus as Substrate for Lysozyme.

Summary(1) A broth consisting of 1% Bacto-peptone and 0.5% NaCl at pH 7.5 is recommended for growth of M. lysodeikticus as substrate for lysozyme. (2) Cells grown and prepared by the recommended procedure were more susceptible to lysozyme than cells produced by other methods. (3) The rate of lysis of cells of M. lysodeikticus was affected by the concentration of NaCl used in the culture medium.
Sanitary monitoring of drinking water in rural areas of Dalian city 2011

Objective To investigate the health situation of village concentrated water supply,provide scientific basis for improving rural drinking water hygiene and protection of drinking water safety in rural areas.Methods From March to August in 2011,two hundred and fifty concentrated water supply sites were selected randomly in villages,and their basic situation was investigated.The source and peripheral water of each site was detected.Results The decentralized water supply was major source of the water supply in Dalian,and ground water was major source of countryside concentrated supply water,the proportion of complete treated engineering water was 2.09%.In the 1 000 detected water samples,in the case of no sterilization,the total qualification rate was 73.80%,the total qualified rates of drought period and wet season were 80.80% and 66.80%;The qualification rates of source and peripheral water were 75.00% and 72.60%.The microbes and nitrate exceeded national standard obviously,and coli group,the total number of colony,nitrogen and heat proof coli group also exceeded standards obviously,which qualified rates were 93.20%,91.40%,83.70% and 75.00%,respectively.Conclusion The water disinfection facilities of rural central water supply project is not perfect in Dalian,low qualified rate of water,microbial indicators and nitrate exceeding the national standard is high so that safety of drinking water has some hidden troubles.
Investigation on Occupational Health Knowledge,Attitude and Behavior of Employees in Electronic Product Shops of Shenzhen City

[Objective]To understand the occupational health knowledge,attitude and behavior of the employees in electronic product shops in Shenzhen City.[Methods]Stratified random sampling method was adopted.A total of 470 people exposed to organic solvents in a retail e-commerce circle were investigated by cross-sectional survey.[Results]Occupational health knowledge score was significantly different between employees' ages,education levels and residing(P0.05 or P0.01).Scores of attitude and behavior were significantly different between employees' education level and residing(P0.05 or P0.01).[Conclusion]The occupational health knowledge level of employees in a retail e-commerce circle is low.Therefore,the interventions of advocacy and training should focus on the population with low cultural level,residing in rural area and engaging in maintenance operation.
Nonparametric Regression for Learning Nonlinear Transformations

Information processing in animals and artificial movement systems consists of a series of transformations that map sensory signals to intermediate representations, and finally to motor commands. Given the physical and neu-roanatomical differences between individuals and the need for plasticity during development, it is highly likely that such transformations are learned rather than pre-programmed by evolution. Such self-organizing processes, capable of discovering nonlinear dependencies between different groups of signals, are one essential part of prerational intelligence. While neural network algorithms seem to be the natural choice when searching for solutions for learning transformations, this paper will take a more careful look at which types of neural networks are actually suited for the requirements of an autonomous learning system. The approach that we will pursue is guided by recent developments in learning theory that have linked neural network learning to well established statistical theories. In particular, this new statistical understanding has given rise to the development of neural network systems that are directly based on statistical methods. One family of such methods stems from nonparametric regression. This article will compare nonparametric learning with the more widely used parametric counterparts in a non-technical fashion, and investigate how these two families differ in their properties and their applicabilities.
Wicked Nutrition: The Controversial Greening of Official Dietary Guidance

In 2015, controversy over the Dietary Guidelines for Americans reached a new level when the government-appointed Dietary Guidance Advisory Committee (DGAC) recommended that those guidelines promote more sustainable diets, particularly those lower in animal-based foods. Although the committee found ample scientific evidence that such a shift would be a “win-win” for Americans9 health as well as the environment, it met with fierce opposition on both counts, and not only from the livestock industry. This suggests how sustainable diet guidance poses a classic wicked problem, meaning one characterized by high levels of complexity, uncertainty, and epistemological conflict. While relationships between food, bodies, and environments are inevitably complex and uncertain, the controversy surrounding DGAC9s recommendation offers an opportunity to explore how the scientific evidence on dietary sustainability is actually produced, and how it does or does not speak to other knowledge about eating for bodily and ecological health. To do this I look first at the research behind DGAC9s endorsement of diets high in plant-based versus animal-based foods, and then at select responses in the public comments. The contrast not only highlights the incommensurability of modeled versus experiential evidence, but also suggests that efforts to promote more sustainable food consumption cannot credibly ignore questions (however unresolved) about what constitutes more sustainable production.
The usage of an informatic system to improve monitoring patients with diabetes

The primary objective of the project is to create a medical database that includes all the data needed for efficient monitoring of patients, drawn after meeting the diabetes physicians. For an adequate Diabetes Physicians activity analysis, we obtained data after the focus-groups, data that were interrelated with the analysis of standard type medical forms. The application we used is web-based, realized in PHP-scripts, so it has a great advantage: it can be accessed anytime, anywhere on-line. The data are organized in one database, so that by opening the medical record of one particular patient, you have there summed all his exams, diagnostics, symptoms, prescriptions and investigations. Each diabetes physician has its own username and password. To assure the security and the private character of his data, if the user needs, he has a "change username or password" option available, so he can change them anytime he likes. The user-handbook, the simple, friendly interfaces, the sliding-scenario from a function to another, are strong points for the application, appreciated in the feed-back stage by the diabetes physicians.
On a flawed conclusion that the 1255 A.D. earthquake ruptured 800 km of the Himalayan Frontal Thrust east of Kathmandu

A reexamination of the observations and analysis recently reported to conclude that an 800 km section of the Himalayan Frontal Thrust ruptured in 1255 A.D. shows that the conclusion is flawed and without merit because of misinterpretations of trench logs and incorrect interpretation of radiocarbon statistics.
Una aproximación al pensamiento filosófico de Rosas

Nuestro trabajo se inicia a partir de la relacion entre el discurso rosista y el imaginario social que devienen del mismo, es decir la practica del efecto verdad -como diria Foucault- que Myers analiza. Esto nos permite desplazar los ejes tradicionales de discusion que se han dado en pares dicotomicos, caracteristicos de la mayoria de los estudios sobre el periodo rosista.
Regression test selection across JVM boundaries

Modern software development processes recommend that changes be integrated into the main development line of a project multiple times a day. Before a new revision may be integrated, developers practice regression testing to ensure that the latest changes do not break any previously established functionality. The cost of regression testing is high, due to an increase in the number of revisions that are introduced per day, as well as the number of tests developers write per revision. Regression test selection (RTS) optimizes regression testing by skipping tests that are not affected by recent project changes. Existing dynamic RTS techniques support only projects written in a single programming language, which is unfortunate knowing that an open-source project is on average written in several programming languages. We present the first dynamic RTS technique that does not stop at predefined language boundaries. Our technique dynamically detects, at the operating system level, all file artifacts a test depends on. Our technique is, hence, oblivious to the specific means the test uses to actually access the files: be it through spawning a new process, invoking a system call, invoking a library written in a different language, invoking a library that spawns a process which makes a system call, etc. We also provide a set of extension points which allow for a smooth integration with testing frameworks and build systems. We implemented our technique in a tool called RTSLinux as a loadable Linux kernel module and evaluated it on 21 Java projects that escape JVM by spawning new processes or invoking native code, totaling 2,050,791 lines of code. Our results show that RTSLinux, on average, skips 74.17% of tests and saves 52.83% of test execution time compared to executing all tests.
“At heart, I am a village person”: An interview with Bhalchandra Nemade

Bhalchandra Nemade is the author of six novels, ranging from Kosla (1963) to Hindu (2010). He has also published two collections of poetry and several substantial books of criticism. He occupied a ...
Charting New Frames for African Global Engagement: Resuscitated Histories, Reimagined Concepts, and Reapplied Contexts

This chapter functions as an opening theoretical and historical discussion that conceptualizes the book’s title and thesis while providing historiographical background and heuristic mapping to guide the book’s core theme about Afri-capitalist and Ubuntu business’ interactions, connections, and engagements within Africa Rising and Pan African economic narratives. The chapter elaborates upon the book’s main themes and thesis about cultural identity, development, and political-economic change in the contemporary global political economy as it affects the African Continent. In doing so, while engaging in core issues of economic growth, inequality, poverty, and development, we treat these elements of economy together through the larger prism of cultural political economy, on the one hand, and the current state of the African political economy in global context, on the other. The chapter grounds the book’s thesis about the relevance of Pan African economics to African engagement and navigation of the international political economy by critically reviewing the literature of contemporary international African political economy and ties these three themes together to position and forefront the book’s thesis and subsequent chapter evidence about Pan Africa Rising.
Dynamic Susceptibility Studies via NMR for the Cuprates

In Chaps. 3 and 4 we saw how the dynamic susceptibility has come to play a pivotal role in interpreting cuprate spin-lattice relaxation data and rationalizing the sharp contrasts in \(T_1\) behavior among sites in and near the \(CuO_2\) planes. The principal driving force in all of the magnetic phenomenology of the cuprates is clearly the AFM fluctuation peak at or near \({\varvec{Q}} = (\pi ,\pi )\), which occurs in varying degrees of dominance depending in an inverse fashion on the degree of carrier doping. This scenario appears to be a unique property of doped Mott insulators.
Coordination and Communication Challenges in Global Group Audits

SUMMARY Inspectors frequently identify deficiencies on global group audits (GGAs) attributed to problems in coordination and communication among the multiple participating firms. As GGAs involve la...
Regulating Renewable Energy: Connecting AMPKα2 to PINK1/Parkin-Mediated Mitophagy in the Heart.

Heart failure is a multifaceted disease in which mitochondrial dysfunction plays a large contributing role. Mitochondria are essential for maintaining cellular ATP levels sufficient to sustain the beating cardiac myocytes. Their function, however, extends beyond providing myocytes with energy, as they also regulate metabolism, heme synthesis, calcium homeostasis, reactive oxygen species production, and programmed cell death.1 To ensure a network of operational and efficient mitochondria, myocytes use mitochondrial autophagy or mitophagy to eliminate damaged or unwanted mitochondria. The most well-known and studied mitophagy pathway to date is mediated by 2 proteins, PINK1 (PTEN-inducible kinase 1) and Parkin. The PINK1/Parkin pathway was initially identified to be an important regulator of mitochondrial integrity and function in muscle cells and dopaminergic neurons in Drosophila,2,3 but recent studies have additionally confirmed its importance in maintaining cardiac homeostasis and adaptation to stress.4–6 Most mechanistic studies on the PINK1/Parkin pathway have been conducted in vitro using harsh mitochondrial toxins to activate mitophagy. However, these conditions do not appropriately mimic conditions in vivo. Thus, physiological mechanisms upstream of PINK1 and Parkin activation are still under intense investigation. In this issue of Circulation Research , Wang et al7 sheds light on the regulation of PINK1/Parkin-mediated mitophagy in the heart. Specifically, the authors have identified a role for AMPK (AMP-activated protein kinase) in activating mitophagy via PINK1 phosphorylation to prevent development of heart failure. Article, see p 712 The selective degradation of mitochondria is an essential process for mitochondrial quality control, both under physiological conditions and in response to pathological stress. When mitochondria are healthy, the serine/threonine kinase PINK1 is rapidly imported into the mitochondria via the TOM/TIM complex where it is cleaved by the mitochondrial protease PARL (presenilins-associated rhomboid-like; Figure [A]). Cleaved PINK1 is then retro-translocated into the cytosol …
3-Substituted 1,5-Diaryl-1 H-1,2,4-triazoles as Prospective PET Radioligands for Imaging Brain COX-1 in Monkey. Part 2: Selection and Evaluation of [ 11 C]PS13 for Quantitative Imaging.

In our preceding paper (Part 1), we identified three 1,5-bis-diaryl-1,2,4-triazole-based compounds that merited evaluation as potential positron emission tomography (PET) radioligands for selectively imaging cyclooxygenase-1 (COX-1) in monkey and human brain, namely, 1,5-bis(4-methoxyphenyl)-3-(alkoxy)-1 H-1,2,4-triazoles bearing a 3-methoxy (PS1), a 3-(2,2,2-trifluoroethoxy) (PS13), or a 3-fluoromethoxy substituent (PS2). PS1 and PS13 were labeled from phenol precursors by O-11C-methylation with [11C]iodomethane and PS2 by O-18F-fluoroalkylation with [2H2,18F]fluorobromomethane. Here, we evaluated these PET radioligands in monkey. All three radioligands gave moderately high uptake in brain, although [2H2,18F]PS2 also showed undesirable radioactivity uptake in skull. [11C]PS13 was selected for further evaluation, mainly based on more favorable brain kinetics than [11C]PS1. Pharmacological preblock experiments showed that about 55% of the radioactivity uptake in brain was specifically bound to COX-1. An index of enzyme density, VT, was well identified from serial brain scans and from the concentrations of parent radioligand in arterial plasma. In addition, VT values were stable within 80 min, suggesting that brain uptake was not contaminated by radiometabolites. [11C]PS13 successfully images and quantifies COX-1 in monkey brain, and merits further investigation for imaging COX-1 in monkey models of neuroinflammation and in healthy human subjects.
Intra-axial CNS Involvement of Langerhans Cell Histiocytosis (P6.103)

Objective: N/A Background: Langerhans cell histiocytosis (LCH) involves the clonal proliferation of CD1a-positive histiocytes (activated epidermal dendritic cells) and most often affects children with a peak incidence of 5–10 years. Inflammatory lesions containing histiocytes, macrophages, lymphocytes, plasma cells, and eosnophils can be found as isolated lesions in bone or skin or may present as a multifocal multisystem disease. Mutations in BRAF-V600E and other MAP kinase pathway genes have been identified. Involvement of the intra-axial central nervous system is rare but most commonly involves the hypothalamic/pituitary region leading to diabetes insipidus and growth hormone deficiency. Treatment consists of topical or systemic steroids, chemotherapy with alkylating agents or vinca alkaloids, and intravenous immunoglobulin (IVIG) or plasmapheresis. We present the case of a 52-year-old woman with known LCH (CD1a positive, BRAF testing negative) who presented two years after her initial diagnosis with simple partial seizures and was found to have pontine and bilateral temporal lesions. Spinal fluid was normal and a biopsy was inconclusive, though assumed to be related to LCH. IVIG and plasmapheresis afforded some improvement but further lesions were noted in her hypothalamus with progression of the pontine lesion. A second biopsy was likewise inconclusive and though no CD1a staining was seen, the process was again thought to be due to LCH. She was treated with infliximab and plasmapheresis, which improved her symptoms and achieved radiographic improvement. This is a rare manifestation of LCH, and because no consensus exists for treatment of this unusual presentation, we present this case for consideration. Design/Methods: N/A Results: N/A Conclusions: N/A Study Supported by: N/A Disclosure: Dr. Turner has nothing to disclose. Dr. Kazmi has nothing to disclose. Dr. Lacroix has nothing to disclose.
Screening for Peripheral Artery Disease Using the Ankle-Brachial Index: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force.

Importance Peripheral artery disease (PAD) is associated with a high risk for cardiovascular events and poor ambulatory function, even in the absence of symptoms. Screening for PAD with the ankle-brachial index (ABI) may identify patients in need of treatment to improve health outcomes. Objective To systematically review evidence for the US Preventive Services Task Force on PAD screening with the ABI, the diagnostic accuracy of the test, and the benefits and harms of treatment of screen-detected PAD. Data Sources MEDLINE, PubMed, and the Cochrane Central Register of Controlled Trials for relevant English-language studies published between January 2012 and May 2, 2017. Surveillance continued through February 7, 2018. Study Selection Studies of unselected or generally asymptomatic adults with no known cardiovascular disease. Data Extraction and Synthesis Independent critical appraisal and data abstraction by 2 reviewers. Main Outcomes and Measures Cardiovascular morbidity; PAD morbidity; mortality; health-related quality of life; diagnostic accuracy; and serious adverse events. Results Five studies (N = 5864 participants) were included that examined the indirect evidence for the benefits and harms of screening and treatment of screen-detected PAD. No population-based screening trials evaluated the direct benefits or harms of PAD screening with the ABI alone. A single diagnostic accuracy study of the ABI compared with magnetic resonance angiography gold-standard imaging (n = 306) found low sensitivity (7%-34%) and high specificity (96%-100%) in a screening population. Two adequately powered trials (n = 4626) in asymptomatic populations with and without diabetes with a variably defined low ABI (≤0.95 or ≤0.99) showed no statistically significant effect of aspirin (100 mg daily) for composite CVD outcomes (adjusted hazard ratio [HR], 1.00 [95% CI, 0.81-1.23] and HR, 0.98 [95% CI, 0.76-1.26]). One trial (n = 3350) demonstrated no statistically significant increase in major bleeding events with the use of aspirin (adjusted HR, 1.71 [95% CI, 0.99- 2.97]) and no statistically significant increase in major gastrointestinal bleeding (relative risk, 1.13 [95% CI, 0.44-2.91]). Two exercise trials (n = 932) in screen-relevant populations reported no differences in quality of life, Walking Impairment Questionnaire walking distance, or symptoms at 12 and 52 weeks; no harms were reported. Conclusions and Relevance There was no direct evidence and limited indirect evidence on the benefits of PAD screening with the ABI in unselected or asymptomatic populations. Available studies suggest low sensitivity and lack of beneficial effect on health outcomes, but these studies have important limitations.
Endoscopic Treatment of Premalignant and Early Esophageal Malignancy

Barrett’s esophagus (BE) is a well-known risk factor for esophageal adenocarcinoma, and progression of metaplasia through dysplasia to adenocarcinoma is a widely accepted theory of esophageal carcinogenesis. High-grade dysplasia (HGD) has a high risk of progression to cancer, and esophageal resection (esophagectomy) has been recommended as a standard surgical therapy to treat HGD based on the previous studies demonstrating that the incidence of concomitant invasive cancer in the surgically resected specimens of patients with biopsy-proven HGD has been reported to be approximately 40 %. Esophagectomy is one of the most invasive surgeries in the upper gastrointestinal tract and is associated with high mortality and morbidity even with the recent refinement of surgical techniques and perioperative care. Given that lymph node involvement in patients with HGD and T1a cancer is unlikely (<2 %), esophagectomy may be unreasonably invasive. However, patients with HGD and T1a cancer have a chance for cure of disease, although overall prognosis of esophageal cancer is poor with 5-year survival of approximately 15 % despite multidisciplinary approaches including chemoradiation and surgical therapy. Therefore, it is extremely important to determine what the best approach is for this population to accomplish cure without residual or recurrent disease, while minimizing the postoperative morbidity and mortality.
Dialect analysis and modeling for automatic classification.

In this paper, we present our recent work in the analysis and modeling of speech under dialect. Dialect and accent significantly influence automatic speech recognition performance, and therefore it is critical to detect and classify non-native speech. In this study, we consider three areas that include: (i) prosodic structure (normalized f0, syllable rate, and sentence duration), (ii) phoneme acoustic space modeling and sub-word classification, and (iii) word-level based modeling using large vocabulary data. The corpora used in this study include: the NATO N-4 corpus (2 accents, 2 dialects of English), TIMIT (7 dialect regions), and American and British English versions of the WSJ corpus. These corpora were selected because the contained audio material from specific dialects/accents of English (N-4), were phonetically balanced and organized across U.S. (TIMIT), or contained significant amounts of read audio material from distinct dialects (WSJ). The results show that significant changes occur at the prosodic, phoneme space, and word levels for dialect analysis, and that effective dialect classification can be achieved using processing strategies from each domain.
Fuzzy Inventory Management

Inventory is one of the most expensive and important assets to many companies, representing as much as 50% of total invested capital. Combined with the fierce pressure to cut costs and the challenge of dealing with various types of uncertainties, researchers and practitioners alike have been motivated to use fuzziness in inventory management. In this chapter, we present economic order quantity, economic production quantity, single period, and periodic review inventory models under fuzziness. All models are demonstrated through numerical examples.
Abstract B12: Therapeutic potential of NTRK3 in desmoplastic small round cell tumor

Desmoplastic small round cell tumor (DSRCT) is a soft-tissue sarcoma that predominantly affects adolescent and young adult males and has a dismal prognosis, despite aggressive treatment. It is characterized by the t(11;22)(p13:q12) translocation that generates the EWSR1-WT1 chimeric transcription factor, a powerful oncogene and the main molecular driver of DSRCT. EWSR1-WT1 rewires global gene expression networks and activates aberrant expression of targets that contribute to an oncogenic expression program. It has been previously described that EWSR1-WT1 can activate neural gene expression (1), supporting the hypothesis that targeting neural differentiation markers might offer a novel therapeutic approach to treat DSRCT. Among those markers, our analysis of DSRCT tumors demonstrated prominent expression of neurotrophic tyrosine kinase receptor 3 (NTRK3; TrkC), a druggable receptor tyrosine kinase, specifically expressed in DSRCT compared to other translocation-driven sarcomas. We show that EWSR1-WT1 directly activates its expression, and that abrogation of NTRK3 reduces growth of DSRCT cells. Conversely, we show that pharmacologic targeting of NTRK3 is effective both in in vitro and in vivo models of DSRCT, suggesting that NTRK3 is a viable therapeutic target, especially in light of the recent clinical development of highly specific and effective NTRK inhibitors. Reference 1. Kang et al., Cancer Res 2014;15;74(16):4526-35. Citation Format: Lee Spraggon, Julija Hmeljak, Heather Magnan, Romel Somwar, Marina Asher, Alifiani B. Hartono, Sean Bong Lee, Marc Ladanyi. Therapeutic potential of NTRK3 in desmoplastic small round cell tumor [abstract]. In: Proceedings of the AACR Conference on Advances in Sarcomas: From Basic Science to Clinical Translation; May 16-19, 2017; Philadelphia, PA. Philadelphia (PA): AACR; Clin Cancer Res 2018;24(2_Suppl):Abstract nr B12.
Utilizing compassion and collaboration to reduce violence in healthcare settings

Violence in healthcare settings is a global problem and violent acts are more likely to occur in emergency departments (EDs). Significant barriers to reporting workplace violence persist among healthcare workers. This, and lack of shared definitions and metrics, increase the difficulty of assessing its prevalence, understanding its causes, and comparing the impact of interventions to reduce its frequency. While risk factors for violence in EDs have been articulated, less is known about how the perspectives of patients and accompanying persons, and their interactions with ED staff may contribute to violence. We discuss the nature and social context of ED violence and some approaches used to address this problem in the U.S. We argue that perpetrators of violence as well as healthcare staff who experience ED violence suffer when it occurs. While securing safety is paramount, compassionate practices to address this suffering and the social context from which it emerges should be developed and provided for all involved. Collaboration among stakeholders, including patients and family members, may lead to effective approaches to address this problem.
A Statistical Comparison of Security Visualization Efficiency Compared to Manual Analysis of IDS Log Data

For the security and identification of threats to computer network systems, system log files play a critical role in allowing system administrators to monitor and respond to security incidents. However, as threats continue to increase in size and complexity, the amount of raw data generated by intrusion detection systems (IDS) can quickly overwhelm security analysts who are tasked with sorting through the data in order to identify malicious traffic patterns. Security visualization provides big picture context for activities identified by the IDS as potentially malicious and this can then direct the analyst to view a smaller number of packets at a more granular level. The results of this research will show that there is a measurable gain in analyst performance using security visualization as compared to manually analyzing network data at the packet level alone.
Oral Health of Individuals with Mental Health Disorders

Objective: To analyze the oral and dental health conditions in a population of patients with a history of mental health disorders. Background: Individuals with mental health disorders are susceptible to dental disease related to poor oral hygiene, behavioral changes, medication effects, and systemic disease. Mental health and dental health reciprocally affect one another. Poor mental health has been associated with selfneglect, dry mouth, increased likelihood of substance abuse, and a higher susceptibility to oral infection. Similarly, poor dental health negatively affects mental health. Halitosis, dental caries, missing teeth, and affected speech can exacerbate mental health illness related to self-esteem and social anxiety. Methods: The Dental Registry and DNA repository (DRDR) at the University of Pittsburgh School of Dental Medicine was analyzed for patients with a history of mental health disorder. A total of 6,015 patient records were available from the DRDR at the time of this analysis. 1,068 patient records were available for individuals reporting a mental health disorder. We examined the prevalence of various dental conditions in a population of patients reporting a mental health disorder (N=1,068) in comparison to the rest of the registry (N=4,947), as well as the distribution of disorders and demographics. Mental health disorders included in this study are depression, anxiety, schizophrenia, bipolar disorder, post-traumatic stress disorder (PTSD), and eating disorders. Oral and dental health was assessed by dental caries, periodontal disease, gingivitis, tooth wear, complete and partial edentulism, xerostomia, coated tongue, gingivitis, oral ulceration, periapical lesions, and TMD. The prevalence of smoking, alcohol abuse, and substance abuse was also determined. Sex and ethnicity were also examined. Results: Of 6,015 patients, 1,068 reported a history of mental health disorder. 59.2% reported having depression, 16.7% reported anxiety, 13.3% reported bipolar disorder, 3.6% reported schizophrenia, 2.3% reported post-traumatic stress disorder (PTSD), and 2.3% reported an eating disorder. Mental illness was significantly associated with partial and complete edentulism, dental caries, tooth wear, xerostomia, erosion, TMD, ulceration, and gingivitis. Mental illness was also significantly associated with female sex and Whites. Conclusions: Mental health conditions can significantly affect the dental and oral health of affected individuals. Individuals with mental health conditions may be more susceptible to dental disease including dental caries, tooth wear, erosion, edentulism, dry mouth, gingival inflammation, and TMD. Understanding the association between mental and dental health can help direct prevention and treatment in a multidisciplinary setting.
Race/Ethnicity, Residential Segregation And Exposure To Ambient Air Pollution: The Multi-Ethnic Study Of Atherosclerosis (Mesa)

Objectives: We described the associations of ambient air pollution exposure with race/ethnicity and racial residential segregation. Methods: We studied 5921 White, Black, Hispanic, and Chinese adul...
Effect of Neuromuscular Blocking Agents on Sedation Requirements in Trauma Patients with an Open Abdomen.

The appropriate level of sedation in patients with an open abdomen following damage control laparotomy (DCL) is debated. Chemical paralysis with neuromuscular blocking agents (NMBAs) has been used to decrease time to abdominal closure. We sought to evaluate the effect of NMBA use on sedation requirements in patients with an open abdomen and to determine the effect of sedation on patient outcomes. A retrospective cohort study was conducted at an American College of Surgeons' verified level 1 trauma center. Adult trauma patients who underwent DCL between 2009 and 2015 were included. Patients with an intensive care unit length of stay of less than 48 hours and those who died before abdominal closure were excluded. The NMBA+ group received continuous NMBA within 24 hours of DCL; the NMBA- group did not. The primary outcome was cumulative sedation dose during the 7 days following DCL. Secondary outcomes included Richmond Agitation-Sedation Scale (RASS) score, mechanical ventilation-free days, and delirium-coma-free days. Delirium-coma-free days were analyzed with linear regression. A total of 222 patients were included (NMBA+ 125; NMBA- 97). Demographics were similar between groups including age, Injury Severity Score, and mechanism of injury. The median time to closure in the overall cohort was 2 days (interquartile range [IQR] 1-2 days). Propofol and fentanyl were the primary sedatives used. The NMBA+ group received higher cumulative doses of propofol (NMBA+ 5405 mg, IQR 3103-10,573 mg; NMBA- 3601 mg, IQR 1605-6887 mg; p=0.007), but not of fentanyl. Time to abdominal closure, but not NMBA use, was associated with a higher cumulative propofol dose on multivariate analysis. The NMBA+ group had significantly lower RASS scores on the first 3 days following DCL. Mechanical ventilation-free days (NMBA+ 20 days vs NMBA- 18 days, p=0.960) and delirium-coma-free days (NMBA+ 18 days vs NMBA- 18 days, p=0.610) were similar between the groups. On linear regression, cumulative propofol dose was associated with fewer delirium-coma-free days (β-coefficient -0.007, 95% confidence interval -0.015 to -0.003). In trauma patients managed with DCL, higher cumulative sedative doses were administered in patients who received adjunctive NMBA, although NMBA therapy was not associated with a higher cumulative propofol dose on multivariate analysis. Consideration must be given to the potential effect of sedation on delirium and awakening following DCL.
Constraint-based analysis for causal discovery in population-based biobanks

Abstract Availability of large genetic databases has led to the development of powerful causal inference methods that use genetic variables as instruments to estimate causal effects. Such methods typically make many assumptions about the underlying causal graphical model, are limited in the patterns they search for in the data, and there is no guide for systematic analysis of a large database. Here, we present cGAUGE, a new pipeline for causal Graphical Analysis Using GEnetics that utilizes large changes in the significance of local conditional independencies between the genetic instruments and the phenotypes. We detect cases where causal inference can be performed with minimal risk of horizontal pleiotropy. Moreover, we search for new graphical patterns to reveal novel information about the underlying causal diagram that is not covered by extant methods, including new direct links, colliders, and evidence for confounding. We present theoretical justification, simulations, and apply our pipeline to 70 complex phenotypes from 337,198 subjects from the UK Biobank. Our results cover 102 detected causal relationships, of which some are new and many are expected. For example, we detect a direct causal link from high cholesterol to angina and a feedback loop between angina and myocardial infarction. We also corroborate a recent observational link between asthma and Crohn’s disease. Finally, we detect important features of the causal network structure including several causal hubs such as intelligence and waist circumference.