cssi/SciSciGPT-SciSciNet huggingface dataset:
Epidural catheter placement in children with baclofen pumps.

Background Children with cerebral palsy often suffer from increased tone, which can be treated with intrathecal baclofen via implanted pump. Additionally, they often require major orthopedic surgery for hip reconstruction; however, the presence of an intrathecal baclofen pump is a relative contraindication to regional anesthesia due to concerns about damaging the intrathecal baclofen pump system. Aims (a) To evaluate adverse events related to placing epidural catheters in children with intrathecal baclofen pumps and (b) describe our multidisciplinary approach to the care of these complex patients. Methods Children with cerebral palsy and intrathecal baclofen pump in situ who underwent hip reconstruction between 2010 and 2019 and had a perioperative epidural placed were reviewed retrospectively. Charts were assessed for adverse events or intrathecal baclofen complications. Fluoroscopic images were reviewed to evaluate the proximity between epidural and intrathecal baclofen catheters. The process of coordinating multiple services was examined. Results Sixteen children met the inclusion criteria. There were no major complications following epidural placement. Postoperative pump interrogation was normal for all patients. Fluoroscopy was utilized for 9/16 (56%) epidural procedures. Epidurogram was used to confirm 11/16 catheters (68%). Children with an intrathecal baclofen pump were identified by orthopedic surgeons at the time of surgical booking and referred to the regional anesthesia team for review. The neurosurgical, pain, and regional anesthesia teams determined the appropriateness and safety of approaching the neuraxis. Pain and/or regional anesthesiologists with competency in spine fluoroscopy were scheduled on the day of surgery for fluoroscopically guided epidural placement. Postoperatively, catheters were managed by the acute pain team. Intrathecal baclofen pumps were interrogated by the baclofen pump team prior to patient discharge. Discussion In this case series, not only was epidural placement feasible but also there were no observed complications. This work highlights the importance of a multidisciplinary approach to complex regional anesthetic techniques, as well as the importance of basic competency in spine fluoroscopy for regional anesthesiologists.
Inter‐group conflict in a cooperatively breeding bird: New insights into “home field advantage”

Conflicts between groups of animals have individual‐level fitness consequences that can influence the evolution of social behaviour. In the cooperatively breeding greater ani (Crotophaga major), groups occasionally destroy the eggs of their neighbours, causing the attacked group to abandon their nest. Prior research suggested that such conflicts occur when two groups build nests in close proximity, and that established groups tend to evict newcomers. However, inter‐group conflict had never been directly observed. Here, we report the first photographic evidence of egg destruction by greater anis. Twelve artificial nests containing clay eggs were placed in the field with the intent of attracting nest predators. Camera footage revealed that although only two nests were discovered by heterospecific predators (white‐faced capuchins, Cebus capucinus), five nests were visited by resident anis, who in three cases damaged the clay eggs by grasping them with their bills and ejecting them from the nest cup. Nests were discovered between 2 and 96 hr after being placed in the field (mean = 34 hr) and were visited up to 18 times by up to 4 individuals simultaneously. The distance between artificial nests and the nearest known ani territory ranged from 0.13 to 0.28 km (mean = 0.2 km). Resident groups did not subsequently breed at the nest sites that they attacked, consistent with the hypothesis that the main benefit of inter‐group conflict is to reduce competition for local resources rather than to usurp nest sites. This accidental experiment reveals that greater anis closely monitor nesting activity near their territories, which may contribute to the strong “home field advantage” that resident groups hold over intruders.
Compliance to Patient Safety Culture

Health care regulation and compliance create an effective framework for safety; however the time has come to synchronize high reliability concepts and shift the focus to strategies that will achieve a culture of safety.
Fan Ties and Friendships: A Longitudinal Network Study of Division III Sports on Campus

The purpose of this longitudinal actor-based network study is to examine the evolution of sport fan ties and friendship ties on Division III campuses. Using two years of network data from a cohort of new students at a Division III institution, a SIENA model is developed to empirically test the co-evolution of fan ties and friendship ties. Grounded in student development, sport consumer behavior, and network theories, the overarching goal of this study is to explore the causal effect of fan ties on friendship ties among new students. To ascertain the value of Division III sports on campus, the authors explore the role of sports on campus in promoting friendships for new students based on the strong theoretical tradition from student development highlighting the salience of peer relationship in student success and retention. Accordingly, theoretical implications related to sport fan networks are considered within practical discussion of Division III sports and retention.
DCGH: Dynamic Computer Generated Holography for Speckle-Free, High Fidelity 3D Displays

Computer Generated Holography (CGH) is a promising technique for synthesizing 3D images on-demand. CGH systems sculpt light by computing a 2D modulation pattern to shape the phase or the amplitude of a coherent light source. Yet, static wave modulation restricts feasible holograms to a very small subset of all the possible illumination patterns where speckle noise is omnipresent. Here, we introduce Dynamic Computer Generated Holography (DCGH), a novel light sculpting technique that modulates light both spatially and temporally. DCGH has many more degrees of control to eliminate unwanted wave correlations and yields high fidelity, speckle- free 3D holograms. Our technique relies on an algorithm that simultaneously computes a set of engineered coherent wavefronts by optimizing them as a whole to best render the desired 3D illumination pattern when their contributions are rapidly superimposed and averaged in time. We have implemented DCGH with a Digital Micromirror Device (DMD) and synthesized 3D holograms made of up to 50 mutually optimized waves with refresh rates of 190 3D images per second. Our experimental results indicate that DCGH yields 3D images with improved resolution and contrast, successfully addressing the shortcomings of single-frame holography. Our technique can be implemented with inexpensive, low-power hardware, as a compact, portable 3D display that is perfectly suited for virtual and augmented reality applications.
Smooth graph learning for functional connectivity estimation.

Abstract Functional connectivity (FC) estimated from functional magnetic resonance imaging (fMRI) signals is important in understanding neural representation and information processing in cortical networks. However, due to a lack of ”ground truth” FC pattern, the reliability and robustness of FC estimates are usually examined in downstream FC analysis tasks, such as performing participant’s identification (also known as ”fingerprinting”). In this paper, we propose to learn FC via a smooth graph learning framework. In particular, we treat each time frame of the fMRI time series as a graph signal on an underlying functional brain graph, and estimate the smooth graph functional connectivity (SGFC) by learning the weighted graph adjacency matrix based on graph signal smoothness assumption. We demonstrate that our approach gives rise to a natural and sparse graph representation of FC from which reliable graph measures can be extracted. Reliability of SGFC is evaluated in the context of fingerprinting and compared to correlation FC (CFC). SGFC achieves higher fingerprinting accuracy across several different experiment settings; the improvement is even more significant when a shorter fMRI scanning length is used for FC estimation. In addition to being reliable, we also validate the cognitive relevance of SGFC by using it to predict fluid intelligence. Finally, in evaluating topological measures of the sparse graph, SGFC reveals a more small-world and modular structure compared to CFC. Together, our results suggest that the smooth graph learning framework produces a naturally sparse, reliable, and cognitive-relevant representation of functional connectivity.
Ferrate(VI)-peracetic acid oxidation process: Rapid degradation of pharmaceuticals in water

Abstract This paper presents, for the first time, an oxidation process of ferrate(VI) (Fe(VI), FeO42-)-peracetic acid (CH3C(O)OOH, PAA) to rapidly degrade micropollutants in water. The effect of concentrations of Fe(VI) and PAA showed that complete removal (degradation below detection limit) of a pharmaceutical, carbamazepine (CBZ, 10.0 µM), could be achieved in 60 s at a molar ratio of Fe(VI) to CBZ of 20.0 and 100.0 µM PAA under mild alkaline condition (pH 9.0). The results of the experiments performed in the presence of quenching agents, i.e., tert-butyl alcohol and 2,4-hexadiene, suggested that the iron-based reactive species (Fe(V)/Fe(IV)) and/or acetylperoxyl radicals (CH3C(O)OO●/CH3C(O)O●) were most likely responsible for the rapid oxidation of CBZ, rather than the hydroxyl radical (●OH). The major role of Fe(V)/Fe(IV) was supported by the high mass balance between loss of PMSO and formation of PMSO2 (>90%) during the oxidation of PMSO by Fe(VI)-PAA, which was not observed in the absence of iron species, i.e., PAA-Co(II)-PMSO system having acetylperoxyl radicals as reactive species. Significantly, the Fe(VI)-PAA oxidation process could degrade several other pharmaceuticals (i.e., sulfamethoxazole, sulfadimethoxine, trimethoprim, atenolol, propranolol, and caffeine) within 60 s, indicating its great potential in eliminating pollutants of emerging concern from water.
Specificity of California mouse pup vocalizations in response to olfactory cues

In rodents, young pups communicate with their parents through harmonic calls and ultrasonic vocalizations (USVs). These forms of communication can improve chances of survival, since pups rely on their parents for thermoregulation, nutrition and protection. The extent to which pups modulate calls in response to their surroundings remains unclear. In this study we examined whether olfactory stimuli influence characteristics of pup calls, and how these calls may be affected by pup sex and litter size, in the California mouse (Peromyscus californicus). Pups were isolated and audio recorded during an initial, 3-minute control period, after which they were exposed for 5 minutes to bedding containing one of 4 olfactory cues: scent from their home cage, scent from the home cage of an unfamiliar family, coyote urine, or no scent. Latency to call, call rate, call duration and call characteristics (e.g. frequency and amplitude) were compared between the control period and olfactory-exposure period as well as among olfactory conditions. Pups from 2-pup litters called more quietly (lower amplitude) when exposed to odor from a predator while pups from 3-pup litters called louder (higher amplitude). Additionally, pups tended to reduce their call rates in response to odors from their home cage, consistent with contact quieting. However, pups tended to increase their rate of calling when exposed to predator urine, in contrast to the expectations of predator-induced vocal suppression. Lastly, male pups produced higher-frequency calls and more USVs than females. These results indicate that a number of pup call characteristics in this species can be influenced by acute olfactory stimuli as well as factors such as litter size and sex. The value of these pup call variations for offspring-parent communication is unclear: whether they elicit different parental responses is unknown and would be an interesting/valuable/informative avenue for future studies.
The Molecular Weights of Vertebrate Histones Exploiting a Modified Sodium Dodecyl Sulfate Electrophoretic Method

Histones have been analyzed by use of sodium dodecyl sulfate gel electrophoresis. A standard curve of histone mobility versus the logarithm of molecular weight was obtained and it was found to be different from the standard protein curve commonly used for molecular weight determination with this technique. One histone fraction (the lysine-rich histone) consists of two groups of molecules differing in molecular weight by approximately 1000. All the other histone fractions are homogenous with respect to molecular weight. The molecular weights of lysine-rich histones vary somewhat in different phylogenetic orders whereas the molecular weights of the other histones are constant in all vertebrates with the sole exception of histone F2b which has a somewhat smaller molecular weight in fish. The observations are correlated with recent observations on the mobility of these histones in a pH 2.7 electrophoretic system in the absence of sodium dodecyl sulfate (Panyim, S., Bilek, D. and Chalkley, R., J. Biol. Chem., 246, 4206 (1971)).
Exterior stokes flows with stick-slip boundary conditions

Steady two-dimensional creeping flows induced by line singularities in the presence of an infinitely long circular cylinder with stick-slip boundary conditions are examined. The singularities considered here include a rotlet, a potential source and a stokeslet located outside a cylinder and lying in a plane containing the cylinder axis. The general exterior boundary value problem is formulated and solved in terms of a stream function by making use of the Fourier expansion method. The solutions for various singularity driven flows in the presence of a cylinder are derived from the general results. The stream function representation of the solutions involves a definite integral whose evaluation depends on a non-dimensional slip parameter λ1. For extremal values, λ1 = 0 and λ1 = 1, of the slip parameter our results reduce to solutions of boundary value problems with stick (no-slip) and perfect slip conditions, respectively.The slip parameter influences the flow patterns significantly. The plots of streamlines in each case show interesting flow patterns. In particular, in the case of a single rotlet/stokeslet (with axis along y-direction) flows, eddies are observed for various values of λ1. The flow fields for a pair of singularities located on either side of the cylinder are also presented. In these flows, eddies of different sizes and shapes exist for various values of λ1 and the singularity locations. Plots of the fluid velocity on the surface show locations of the stagnation points on the surface of the cylinder and their dependencies on λ1 and singularity locations.
Chapter 14 The timing of innovation: Research, development, and diffusion

Publisher Summary The analysis of the timing of innovation posits a particular innovation and examines the way the expected benefits, the cost of research and development, and interactions among competing firms combine to determine the pattern of expenditure across firms and over time, the date of introduction, and the identity of the innovating firm. In the case of a sequence of innovations, the expected lifetime of a given innovation and the pattern of technological leadership are also determined endogenously. Given that an innovation has been perfected, the extent and timing of its dissemination into use may be examined. This may depend upon a number of factors, including the existence of rival firms and institutions, which may facilitate or retard the dissemination of innovations. The chapter discusses the issues of innovation production in the context of symmetric noncooperative models. The chapter investigates the extent of dissemination of the innovation, where this dissemination is achieved through licensing.
Production of and Sensitivity to Colicins Among Serologically Classified Strains of Escherichia coli

Abstract A significant proportion of 242 serologically classified strains of Escherichia coli of human origin produced colicins (33%) or were inhibited by one or more of six standard colicins (57%). The most common colicins identified were E1, I, and B; colicins B and V had greatest range of activity. Generally, neither the production of, nor sensitivity to, individual colicins was restricted to strains of a single serogroup. The coexistence of strains of one serogroup that were sensitive to the action of a colicin produced by strains of another serogroup was encountered among 2 of 21 fecal specimens containing strains of multiple serogroups. The production of colicins was not a major determinant in the acquistion of, or subsequent changes in, strains of E. coli in the feces of 10 newborn infants.
A Metrics Suite for Evaluating Flexibility and Complexity in Service Oriented Architectures

Service Oriented Architecture (SOA) is emerging to be the predominant architectural style of choice for many organizations due to the promised agility, flexibility and resilience benefits. However, there are currently few SOA metrics designed to evaluate complexity, effort estimates and health status of SOA solutions. This paper therefore proposes a SOA metrics framework which includes both service level and SOA-wide metrics to measure design and runtime qualities of a SOA solution. The SOA-wide metrics predict the overall complexity, agility and health status of SOA solutions, while service level metrics focus on the fundamental building blocks of SOA, i.e. services. The combined views deliver a compelling suite of SOA metrics that would benefit organizations as they consider adopting SOA. These metrics, which are based on observations of many SOA engagements, are illustrated through a case study that describes a recent ongoing project at IBM where SOA was utilized to build the solution assets.
Low self-efficacy is associated with decreased emergency department use in underserved men with prostate cancer.

Abstract Background Self-efficacy has been strongly associated with health behavior and health maintenance. We examined the relationship between patient-provider self-efficacy and emergency department usage in low-income, underinsured, or uninsured patients with prostate cancer. Methods We prospectively analyzed quality of life, behavior, and self-efficacy data from men enrolled in a state-funded program providing free prostate cancer care. We summarized patient characteristics stratified by self-efficacy scores (high, mid, and low) and by emergency department visit (any vs. none). We conducted a multivariate repeated measures regression analysis with negative binomial distribution to calculate predicted counts of emergency department visits over time across the self-efficacy strata. Results Our cohort included 469 men with a maximum follow-up time of 84 months. Of these men, 70 had visited the emergency department during their enrollment for a total of 118 unique visits. The regression analysis demonstrated a decreasing number of emergency department visits over time for the low (P = 0.0633) and mid (P = 0.0450) self-efficacy groups but not for the high self-efficacy group (P = 0.1155). Pain (22.9%), urinary retention (18.6%), and fever (5.9%) were the most common reasons for emergency department visits. Conclusions Patients with low and mid self-efficacy had a decreasing number of emergency department usage over time. Those with high self-efficacy did not follow these trends. Interventions to improve communication between patients and primary treatment teams could prove beneficial in avoiding excess emergency department use.
Comparison of the Pathogenesis of the Angola and Ravn Strains of Marburg Virus in the Outbred Guinea Pig Model

Background. Phylogenetic comparisons of known Marburg virus (MARV) strains reveal 2 distinct genetic lineages: Ravn and the Lake Victoria Marburg complex (eg, Musoke, Popp, and Angola strains). Nucleotide variances of >20% between Ravn and other MARV genomes suggest that differing virulence between lineages may accompany this genetic divergence. To date, there exists limited systematic experimental evidence of pathogenic differences between MARV strains. Methods. Uniformly lethal outbred guinea pig models of MARV-Angola (MARV-Ang) and MARV-Ravn (MARV-Rav) were developed by serial adaptation. Changes in genomic sequence, weight, temperature, histopathologic findings, immunohistochemical findings, hematologic profiles, circulating biochemical enzyme levels, coagulation parameters, viremia levels, cytokine levels, eicanosoid levels, and nitric oxide production were compared between strains. Results. MARV-Rav infection resulted in delayed increases in circulating inflammatory and prothrombotic elements, notably lower viremia levels, less severe histologic alterations, and a delay in mean time to death, compared with MARV-Ang infection. Both strains produced more marked coagulation abnormalities than previously seen in MARV-infected mice or inbred guinea pigs. Conclusions. Although both strains exhibit great similarity to pathogenic markers of human and nonhuman primate MARV infection, these data highlight several key differences in pathogenicity that may serve to guide the choice of strain and model used for development of vaccines or therapeutics for Marburg hemorrhagic fever.
Richard H. Thaler, Cass R. Sunstein, Nudge: Improving decisions about health, wealth, and happiness

Thaler and Sunstein have written an important book. Though costumed in the guise of pop economics, complete with a cute logo—Nudge is, in fact, a manifesto for the new paternalism. Well written, witty to the point of being charming, consistently interesting, disarmingly self-referential, and loaded with crisp summaries of the psychology literature on human fallibility, Nudge’s dust jacket is justly festooned with blurbs from luminaries. But don’t be fooled. Thaler and Sunstein charm their readers, but they are after some very big game. This is a book that both measures the inroads psychology has made into contemporary economics, and argues a compelling brief for the new paternalism. We have ways, say Thaler and Sunstein, of making you happy. Thaler and Sunstein begin with ‘‘dogmatic anti-paternalists’’ in their sights. Economists, traditionally heavily represented among those opposed to paternalism, hold three mistaken beliefs about paternalism. They are: one, the belief that paternalism must be coercive, two, the belief that paternalism is avoidable, and, most important, three, the belief that people make choices that are better, by their own lights, than the choices that would be made for them by paternalists. Each of these traditional beliefs is a misconception or false, say the authors. Thaler and Sunstein regard three as simply false. In many situations, they say, paternalistic experts really do know better, and the proof is that those who have benefited from paternalistic expertise seem to concur. Traditional paternalism is coercive, so it is a stretch to label this belief a misconception, but never mind: Thaler and Sunstein want to rebrand the term, arguing that their ‘‘libertarian paternalism’’ is not an oxymoron. Nudgers, unlike bad old paternalists, help people without compulsion. A nudge steers the paternalized person, but always leaves open the option for the paternalized person to choose another course.
A spur unfolding model for the radiolysis of water

Abstract A previous treatment of the theory of the chemical action of high energy electrons contains the spur yield, Gsp, as a parameter. Use of this theory allows one to obtain Gsp for any reaction for which sufficient experimental data are available. A model for the spur in dilute aqueous solution is considered here with the aim to provide some reaction details in that track entity. From the detailed considerations presented here, it appears that the size of the spurs must be taken as decreasing with the number of radical pairs initially present, if the radiation chemical yields are to be compatible with experiments. There is an unavoidable lack of uniqueness in such treatments which has led to the question of further comparison with experiments. This important question is also discussed.
Inversion of nonlinear and time-varying systems

This paper is concerned with the inversion of implementations for systems that may generally be nonlinear and time-varying. Specifically, techniques are presented for modifying an implementation of a forward system, represented as an interconnection of subsystems, in such a way that an implementation for the inverse system is obtained. We focus on a class of modifications that leave subsystems in the inverse system unchanged with respect to those in the forward implementation. The techniques are therefore well-suited to the design of matched pre-emphasis and de-emphasis filters, as approximations due to coefficient quantization in the forward system are naturally matched in the inverse. In performing the inversion, an explicit input-output characterization of the system is not required, although the forward system must be known to be invertible. The techniques are applied to the inversion of nonlinear and time-varying systems, as well as to the problem of sparse matrix inversion.
True or false: All genes are rhythmic

Multiple microarray studies have documented the importance of circadian regulation of gene expression in different species under many experimental conditions. However, these reports often differ with respect to the identity and total number of oscillating genes. This review explores the interrelated questions of: How many genes are oscillating within individual tissues or systems? What are the forces that drive these oscillations? What are the methodological sources contributing to the discrepancy between estimates of gene oscillation? And finally, what are the physiological and systemic implications of oscillatory gene expression with respect to circadian molecular biology? Since this remains an evolving area of investigation, this hypothetical and speculative review also highlights the potential limitations faced by the current data in the literature relating to the novel paradigm(s) proposed.
Determination of the 6 Li → α + d asymptotic D - to S -state ratio by a restricted phase shift analysis

We describe a new method for determining the asymptotic normalization constants of the ${}^{6}\mathrm{Li}\ensuremath{\rightarrow}\ensuremath{\alpha}+d$ wave function. This method is based on a phase shift analysis of ${}^{6}\mathrm{Li}{+}^{4}\mathrm{He}$ elastic scattering data, with high partial wave parameters obtained from Coulomb-wave Born approximation calculations for d-exchange scattering. Applying this analysis to ${}^{6}\mathrm{Li}{+}^{4}\mathrm{He}$ elastic scattering at ${E}_{\mathrm{c}.\mathrm{m}.}=2.2 \mathrm{MeV},$ we obtain a value for the asymptotic D- to S-state ratio of the ${}^{6}\mathrm{Li}\ensuremath{\rightarrow}\ensuremath{\alpha}+d$ wave function of $\ensuremath{-}0.025\ifmmode\pm\else\textpm\fi{}0.006\ifmmode\pm\else\textpm\fi{}0.010.$
Neutrophil leukocyte reserves in lymphoreticular malignancies

The marginal neutrophil leukocyte pool and the bone marrow neutrophil reserves were assessed in 43 patients with lymphoreticular malignancies, using epinephrine and steroid stimulation. Thirty-three patients were studied before staging, following splenectomy, before and after nodal irradiation and during remission induction chemotherapy. Ten patients in partial remission were studied after 12 months or more of chemotherapy. A neutrophil count of 1,500–2,500 cells/mm3 is not a sufficient guide for modifying the chemotherapy. The response to steroid stimulation may be a more dependable guide to evaluate the patient's potential risk for infection.
Lung function, 25-hydroxyvitamin D concentrations and mortality in US adults

To explore the associations between serum concentrations of vitamin D (25(OH)D) and all-cause mortality among US adults defined by lung function (LF) status, particularly among adults with obstructive LF (OLF). Data from 10 795 adults aged 20–79 years (685 with restrictive LF (RLF) and 1309 with OLF) who participated in the Third National Health and Nutrition Examination Survey (1988–1994), had a spirometric examination, and were followed through 2006 were included. During 14.2 years of follow-up, 1792 participants died. Mean adjusted concentrations of 25(OH)D were 75.0 nmol/l (s.e. 0.7) for adults with normal LF (NLF), 70.4 nmol/l (s.e. 1.8) for adults with RLF, 75.5 nmol/l (s.e. 1.5) for adults with mild obstruction and 71.0 nmol/l (s.e. 1.9) among adults with moderate or worse obstruction (P=0.030). After adjustment for sociodemographic factors, lifestyle factors, clinical variables and prevalent chronic conditions, a concentration of <25 nmol/l compared with ⩾75 nmol//l was associated with mortality only among adults with NLF (hazard ratio (HR) 1.76; 95% confidence interval (CI) 1.03, 3.00). Among participants with OLF, adjusted HRs were 0.65 (95% CI 0.29, 1.48), 1.21 (95% CI 0.89, 1.66) and 0.97 (95% CI 0.78, 1.19) among those with concentrations <25, 25–<50 and 50–<75 nmol/l, respectively. Baseline concentrations of 25(OH)D did not significantly predict mortality among US adults with impaired LF.
An analytical treatment of discretely varying constraints and inertial properties in multi-body dynamics

A computerized procedure is presented for calculating instantaneous velocity changes due to discrete imposition of constraints, impact or discrete inertial changes. Such discrete changes are impulsive in nature, involve wave propagation and therefore usually require detailed modeling for accurate prediction. It is demonstrated that when modeling is coarse, physically unrealistic results can be produced. The present procedure, which concentrates on finite element analysis, reduces the need for detailed modeling by assuming that only those velocities in the neighborhood of grid points involved in the constraint or those rigidly connected to grid points involved in the constraint need be considered in calculating velocity changes. The procedure utilizes Newton's second law and as such conserves momentum where valid. Sample problems are provided.
Identifying Patients Nearing the End of Life From Congestive Heart Failure or Chronic Obstructive Pulmonary Disease

PURPOSE: A prospective cohort study was conducted to test our ability to identify chronically ill patients at near term risk of death by asking their primary care physician (PCP) the question, "Would you be surprised if this patient died within the next year of CHF or COPD?" METHODS: Patients were eligible for inclusion if 1) their clinic chart problem list carried a diagnosis of CHF or COPD, 2) they had been hospitalized within the past two years with primary or secondary diagnosis of CHF or COPD, or 3) direct identification by their PCP. Chart review was used to exclude patients erroneously carrying these diagnoses (e.g. coding errors), inactive patients (deceased or changed providers) and those patients with normal ejection fractions or not requiring scheduled β-2 agonist and anticholinergic bronchodialator therapy. Patients were then stratified on the basis of their PCP's response to the question, "Would you be surprised if this patient died in the next year from CHF or COPD?" All patients screened and stratified by the question were followed for the primary endpoint of death. RESULTS: The initial data query identified 190 patients with CHF and/or COPD. A chart review excluded eight inactive patients and thirty-one patients who did not meet inclusion criteria or did meet exclusion criteria for significant disease. Of the remaining 151 patients, there were 72 whose PCP answered that he/she would not be surprised if the patient died from CHF and/or COPD in the next year. Within nine months, nine of these patients have died from complications of their CHF or COPD. There have been no deaths in the 79 patients whose PCP answered that they would be surprised if their patient died in the next year from CHF or COPD. (p-value < 0.01) CONCLUSION: Patients with CHF and/or COPD at risk of near term death can be differentiated from those who are not at high risk by the PCPs'response to the question, "Would you be surprised if this patient died within the next year of their CHF and/or COPD?" Such screening may be useful to more efficiently target palliative services and end of life care planning to patients with advanced CHF and/or COPD.
Effects of acoustic- and optical-phonon sidebands on the fundamental optical-absorption edge in crystals and disordered semiconductors

We present the results of a parameter-free first-principles theory for the fine structure of the Urbach optical-absorption edge in crystalline and disordered semiconductors. The dominant features are recaptured by means of a simple physical argument based on the most probable potential-well analogy. At finite temperatures, the overall linear exponential Urbach behavior of the subgap optical-absorption coefficient is a consequence of multiple LA-phonon emission and absorption sidebands that accompany the electronic transition. The fine structure of subgap absorption spectra observed in some materials is accounted for by multiple TO-, LO-, and TA-phonon absorption and emission sidebands. Good agreement is found with experimental data on crystalline silicon. The effects of nonadiabaticity in the electron-phonon interaction are calculated.
Analysis of the measurement precision of arterial lumen and wall areas using high‐resolution MRI

High-resolution MRI may be used to monitor the progression of human carotid atherosclerosis by measuring the lumen and wall area changes over time. The purpose of this study was to analyze the precision of quantitative measurements of lumen and wall areas. Two independent MR scans near the carotid bifurcation were conducted on eight patients within 2 weeks. The error of lumen area measurement was 6.2%, 9.2%, and 9.7% for T1, proton density, and T2-weighted images, respectively, and the error of wall area measurement was 10.8%, 10.9%, and 12.0%. The precision of area measurement correlates strongly with image quality. Magn Reson Med 44:968–972, 2000. © 2000 Wiley-Liss, Inc.
Transfer of learned perception of sensorimotor simultaneity

Synchronizing a motor response to a predictable sensory stimulus, like a periodic flash or click, relies on feedback (somesthetic, auditory, visual, or other) from the motor response. Practically, this results in a small (<50 ms) asynchrony in which the motor response leads the sensory event. Here we show that the perceived simultaneity in a coincidence-anticipation task (line crossing) is affected by changing the perceived simultaneity in a different task (pacing). In the pace task, human subjects were instructed to press a key in perfect synchrony with a red square flashed every second. In training sessions, feedback was provided by flashing a blue square with each key press, below the red square. There were two types of training pace sessions: one in which the feedback was provided with no delay, the other (adapting), in which the feedback was progressively delayed (up to 100 ms). Subjects’ asynchrony was unchanged in the first case, but it was significantly increased in the pace task with delay. In the coincidence-anticipation task, a horizontally moving vertical bar crossed a vertical line in the middle of a screen. Subjects were instructed to press a key exactly when the bar crossed the line. They were given no feedback on their performance. Asynchrony on the line-crossing task was tested after the training pace task with feedback. We found that this asynchrony to be significantly increased even though there never was any feedback on the coincidence-anticipation task itself. Subjects were not aware that their sensorimotor asynchrony had been lengthened (sometimes doubled). We conclude that perception of simultaneity in a sensorimotor task is learned. If this perception is caused by coincidence of signals in the brain, the timing of these signals depends on something—acquired by experience—more adaptable than physiological latencies.
Estrogen Facilitates Neurite Extension via Apolipoprotein E in Cultured Adult Mouse Cortical Neurons

Literature review suggests a close relationship between estrogen and apolipoprotein E (ApoE) in the central nervous system. Epidemiology studies show that estrogen replacement therapy (ERT) decreases the morbidity from several chronic neurological diseases. Alleles of ApoE modify the risk for and progression of the same diseases. ApoE levels in the rodent brain vary during the estrous cycle and increase after 17beta-estradiol administration. Both estradiol and ApoE3, the most common isoform of human ApoE, increase the extent of neurite outgrowth in culture. Combined, these observations suggest a common mechanism whereby estrogen may increase ApoE levels to facilitate neurite growth. We tested this hypothesis by characterizing the effects of estradiol and ApoE isoforms on neurite outgrowth in cultured adult mouse cortical neurons. Estradiol increased ApoE levels and neurite outgrowth. ApoE2 increased neurite length more so than ApoE3 in the presence of estradiol. Estradiol had no effect on neurite outgrowth from mice lacking the ApoE gene or when only ApoE4, the isoform of ApoE that is associated with increased risk of neurological disease, was exogenously supplied. Cultures from mice transgenic for human ApoE3 or ApoE4 showed the same isoform-specific effect. Neuronal internalization of recombinant human ApoE3 was greater than ApoE4, and ApoE3 was more effective than ApoE4 in facilitating neuronal uptake of a fatty acid. We conclude that estradiol facilitates neurite growth through an ApoE-dependent mechanism. The effects of ERT on chronic neurological diseases may vary with ApoE genotype. The clinical use of ERT may require ApoE genotyping for optimal efficacy.
On linear differential operators related to the Jacobian conjecture

The main result of this work is the following theorem: Let P, Q ∈ C [x,y] satisfy the Jacobian identity ∂P∂x∂Q∂y−∂P∂y∂Q∂x=1. Let E2 denote the ring of entire functions on C2. For f ∈ E2, set D1(f)∂P∂x∂f∂y−∂P∂y∂f∂x. If D1(E2) is dense in E2, then C [P,Q] = C[x,y]. The question whether or not D1(E2) is dense in E2 is reduced to the question whether or not a certain Frechet space admits continuous linear operators with empty spectrum.
Remodeling of the aorta after successful balloon coarctation angioplasty

Abstract The purpose of this study was to examine whether remodeling of the aorta takes place after successful balloon angioplasty of aortic coarctation. During the 35 month period ending in December 1987, 30 children, aged 14 days to 13 years, underwent balloon angioplasty of unoperated aortic coarctation, with a resultant reduction in mean coarctation gradient from 44 ± 20 to 10 ± 8 mm Hg (p 20 mm Hg with or without recoarctation on angiography). Measurements of the aorta at five sites (the ascending aorta, isthmus, coarcted segment and descending aorta distal to the coarctation and at the level of the diaphragm) were made in two angiographic views, corrected for magnification and averaged. A standardized diameter of the aorta at the five locations was calculated for each case before angioplasty and at follow-up study, and variance of the diameter was then determined. The variance of standardized aortic measures (0.233 versus 0.287) was similar (p > 0.05) in both groups before angioplasty, whereas at follow-up study (0.057 versus 0.129) they were different (p = 0.01). There was a greater percent improvement at follow-up study (0.233 versus 0.057) in the group with good results than in the group with fair or poor results (0.287 versus 0.129). Cluster analysis was also indicative of remodeling of the aorta in the group with good results. These data indicate a greater remodeling and normalization of the aorta after successful balloon angioplasty of aortic coarctation, suggesting that normalized flow across the dilated coarctation allows optimal growth of the aortic segments.
A proposed classification for uniform endoscopic description of surgical fundoplication.

Objective assessment of postfundoplication anatomy is of utmost importance especially if reoperative intervention is being planned. There is a lack of uniformity in the description of endoscopic findings in these patients. The purpose of this study was to propose a classification for standardized endoscopic reporting of postfundoplication anatomy. After institutional review board approval, preoperative endoscopic findings of patients who underwent reoperative intervention from 1992 to 2011 were reviewed and classified. The classification included four factors: E (distance of GEJ to crus), S (amount of gastric tissue between the GEJ and fundoplication), F (fundoplication configuration), and P (paraesophageal hernia). The endoscopic findings of 310 patients who underwent reoperative antireflux surgery were classified using the newly proposed classification model. A significant increase in the number of procedures was noted over the years. There was no change in presenting symptoms and patterns of failure over the years. The classification model was easily applicable to previous endoscopy reports. There was good symptom association with our classification model. An endoscopic anatomical classification is proposed for description of failed fundoplication. With this classification, we hope to fill the gap in developing a uniform classification of failed fundoplications. Further studies addressing widespread applicability and outcome analysis are needed.
Production of adeno-associated virus (AAV) serotypes by transient transfection of HEK293 cell suspension cultures for gene delivery.

Adeno-associated virus (AAV) is being used successfully in gene therapy. Different serotypes of AAV target specific organs and tissues with high efficiency. There exists an increasing demand to manufacture various AAV serotypes in large quantities for pre-clinical and clinical trials. A generic and scalable method has been described in this study to efficiently produce AAV serotypes (AAV1-9) by transfection of a fully characterized cGMP HEK293SF cell line grown in suspension and serum-free medium. First, the production parameters were evaluated using AAV2 as a model serotype. Second, all nine AAV serotypes were produced successfully with yields of 1013 Vg/L cell culture. Subsequently, AAV2 and AAV6 serotypes were produced in 3-L controlled bioreactors where productions yielded up to 1013 Vg/L similar to the yields obtained in shake-flasks. For example, for AAV2 1013 Vg/L cell culture (6.8 × 1011 IVP/L) were measured between 48 and 64 h post transfection (hpt). During this period, the average cell specific AAV2 yields of 6800 Vg per cell and 460 IVP per cell were obtained with a Vg to IVP ratio of less than 20. Successful operations in bioreactors demonstrated the potential for scale-up and industrialization of this generic process for manufacturing AAV serotypes efficiently.
Comparative results of endoluminal gastroplasty and laparoscopic antireflux surgery for the treatment of GERD

Background: Transoral endoluminal gastroplasty (EG) by the Bard Endocinch device is available for the treatment of gastroesophageal reflux disease (GERD). This study assessed the early (≤12 months) outcomes in patients undergoing EG performed by one gastroenterologist compared with another set of patients referred by the same gastroenterologist for laparoscopic antireflux surgery (LAS) at a foregut surgery center. Methods: From June 2000 to July 2002, 87 consecutive patients cared for by a single gastroenterologist were diagnosed with refractory GERD and underwent either EG (n = 47) or referral for LAS (n = 40). Preoperative evaluation included symptom assessment, pH studies, and motility studies. Outcomes were assessed by symptomatic improvement and dependence on anti-acid medications. Data analyzed by chi-square or Mann-Whitney tests are reported as mean ± SEM. Results: Preoperative symptom duration, Johnson-DeMeester (JD) score, % time pH < 4, and reflux episodes were statistically similar in both treatment groups. The follow-up times for EG and LAS groups were 7.3 ± 0.9 and 8 ± 0.4 months, respectively. Of EG patients, 94% were available for follow-up, and all LAS patients had follow-up data. Overall, 66% of patients were satisfied with EG as compared to 93% after LAS (p = 0.1). Postoperative PPI/motility agent use was 32% for EG and 13% for LAS (p = 0.03). Identifiable causes of EG failure were premature procedure termination due to hypoxia or bleeding (three patients), intractable vomiting (two patients), and delayed gastric emptying (five patients). Three EG patients subsequently had LAS within 6 months of the procedure. Conclusions: LAS offers greater reduction in medication use than EG, as well as more durable patient satisfaction. Benefits of EG may include short-term symptomatic improvement while considering definitive surgical management.
Effects of pressure on magnetic properties of F-centers in rubidium halides

Abstract Room temperature magnetic resonance measurements have been made on additively colored RbCl and RbBr and on X-irradiated RbH at pressures up to 8 kbar. In RbCl and RbH pressure shifts of the F -center isotropic coupling constant a 1 were obtained from changes in the resolved EPR hyperfine structure. Pressure shifts of first and second shell hyperfine coupling constants of F -centers in RbBr were found from high pressure ENDOR spectra. Effects of the pressure induced polymorphic phase transformations in RbCl and RbBr are discussed. No evidence was found for a structure transformation in RbH. Room pressure ENDOR measurements on additively colored RbI were made at 77°K. The first and second shell hyperfine coupling constants are reported. All results accord well with the behavior of F -centers in other alkali halides.
Significance of the cis–trans isomerization of early intermediates in the carotene biosynthetic pathway

Using semi-empirical self-consistent field molecular orbital (SCF-MO) quantum chemical calculations, structures of putative intermediates of the desaturation pathway for both cis- and trans- carotene biosynthesis have been optimized. It was observed that the cis isomers of the early biosynthetic intermediates are more stable than corresponding trans isomers. Both desaturation and cyclization steps confer increased stability on these carotenes. The results also argue for phytofluene, rather than the earlier suggested phytoene or ζ-carotene, as the energetically favored branch point for poly-cis-carotene biosynthesis.