cssi/SciSciGPT-SciSciNet huggingface dataset:
Effects of Aspect Ratios of Ellipsoidal Inclusions on Elastic Stress Transfer of Ceramic Composites

The elastic stress transfer from a ceramic matrix to aligned elliposidal inclusions is analyzed for the case where the axis of the applied load is parallel to the axis of the ellipsoid. Perfect bonding between the matrix and inclusions is assumed. The calculation is based on Eshelby's model for loading of an infinite matrix containing an ellipsoidal inclusion, and the modification developed by Mori and Tanaka to account for the effect of finite volume fractions of inclusions. The results show that the transfer of the axial stress from the matrix to inclusions increases with the increase in the aspect ratio of the ellipsoid, and decreases with the increase in the volume fraction of inclusions when Young's modulus of the inclusion is higher than that of the matrix.
Ideological Values and the Votes of U.S. Supreme Court Justices

It is commonly assumed that Supreme Court justices' votes largely reflect their attitudes, values, or personal policy preferences. Nevertheless, this assumption has never been adequately tested with independent measures of the ideological values of justices, that is, measures not taken from their votes on the Court. Using content analytic techniques, we derive independent and reliable measures of the values of all Supreme Court justices from Earl Warren to Anthony Kennedy. These values correlate highly with the votes of the justices, providing strong support for the attitudinal model.
Influence of protection on power quality for system with distributed generation units

Power quality is extensively affected by power system faults. One of the power quality events is the voltage sag. The depth of the voltage sag is determined by the types of fault, fault location, system configuration, and load representation, while the duration of voltage sag can be distinctly impacted by protection systems. In the paper, the accelerated protection strategies are presented to reduce the voltage sag duration. The fixed time delay zone of the relay on the system side can be accelerated depending on the second variations of the current sequence components; which on the distributed generation units side can be accelerated by the undervoltage. Simulation results show that the acceleration of the directional overcurrent protection scheme can effectively reduce the duration of fault, thus reducing the voltage sag duration, and the reasonable micro-grid operation may benefit the voltage recover to avoid the large scale loss of load.
When Trade-Offs Matter: The Effect of Choice Construal on Context Effects

Abstract Everyday decisions present consumers with several trade-offs. In turn, these trade-offs can influence the decision outcome. The authors show that the level at which people construe a choice can affect trade-off making, such that a high construal of a choice decreases comparative trade-offs relative to a low construal. They use six studies to illustrate the idea in three important trade-off-relevant context effects. The results show that a high (versus a low) construal decreases the compromise and background-contrast effects and increases the attraction effect by reducing attribute-level trade-offs.
H2 receptor antagonists and right ventricular morphology: the MESA right ventricle study.

Rationale: H2 receptor antagonist (H2RA) use is common and may act directly on the heart through myocardial H2 receptors or indirectly through changes in pulmonary vascular resistance.Objectives: To determine the relationship between histamine H2RA use and right ventricular (RV) morphology.Methods: We studied 4,122 participants in the Multi-Ethnic Study of Atherosclerosis without clinical cardiovascular disease who had magnetic resonance imaging assessment of RV morphology and ascertainment of medication use. Multivariable linear regression estimated cross-sectional associations between H2RA use and RV morphology after adjusting for demographics, anthropometrics, smoking status, diabetes mellitus, and hypertension. Further adjustments for co-medication use, left ventricular parameters, lung structure and function, renal function, or inflammatory markers were considered in separate models. Analyses in a subcohort restricted to H2RA or proton pump inhibitor users accounted for confounding by the indication ...
The association of patient age with cardiovascular disease risk factor treatment and control in diabetes.

BACKGROUND While inadequate treatment intensification may contribute to sub-optimal CVD risk factor control in older patients with diabetes, the relationship between patient age and treatment intensification is largely unexplored.
Virtual Displacement and Virtual Work

The central concepts permitting the extension of mechanics from the Newtonian point of view to the Lagrangean are the notions of virtual displacement and of virtual work. These concepts were formulated early in the development of mechanics insofar as their application to statics is concerned. Johann Bernoulli (1667–1748) discovered them (1717) for the case of holonomic configuration constraints, and Gabriel Fourier extended them in 1798 to inequality constraints.
Modulation of signal transduction in cancer cells by phytosterols

Phytosterols are biofactors found enriched in plant foods such as seeds, grains, and legumes. Their dietary consumption is associated with numerous health benefits. Epidemiologic and experimental animal studies indicate that phytosterols are cancer chemopreventive agents particularly against cancers of the colon, breast, and prostate. Phytosterols impede oncogenesis and prevent cancer cell proliferation and survival. The molecular mechanisms underlying these beneficial actions involve effects on signal transduction processes which regulate cell growth and apoptosis. Phytosterols increase sphingomyelin turnover, ceramide formation, and liver X receptor activation. In concert, these actions slow cell cycle progression, inhibit cell proliferation, and activate caspase cascades and apoptosis in cancer cells.
The ionic structure of lecithin monolayers

Surface potentials of mixed monolayers of dicetyl phosphate and eicosanyl trimethylammonium bromide (1:1) were the same on subsolutions of 0.02 M NaCl or 0.01 M CaCl(2), which indicated that ionic phosphate does not interact with Ca(++) in the presence of a neighboring trimethylammonium group. Surface potential-pH plots of dicetyl phosphate, and of dipalmitoyl, egg, and dioleoyl lecithins showed that as the pH of the subsolution is decreased the phosphate groups in the monolayer are neutralized in the order: dicetyl phosphate > dipalmitoyl lecithin > egg lecithin > dioleoyl lecithin. The binding of cations (Na(+), Ca(++)) to the phosphate group of lecithin also showed the same order. The binding of Ca(++)) to egg phosphatidic acid monolayers, as measured by the increase in surface potential, is considerably greater than that to egg lecithin. These results suggest that there is an internal salt linkage between the phosphate and trimethylammonium groups on the same lecithin molecule. An increase in unsaturation of fatty acyl chains increases the intermolecular spacing, which reduces the ionic repulsion between polar groups, and hence strengthens the internal salt linkage. The results support the concept of a vertical rather than coplanar orientation of the phosphoryl choline group with respect to the interface. A position has been proposed for Ca(++) in the dipole lattice of lecithin from a consideration of the surface potential measurements.
Assortment optimization over time

In this note we introduce the problem of assortment optimization over time. We have a sequence of time steps and can introduce one new product per time step. Once introduced a product cannot be removed. The goal is to determine which products to introduce so as to maximize revenue over all time steps under some choice model. Given a 1 / α -approximation algorithm for the capacitated assortment optimization problem we give a 1 / 2 α -approximation algorithm for this problem.
An extended comparative study of language support for generic programming

Many modern programming languages support basic generics, sufficient to implement type-safe polymorphic containers. Some languages have moved beyond this basic support, and in doing so have enabled a broader, more powerful form of generic programming. This paper reports on a comprehensive comparison of facilities for generic programming in eight programming languages: C++, Standard ML, Objective Caml, Haskell, Eiffel, Java, Cn (with its proposed generics extension), and Cecil. By implementing a substantial example in each of these languages, we illustrate how the basic roles of generic programming can be represented in each language. We also identify eight language properties that support this broader view of generic programming: support for multi-type concepts, multiple constraints on type parameters, convenient associated type access, constraints on associated types, retroactive modeling, type aliases, separate compilation of algorithms and data structures, and implicit argument type deduction for generic algorithms. We find that these features are necessary to avoid awkward designs, poor maintainability, and painfully verbose code. As languages increasingly support generics, it is important that language designers understand the features necessary to enable the effective use of generics and that their absence can cause difficulties for programmers.
Nomenclatural changes and new species of Scolytidae (Coleoptera), Part II.

New synonymy is proposed for Phlocosinus (Hylesinus) machilus (Schedl) (= Phlocosinus cinnamomi Tsai & Yin). New replacement names are proposed for junior homonyms as follows: Cyrtogenius africus for Cyrtogenius (Metahylastes) africanus (Eggers). Cyrtogenius elongatissimus for Cyrtogenius (Ozodendron) elongatus (Schedl), Cyrtogenius elongatulus for Cyrtogenius elongatulus for Cyrtogenius (Eidophelus) elongatus (Schedl), Cyrtogenius gracillimus for Cyrtogenius gracilis Browne, Cyrtogenius papuae for Cyrtogenius (Pelicerus) papuanus (Eggers), Cyrtogenius papuensis for Cyrtogenius (Eidophelus) papuanus (Shedl), Cyrtogenius ruginosus for Cyrtogenius (mimidendrulus) rugicollis (Browne). The following species are named as new to science: Indocryphalus machili (India), Olonthogaster jiri (India), Olonthogaster regalis (Sri Lanka), Phlocosinus phoebe (India), Scolytomimus andamanensis (Andaman Islands), Scolytomimus mimusopis (Sri Lanka), ( Scolytomimus quadridens (New Guinea), and Scolytomimus rectus (Sri Lanka).
Scattering of electromagnetic radiation for a perfect electric conducting cylinder by using multiple angles of polarization

Radar is a device which detects distant or non visible objects by means of reflected radio waves [1]. The quality of the reflected signal depends on the shape and orientation of the target with respect to the type of polarization used. Most of the antennas currently used on radar systems employ one type of polarization at a time for target detection. This paper describes the importance of employing polarizations of multiple angles on targets, approximately at the same instant of time. To implement this idea a generalized set of equations have been derived which represent the backscatter generated by a cylindrical object. Using different angles in these equations would give the backscatters of different polarizations employed on the same target, at small time intervals. The logic behind this is that there would be at least one angle that would have the maximum signal strength in the backscatter. The backscatter for this angle would satisfy the best quality criterion as compared with the rest of the polarization angles.
Genetic variation of high-risk HPV-16 from a cervical cancer biopsy collected in Pakistan

Aim: HPV-16 is one of the causative agents of cervical cancer. The HPV-16 genome is characterized widely to assist mutagenesis studies, phylogenetic analysis and protein annotations. This is the first report of HPV-16 sequence analysis from Pakistan. Materials & methods: The gene and long control region specific primers were used to generate the targeted amplicons that were then cloned and sequenced. Results: The complete genome analysis revealed nine changes both at amino acid and nucleotide level including seven novel and two previously reported mutations. The evolutionary relationship of HPV from Pakistan and reported sequences shows that strain reported in this study segregates with European taxa. Conclusion: This report lays foundation to conduct HPV genome mutation analysis in Pakistan.
Mode-I Interlaminar Fracture Toughness and Fatigue Crack Growth of Carbon Nanofibers Modified Polyester/Glass Fiber Laminates

A major weakness of laminated composite is the susceptibility to delamination. Having a good understanding of composite material resistance to interlaminar fracture and fatigue is important to establish design allowable and damage tolerance guidelines for structures. Previously reported static delamination test results have shown that there is about 100% improvement in the critical energy release rates GIC by adding 1wt% carbon nanofibers (CNFs) to glass fiber/polyester laminates. Hence, this paper presents the fatigue resistance characterization of glass fiber/polyester composite modified with CNFs. CNFs were surfactant treated and dispersed in the thermoset polyester. The matrix with suspended CNFs was infused into glass fiber preform through vacuum assisted resin transfer molding (VARTM). The crack development of the laminated specimens during fatigue delamination testing was recorded along with the displacement and cyclic load applied. The fatigue measurement results for the traditional composite laminate and the one modified with CNFs is compared to understand the role of CNFs in the fatigue delamination process. It was found that CNFs significantly improve the low cycle fatigue performance, but it provides minimal improvement to the high cycle fatigue performance.Copyright © 2007 by ASME
The Imperative Mandate in the Spanish Cortes of the Middle Ages

A study of the beginnings of national representation inevitably brings to the surface details which in their time were part or parcel of mediaeval practices. One cannot expect that these usages, even as connected with representative institutions, can be of concern in our more complex modern circumstances, since the Middle Ages had comparatively few and simple problems for legislative solution. In those days the questions of relationship between the administrative and the legislative, and between the local and the central or national, had not emerged clearly. Nevertheless, such details and questions are interesting as examples of mediaeval theory and efficiency, and, moreover, some of them are not entirely devoid of connection with present-day difficulties.The custom of making in advance a decision which was imposed by the electors upon their chosen representative, a custom known as the imperative mandate, was an important factor in early representative government. It was sound in legal theory, and some of its practice will be seen in the pages which follow. Also, its connection is with that early stage in popular government in which the development of representative institutions corresponded somewhat to one phase of the present. I refer to what is apparently a need to ask from the electors themselves their opinion on large, general questions of principle—for example, in our time, the referendum in Germany on the adoption of the Young Plan.
The Cleveland Clinic Experience with Adrenal Cortical Carcinoma

Between 1936 and 1987, 82 patients with adrenal cortical carcinoma were seen at our clinic. Of these patients 49 (72 per cent) have been seen during the last 25 years. A total of 40 patients (48.8 per cent) presented with a hormonally functional tumor and 42 (51.2 per cent) had a nonfunctional tumor. Forty patients (48.8 per cent) presented with localized disease, 12 (14.6 per cent) with regional disease and 30 (36.6 per cent) with distant metastases. Complete surgical removal of all gross tumor was achieved in 49 patients. Over-all 3 and 5-year patient survival rates in this series were 37.5 and 25.1 per cent, respectively. Survival was significantly improved (43.9 per cent at 5 years, p equals 0.0001) in patients with localized disease that was completely removed surgically; postoperative adjuvant therapy with op'-DDD was of no benefit in these patients. Survival in patients with metastatic disease was poor and was not improved by treatment with op'-DDD, cytotoxic chemotherapy or radiation therapy.
Synthesis and properties of Ni-α-Al2O3 composites via sol-gel

Abstract Ni-α-Al 2 O 3 metal-ceramic composites with metal loadings ranging from 33 to 67 vol.% were synthesized via a sol-gel (both polymeric and colloidal) technique. The polymeric route involves introducing nickel formate during the hydrolysis and condensation of aluminum isopropoxide while the colloidal route involves precipitating Ni(OH) 2 onto boehmite particles. Transformation to Ni-α-Al 2 O 3 composites is accomplished by calcination in a reducing environment followed by hot pressing at about 1400°C in an oxygen partial pressure of 10 −12 atm. The composites exhibit a highly interconnected microstructure, composed of continuous Ni and alumina networks, and enhanced fracture properties compared with pure alumina.
Specific Exceptions Driving Variation: The Role of Orthography in Modern Hebrew Spirantization

This paper reports results from a production experiment examining the patterns of variation in the morphophonemic alternations present in spirantization in Modern Hebrew, a phenomenon to which there are many exceptions and diverse levels of variation. Real and nonce verbs were used to elicit variation in a sentence completion task as a follow-up to a perception experiment (Temkin Martinez 2010) which found gradient levels of acceptability in variation due to the presence of exceptionality. The diverse patterns of variation indicate that not all exceptions affect the same level of variation in alternation. Results of the current study suggest that levels of gradience are linked to the presence or absence of multiple orthographic representations for each of the segments involved. An Optimality Theoretic (OT) account modifying a combined model of set-indexation (Pater 2000) and Stochastic OT (Boersma 1998; Boersma & Hayes 2001; Hayes & Londe 2006; Hayes & MacEachern 1998; Zuraw 2000) presented in Temkin Martinez (2010) is provided to account for the alternation patterns in nonce verbs.
The Family Physician Looks at Occupational Health Information

Although much is known about occupational and environmental health risks, this information is rarely used by physicians practicing primary-care medicine. As a specialty with roots in the epidemiologic tradition, family medicine should be able to use these data to help care for the individual in the context of the family and community. In this discussion, the historical links between family medicine and epidemiology are reviewed, barriers to the use of epidemiologically derived occupational health information are analyzed, and solutions to the problem of integration are proposed. The relationship between primary care and occupational medicine is a subset of the relationship of clinical practice to epidemiology in general.
Polychlorinated biphenyls, polybrominated biphenyls, and brominated flame retardants

This chapter describes selected organohalogen chemicals such as polychlorinated biphenyls (PCBs), polybrominated biphenyls (PBBs), and brominated flame retardants (BFRs) with emphasis on the background, physico-chemical properties, environmental levels, health effects, and possible modes of action. Since the focus of this chapter is on biomarkers, three well-known mechanisms are postulated as biomarkers of exposure and effect. Thyroid hormone disruption, perturbed calcium homeostasis, and kinase signaling and induction of cytochrome-P450 enzymes are described in detail as biomarkers of exposure to and effect of PCBs, PBBs, and BFRs in organisms. Although there have been other biochemical effects reported with these chemicals, only these three pathways are discussed. Further research is needed in order to identify specific biomarkers of exposure and effect for these groups of chemicals.
Novel Application of Localized Nanodelivery of Anti–Interleukin‐6 Protects Organ Transplant From Ischemia–Reperfusion Injuries

Ischemia-reperfusion injury (IRI) evokes intragraft inflammatory responses, which markedly augment alloimmune responses against the graft. Understanding the mechanisms underlying these responses is fundamental to develop therapeutic regimens to prevent/ameliorate organ IRI. Here, we demonstrate that IRI results in a marked increase in mitochondrial damage and autophagy in dendritic cells (DCs). While autophagy is a survival mechanism for ischemic DCs, it also augments their production of interleukin (IL)-6. Allograft-derived dendritic cells (ADDCs) lacking autophagy-related gene 5 (Atg5) showed higher death rates posttransplantation. Transplanted ischemic hearts from CD11cCre/Atg5 conditional knockout mice showed marked reduction in intragraft expression of IL-6 compared with controls. To antagonize the effect of IL-6 locally in the heart, we synthesized novel anti-IL-6 nanoparticles with capacity for controlled release of anti-IL-6 over time. Compared with systemic delivery of anti-IL-6, localized delivery of anti-IL-6 significantly reduced chronic rejection with a markedly lower amount administered. Despite improved allograft histology, there were no changes to splenic T cell populations, illustrating the importance of local IL-6 in driving chronic rejection after IRI. These data carry potential clinical significance by identifying an innovative, targeted strategy to manipulate organs before transplantation to diminish inflammation, leading to improved long-term outcomes.
Role perceptions and attitudes toward discretion at a decentralized regulatory frontline: The case of organic inspectors

The complexity of decentralized regulatory contexts can threaten program fidelity, particularly if it results in divergence between program goals and the intents of regulatory inspectors. This paper investigates how inspectors negotiate the conflicting demands of a decentralized program by examining how they perceive their regulatory roles – the primary responsibilities that inspectors ascribe to their functions and the entities to which they feel responsible – and how these role orientations are related to inspectors' attitudes toward the use of discretion. The study findings indicate that in the decentralized administration of United States organic food regulations, inspectors experience multiple, and sometimes conflicting, role orientations. The presence of multiple role orientations, however, does not seem to affect how inspectors approach their responsibilities. The combined strengths of quantitative and qualitative data are leveraged to offer explanations for the study findings and identify avenues for future research.
Is Rasburicase Effective In Reversing Acute Renal Failure In Patients with Tumor Lyses Syndrome

Abstract Abstract 4939 Tumor lysis syndrome (TLS) is a potentially life-threatening complication that can occur spontaneously or following treatment of malignant neoplasms, particularly leukemias and lymphomas. TLS can cause acute renal failure (ARF) by precipitation of uric acid (UA) and phosphate crystals in renal tubules. Rasburicase, a recombinant urate oxidase, was proven to be effective in the treatment of TLS and is known to cause an improvement in renal function in a subset of patients with TLS. For the purposes of our analysis ARF was defined as more than 50% increase in creatinine from baseline value or presenting with creatinine more or equal to 2 mg/dl with no previous history of chronic renal failure. To assess the efficacy of Rasburicase in adult patients with documented TLS and ARF in improving or normalizing the creatinine clearance (CrCl), we conducted a retrospective analysis of 53 patients that received Rasburicase for documented TLS. 41 patients fit the inclusion criteria. The median age was 54 yr (26-90), 13 were female. The majority of patients had hematological malignancies (acute leukemia, 11; chronic leukemia, 5; myeloproliferative/myelodysplastic syndromes, 4; lymphoma or myeloma, 10; solid tumor; 11). Results: On the first day of rasburicase infusion (day 0), median UA, creatinine and CrCl were 11.5 mg/dl (5.1 - 23.7mg/dl), 3.26 mg/dl and 32.5 ml/min (8.0 - 97.8 ml/min) calculated using Cockcroft-Gault equation, respectively. Patients received an average total dose of 0.17 mg/kg (0.06-0.51 mg/kg) of rasburicase in one or two doses. UA levels normalized in 97.3% and 100% of patients by day 2 and 7 respectively. Creatinine levels normalized in 19% and 59.4% by day 2 and 7 respectively. CrCl improved form a median of 32.5 ml/min to 40.5 ml/min and 58 ml/min by day 2 and 7 respectively. A sub analysis for patients with baseline CrCl 30 ml/min. CrCl improved in this subset of patients from a median of 17 ml/min (8-28.2 ml/min) to 24.5 and 47.4 ml/min on days 2 and 7 respectively. Patients who received a total dose of Conclusion: Rasburicase infusion is effective in improving the creatinine clearance even in patients with advanced renal failure (CrCl Disclosures: No relevant conflicts of interest to declare.
Unknowable Unknowns of Tax Reform: Wicked Systems, Cloud Seeding, and the Border Adjustment Tax

This brief response to Michael Graetz's forthcoming article in the Columbia Tax Journal explores just one of the "unknowable unknowns" concerning the border-adjustment tax proposal in the House Republican Blueprint. The implication is that there are most likely numerous lurking unknowable unknowns and tax policy makers should be cautious in relying on future linear economic projections in order to fund (or even justify) current tax reform measures.
Synthesis and Characterization of a Methanofullerene-4-Fluoro-α-Cyanostilbene Dyad as a Potential Acceptor for Organic Solar Cells

A series of fluorine appended highly conjugated fullerenes were prepared containing fluoro-α-cyanostilbene and aryl ester units. These modified PCBM dyads are fully characterized by NMR, Mass spectrometry, UV-vis, and cyclic voltammetry (Figures 1-4). It was found that the presence of fluoro-α-cyanostilbenes and esters affects the cyclic voltammetry and absorption in the UV-Vis region. The PCBA modified fullerenes significantly influences the HOMO-LUMO energy and wide absorption compared to PCBM.
The Tumor Microenvironment Regulates Sensitivity of Murine Lung Tumors to PD-1/PD-L1 Antibody Blockade

Immune checkpoint inhibitors targeting the interaction between programmed cell death-1 (PD-1) and its ligand PD-L1 induce tumor regression in a subset of non-small cell lung cancer patients. However, clinical response rates are less than 25%. Evaluation of combinations of immunotherapy with existing therapies requires appropriate preclinical animal models. In this study, murine lung cancer cells (CMT167 and LLC) were implanted either orthotopically in the lung or subcutaneously in syngeneic mice, and response to anti-PD-1/PD-L1 therapy was determined. Anti-PD-1/PD-L1 therapy inhibited CMT167 orthotopic lung tumors by 95%. The same treatments inhibited CMT167 subcutaneous tumors by only 30% and LLC orthotopic lung tumors by 35%. CMT167 subcutaneous tumors had more Foxp3+ CD4+ T cells and fewer PD-1+ CD4+ T cells compared with CMT167 orthotopic tumors. Flow cytometric analysis also demonstrated increased abundance of PD-L1high cells in the tumor microenvironment in CMT167 tumor-bearing lungs compared with CMT167 subcutaneous tumors or LLC tumor-bearing lungs. Silencing PD-L1 expression in CMT167 cells resulted in smaller orthotopic tumors that remained sensitive to anti-PD-L1 therapy, whereas implantation of CMT167 cells into PD-L1- mice blocked orthotopic tumor growth, indicating a role for PD-L1 in both the cancer cell and the microenvironment. These findings indicate that the response of cancer cells to immunotherapy will be determined by both intrinsic properties of the cancer cells and specific interactions with the microenvironment. Experimental models that accurately recapitulate the lung tumor microenvironment are useful for evaluation of immunotherapeutic agents. Cancer Immunol Res; 5(9); 767-77. ©2017 AACR.
Calmodulin And Ca2+-Binding Proteins (CaBPs): Variations on a Theme

Ca2+is a ubiquitous second messenger that frequently exerts its effects through Ca2+-binding proteins. In response to changes in the intracellular [Ca21, Ca2+-binding proteins modulate the cellular activities of enzymes, channels and structural proteins. Multiple Ca2+-binding proteins are expressed in the retina and, in most cases, in a unique cellular and sub-cellular manner. CaBPs are retinal Ca2+-binding proteins displaying a high similarity to calmodulin (CaM). CaBPs are able to mimic some of the interactions of CaM with effector enzymes, although their physiological role has not yet been resolved. CaBPs could be cell-type specific proteins that play a key role in the Ca2+signaling of specialized retinal neurons.
Continuous Glucose Monitoring in the Cardiac ICU: Current Use and Future Directions

Perioperative glucose control is highly important, particularly for patients undergoing cardiac surgery. Variable glucose levels before, during and after cardiac surgery lead to increased post-operative complications and patient mortality. [1] Current methods for intensive monitoring and treating hyperglycemia in the Intensive Care Unit (ICU) usually involve hourly glucose monitoring and continuous intravenous insulin infusions. With the advent of more accurate subcutaneous glucose monitoring systems, the role of improved glucose control with newer systems deserves consideration for widespread adoption.
Factors associated with variation in long-term acute care hospital vs skilled nursing facility use among hospitalized older adults

Importance Despite providing an overlapping level of care, it is unknown why hospitalized older adults are transferred to long-term acute care hospitals (LTACs) vs less costly skilled nursing facilities (SNFs) for postacute care. Objective To examine factors associated with variation in LTAC vs SNF transfer among hospitalized older adults. Design, Setting, and Participants We conducted this retrospective observational cohort study of hospitalized older adults (≥65 years) transferred to an LTAC vs SNF during fiscal year 2012 using national 5% Medicare data. Main Outcomes and Measures Predictors of LTAC transfer were assessed using a multilevel mixed-effects model adjusting for patient-, hospital-, and region-level factors. We estimated variation partition coefficients and adjusted hospital- and region-specific LTAC transfer rates using sequential models. Results Among 65 525 hospitalized older adults (42 461 [64.8%] women; 39 908 [60.9%] ≥85 years) transferred to an LTAC or SNF, 3093 (4.7%) were transferred to an LTAC. We identified 29 patient-, 3 hospital-, and 5 region-level independent predictors. The strongest predictors of LTAC transfer were receiving a tracheostomy (adjusted odds ration [aOR], 23.8; 95% CI, 15.8-35.9) and being hospitalized in close proximity to an LTAC (0-2 vs >42 miles; aOR, 8.4, 95% CI, 6.1-11.5). After adjusting for case-mix, differences between patients explained 52.1% (95% CI, 47.7%-56.5%) of the variation in LTAC use. The remainder was attributable to hospital (15.0%; 95% CI, 12.3%-17.6%), and regional differences (32.9%; 95% CI, 27.6%-38.3%). Case-mix adjusted LTAC use was very high in the South (17%-37%) compared with the Pacific Northwest, North, and Northeast ( Conclusions and Relevance Although many patient-level factors were associated with LTAC use, half of the variation in LTAC vs SNF transfer is independent of patients’ illness severity or clinical complexity, and is explained by where the patient was hospitalized and in what region, with far greater use in the South. Even among hospitals in regions with similar LTAC access, there was considerable variation in LTAC use. Given the higher expense associated with LTACs vs SNFs, greater attention is needed to define the optimal role of LTACs in the postacute care of older adults.
Diplopia: a focal neurologic presentation of West Nile meningoencephalitis.

Abstract This is a report of a 45-year-old white man who presented to our emergency department with a 2-day history of "seeing double" preceded by a resolving 5-day syndrome of fevers and headache. Clinical suspicion of West Nile virus central nervous system infection was confirmed on the basis of laboratory studies. The current knowledge of West Nile virus pathophysiology and clinical features are discussed. Although commonly associated with global and nonspecific syndromes, this patient presented with focal neurologic symptoms.
Three decades of experience with emergency portacaval shunt for acutely bleeding esophageal varices in 400 unselected patients with cirrhosis of the liver.

BACKGROUND Emergency treatment of acute bleeding is of singular and paramount importance in the therapy of portal hypertension and esophagogastric varices. Accordingly, for more than three decades we have conducted prospective studies of emergency therapy, and particularly of emergency portacaval shunt (EPCS). STUDY DESIGN Emergency portacaval shunt was performed upon 400 patients with cirrhosis of the liver and acutely bleeding esophagogastric varices according to three principles: operation within eight hours of initial contact; unselected patients, meaning that no patient with variceal bleeding caused by hepatic disease was excluded from EPCS, and prospective study, meaning that a well-defined protocol was consistently used and data were collected on-line. Patients were divided into an early group of 180 treated from 1963 to 1978 and a recent group of 220 treated from 1978 to July, 1990, with similar characteristics, but strikingly different outcome. Follow-up rates at one, five, and ten years were 100, 98, and 97 percent, respectively; 96 percent of patients underwent EPCS five or more years ago. Proof of acute variceal bleeding and of cirrhosis of the liver (alcoholic in 95 percent) was obtained in every patient. Child's risk classes determined quantitatively were A in 11 percent of the patients, B in 65 percent, and C in 24 percent. All patients had a direct portacaval shunt, side-to-side in 85 percent, which reduced the mean portal vein to inferior vena cava pressure gradient from 271 to 21 mm saline solution. RESULTS All but four patients (99 percent) had immediate and permanent control of variceal bleeding. Thrombosis of the shunt occurred in only two patients (0.5 percent). Survival rates at 30 days, five years, ten years, and 15 years in the early group were 58, 40, 30, and 30 percent, respectively, while in the recent group they were 85, 78, 71, and 57 percent, respectively (p < 0.0001). Other striking gains in the recent group were abstention from alcohol, improvement in liver function and improvement in Child's class, all in 70 percent of patients. Recurrent portal-systemic encephalopathy occurred in 9 percent of the early group and 8 percent of the recent group. CONCLUSIONS Emergency portacaval shunt substantially improved survival and quality of life of patients with cirrhosis of the liver and bleeding varices. Our results are attributable to rapid and simplified diagnosis, prompt operation, an organized system of care, and rigorous, lifelong follow-up evaluation that emphasized abstinence from alcohol and dietary protein control. Transplantation of the liver is infrequently required in patients whose bleeding is permanently controlled.
The SAGES flexible endoscopy course for fellows: a worthwhile investment in furthering surgical endoscopy.

The SAGES flexible endoscopy course for minimally invasive surgery (MIS) fellows improves confidence and skills in performing gastrointestinal (GI) endoscopy. This study evaluated the long-term retention of these confidence levels and investigated how fellows changed practices within their fellowships due to the course. Participating MIS fellows completed surveys 6 months after the course. Respondents rated their confidence to independently perform 16 endoscopic procedures (1 = not at all; 5 = very), barriers to use of endoscopy, and current uses of endoscopy. Respondents also noted participation in additional skills courses and status of fundamentals of endoscopic surgery (FES) certification. Comparisons of responses from the immediate post-course survey to the 6-month follow-up survey were examined. McNemar and paired t tests were used for analyses. 23 of 57 (40%) course participants returned to the 6-month survey. No major barriers to endoscopy use were identified. Fellows reported less competition with GI providers as a barrier to practice compared to their original post-course expectations (50% vs. 86%, p < 0.01). In addition, confidence was maintained in performing the majority of the 16 endoscopic procedures, although fellows reported significant decreases in confidence in independently performing snare polypectomy (− 26%; p < 0.05), control of variceal bleeding (− 39%; p < 0.05), colonic stenting (− 48%; p < 0.01), BARRX (− 40%; p < 0.05), and TIF (− 31%; p < 0.05). Fewer fellows used the GI suite to manage surgical problems than was anticipated post course (26% vs. 74%, p < 0.01). Fellows who passed FES noted no significant loss of independence, changes in use, or barriers to use. 18% made additional partnerships with industry after the course. 41% stated flexible endoscopy has influenced their post-fellowship job choice. The SAGES flexible endoscopy course for MIS fellows results in long-term practice changes with participating fellows maintaining confidence to perform the majority of taught endoscopic procedures 6 months later. Additionally, fellows experienced no major barriers to implementing endoscopy into practice.
Increased microbial uptake and plant nitrogen availability in response to simulated nitrogen deposition in alpine meadows

Abstract As global industry and intensive agriculture increase in response to an expanding human population, oligotrophic ecosystems such as alpine and subalpine habitats are increasingly vulnerable to transported atmospheric nitrogen (N) pollution. Even at low levels, N deposition can alter soil chemistry via changes in decomposition rates and mineralization of N from soil organic matter. We used fertilization to mimic N deposition in three National Park alpine meadow ecosystems in the Pacific Northwest (PNW) of the United States (an area of low ambient N deposition) over a 3-year period. Our sites were two moist heath meadow ecosystems in the western Cascade Mountains and one dry meadow ecosystem in the eastern Olympic Mountains. We assessed alpine soil chemistry and N cycling responses to simulated N deposition, using soil inorganic N availability to plants as a critical loads indicator. Soil solution inorganic N supply as measured by resin probes increased in response to N treatment at all sites by Year 3 in plots fertilized at the 10 kg N ha−1 yr−1 treatment level. At the heath meadow sites, we observed increased soil NO3-N during the summer and decreased extractable organic carbon (C) during the fall in response to applied N. We also observed seasonal increases in the proportion of soil N contained in microbial biomass in response to treatment. These data indicate season-specific increases in microbial N uptake and mineralization in response to fertilizer treatment. The carbon-rich, fine-ash volcanic soils of the North Cascades were the most sensitive to N treatment with low microbial N uptake. From those soils, we derived an empirical critical load of 6 kg N per ha−1 yr−1 for increased soil N availability. However, alpine meadow soils in the Western Cascades undergo N limitation in the fall and may have less potential for N leaching with fall rains. In contrast, soils at the dry meadow site had much greater potential for N mineralization, and are temperature- and moisture-limited rather than N limited. Changes in soil chemistry in response to N deposition were site-specific and resulted from differences in plant uptake and soil N mineralization capacity, indicating two very different regimes for response to N deposition for N-limited alpine meadows vs moisture-limited alpine meadows.
Willingness to pay premium prices in accommodation establishments

Although, tourism research often concerns the phenomenon of ‘willingness to pay premium prices’, it has under-researched the relevant propensity with regard to brand identification in the hospitality sector, as a component of tourism activity overall. The study examines the perceptions of 328 holidaymakers leaving Athens, Greece. The findings unveiled relationships between multiple elements of brand identity, such as brand image, price and quality, need for belonging, need for uniqueness, and the conformity to consumption trend. Moreover, they suggest that the stronger the brand identification, the less likely holiday makers are to pay premium prices. In addition to its theoretical and managerial contribution, the research presents relevant implications and provides suggestions for further study.
Palatal, Maxillary, and Orbital Reconstruction

Successful reconstruction of the maxilla or midface requires a thorough understanding of the anatomy, defect dimensions, and flap options. Several classifications of maxillectomy defects exist, with Cordeiro’s and Bronn’s being commonly uses. With the advances of reconstructive techniques, free tissue transfer become more widely used and is able to provide satisfactory results in palatal, maxillary, and orbital reconstruction. Workhorse free flaps include the anterolateral thigh flap, the profunda artery perforator flap, the medial sural artery perforator flap, the radial or ulnar forearm flap, the rectus abdominis myocutaneous flap, the iliac flap, the scapular flap, and the fibula flap. For palatal defect, the goal is to seal the defect and recreate the barrier between the nasal cavity and the oral cavity; a proper selection of flap based on the dimension of the defect and the thickness of the flap is important. For orbitomaxillary or maxillary defect, decisions are commonly made between soft-tissue flaps or bone-containing flaps. Decision is first made whether to provide bony reconstruction or not. In general, bony reconstruction is strongly considered if the infraorbital rim or the premaxilla is involved. Non-vascularized bone can be considered for infraorbital rim reconstruction but not the premaxilla. For vascularized bony reconstruction, the fibula flap is the primary choice.
Navigating Minority and Majority Cultures in Emerging Adulthood: A Pilot Study of Young Hearing Adults of Deaf Parents and Young Heterosexual Adults of Lesbian/Gay Parents:

This exploratory study examined the navigation of emerging adulthood for six young hearing adults raised by Deaf parents and six young heterosexual adults raised by lesbian or gay parents. Qualitat...
Toward a Mathematical Modeling of Creativity

“Creativity” is fascinating! We know so much about the topic without having the slightest idea what it is. We even know how to promote creative behavior by encouraging subjects to avoid strict adherence to rules, to explore new explanations or paradigms, to welcome novelty, to transform a problem into a different framework, to generalize through abstraction, to brainstorm, and to explore options before making evaluations. But, other than knowing that these approaches tend to work (sufficiently well so that some are “corporate brainstorming strategies” while others are tried in the classroom), we really don’t know why. The “why” becomes an important issue. Also, all these different approaches emphasize “generality” over details. What explains this commonality?
The Complexity of College Consent

Teachers, parents, and administrators tell students that consent is “simple.” To be sure, every day, millions of people follow the directive to have only consensual sex with great success and have mutually wanted, unproblematic intimate contact. Law and policy, however, rarely intervene in easy cases. Consent standards intervene in the hard cases. College sexual consent policies delineate when sex between two competent adults of equal status, without force or threat, is a punishable offense. They determine what should happen when the accuser feels harmed but the accused believes he or she has not committed harm. They weigh in on default views of sex — whether people generally desire, are ambivalent toward, or fear sex. They guide decision makers on whom to believe in “he-said-she-said” cases. In short, consent is far from simple. This chapter, written for the book Adjudicating Campus Sexual Misconduct and Assault, unpacks the complex concept of consent in college codes. Its aim is taxonomical and explanatory: to categorize various consent formulations and clarify how they regulate behavior and resolve disputes. The first part of the chapter is a brief history of “ordinary” and affirmative consent standards in criminal law. The second turns to the concept of consent itself. There, I explore what it means to say that a sexual transaction between two people is consensual and whether consent relates to a state of mind, communication, or both. The third part examines the various formulations of consent in college codes, placing them on a scale from most to least regulatory. Finally, I discuss the complicated costs and benefits of affirmative consent.
Estimating the prevalence and spatial clusters of coal workers' pneumoconiosis cases using medicare claims data, 2011-2014.

Background Workers employed in the coal mining sector are at increased risk of respiratory diseases, including coal workers' pneumoconiosis (CWP). We investigated the prevalence of CWP and its association with sociodemographic factors among Medicare beneficiaries. Methods We used 5% Medicare Limited Data Set claims data from 2011 to 2014 to select Medicare beneficiaries with a diagnosis of ICD-9-CM 500 (CWP). We aggregated the data by county and limited our analysis to seven contiguous states: Illinois, Indiana, Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. We estimated county-level prevalence rates using total Medicare beneficiaries and miners as denominators and performed spatial hotspot analysis. We used negative binomial regression analysis to determine the association of county-wise sociodemographic factors with CWP. Results There was significant spatial clustering of CWP cases in Kentucky, Virginia, and West Virginia. Spatial clusters of 210 and 605 CWP cases representing an estimated 4200 to 12 100 cases of Medicare beneficiaries with CWP were identified in the three states. Counties with higher poverty levels had a significantly elevated rate of CWP (adjusted rate ratios [RR]: 1.15; 95% CI, 1.12-1.18). There was a small but significant association of CWP with the county-wise catchment area. Rurality was associated with a more than three-fold elevated rate of CWP in the unadjusted analysis (RR: 3.28, 95% CI, 2.22-4.84). However, the rate declined to 1.45 (95% CI, 1.04-2.01) after adjusting for other factors in the analysis. Conclusions We found evidence of significant spatial clustering of CWP among Medicare beneficiaries living in the seven states of the USA.