cssi/SciSciGPT-SciSciNet huggingface dataset:
Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated. (1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery? Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006–2014) were identified. Patients were divided into two groups based on whether the surgery was performed in the fee-for-service setting (beneficiaries receive care at a civilian facility with expenses covered by TRICARE insurance) or at a Department of Defense facility (direct care). There were 28,344 patients in the entire study, 21,290 treated in fee-for-service and 7054 treated in Department of Defense facilities. Differences in the rates of fusion-based procedures, discectomy, and decompression between both healthcare settings were assessed using multinomial logistic regression to adjust for differences in case-mix and surgical indication. TRICARE beneficiaries treated for lumbar spinal disorders in the fee-for-service setting had higher odds of receiving interbody fusions (fee-for-service: 7267 of 21,290 [34%], direct care: 1539 of 7054 [22%], odds ratio [OR]: 1.25 [95% confidence interval 1.20–1.30], p < 0.001). Purchased care patients were more likely to receive interbody fusions for a diagnosis of disc herniation (adjusted OR 2.61 [2.36–2.89], p < 0.001) and for spinal stenosis (adjusted OR 1.39 [1.15–1.69], p < 0.001); however, there was no difference for patients with spondylolisthesis (adjusted OR 0.99 [0.84–1.16], p = 0.86). The preferential use of interbody fusion procedures was higher in the fee-for-service setting irrespective of the underlying diagnosis. These results speak to the existence of provider inducement within the field of spine surgery. This reality portends poor performance for surgical practices and hospitals in Accountable Care Organizations and bundled payment programs in which provider inducement is allowed to persist. Level III, economic and decision analysis.
On Maximizing Transmission Reliability for Real-Time Routing in Multi-hop Wireless LANs

Three factors have been often shown to significantly affect the reliability of real-time transmission in wireless local area networks—transmission rate, power, and packet size. We analyze these factors and determine the optimal combination of factors subject to time constraints that yields the most reliable transmission of real-time data. We propose a cross-layer framework to jointly design the routing and MAC protocol combined with our optimization approach. The approach under a non-real-time routing protocol that produces a path metric is compared with a real-time routing protocol. Additionally, the real-time routing protocol enhances a guaranteed rate with our approach. Our experiments reveal that real-time performance in terms of miss ratio and throughput is significantly increased in lossy link and heavy traffic environments. Miss ratio and average throughput are improved by up to 30% over a state-of-the art routing protocol and 35% over a MAC protocol, respectively.
DIABETES MELLITUS AND THE DEVELOPMENT OF ATRIAL FIBRILLATION IN HISPANICS, BLACKS AND WHITES

Background: No previous studies have examined the interaction between diabetes mellitus (DM) across a large Hispanic, Black and White cohort with the development of atrial fibrillation (AF). Methods: We retrospectively followed 32,245 persons free of AF (46% Hispanic, 39% Black and 15% White, mean
The Complementarity of Improving Quality of Life and Reducing Environmental Footprints in Urban Spaces: The Argument for ‘Hedonistic Sustainability’

In recent decades, the phenomena of urbanization and globalization have transformed cities into of technology, innovation, wealth and human capital. Cities have become spaces of high environmental destruction, and concurrently, frontrunner of climate change adaptation and mitigation strategies. The urban landscape consists of a complex network of actors, requiring an integrative and adaptive approach to be taken when considering sustainability and environmental soundness. Much of the sustainability discourse focuses on functionality, sacrifice, and often, individual lifestyle changes. This paper seeks to challenge that perspective by proposing that a collectivistic approach with implications of prosperity can optimize urban adaptation, remediation, and expansion amidst the agglomerations threat of climate change.
Extended vs. brief intermittent access to palatable food differently promote binge-like intake, rejection of less preferred food, and weight cycling in female rats

Abstract Background Palatable food access promotes obesity leading some to diet. Here, we modeled the roles of duration, intermittency and choice of access in bingeing, escalation of daily intake, and underacceptance of alternatives. Method Female rats with (“Choice”) or without continuous chow access, received chow or continuous (Chocolate), intermittent (MWF) long (24 h, Int-Long), or intermittent short (30 min, Int-Short) access to a sucrose-rich, chocolate-flavored diet (CHOC). Results Int-Long rats showed cycling body weight; they overate CHOC, had increased feed efficiency on access days and underate chow and lost weight on non-access days, the latter correlating with their reduced brown fat. Int-Short rats had the greatest 30-min intake upon CHOC access, but did not underaccept chow or weight cycle. Individual vulnerability for intermittent access-induced feeding adaptations was seen. Continuous access rats gained fat disproportionate, but in direct relation, to their normalized energy intake and persistently underaccepted chow despite abstinence and return to normal weight. Abstinence reduced the binge-like CHOC intake of Int-Short rats and increased that of continuous access rats, but not to levels associated with intermittent access history. Choice increased daily CHOC intake under Continuous access and binge-like intake under Int-Short access. Conclusions Intermittency and duration of past access to palatable food have dissociable, individually-vulnerable influences on its intake and that of alternatives. With extended access, daily intake reflects the palatability of available food, rather than metabolic need. Ongoing restrictedness of access or a history of intermittency each drive binge-like intake. Aspects of palatable food availability, similar and different to drug availability, promote disordered eating.
Simulation of Deepwater Horizon oil plume reveals substrate specialization within a complex community of hydrocarbon degraders

The Deepwater Horizon (DWH) accident released an estimated 4.1 million barrels of oil and 1010 mol of natural gas into the Gulf of Mexico, forming deep-sea plumes of dispersed oil droplets and dissolved gases that were largely degraded by bacteria. During the course of this 3-mo disaster a series of different bacterial taxa were enriched in succession within deep plumes, but the metabolic capabilities of the different populations that controlled degradation rates of crude oil components are poorly understood. We experimentally reproduced dispersed plumes of fine oil droplets in Gulf of Mexico seawater and successfully replicated the enrichment and succession of the principal oil-degrading bacteria observed during the DWH event. We recovered near-complete genomes, whose phylogeny matched those of the principal biodegrading taxa observed in the field, including the DWH Oceanospirillales (now identified as a Bermanella species), multiple species of Colwellia, Cycloclasticus, and other members of Gammaproteobacteria, Flavobacteria, and Rhodobacteria. Metabolic pathway analysis, combined with hydrocarbon compositional analysis and species abundance data, revealed substrate specialization that explained the successional pattern of oil-degrading bacteria. The fastest-growing bacteria used short-chain alkanes. The analyses also uncovered potential cooperative and competitive relationships, even among close relatives. We conclude that patterns of microbial succession following deep ocean hydrocarbon blowouts are predictable and primarily driven by the availability of liquid petroleum hydrocarbons rather than natural gases.
Reduction of Thoroughbred racing fatalities at New York Racing Association racetracks using a multi-disciplinary mortality review process.

Between January 1, 2013 and December 31, 2015, findings of a New York State Gaming Commission–Cornell University postmortem examination program were utilized in a multi-disciplinary mortality revie...
Diplopia-Related Ambulatory and Emergency Department Visits in the United States, 2003-2012.

Importance Diplopia is believed to be a common eye-related symptom. However, to date, there are no available population-based estimates, which are necessary to understand the impact of this disabling symptom on the health care system and to identify steps to optimize patient care. Objective To describe diplopia presentations in US ambulatory and emergency department (ED) settings. Design, Setting, and Participants Ambulatory and ED visits in the United States by patients with diplopia were analyzed in this prespecified secondary analysis of National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data collected for a 10-year period (2003-2012). Data were analyzed for the present study from October 6, 2016 to August 18, 2017. Main Outcomes and Measures Numbers of ambulatory and ED diplopia presentations were estimated using weighted sample data. Weighted proportions of patient and clinician (ie, ophthalmologists, general practitioners, and specialty physicians) characteristics, diagnoses, and imaging use were calculated. Results In total, 804 647 (95% CI, 662 075-947 218) ambulatory and 49 790 (95% CI, 38 318-61 262) diplopia-related ED visits occurred annually; 12.3% of ambulatory visits were primarily for acute- or subacute-onset diplopia. Mean (SD) patient age was 62.1 (20.3) years for ambulatory vs 48.1 (22.3) years for diplopia-related ED visits. Most visits primarily for diplopia were by patients 50 years or older (ambulatory, 79.1% [95% CI, 72.9%-84.2%]; ED, 51.8% [95% CI, 41.0%-62.4%]) who were white (ambulatory, 81.7% [95% CI, 74.8%-87.0%]; ED, 86.1% [95% CI, 77.8%-91.6%]) women (ambulatory, 51.1% [95% CI, 44.1-58.1]; ED, 52.8% [95% CI, 41.6%-63.7%]). Most diplopia-related ambulatory visits were conducted by ophthalmologists (70.4% [95% CI, 62.2%-77.5%]) even when symptoms were acute or subacute (89.0% [95% CI, 81.0%-93.9%]). The most common diagnosis in both settings was diplopia (International Classification of Diseases, Ninth Revision, Clinical Modificationcode 368.2). None of the 10 most frequent diagnoses was life threatening in the ambulatory setting, but approximately 16% of diplopia-related ED visits resulted in a stroke or transient ischemic attack diagnosis. Computed tomography or magnetic resonance imaging was ordered in 6.2% (95% CI, 2.8%-12.9%) of ambulatory and 59.7% (95% CI, 38.6%-77.7%) of ED visits, primarily for diplopia. Conclusions and Relevance Approximately 850 000 diplopia visits occur in the United States annually; 95% were outpatient visits, and diagnoses were rarely serious in the ambulatory setting but potentially life threatening in 16% of diplopia-related ED visits. Given the low probability of a serious neurologic diagnosis in the ambulatory setting and higher probability in an ED, future cohort studies are needed to define the association of various diagnostic practice patterns, such as imaging, with patient outcomes.
Instantly Hooked? Freebies and Samples of Opioids, Cannabis, MDMA, and Other Drugs in an Illicit E-Commerce Market:

Do drug dealers entice nonusers with free samples? Police, the popular press, and social media users say so, but crime researchers have found little support for this theory and argue instead that s...
Effect of Visitor Perspective on Adoption Decisions at One Animal Shelter.

This study investigated the visitor experience at one urban animal shelter. While several previous studies have examined the reasons particular nonhuman animals are chosen by adopters, few have inv...
Abstract WMP54: Association Between Arterial Stiffness and All-cause Mortality Among Stroke Survivors in the United States

Introduction: Indirect measures of arterial stiffness such as wide pulse-pressure, high BP variability, elevated LDL, and abnormal ankle-brachial index (ABI) each predict cerebrovascular events and outcomes; however, less is known about the utility of these markers in combination. Hypothesis: Higher number of abnormal indirect measurements of arterial stiffness is associated with higher mortality after stroke. Methods: Using the US National Health and Nutrition Examination Surveys 1999-2004 (with linked mortality through 2010), we assessed arterial stiffness scores for adults aged ≥40 years. Arterial stiffness score (range 0-4) was defined as number of positive findings among the following: high SBP variability (highest quartile), wide pulse pressure (highest quartile), abnormal ABI ( 1.3), or LDL ≥ 100 mg/dL. We assessed stroke prevalence across arterial stiffness scores. Independent relationships between arterial stiffness score and all-cause-mortality were assessed using Cox regression models. Results: Among 6,711 individuals, 25% were aged ≥ 65 years, 51% were women, and 79% were White. Factors associated with higher arterial stiffness scores were: older age, female sex, lower education, and lower socioeconomic status (all P Conclusions: Simultaneous assessment of common ambulatory markers for arterial stiffness provides a simple, readily available scheme for stroke risk outcome stratification.
Recognition of Miconia sect. Sagraeoides (Melastomataceae: Miconieae) and associated nomenclatural changes

Recent phylogenetic studies incorporating DNA sequence data have corroborated the suspected non-monophyly of many currently recognized genera of tribe Miconieae (Melastomataceae), which includes about 1800 species restricted to the Neotropics. The genus Mecranium, comprising 24 species endemic to the Greater Antilles and their satellite islands, appears to be a monophyletic exception within the tribe. However, the continued recognition of Mecranium as a genus, at best, would render Miconia paraphyletic. The most practical solution to the problem of non-monophyletic circumscription of genera in the Miconieae is the recognition of a broadly defined Miconia, with the taxonomic recognition of its subclades as subgenera and sections. Here the Mecranium clade is recognized as a section within a broadly circumscribed Miconia, all recognized species are listed, and 26 new names and nomenclatural combinations are published. In addition, the section is described, and the phylogenetic relationships of its species are discussed briefly based on molecular and morphological phylogenetic analyses.
Some Effects of Visual Deprivation on the Cat Superior Colliculus

anywhere from 200 to 2,000 /tAmps to elicit eye movement. This means considerable current spread, so that we could be stimulating the fibers of the underlying white matter, some of which may be quite remote in terms of retinal topography. DAW: Did you look for visual receptive fields in the frontal eye fields? SCHILLER: Yes we have, but only in one animal so far, in which we studied about 50 units. We did not find any visual receptive fields for these cells. ROBINSON: The lack of smooth pursuit movements with punctate stimulation doesn't mean that they are not in a structure there. The use of more refined electrical stimuli might bring them out. SCHILLER: YOU are quite right. Matter of fact, on the basis of our single unit work we gained the impression that the eye movement cells in the anterior tip of the colliculus discharged not only in association with small saccades but also in association with certain pursuit movements. So we fully expected that when stimulating in this region with continuously varied frequencies we might get pursuit. This seemed to work sometimes in the dark, but I am not really convinced. It is clear, however, that in the light we never succeeded in eliciting smooth pursuit eye movement.
Californium-252 Brachytherapy of Intracerebral Melanoma with and without Administration of Boronophenylalanine Utilizing a Nude Rat Model

Californium-252 brachytherapy has been used clinically to treat bulky localized tumors such as cervical carcinomas and glioblastoma multiforme1,2. Results from the initial therapy trials have been promising, and have stimulated others to consider this therapeutic modality1,2.
Research on risk assessment and risk management: future directions.

This paper has been reviewed by the Office of Health and Environmental Assessment, U.S. Environmental Protection Agency, and approved for publication. Approval does not signify that the contents necessarily reflect the views and policies of the Agency, nor does mention of trade names or commercial products constitute endorsement or recommendation for use. The U.S. EPA has increasingly relied upon quantitative health risk assessments as the basis for management decisions about public health protection. Full utilization of risk assessment in management applications, however, is limited by uncertainties in the resultant accuracy of the risk estimates. This paper will discuss a research strategy to address the uncertainties in the risk assessment process and describe parallel issues to address in the risk management area. An attendant need for effective communication of complex scientific concepts is also identified. 11 refs.
Correlation of Recent and Historical Hemispherical Nose Tip Distributed Roughness Transition Data

An analysis of distributed roughness effects on boundary-layer transition for hemispherical nose tips has been conducted using archival data and new data generated through hypersonic wind-tunnel te...
Prototype, Evaluate, Iterate

As we have talked about a lot of the theory and psychology behind user experience design, and why it's important for developers to realize how much of an effect this can have on our users – which in turn reflects on our products – we must move on to how we can implement these learnings in our daily work, and specifically how we can use our development skills to benefit our products by lending them to different aspects of the software development life cycle.
Biogenetic-type synthesis of polyketides part VIII

Abstract Syntheses of a number of 4-oxygenated 2-pyrones, including the ethionine-induced metabolite of Penicillium stipitatum, tetraacetic lactone (III) are described. The use of these compounds in devising biogenetic-type syntheses of naturally-occurring polyketides is explored.
Decoder for Switching State-Space Models with Spike-Field Observations

The dynamics of brain activity are inherently non-stationary and can change depending on context, for example based on the tasks performed, the stimuli received, or the attention focus maintained. Thus to decode brain states in naturalistic scenarios, it is necessary to track such changes. Further, it is becoming increasingly common to measure the brain at multiple spatiotemporal scales by recording both spike and field activities simultaneously. Thus tracking non-stationarity necessitates efficient decoders that can detect changes in spike-field neural dynamics and accurately estimate the underlying neural and behavioral states. Here, we develop a new decoding framework to address this challenge. We build a multiscale switching dynamical model that assumes the underlying hidden neural state can evolve with dynamics chosen from an arbitrary finite set. The choice of dynamics could for example be dictated by a higher-level cognitive state such as attention level, which we call a switch state. This switch state would also dictate how the neural state is represented in the recorded binary spike events and continuous field signals, which may also have different time-scales. We use a mix of point process and linear Gaussian process models to characterize the spike-field observations. We derive a new multiscale decoder that simultaneously estimates the underlying neural and switch states from these spike-field observations. We show with closed-loop simulations that our new decoder is able to accurately estimate the switch state while accurately decoding the neural and behavioral states. We also show that not accounting for potential switches in dynamics leads to poor decoding. This new decoder has the potential to enhance future neurotechnologies.
WHAT MACROPOTENTIALS TELL US ABOUT THE FUNCTIONS OF MONKEYS' PREFRONTAL CORTEX

Publisher Summary This chapter discusses the role of macropotentials in the functions of monkeys' prefrontal cortex. Macropotentials offers certain advantages to behaviorally-oriented research. With chronically implanted nonpolarizable electrodes in several cortical locations, comparisons may be made among concurrent electrophysiological events from the different electrodes. Also, for any one electrode site, recordings can be obtained for many months while the monkey is trained on different tasks. Finally, endogenous potentials can be used as feedback signals for programming of the behavioral task. In a study described in the chapter, the larger evoked potentials to contralateral visual stimuli seemed to reflect different neuronal processes than those involved in the enhancement effect of prefrontal units for eye movements, because the potential amplitude was found to be a function of the magnitude of the saccade.
Impact of fuel and engine operating conditions on efficiency of a heavy duty truck engine running compression ignition mode using energy and exergy analysis

Abstract Gasoline compression ignition using a single gasoline-type fuel for direct/port injection has been shown as a method to achieve low temperature combustion with low engine-out NOx and soot emissions and high indicated thermal efficiency. However, key technical barriers to achieving low temperature combustion on multi-cylinder engines include the air handling system (limited amount of exhaust gas recirculation) as well as mechanical engine limitations (e.g. peak pressure rise rate). In light of these limitations, high temperature combustion with reduced amounts of exhaust gas recirculation appears more practical. Previous studies by the authors demonstrated that utilizing port and direct injection of E85 gasoline simultaneously resulted in the best performance and the highest brake thermal efficiency of 47.1%, which was 1.2% higher compared to diesel baseline. For further efficiency improvement, a better understanding of energy and exergy loss mechanisms is required. In this work, first and second law thermodynamics analysis were applied to experiments with gasoline compression ignition at an engine speed of 1038 rpm and brake mean effective pressure of 1.4 MPa on a 12.4 L multi-cylinder heavy-duty diesel engine. The impact on the efficiency, losses, and irreversibility with respect to various parameters such as fuel, injection strategy, intake condition, and port injected water mass was quantified. The peak efficiency of ideal cycles and the combined efficiency with a waste heat recovery system were also estimated in this study to assess opportunities for further efficiency gains. It was found that the combustion irreversibility was dominated by the combustion temperature rather than the fuel structure. Despite its highest brake thermal efficiency, E85 gasoline generated the highest exergy destruction due to its lowest combustion temperature. For the same reason, retarding the combustion phasing or adopting a port and direct injection strategy increased the exergy destruction. The combustion duration loss was more notable than the phasing loss and was affected by both the combustion duration and shape of heat release profile. Water port injection increased the exhaust energy, but the available energy dropped significantly attributed to the decrease in the exhaust temperature, rendering waste heat recovery ineffective. The second law analysis serves as a helpful tool in conjunction with the first law analysis to explore pathways to maximize engine efficiency.
Rearranging the Chairs on the Deck or True Reform? Private Sector Bureaucracies in the Age of Choice—An Analysis of Autonomy and Control:

This article uses edvertising as a vehicle through which to examine autonomy and control for key agents in education when market-like reforms are combined with privately led management of schools. ...
LPV Modeling and Switched Control for EGR Valves with Dry Friction

Engine EGR (exhaust gas recirculation) valves are highly nonlinear due to its nonlinear friction, especially at the low-velocity region, where the friction increases sharply, resulting in a large steady-state valve displacement error. Multiple friction factors are considered in this paper using a switched LPV (linear parameter-varying) model, where the scheduling parameter is the friction coefficient as a function of valve velocity. Switched gain-scheduling LPV controllers are designed with hysteresis switching logic using the linear matrix inequality (LMI) convex optimization approach. The LPV controller performance is compared with that of PID controllers in the simulation study, showing a notable improvement in the system response performance and robustness.
ASL Recognition with Metric-Learning based Lightweight Network

In the past decades the set of human tasks that are solved by machines was extended dramatically. From simple image classification problems researchers now move towards solving more sophisticated and vital problems, like, autonomous driving and language translation. The case of language translation includes a challenging area of sign language translation that incorporates both image and language processing. We make a step in that direction by proposing a lightweight network for ASL gesture recognition with a performance sufficient for practical applications. The proposed solution demonstrates impressive robustness on MS-ASL dataset and in live mode for continuous sign gesture recognition scenario. Additionally, we describe how to combine action recognition model training with metric-learning to train the network on the database of limited size. The training code is available as part of Intel OpenVINO Training Extensions.
Chronic infection and inflammation: Hallmarks of diabetic foot ulcers

Abstract The pathogenesis of the diabetic foot ulcer (DFU) is very complex. Among other known factors, such as poor innervation and vascularization, chronic infection and inflammation are critical factors that result in chronicity of these wounds. Novel and emerging concepts in chronic infection and inflammatory response are discussed in this chapter. Lack of adequate solutions for treatment of chronic wound infections such as antibiotic resistant and biofilm infections may result in serious consequences, including poor quality of life and amputations in patients with diabetes. Novel solutions that can counter these threats are urgently needed. A thorough understanding of the principles of immune dysfunction and insufficient resolution of inflammation will lead to innovative interventions that can drive a diabetic wound towards resolution of inflammation, which is conducive to healing.
Abnormal Thyroid Function

Understand the vocabulary used to describe thyroid functional diseases; review the signs, symptoms, and causes of hypothyroidism; review the signs, symptoms, and causes of thyrotoxicosis; and present the euthyroid sick syndrome.
Eph receptors as cancer targets for antibody-based therapy.

Receptor tyrosine kinases (RTKs) are integral membrane sensors that govern cell differentiation, proliferation and mobility, and enable rapid communication between cells and their environment. Of the 20 RTK subfamilies currently known, Eph receptors are the largest group. Together with their corresponding ephrin ligands, Eph receptors regulate a diverse array of physiologic processes including axonal guidance, bone remodeling, and immune cell development and trafficking. Deregulation of Eph signaling pathways is linked to cancer and other proliferative diseases and, because RTKs play critical roles in cancer development, the specific targeting of these molecules in malignancies provides a promising treatment approach. Monoclonal antibodies targeting RTKs represent a potentially attractive modality for pharmaceutical development due to their relatively high target specificity and low off-target binding rates. Therefore, new technologies to generate antibodies able to target RTKs in their native in vivo context are likely to facilitate pre-clinical and clinical development of antibody-based therapies. Our group has recently reported a platform discovery methodology termed Selection of Phage-displayed Accessible Recombinant Targeted Antibodies (SPARTA). SPARTA is a novel and robust stepwise method, which combines the attributes of in vitro screenings of a naive human recombinant antibody library against known tumor targets with those features of in vivo selections based on tumor-homing capabilities of a pre-enriched antibody pool. This unique approach overcomes several rate-limiting challenges to generate human monoclonal antibodies amenable to rapid translation into medical applications.
Suburban schools as sites of inspection: Understanding Latinx youth’s sense of belonging in a suburban high school

Through a critical ethnographic approach, this study examines how Latinx youth made sense of race, space, and place at a predominantly white, well-resourced suburban high school outside of Chicago,...
Motility Disorders of the Gastrointestinal Tract

This chapter covers a wide range of disorders that affect the motility function of the gastrointestinal tract. These mainly include primary and secondary visceral neuropathies, primary and secondary visceral myopathies, and adverse effect of medications. Detailed discussion is given to common disorders such as Hirschsprung disease and intestinal pseudo-obstruction. The roles of immunohistochemistry, histochemical stains, and electron microscopy in the workup of motility disorders are also discussed. Histologic characteristics and clinical correlates described in this chapter are practical to the diagnosis of motility disorders that are frequently challenging and frustrating to pathologists.
Understanding the Perspectives of Seniors on Dementia and Decision-Making.

The legal doctrine of capacity, which governs legally-authorized intervention in the decision-making of persons with dementia, has been subject to recent scholarly criticism and reform efforts. Suc...
Optimizing Teleneonatology Service Activation and Utilization through Simulation and Site Visits

Background: Teleneonatology allows neonatologists to establish real-time audio-video telemedicine connections with community hospital care teams when neonates require advance resuscitation or critical care. For acute care services, such as teleneonatology, efficient service activation and appropriate rates of service utilization are necessary to ensure ongoing and timely access to specialty care during newborn emergencies. However, there is limited information on what programs can do to facilitate efficient and appropriate use of their services by spoke sites. Objective: The objectives of this study were to 1) determine the impact of simulated teleneonatology …
Implementation of a Continuous Glucose Monitoring Program at a Safety Net Hospital During Covid 19 Pandemic

Background: COVID 19 disproportionately impacts individuals with diabetes leading to increased morbidity and mortality. Hyperglycemia is common in hospitalized patients with COVID requiring intensive monitoring and management. Close monitoring of glucoses requires increased use of personal protective equipment (PPE), which has been in limited supply since the beginning of the pandemic. The FDA granted conditional allowance for use of continuous glucose monitors (CGM) in hospital settings during the COVID pandemic to allow for preservation of PPE. We present the process of implementing a continuous glucose monitoring program in an urban safety net hospital.
Viral shedding and transmission after natural infection and vaccination in an animal model of SARS-CoV-2 propagation

At present, global immunity to SARS-CoV-2 resides within a heterogeneous combination of susceptible, naturally infected and vaccinated individuals. The extent to which viral shedding and transmission occurs on re-exposure to SARS-CoV-2 after prior natural exposure or vaccination is an emerging area of understanding. We used Sialodacryoadenitis Virus (SDAV) in rats to model the extent to which immune protection afforded by prior natural infection via high risk (inoculation; direct contact) or low risk (fomite) exposure, or by vaccination, influenced viral shedding and transmission on re-exposure. On initial infection, we confirmed that amount, duration and consistency of viral shedding were correlated with exposure risk. Animals were reinfected after 3.7-5.5 months using the same exposure paradigm. Amount and duration of viral shedding were correlated with re-exposure type and serologic status. 59% of seropositive animals shed virus. Previously exposed seropositive reinfected animals were able to transmit virus to 25% of naive recipient rats after 24-hour exposure by direct contact. Rats vaccinated intranasally with a related virus (Parkers Rat Coronavirus) were able to transmit SDAV to only 4.7% of naive animals after a 7-day direct contact exposure, despite comparable viral shedding. Observed cycle threshold values associated with transmission in both groups ranged from 29-36 cycles, however observed shedding was not a prerequisite for transmission. Results indicate that low-level shedding in both naturally infected and vaccinated seropositive animals can propagate infection in susceptible individuals. Extrapolated to COVID-19, our results suggest that continued propagation of SARS-CoV-2 by seropositive previously infected or vaccinated individuals is possible.
Increasing Psychiatrists' Role in Addressing the Cardiovascular Health of Patients With Severe Mental Illness.

The early mortality of individuals with serious mental illness has long been documented yet persists despite calls for change. Individuals with serious mental illness have a higher rate of medical ...
Reach Outcomes and Costs of Different Physician Referral Strategies for a Weight Management Program Among Rural Primary Care Patients: Type 3 Hybrid Effectiveness-Implementation Trial

Background: Rural residents are at high risk for obesity; however, little resources exist to address this disproportional burden of disease. Primary care may provide an opportunity to connect primary care patients with overweight and obesity to effective weight management programming. Objective: The purpose of this study is to examine the utility of different physician referral and engagement processes for improving the reach of an evidence-based and technology-delivered weight management program with counseling support for rural primary care patients. Methods: A total of 5 rural primary care physicians were randomly assigned a sequence of four referral strategies: point-of-care (POC) referral with active telephone follow-up (ATF); POC referral, no ATF; a population health registry–derived letter referral with ATF; and letter referral, no ATF. For registry-derived referrals, physicians screened a list of patients with BMI ≥25 and approved patients for participation to receive a personalized referral letter via mail. Results: Out of a potential 991 referrals, 573 (57.8%) referrals were made over 16 weeks, and 98 (9.9%) patients were enrolled in the program (58/98, 59.2% female). Differences based on letter (485/991, 48.9%) versus POC (506/991, 51.1%) referrals were identified for completion (100% vs 7%; P<.001) and for proportion screened (36% vs 12%; P<.001) but not for proportion enrolled (12% vs 8%; P=.10). Patients receiving ATF were more likely to be screened (47% vs 7%; P<.001) and enrolled (15% vs 7%; P<.001) than those not receiving ATF. On the basis of the number of referrals made in each condition, we found variations in the proportion and number of enrollees (POC with ATF: 27/190, 50%; POC no ATF: 14/316, 41%; letter ATF: 30/199; 15.1%; letter no ATF: 27/286, 9.4%). Across all conditions, participants were representative of the racial and ethnic characteristics of the region (60% female, P=.15; 94% White individuals, P=.60; 94% non-Hispanic, P=.19). Recruitment costs totaled US $6192, and the overall recruitment cost per enrolled participant was US $63. Cost per enrolled participant ranged from POC with ATF (US $47), registry-derived letter without ATF (US $52), and POC without ATF (US $56) to registry-derived letter with ATF (US $91). Conclusions: Letter referral with ATF appears to be the best option for enrolling a large number of patients in a digitally delivered weight management program; however, POC with ATF and letters without ATF yielded similar numbers at a lower cost. The best referral option is likely dependent on the best fit with clinical resources. Trial Registration: ClinicalTrials.gov NCT03690557; http://clinicaltrials.gov/ct2/show/NCT03690557
Coordinate Regulation of 3-Hydroxy-3-methylglutaryl-coenzyme A Synthase, 3-Hydroxy-3-methylglutaryl-coenzyme A Reductase, and Prenyltransferase Synthesis but Not Degradation in HepG2 Cells

Human hepatoma HepG2 cells were used to demonstrate coordinate regulation of three enzymes of cholesterol synthesis under a variety of conditions. Addition of either delipidized serum and mevinolin or low density lipoprotein, 25-hydroxycholesterol, or mevalonic acid to HepG2 cells resulted in rapid changes both in the levels of the mRNAs and in the rates of synthesis of 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) synthase, HMG-CoA reductase, and farnesyl pyrophosphate synthetase (prenyltranferase). In all cases, the changes in mRNA levels were paralleled by changes in the rates of specific protein synthesis. Pulse-chase techniques were used to determine the half-lives of all three proteins. Addition of low density lipoprotein to the media during the chase increased the rate of degradation of HMG-CoA reductase 4.6-fold but had no affect on the half-lives of HMG-CoA synthase or prenyltransferase. Therefore, we conclude that the coordinate regulation of these three enzymes under a variety of conditions occurs at the level of enzyme synthesis and not at the level of protein stability.
Simultaneous ascending auctions with common complementarities

Competitive equilibria are shown to exist in two-object exchange economies with indivisibilities and additive complementarities in agent valuations between objects, provided that complementarities are common across agents. We further investigate whether the competitive equilibrium can be obtained as an outcome of a simultaneous English-type auction mechanism under non-strategic (honest) bidding.
Design and characterization of a model alpha beta peptide.

CD and nmr spectroscopy were used to compare the conformational properties of two related peptides. One of the peptides, Model AB, was designed to adopt a helix-turn-extended strand (αβ) tertiary structure in water that might be stabilized by hydrophobic interactions between two leucine residues in the amino-terminal segment and two methionine residues in the carboxyl terminal segment. The other peptide, AB Helix, has the same amino acid sequence as Model AB except that it lacks the-Pro-Met-Thr-Met-Thr-Gly segment at the carboxyl-terminus. Although the carboxyl-terminal segment of Model AB was found to be unstructured, its presence increases the number of residues in a helical conformation, shifts the pKas of three ionizable side chains by 1 pH unit or more compared to an unstructured peptide, stabilizes the peptide as a monomer in high concentrations of ammonium sulfate, increases the conformational stability of residues at the terminal ends of the helix, and results in many slowly exchanging amide protons throughout the entire backbone of the peptide. These results suggest that interactions between adjacent segments in a small peptide can have significant structure organizing effects. Similar kinds of interactions may be important in determining the structure of early intermediates in protein folding and may be useful in the de novo design of independently folding peptides. © 1995 John Wiley & Sons, Inc.
Resampling for face recognition

A number of applications require robust human face recognition under varying environmental lighting conditions and different facial expressions, which considerably vary the appearance of human face. However, in many face recognition applications, only a small number of training samples for each subject are available; these samples are not able to capture all the facial appearance variations. We utilize the resampling techniques to generate several subsets of samples from the original training dataset. A classic appearance-based recognizer, LDA-based classifier, is applied to each of the generated subsets to construct a LDA representation for face recognition. The classification results from each subset are integrated by two strategies: majority voting and the sum rule. Experiments conducted on a face database containing 206 subjects (2,060 face images) show that the proposed approaches improve the recognition accuracy of the classical LDA-based face classifier by about 7 percentages.
Image compression and transmission for HF radio systems

This paper presents a novel image compression technique coupled with three HF transmission schemes. The image compression scheme is based on a phase dispersion technique originally developed for the design of pulse compression radar waveforms. The technique forms the basis for a lossless, invertible transform that converts sub-band coefficients to an intermediate domain. This image compression scheme generates significance map bits, which must be transferred across the HF link error free (hard bits) as well as magnitude vectors, which can sustain some degree of received errors (soft bits). The paper gives a brief overview of the image compression scheme followed by a discussion of three transmission schemes. The first transmission scheme investigated is the forward transmission HF modem. In this technique an HF modem is utilized set at an appropriate on-air data rate for the current HF channel conditions. This is a one way broadcast technique with no feedback from the destination. The second transmission scheme investigated is an automatic repeat request (ARQ) technique. This technique utilizes requests from the destination to resend data packets received in error and guarantees error free transmission of the image data. The third transmission scheme examined is a hybrid scheme, which couples an ARQ technique for the error free delivery of the hard bits with a forward transmission HF modem to provide good protection for the soft bits.
Spanning binding sites on allosteric proteins with polymer-linked ligand dimers

One approach to drug design involves determination of the structure of binding sites on target proteins to provide templates for ligand construction. Alternatively, random combinations of chemical groups can be used to generate diverse molecules for screening in the search for effective compounds. Here we report a strategy for developing potent ligands for proteins with multiple binding sites, which combines elements of both approaches: 'polymer-linked ligand dimers', in which two ligands are joined by a polymer chain of variable length. We find that polymer-linked ligand dimers containing two cyclic GMP moieties are up to a thousand times more potent than cyclic GMP in activating cyclic-nucleotide-gated channels and cGMP-dependent protein kinase. Each target protein responds optimally to a polymer-linked ligand dimer with a different average polymer length, even though their cyclic-nucleotide-binding sites are conserved. The tuning of polymer-linked ligand dimers indicates that each protein has a unique spacing of binding sites and provides an estimate of the distance between these sites. As optimal ligands are selected empirically, the polymer-linked ligand dimer strategy enables potent and selective agents to be identified without requiring previous structural information about the target proteins.
Anti-jamming property of clustered OFDM for dispersive channels

Clustered OFDM has not only inherent ability to mitigate intersymbol interference (ISI) caused by delay spread of radio channels, but also great flexibility for multiple access. In this paper, we combine clustered OFDM with spread spectrum techniques to design anti-jamming modulation for tactical communications. We analyze the anti-jamming performance of clustered OFDM spread spectrum systems for dispersive channels and derive an exact bit-error-rate (BER) expression for uncoded systems. For coded systems with hard and soft-decision, we investigate their performance bounds. Our numerical results show that the proposed scheme provides great ability of anti-jamming and combating dispersive fading of radio channels.
The addition of computed tomography to V/Q SPECT imaging in terms of sensitivity specificity and accuracy

2735 Objectives Few investigations to date have compared the sensitivity, specificity, and accuracy of the imaging modalities, Ventilation/ Perfusion (V/Q) single-photon emission computed tomography (SPECT), V/Q SPECT/computed tomography (CT), and multi-detector computed tomography (MDCT) when imaging for pulmonary embolisms (PE), prompting the purpose of this review in comparing the data available on the imaging modalities. Methods Peer-reviewed articles were searched dating back fifteen years on diagnostic imaging modalities used in identifying PE. Results Of the three imaging modalities, sensitivity was the highest in V/Q SPECT and V/Q SPECT/CT both averaging 97% from the investigations. According to the investigation results, the three imaging modalities specificities were above 90%, with V/Q SPECT/CT having the highest of 100%. The modality with the highest accuracy was V/Q SPECT/CT at 99%, followed by V/Q SPECT at 95%. Conclusions For the purpose of identifying PE’s, V/Q SPECT/CT yielded an overall greater sensitivity, specificity, and accuracy than MDCT and SPECT alone. Further investigations are needed for a more accurate determination of V/Q SPECT/CT’s role in diagnosing PE