cssi/SciSciGPT-SciSciNet huggingface dataset:
Effect of paratenon and repetitive motion on the gliding resistance of tendon of extrasynovial origin

We measured the gliding resistance of canine and human tendons of intrasynovial origin and tendons of extrasynovial origin with and without paratenon, and investigated the structure of paratenon using scanning electron microscopy. In the canine study, seven intrasynovial flexor digitorum profundus (FDP) tendons, seven extrasynovial fibularis (peroneus) longus (FL) tendons with paratenon, and seven FL tendons without paratenon were used. In the human study, seven intrasynovial FDP tendons and seven extrasynovial palmaris longus (PL) tendons cut in half (one half with paratenon, the other half without paratenon) were used. The gliding resistance of each tendon was measured at 1, 5, 10, 20, 50, and100 flexion/extension cycles. The canine and human FDP tendons maintained a gliding resistance significantly lower than that of the other tendons at all observation points (P < 0.05). In the canine, the gliding resistance of the FL tendon with paratenon was significantly lower than that of the FL tendon without paratenon up to 50 flexion/extension cycles (P < 0.05), but the two were not significantly different at 100 cycles. In the human, the gliding resistance of PL tendons with paratenon was significantly lower than that of the PL tendons without paratenon at all measuring points (P < 0.05). Preservation of paratenon thus appears to decrease the gliding resistance of extrasynovial tendons after repetitive motion in vitro. Clin. Anat. 15:199–205, 2002. © 2002 Wiley-Liss, Inc.
Nonword repetition errors of children with and without specific language impairments (SLI).

Background Two ubiquitous findings from the literature are that (1) children with specific language impairments (SLI) repeat nonwords less accurately than peers with typical language development (TLD), and (2) all children repeat nonwords with frequent phonotactic patterns more accurately than low-probability nonwords. Many studies have examined repetition accuracy, but little work has examined children's errors. Aims To examine nonword repetition errors from a previously published study in terms of phonotactic probability. Methods & Procedures Eighteen children with SLI (mean age = 9;2) and 18 age-matched controls (mean age = 8;11) repeated three- and four-syllable nonwords. Substitutions were analysed in terms of phoneme frequency and phonotactic probability of the syllable containing the substitution. Outcomes & Results Results for all children show that phoneme substitutions generally involved replacement with more frequently occurring phonemes. Also, the resulting phonotactic probability within syllables containing substitutions was greater than the probability of the targets. This trend did not differ by group. Conclusions & Implications These results suggest that both children with SLI and children with TLD substitute less frequent phonemes with more frequent ones, and less probabilistic syllables with higher probability ones.
Sequence stratigraphy of the Kingak Shale (Jurassic–Lower Cretaceous), National Petroleum Reserve in Alaska

Beaufortian strata (Jurassic–Lower Cretaceous) in the National Petroleum Reserve in Alaska (NPRA) are a focus of exploration since the 1994 discovery of the nearby Alpine oil field (400 MMBO). These strata include the Kingak Shale, a succession of depositional sequences influenced by rift opening of the Arctic Ocean Basin. Interpretation of sequence stratigraphy and depositional facies from a regional two-dimensional seismic grid and well data allows the definition of four sequence sets that each displays unique stratal geometries and thickness trends across NPRA.A Lower to Middle Jurassic sequence set includes numerous transgressive-regressive sequences that collectively built a clastic shelf in north-central NPRA. Along the south-facing, lobate shelf margin, condensed shales in transgressive systems tracts downlap and coalesce into a basinal condensed section that is likely an important hydrocarbon source rock. An Oxfordian–Kimmeridgian sequence set, deposited during pulses of uplift on the Barrow arch, includes multiple transgressive-regressive sequences that locally contain well-winnowed, shoreface sandstones at the base of transgressive systems tracts. These shoreface sandstones and overlying shales, deposited during maximum flooding, form stratigraphic traps that are the main objective of exploration in the Alpine play in NPRA. A Valanginian sequence set includes at least two transgressive-regressive sequences that display relatively distal characteristics, suggesting high relative sea level. An important exception is the presence of a basal transgressive systems tract that locally contains shoreface sandstones of reservoir quality. A Hauterivian sequence set includes two transgressive-regressive sequences that constitute a shelf-margin wedge developed as the result of tectonic uplift along the Barrow arch during rift opening of the Arctic Ocean Basin. This sequence set displays stratal geometries suggesting incision and synsedimentary collapse of the shelf margin.
Comparison of the Pharmacological Profiles of Murine Antisense Oligonucleotides Targeting Apolipoprotein B and Microsomal Triglyceride Transfer Protein

Therapeutic agents that suppress apolipoprotein B (apoB) and microsomal triglyceride transfer protein (MTP) levels/activity are being developed in the clinic to benefit patients who are unable to reach target LDL-C levels with maximally tolerated lipid-lowering drugs. To compare and contrast the metabolic consequences of reducing these targets, murine-specific apoB or MTP antisense oligonucleotides (ASOs) were administered to chow-fed and high fat-fed C57BL/6 or to chow-fed and Western diet-fed LDLr−/− mice for periods ranging from 2 to 12 weeks, and detailed analyses of various factors affecting fatty acid metabolism were performed. Administration of these drugs significantly reduced target hepatic mRNA and protein, leading to similar reductions in hepatic VLDL/triglyceride secretion. MTP ASO treatment consistently led to increases in hepatic triglyceride accumulation and biomarkers of hepatotoxicity relative to apoB ASO due in part to enhanced expression of peroxisome proliferator activated receptor γ target genes and the inability to reduce hepatic fatty acid synthesis. Thus, although both drugs effectively lowered LDL-C levels in mice, the apoB ASO produced a more positive liver safety profile.
The early use of transurethral alprostadil after radical prostatectomy potentially facilitates an earlier return of erectile function and successful sexual activity

OBJECTIVE To assess whether early introduction of the Medicated Urethral System for Erection (MUSETM, Vivus Inc., Mountain View, CA, USA) after radical prostatectomy (RP) results in a shorter recovery time for the return to functional erections and successful sexual activity. PATIENTS AND METHODS In a prospective study of 91 sexually active men who had a nerve-sparing RP for prostate cancer, 56 were treated with MUSE (125 or 250 µg three times per week for 6 months) while the remaining 35 had no erectogenic aids, except as necessary when attempting sexual activity. Self-administration of MUSE was initiated ≈ 3 weeks after RP. Treatment efficacy was analysed by the patient’s response to the Sexual Health Inventory for Men (SHIM) questionnaire. RESULTS The mean patient age was ≈ 59 years and the median follow-up 6 months; the compliance rate was 68%. Patients reported a significant improvement in all domains of the SHIM questionnaire after using MUSE. At the end of 6 months 74% of the patients who remained on MUSE were able to have successful vaginal intercourse. Of patients who completed the 6-month course of MUSE, half were able to have successful vaginal intercourse by the end of treatment. Most of these patients reported the recovery of spontaneous erections and required no additional erectogenic aids for successful intercourse. They had a mean SHIM score of 18.9. All 56 patients who received MUSE reported mild penile aching or urethral burning, and of these, 32% discontinued treatment. In the untreated control group, 37% regained erections sufficient for vaginal intercourse at the 6-month follow-up, with a mean SHIM score of 15.8. Of the control patients who recovered penile function, 71% were dissatisfied with the quality of their erections and sought adjuvant therapy. CONCLUSIONS Initiating MUSE shortly after RP is safe and tolerable, and appears to shorten the recovery time to reagin erectile function.
Studies in the synthesis of control structures for chemical processes: Part III: Optimal selection of secondary measurements within the framework of state estimation in the presence of persistent unknown disturbances

When primary control objectives cannot be measured directly, secondary measurements have to be selected and used in conjunction with estimators to infer the value of the unmeasurable variables. Unmeasured process disturbances (state excitation noise) are assumed to be of major importance, dominating the errors caused by measurement noise. Since the white noise assumption is generally insufficient for the persistent disturbances commonly occuring in the Chemical Engineering, environment, a nonstationary noise model has been employed, and is shown to yield superior estimations under these circumstances. New necessary and sufficient conditions have been developed for the observability of the dynamic system augmented to include the noise model. A variety of new measurement selection criteria is presented here, with the goal of minimizing estimation error. One class of criteria aims at minimizing the transient estimation error when a static estimator is used. The other class minimizes the measurement error caused by the unobservable subspace. The design of state reconstruction procedures (which are able to handle persistent unmeasured process disturbances) is explained in a stochastic and a deterministic framework. Finally, the synthesis of reduced order control schemes is discussed. The power of the selection criteria and the superiority of a Kalman filter design employing a nonstationary noise model is demonstrated in many examples.
Aerospace applications of shape memory alloys

AbstractWith the increased emphasis on both reliability and multi-functionality in the aerospace industry, active materials are fast becoming an enabling technology capturing the attention of an increasing number of engineers and scientists worldwide. This article reviews the class of active materials known as shape memory alloys (SMAs), especially as used in aerospace applications. To begin, a general overview of SMAs is provided. Their useful properties and engineering effects are described and the methods in which these may be utilized are discussed. A review of past and present aerospace applications is presented. The discussion addresses applications for both atmospheric earth flight as well as space flight. To complete the discussion, SMA design challenges and methodologies are addressed and the future of the field is examined.
Intraplate deformation in the Samoa-Gilbert-Ralik area: A prelude to a change of plate boundaries in the Southwest Pacific?

Okal, E.A., Woods, D.F. and Lay, T., 1986. Intraplate deformation in the Samoa-Gilbert-Ralik area: a prelude to a change of plate boundaries in the Southwest Pacific? In: B. Johnson and A.W. Bally (Editors), Intraplate Deformation: Characteristics, Processes and Causes. Tectonophysics, 132: 69-71. Intense intraplate seismic activity has recently been identified in the west-central Pacific, along a line extending from Samoa through the Gilbert Islands and the Ralik Fracture Zone to the Caroline Islands. Over the past 50 years, this seismic line has contributed an estimated 15-30% of the entire intraplate seismicity for the Pacific plate (Hawaii excepted). Focal mechanisms available for ten of the largest events during the 1981-1983 Gilbert Islands swarm, with horizontal compressional stress oriented at right angles to the direction of motion of the plate, cannot be reconciled with simple models of intraplate stresses. We speculate that they express large scale deformation of that part of the Pacific plate, related to incipient detachment of a microplate and relocation of the Pacific-Australian subduction zone some 1000 km to the north of its present position.
Selling St. Petersburg: John Lodwick and the Promotion of a Florida Paradise

A thesis submitted in partial fulfillment of the requirements for the degree of Master of Liberal Arts, Department of Humanities, College of Arts and Sciences, University of South Florida St. Petersburg
A flexible decoder buffer model for JVT video coding

Video coding standards require that a compliant bit stream be decodable by a hypothetical decoder that is conceptually connected to the output of an encoder and consists of a decoder buffer, a decoder, and a display unit. The encoder must create a bit stream so that the hypothetical decoder buffer does not overflow or underflow. Previous decoder models assume that a given bit stream will be transmitted through a channel of a given constant bit rate and will be decoded (after a given buffering delay) by a device of some given buffer size. Therefore, these models are quite rigid and do not address the requirements of many of today's important video applications such as broadcasting live video or streaming pre-encoded video on demand over network paths with various peak bit rates to devices with various buffer sizes. In this contribution, we present a new hypothetical reference decoder for JVT that is more general and flexible than those defined in prior standards and provides significant additional benefits.
Detection of high-risk atherosclerotic coronary plaques by intravascular spectroscopy.

Multiple technologies are under development to identify plaque composition and vulnerability. This review article is intended to provide basic knowledge to the interventional cardiologist and the clinician about spectroscopy. The concept of light, the wavelength unit and the electromagnetic spectrum are discussed. Different types of spectra analysis including nuclear magnetic resonance, Raman, fluorescence and diffuse reflectance near-infrared spectroscopy are then carefully reviewed. Experimental data to identify atherosclerotic plaque composition for each of these techniques is provided. Potential benefits and challenges are addressed. Finally, diffuse reflectance near-infrared spectroscopy is discussed in more detail as a promising technique to characterize plaque vulnerability in humans. (J Interven Cardiol 2003;16:243–252)
Kinetic Theory of Gases—Transport

According to the kinetic model, molecules move very rapidly. At 300 K the rms speed of gaseous bromine is 125 m sec-1. Yet, if a small amount of bromine is added to nitrogen at 300 K and 1 atm the rate at which the bromine diffuses through the gas is much slower, about 10-3 m sec-1. The presence of the nitrogen impedes the movement of the bromine, reducing the effective rate of travel by a factor of 105 from that which occurs in the absence of nitrogen. The most obvious possible cause for such retardation is the effect of molecular collision.
Half-Lives of Some Cosmogenic Radionuclides: 7Be, 46Sc, 54Mn, 56Co, and 65Zn

The decay of five radionuclides used as calibration sources in cosmogenic radionuclide studies was followed for from 3 to 11 half-lives. Least-squares analyses of the gamma-ray counting data yielde...
Freeze-thawing at point-of-use to extend shelf stability of lipid-based oxygen microbubbles for intravenous oxygen delivery

Abstract A continuous supply of oxygen gas is critical to sustain life. However, current delivery strategies are dependent on functioning lungs for effective gas delivery. We have recently shown that oxygen gas can be safely administered through intravenous routes when packaged within lipid-based oxygen microbubbles (LOMs). However, the long-term stability of LOMs is poor, which may limit the clinical applicability of this technology. Here, we describe a freeze-thawing strategy to prolong the shelf life of concentrated LOMs. In addition, we examine the effect of various rapid thawing strategies in an attempt to identify an approach that would enable use of this technique in emergent clinical situations. Our results suggest that LOM emulsions stored at −20 °C followed by rapid thawing under warm running water or microwave irradiation exhibit preserved microbubble size distribution and oxygen carrying capacity for at least 30 days. Further investigation into the limits and clinical viability of these techniques are warranted.
Confocal Raman microscopy probing of temperature-controlled release from individual, optically-trapped phospholipid vesicles.

Control of permeability of phospholipid vesicle (liposome) membranes is critical to their applications in analytical sensing, in fundamental studies of chemistry in small volumes, and in encapsulation and release of payloads for site-directed drug delivery. Applications of liposome formulations in drug delivery often take advantage of the enhanced permeability of phospholipid membranes at their gel-to-fluid phase transition, where the release of encapsulated molecules can be initiated by an increase in temperature. Despite numerous successful liposome formulations for encapsulation and release methods to study the kinetics, this process has been limited to investigations of bulk vesicle dispersions, which provide little or no information about the vesicle membrane structure and its relationship to the kinetics of trans-membrane transport. In this work, confocal Raman microscopy is adapted to study temperature-dependent release of a model compound, 3-nitrobenzene sulfonate (3-NBS), from individual opticall...
The Effects of Electric Fields on the Thermodiffusive Instability in Hydrocarbon - Air Flames

[Abstract] Thi s work focuses upon the effects of DC electric fields on the stability of downward propagating, atmospheric - pressure pre - mixed propane - air flames under experimental conditions that provide close coupling of the electric field to the flame. With the approp riate electrode geometry, modest applied voltages are shown to force pre - mixed light hydrocarbon/air flame fronts to transition from flow - induced hydrodynamic - instability - dominated behavior, to field stabilized laminar flow, and finally to field - induced th ermal - diffusive - instability - dominated oscillatory and turbulent flame. Applied potentials up through 5.5 kV over a 40 - mm gap encompassing the flame front have been used to force that transition sequence in flames with equivalence ratios between 0.8 – 1.3 and flow velocities up to 1.9 m/s. Experiments are reported that characterize the field - induced changes in the geometry of the reaction zone and the stability of the resulting turbulized flame. The former is quantified by combustion intensity enhancement estimates derived from high - speed two - dimensional direct and spectroscopic imaging of chemi - luminescence. The flame fluid mechanical response to the applied field, brought about by forcing positive flame ions counter to the flow, drives the effective fla me Lewis number below unity and on to levels below the critical value for the onset of the thermodiffusive instability, even near stoichiometric conditions. Possible field - driven flame ion recombination chemistry that would inject light reactants near the burner head and precipitate the onset of the thermodiffusive instability is proposed. Electrical measurements are also reported which establish that minimal electrical power input is required to produce the observed flame instabilities. Current - continui ty - based calculations allow estimates of the level of deficient light reactant necessary to turbulize the flame. This applied - electric - field induced modification of the thermodiffusive effect could serve as a potentially attractive means of controlling fl ame fluid mechanical characteristics and validating combustion instability models over a wide range of equivalence ratios. Measurements further suggest that electrical sensing of the onset of combustion instability should be feasible.
Control Charts for Radial Error

AbstractIn applications such as the drilling of holes or placement of components at a targeted location, the quality characteristic of interest is the radial distance of the center from its desired location. Control charts for radial error are established for the case where the center displacement errors in two orthogonal directions are normally and independently distributed with the same variance about the true center location. It is shown that a second chart based on the ratio of individual observed values of radial error can be used to distinguish between a radial shift in the means of the error distributions and an increase in their variability.
Xylaria Polymorpha and Its Allies in Continental United States

Biological and taxonomic aspects of Xylaria polymorpha and the closely related taxa X. schweinitzii, X. grandis, and X. scruposa are discussed with particular reference to their occurrence and activities in continental United States. Xylaria polymorpha is frequently encountered east ofthe Rocky Mountains and is rare in the Rocky Mountain and far western states. Xylaria schweinitzii and X. grandis have rarely been collected and X. scruposa is apparently unknown from continental United States. Cultural and anamorphic features of X. polymorpha and X. schweinitzii are discussed. A key to these taxa and others that might be confused with them is included.
A systematic review of human and veterinary applications of noninvasive tissue oxygen monitoring.

Objective To describe the methodology for and utilization of tissue oxygen monitoring by near infrared spectroscopy, and to review the current literature on the use of this monitoring modality in human and veterinary settings. Data Sources Scientific reviews and original research found using the PubMed and CAB Abstract search engines with the following keywords: “tissue oxygen monitoring,” “near-infrared tissue spectroscopy,” and “tissue oxygen saturation (StO2).” Human Data Synthesis Tissue oxygen monitors have been evaluated in a wide variety of human clinical applications including trauma and triage, surgery, sepsis, and septic shock, and early goal-directed therapy. StO2 more rapidly identifies occult shock in human patients compared to traditional methods, which can lead to earlier intervention in these patients. Veterinary Data Synthesis Veterinary studies involving tissue oxygen monitoring are limited, but the technology may have utility for identification of hemorrhagic shock earlier than changes in base excess, blood lactate concentration, or other traditional perfusion parameters. Conclusion Tissue oxygen monitoring is most commonly performed utilizing a noninvasive, portable monitor, which provides real-time, continuous, repeatable StO2 measurements. A decline in StO2 is an early indicator of shock in both human and veterinary patients. Low StO2 values in human patients are associated with increased morbidity, mortality, and length of hospitalization, as well as the development of multiple organ system dysfunction and surgical site infections.
Soil creep in salt marshes

A puzzling aspect of marsh morphodynamics is the occurrence of channel bank slumping despite the absence of channel widening and lateral migration. An apparently unrelated conundrum is why the vertical accretion rate on the low marsh adjacent to channels is higher than the rate of relative sea-level rise; this sedimentation excess should not occur at steady state or in a regime of accelerated sea-level rise. Here we suggest that lateral erosion and vertical sedimentation on channel banks are linked by creep, the process by which soil is moved downslope by gravity. The model presented herein predicts a dynamic equilibrium configuration for the cross section such that sedimentation excess on the channel banks is transferred by creep toward the channel, where tidal flow erosion and suspended sediment transport directed toward the banks close the sediment budget. This model predicts that bank slumping is an equivocal indicator of ongoing marsh loss and that high sedimentation rates on channel banks do not necessarily constitute a margin of resilience to accelerated sea-level rise.
Management of External Ventricular Drains After Subarachnoid Hemorrhage: A Multi-Institutional Survey

Background Patients with aneurysmal subarachnoid hemorrhage (SAH) often develop hydrocephalus requiring an external ventricular drain (EVD). The best available evidence suggests that a rapid EVD wean and intermittent CSF drainage is safe, reduces complications, and shortens ICU and hospital length of stay as compared to a gradual wean and continuous drainage. However, optimal EVD management remains controversial and the baseline practice among neurological ICUs is unclear. Therefore, we sought to determine current institutional practices of EVD management for patients with aneurysmal SAH.
The Metaphysics of Identity: Is Identity Fundamental?

Identity and distinctness facts are ones like “The Eiffel Tower is identical to the Eiffel Tower,” and “The Eiffel Tower is distinct from the Louvre.” This paper concerns one question in the metaphysics of identity: Are identity and distinctness facts metaphysically fundamental or are they nonfundamental? I provide an overview of answers to this question.
Evaluating the Cost, Safety, and Proliferation Risks of Small Floating Nuclear Reactors

It is hard to see how our energy system can be decarbonized if the world abandons nuclear power, but equally hard to introduce the technology in nonnuclear energy states. This is especially true in countries with limited technical, institutional, and regulatory capabilities, where safety and proliferation concerns are acute. Given the need to achieve serious emissions mitigation by mid-century, and the multidecadal effort required to develop robust nuclear governance institutions, we must look to other models that might facilitate nuclear plant deployment while mitigating the technology's risks. One such deployment paradigm is the build-own-operate-return model. Because returning small land-based reactors containing spent fuel is infeasible, we evaluate the cost, safety, and proliferation risks of a system in which small modular reactors are manufactured in a factory, and then deployed to a customer nation on a floating platform. This floating small modular reactor would be owned and operated by a single entity and returned unopened to the developed state for refueling. We developed a decision model that allows for a comparison of floating and land-based alternatives considering key International Atomic Energy Agency plant-siting criteria. Abandoning onsite refueling is beneficial, and floating reactors built in a central facility can potentially reduce the risk of cost overruns and the consequences of accidents. However, if the floating platform must be built to military-grade specifications, then the cost would be much higher than a land-based system. The analysis tool presented is flexible, and can assist planners in determining the scope of risks and uncertainty associated with different deployment options.
Metabolism and Congenital Malformations — NAD’s Effects on Development

A new study shows that a deficiency of nicotinamide adenine dinucleotide causes congenital malformations. The mechanism is not known, but dietary supplementation with NAD precursors merits further study.
Analogy and Relational Representations in the Companion Cognitive Architecture

The Companion cognitive architecture is aimed at reaching human-level AI by creating software social organisms, systems that interact with people using natural modalities, working and learning over extended periods of time as collaborators rather than tools. Our two central hypotheses about how to achieve this are (1) analogical reasoning and learning are central to cognition, and (2) qualitative representations provide a level of description that facilitates reasoning, learning, and communication. This paper discusses the evidence we have gathered supporting these hypotheses from our experiments with the Companion architecture. Although we are far from our ultimate goals, these experiments provide strong breadth for the utility of analogy and QR across a range of tasks. We also discuss three lessons learned and highlight three important open problems for cognitive systems research more broadly.
A (5,5)-Colouring of Kn with Few Colours

For fixed integers p and q , let f ( n , p , q ) denote the minimum number of colours needed to colour all of the edges of the complete graph K n such that no clique of p vertices spans fewer than q distinct colours. Any edge-colouring with this property is known as a ( p , q )-colouring. We construct an explicit (5,5)-colouring that shows that f ( n ,5,5) ≤ n 1/3 + o (1) as n → ∞. This improves upon the best known probabilistic upper bound of O ( n 1/2 ) given by Erdős and Gyarfas, and comes close to matching the best known lower bound Ω( n 1/3 ).
New Nurses’ Views of Quality Improvement Education

Article-at-a-Glance Background Quality improvement (QI) is a focus of hospital managers and policymakers. The role of registered nurses (RNs) in QI in hospitals is vital because most hospital-based RNs provide direct care to patients. QI skills are necessary to identify gaps between current care and best practice and to design, implement, test, and evaluate changes and are essential for R.N.s to participate effectively in QI. Newly licensed registered nurses' (new nurses') positions as direct caregivers could have an impact on QI if nurses lack sufficient knowledge, concepts, and tools required for QI. Methods Data came from the 436 respondents (69.4% response rate) to a 2008 eight-page mailed survey to participants in a nationally representative panel survey of new nurses who graduated between August 1, 2004, and July 31, 2005. Results Overall, 159 (38.6%) of new nurses thought that they were "poorly" or "very poorly" prepared about or had "never heard of" QI. Their perceptions of preparation varied widely by the specific topic. Baccalaureate (B.S.) graduates reported significantly higher levels of preparation than associate degree (A.D.) graduates in evidence-based practice; assessing gaps in practice, teamwork, and collaboration; and many of the research-type skills such as data collection, analysis, measurement, and measuring resulting changes. Discussion Registered-nurse educational programs need to improve education about and application of QI concepts and to consider focusing QI content into a separate course to have some confidence that faculty will teach it. Despite the strong focus on QI in hospitals, new nurses do not see the connection between QI education and successfully performing their hospital jobs. Both nursing programs and hospitals should help new nurses make the connection.
Using Quality Improvement to Change Testing Practices for Community-acquired Pneumonia

Background National guidelines for pediatric community-acquired pneumonia (CAP) contain recommendations regarding diagnostic testing including chest radiographs (CXRs), complete blood counts (CBCs), and blood cultures. Local data indicated that our institution was not delivering care at standards outlined by these guidelines. This project aimed to decrease CXRs for children with CAP discharged from the emergency department (ED) by 10% and decrease CBCs and blood cultures for patients hospitalized with uncomplicated CAP by 20% within 1 year. Methods This single-site quality improvement initiative targeted otherwise healthy children 3 months to 18 years who presented to the ED with uncomplicated CAP at a free-standing academic children's hospital. A quality improvement team performed a series of interventions including guideline implementation, data sharing, and annual education. Process measures included CXR, CBC, and blood culture rates. Balancing measures included the number of patients diagnosed with CAP, the frequency of antibiotic use, length of stay, and ED and hospital return rates. The team used statistical process control charts to plot measures. Results There was special cause improvement with a desirable downward shift in testing that correlated with the project's interventions. The percentage of CXRs for discharged patients decreased from 79% to 57%. CBCs and blood cultures for hospitalized patients decreased from 30% to 19% and 24% to 14%, respectively. Balancing measures remained unchanged. Conclusions We used elements of quality improvement methodology to reduce testing for uncomplicated CAP without impacting the number of patients diagnosed with CAP, the frequency of antibiotic use, length of stay, and reutilization rates.
Minimum Precision Requirements for Deep Learning with Biomedical Datasets

Deep neural networks (DNNs) are powerful machine learning models but are typically deployed in large computing clusters due to their high computational and parameter complexity. Many biomedical applications require embedded inference on resource-constrained platforms thus causing a challenge when considering the deployment of DNNs. One method to address this challenge is via reduced precision implementations. We use an analytical method to determine suitable minimum precision requirements of DNNs and show its application to the CHB-MIT EEG seizure detection dataset and the Bonn dataset for brain electrical activity recognition. We show that our method leads to 2 × reduction in average precision and 45% complexity reduction compared to the minimum uniform precision assignment. Compared to a conventional 16-b precision assignment, our method leads to 9 x complexity reduction. Furthermore, we study the impact of network topology on precision and accuracy. Once again we find our method to be ~2× more efficient that the uniform assignment for all topologies considered.
Kinesin-binding protein ensures accurate chromosome segregation by buffering KIF18A and KIF15

Mitotic kinesins must be regulated to ensure a precise balance of spindle forces and accurate segregation of chromosomes into daughter cells. Here, we demonstrate that kinesin-binding protein (KBP) reduces the activity of KIF18A and KIF15 during metaphase. Overexpression of KBP disrupts the movement and alignment of mitotic chromosomes and decreases spindle length, a combination of phenotypes observed in cells deficient for KIF18A and KIF15, respectively. We show through gliding filament and microtubule co-pelleting assays that KBP directly inhibits KIF18A and KIF15 motor activity by preventing microtubule binding. Consistent with these effects, the mitotic localizations of KIF18A and KIF15 are altered by overexpression of KBP. Cells depleted of KBP exhibit lagging chromosomes in anaphase, an effect that is recapitulated by KIF15 and KIF18A overexpression. Based on these data, we propose a model in which KBP acts as a protein buffer in mitosis, protecting cells from excessive KIF18A and KIF15 activity to promote accurate chromosome segregation.
Scalable Vector Graphics

This chapter explores a powerful two-dimensional graphics format named SVG (scalable vector graphics), which is becoming widely used to represent object-based, vector (nonraster) graphics both on the Web and elsewhere. In addition to displaying scalable plots, the XML-based SVG format provides functionality for interactivity, animation, and a number of filtering effects that allow us to create rich graphical displays, and also to integrate them with Web pages. R can create static SVG displays, and we can post-process them within R as XML documents to add interaction and animation. We show how to provide simple interaction and animation with high-level R functions, and also how to add more customized interaction using R commands that use JavaScript at viewing time. We also discuss how to use both SVG and HTML to create rich “applications” and mash-ups in the Web browser.
Hypertonic Mannitol for the Prevention of Intradialytic Hypotension: A Randomized Controlled Trial

Rationale & Objective Intradialytic hypotension (IDH) is a common complication at the initiation of hemodialysis (HD) therapy, is associated with greater mortality, and may be related to relatively rapid shifts in plasma osmolality. This study sought to evaluate the effect of an intervention to minimize intradialytic changes in plasma osmolality on the occurrence of IDH. Study Design Double-blind, single-center, randomized, controlled trial. Setting & Participants Individuals requiring initiation of HD for acute or chronic kidney disease. Intervention Mannitol, 0.25g/kg/h, versus a similar volume of 0.9% saline solution during the first 3 HD sessions. Outcomes The primary end point was average decline in systolic blood pressure (SBP). The secondary end point was the proportion of total sessions complicated by IDH (defined as a decrease ≥ 20mm Hg from the pre-HD SBP). Exploratory end points included biomarkers of cardiac and kidney injury. Results 52 patients were randomly assigned and contributed to 156 study visits. There were no significant differences in average SBP decline between the mannitol and placebo groups (15±11 vs 19±16mm Hg; P = 0.3). The proportion of total sessions complicated by IDH was lower in the mannitol group compared to placebo (25% vs 43%), with a nominally lower risk for developing an episode of IDH (OR, 0.38; 95% CI, 0.14-1.00), though this finding was of borderline statistical significance (P = 0.05). There were no consistent differences in cardiac and kidney injury biomarker levels between treatment groups. Limitations Modest sample size and number of events. Conclusions In this pilot randomized controlled trial studying patients requiring initiation of HD, we found no difference in absolute SBP decline between those who received mannitol and those who received saline solution. However, there were fewer overall IDH events and a nominally lower risk for dialysis sessions being complicated by IDH in the mannitol group. A larger multicenter randomized controlled trial is warranted. Funding Government funding to an author (Dr Mc Causland is supported by National Institute of Diabetes and Digestive and Kidney Diseases grant K23DK102511). Trial Registration Registered at ClinicalTrials.gov with study number NCT01520207.
Cardiac Metabolic Protection for the Newborn Heart

As the newborn heart transitions into the extrauterine environment, it emerges from a relatively hypoxic state, restricted predominately to glucose for energy, into an oxygen abundant environment in which a wider selection of substrates is available. Exposed to the unique milieu in utero, the fetal cardiac myocyte developed metabolic pathways that will subsequently adapt to postnatal life. Prior to the transition to a more adult-like metabolism, the newborn heart can take advantage of the metabolic profile developed in utero to protect itself during times of stress such as global ischemia and abrupt hypoxia. This relative tolerance to low oxygen levels and robust coronary perfusion of the neonatal heart have been exploited by surgeons to allow prolonged periods of bypass or cardiac arrest, facilitating repair of complex congenital heart defects. The ability of the newborn heart to utilize a variety of energy substrates has generated great interest in defining the optimal composition of cardioplegia solutions to enhance the ability of newborn myocardium to tolerate open heart surgery.
Impact of regional characteristics on the estimation of root-zone soil moisture from the evaporative index or evaporative fraction

Abstract Accurate knowledge of root-zone soil moisture is of vital significance to many applications in agriculture, such as crop yield estimation, precision irrigation, salinity and groundwater management. Remote-sensing methods based on optical and thermal satellite imagery have been proposed to estimate fine-resolution (30 m grid cells) maps of root-zone soil moisture θ ¯ or degree of saturation s ¯ over large regions. These methods usually calculate the evaporative fraction Λ S E B as the ratio of the latent heat flux to the difference of the net radiation and ground heat flux. Then, they estimate θ ¯ or s ¯ from an empirical relationship with Λ S E B . A similar approach estimates θ ¯ or s ¯ using the evaporative index Λ P E T , which is the ratio of the actual to potential evapotranspiration. However, previous research has shown that a single relationship between either θ ¯ or s ¯ and Λ S E B does not apply to all regions. The objective of this study is to evaluate the impact of regional soil, vegetation, and climatic conditions on the form and strength of the Λ S E B − θ ¯ , Λ P E T − θ ¯ , Λ S E B − s ¯ , and Λ P E T − s ¯ relationships. To accomplish this goal, Extended Fourier Amplitude Sensitivity Test (eFAST) is applied to a physically-based model (HYDRUS 1-D) that simulates both evapotranspiration and soil moisture dynamics. The sensitivity results show that, within a given climatic region, soil characteristics such as the percent clay and percent silt are most important in determining the shape of the relationships, while vegetation characteristics such as leaf area index and maximum rooting depth have the greatest effect on the strength of these relationships. The total annual precipitation, which helps determine the climatic region, also has a strong effect on both the form and strength of the relationships. The parameters that define the Λ S E B − θ ¯ and Λ P E T − θ ¯ relationships are also estimated using the regional characteristics. Estimating the parameters in this way allows the methods to be adapted to local conditions and has the potential to improve the θ ¯ and s ¯ estimates.
Molecular typmg of 49 strains of group B Neisseria meningitidis isolates from normal population in Shenzhen,China

脑膜炎奈瑟菌(Nm)是导致流行性脑脊髓膜炎(流脑)的病原体之一,对健康人群咽部分离到的Nm进行分子流行病学研究,有利于了解Nm菌群的特点,同时与流脑病例分离到的Nm进行比较,结合流行病学资料,可以对流脑的传播做出推测,有利于流脑防控。
Hoist the Yellow Flag and Spam® Up: The Separation of Powers Limitation on Hawaii’s Emergency Authority

Hawaii’s government has a long experience responding to public health emergencies. But until 2014, when the Hawaii legislature adopted a comprehensive structural overhaul, Hawaii’s emergency response statutes and organization were a patchwork of scattered provisions that did not conform to modern emergency management and response practices. The law’s first major test has been a dramatic one: the COVID-19 worldwide pandemic. Hawaii’s governor exercised his authority to issue a declaration of emergency, and later issued supplemental proclamations purporting to extend the termination date for the emergency. This article analyzes whether the statute’s internal limitation on delegated emergency power—the “automatic termination” provision, under which an emergency proclamation terminates by law the sixtieth days after it was issued—may be enforced by the courts. It argues that that the circumstances in which a court would sustain a challenge are limited, and that the primary remedy will be a political one. It should not be so, however, because Hawaii precedents confirm that the courts should enforce the essential separation of powers boundaries between the other branches. This article examines the prominent narrative threads that have emerged from Hawaii’s history of adjudicating claims arising out of public health crises, quarantines, and emergencies, as a way of comparing the directions a court might take.
Characterization of Isavuconazole serum concentrations after enteral feeding tube administration in a hospitalized cohort: A case series.

What is known and objective Invasive fungal infections often occur in patients with comorbidities that complicate oral administration. Serum concentrations of isavuconazole were characterized after enteral tube administration. Case description Thirteen of 14 isavuconazole concentrations were >1 mg/dl (median 1.6 mg/dl) among those receiving enteral tube administration, which was comparable to intravenous (median 1.9 mg/dl). Higher concentrations were observed during oral administration (median 3 mg/dl). What is new and conclusion Administration of isavuconazole via tube resulted in concentrations comparable to FDA-approved routes of administration. This route may be feasible and appropriate for select patients.
Nonstate Actors in Intrastate Conflicts: by Dan Miodownik and Oren Barak, Philadelphia, PN, University of Pennsylvania Press, 2013, 231 pp., $75.00 (hardcover), ISBN: 978-0-8122-4543-1

Barak and Miodownik provide an informative volume on the participation of nonstate actors in intrastate conflict processes. This book is a significant contribution to the field of international rel...
Validation of a Machine Learning Brain Electrical Activity-Based Index to Aid in Diagnosing Concussion Among Athletes.

Importance An objective, reliable indicator of the presence and severity of concussive brain injury and of the readiness for the return to activity has the potential to reduce concussion-related disability. Objective To validate the classification accuracy of a previously derived, machine learning, multimodal, brain electrical activity–based Concussion Index in an independent cohort of athletes with concussion. Design, Setting, and Participants This prospective diagnostic cohort study was conducted at 10 clinical sites (ie, US universities and high schools) between February 4, 2017, and March 20, 2019. A cohort comprising a consecutive sample of 207 athletes aged 13 to 25 years with concussion and 373 matched athlete controls without concussion were assessed with electroencephalography, cognitive testing, and symptom inventories within 72 hours of injury, at return to play, and 45 days after return to play. Variables from the multimodal assessment were used to generate a Concussion Index at each time point. Athletes with concussion had experienced a witnessed head impact, were removed from play for 5 days or more, and had an initial Glasgow Coma Scale score of 13 to 15. Participants were excluded for known neurologic disease or history within the last year of traumatic brain injury. Athlete controls were matched to athletes with concussion for age, sex, and type of sport played. Main Outcomes and Measures Classification accuracy of the Concussion Index at time of injury using a prespecified cutoff of 70 or less (total range, 0-100, where ≤70 indicates it is likely the individual has a concussion and >70 indicates it is likely the individual does not have a concussion). Results Of 580 eligible participants with analyzable data, 207 had concussion (124 male participants [59.9%]; mean [SD] age, 19.4 [2.5] years), and 373 were athlete controls (187 male participants [50.1%]; mean [SD] age, 19.6 [2.2] years). The Concussion Index had a sensitivity of 86.0% (95% CI, 80.5%-90.4%), specificity of 70.8% (95% CI, 65.9%-75.4%), negative predictive value of 90.1% (95% CI, 86.1%-93.3%), positive predictive value of 62.0% (95% CI, 56.1%-67.7%), and area under receiver operator characteristic curve of 0.89. At day 0, the mean (SD) Concussion Index among athletes with concussion was significantly lower than among athletes without concussion (75.0 [14.0] vs 32.7 [27.2];P Conclusions and Relevance These results suggest that the multimodal brain activity–based Concussion Index has high classification accuracy for identification of the likelihood of concussion at time of injury and may be associated with the return to control values at the time of recovery. The Concussion Index has the potential to aid in the clinical diagnosis of concussion and in the assessment of athletes’ readiness to return to play.