cssi/SciSciGPT-SciSciNet huggingface dataset:
Downstream Imaging Utilization After MR Angiography Versus CT Angiography for the Initial Evaluation of Pulmonary Embolism.

Abstract Objective To compare the proportion of emergency department (ED) patients who undergo subsequent chest CT or MR within 1 year of an initially negative scan for pulmonary embolism (PE). Methods This single-center, retrospective, observational study examined the use of chest CT or MR for ED patients with MR angiography (MRA) negative for PE during April 2008 to March 2013. We compared the 1-year scan utilization for these cases to an age- and sex-matched cohort of patients who underwent CT angiography (CTA). We also calculated time to first follow-up scan and mean radiation dose in each arm. Trained data abstractors used a standardized protocol and electronic case report form to gather all outcomes of interest. Results are reported as means or proportions with their associated confidence intervals (CIs). Results In all, 717 ED patients (430 MRAs and 287 CTAs) were included. At 1 year, the proportion undergoing subsequent imaging (MRA 16.7%, CTA 15.3%; difference = 1.4%, 95% CI 4.05%-6.86%) and time to first follow-up scan (difference = 13 days, 95% CI −22.69-48.7) did not differ between arms. Mean radiation dose per patient at 1 year was significantly higher in the CTA arm (9.82 mSv; 95% CI 9.12-10.53) compared with 2.92 mSv (95% CI 1.86-3.98) with MRA. Those with an index MRA were more likely to undergo subsequent MRAs (odds ratio 3.68; 95% CI 1.22-11.12) than those with an index CTA. However, in both arms, the majority (85%) of subsequent scans were CTAs. Conclusions When comparing patients initially undergoing MRA versus CTA for the evaluation of PE, there was no difference in downstream chest CT or MR use at 1 year.
Minocycline plus N-acetylcysteine protect oligodendrocytes when first dosed 12 hours after closed head injury in mice

Abstract The mouse closed head injury (CHI) model of traumatic brain injury (TBI) produces widespread demyelination. Myelin content is restored by minocycline (MINO) plus n-acetylcysteine (NAC) or MINO alone when first dosed at 12 h after CHI. In a rat controlled cortical impact model of TBl, a first dose of MINO plus NAC one h after injury protects resident oligodendrocytes that induce remyelination. In contrast, MINO less effectively protects oligodendrocytes and remyelination is mediated by oligodendrocyte precursor cell proliferation and differentiation. MINO plus NAC or MINO alone is hypothesized to work similarly in the CHI model as in the controlled cortical impact model even when first dosed at 12-h post−CHI. We tested this hypothesis by examining the time course of the changes in the oligodendrocyte antigenic markers CC1, 2′,3′-Cyclic-nucleotide 3′-phosphodiesterase and phospholipid protein between 2 and 14 days post−CHI in mice treated with saline, NAC, MINO or MINO plus NAC. CHI produced a long-lasting loss of these markers that was not altered by NAC treatment. In contrast, oligodendrocyte marker expression was maintained by MINO plus NAC between 2 and 14 days post-injury. MINO alone did not prevent the early loss of oligodendrocyte markers, but marker expression significantly increased by 14-days post-injury. These data suggest that MINO plus NAC or MINO alone when first dosed 12 h after CHI increase myelin content using similar mechanisms seen when first dosed 1 h after closed head injury. These data also suggest that drugs protect oligodendrocytes with a clinically useful therapeutic time window.
Requirements for Procedural Skills in Nephrology Training Programs: Framing the Conversation

Procedural training for fellows is an ongoing debate within the nephrology community. This Perspectives article outlines the evolution of Accreditation Council for Graduate Medical Education (ACGME) requirements for procedural training in nephrology and the American Board of Internal Medicine (ABIM
Storage and Wh-Phenomena

In this chapter we shall discuss four kinds of wh-constructions in English: restrictive and non-restrictive relatives, headless relatives and wh-questions. These constructions are described in section 1.1. We will show a way to interpret wh-words (e.g. who, which) so that they have the same meaning no matter which kind of wh-construction they appear in (section 1.2). We will show how this idea can be implemented for both a transformational (section 2) and a non-transformational (section 3) syntax for these constructions.
Cytokinin Production by Rhizobia

Culture media from a number of rhizobial strains, including the type-strains of 8 major cross-inoculation groups, were analyzed for cytokinin content. Cytokinins were partially purified by chromatography on Amberlite XAD-2, then on Sephadex LH-20. The tobacco callus assay, HPLC and/or immunoassay were used for cytokinin analysis. All strains of rhizobia examined produced at least 2 cytokinin-active compounds, with total cytokinin activity ranging from 1 to several µg kinetin equivalents per liter of culture filtrate. There were both qualitative and quantitative differences between rhizobial species. The cytokinin profiles of most strains included zeatin or its derivatives. Addition of adenine, seed extract or flavonoid inducers to the culture medium altered cytokinin synthesis. Preliminary genetic data do not support nod gene involvement in cytokinin synthesis under noninducing conditions. Growth pouch experiments showed increased nodulation of soybean plants treated with trans-zeatin.
Husserl and Foundationalism

Some might think perverse my suggestion in the title for this part of the work that Husserl is committed to realism and not to foundationalism. On the one hand, Husserl clearly identifies his own philosophy as a form of “transcendental idealism” (CM, §41), and on the other, Husserl clearly is committed to the discovery of an indubitable starting point upon which and a clear methodology by which philosophy can establish itself as a sure science of cognition. Husserl, then, certainly seems committed to both idealism and foundationalism.
Difficulties in Emotion Regulation Predict Depressive Symptom Trajectory from Early to Middle Adolescence.

Major depressive disorder begins to increase in early adolescence and is associated with significant impairment (e.g., suicidality). Difficulties in emotion regulation (ER) have been associated with depressive symptoms; however, little research has examined this relation over time beginning in early adolescence. Starting when they were 11–14 years old, 246 adolescents (nboys = 126; nwhite = 158) completed self-report questionnaires on their ER at Time 1 and depressive symptoms every year for 2 years. Results revealed that overall difficulties in ER (and limited access to ER strategies) at Time 1 predicted depressive symptoms both cross-sectionally and longitudinally. Gender moderated this relation cross-sectionally, such that higher overall ER difficulties at Time 1 was more strongly associated with higher depressive symptoms for girls than for boys. These findings suggest that depression prevention efforts should promote adaptive ER in early adolescence, particularly for girls, in order to prevent the increases in depressive symptoms seen into middle adolescence.
FOXO transcription factors at the interface between aging and cancer

SY30-03 Aging is regulated by modifications in single genes and by simple changes in the environment. The signaling pathway connecting insulin, Akt, and FOXO transcription factors provides the most compelling example for a conserved genetic pathway that integrate environmental stimuli to regulate lifespan. FOXO transcription factors (FOXO) promote longevity and tumor suppression, suggesting that these factors may link longevity and cancer prevention. FOXO transcription factors are directly phosphorylated in response to insulin/growth factor signaling by the protein kinase Akt, thereby causing their sequestration in the cytoplasm. In the absence of insulin/growth factors, FOXO factors translocate to the nucleus where they trigger a range of cellular responses, including resistance to oxidative stress, a phenotype highly coupled with lifespan extension. FOXO factors integrate oxidative stress stimuli via phosphorylation and acetylation of a series of novel sites. Oxidative stress stimuli elicit the physical interaction between FOXO and SIRT1 deacetylase, a member of the Sir2 family, which has the remarkable ability to extend longevity in invertebrates. Our recent results indicate that FOXO transcription factors are also regulated in response to nutrient deprivation by AMP-dependent protein kinase (AMPK), a protein kinase activated by the tumor suppressor LKB1. The energy-sensing AMPK directly phosphorylates FOXO transcription factors at six previously unidentified conserved regulatory sites. AMPK phosphorylation enhances FOXO transcriptional activity, leading to the expression of specific target genes involved in stress resistance and changes in energy metabolism. The AMPK-FOXO pathway plays a crucial role in the ability of caloric restriction to extend lifespan in worms. As caloric restriction extends lifespan and delays the onset of cancer cancer, understanding how FOXO translate environmental conditions into changes in gene expression that extend lifespan will be pivotal to identify ways to slow aging and age-dependent diseases.
Highly Conductive Anion-Exchange Membranes Based on Cross-Linked Poly(norbornene): Vinyl Addition Polymerization

Cross-linked (XL) anion-exchange membranes (AEMs) synthesized by vinyl addition polymerization of norbornene were prepared for use in anion-exchange membrane electrochemical devices, including fuel...
Using a coupled agent-based modeling approach to analyze the role of risk perception in water management decisions

Abstract. Managing water resources in a complex adaptive natural–human system is a challenge due to the difficulty of modeling human behavior under uncertain risk perception. The interaction between human-engineered systems and natural processes needs to be modeled explicitly with an approach that can quantify the influence of incomplete/ambiguous information on decision-making processes. In this study, we two-way coupled an agent-based model (ABM) with a river-routing and reservoir management model (RiverWare) to address this challenge. The human decision-making processes is described in the ABM using Bayesian inference (BI) mapping joined with a cost–loss (CL) model (BC-ABM). Incorporating BI mapping into an ABM allows an agent's psychological thinking process to be specified by a cognitive map between decisions and relevant preceding factors that could affect decision-making. A risk perception parameter is used in the BI mapping to represent an agent's belief on the preceding factors. Integration of the CL model addresses an agent's behavior caused by changing socioeconomic conditions. We use the San Juan River basin in New Mexico, USA, to demonstrate the utility of this method. The calibrated BC-ABM–RiverWare model is shown to capture the dynamics of historical irrigated area and streamflow changes. The results suggest that the proposed BC-ABM framework provides an improved representation of human decision-making processes compared to conventional rule-based ABMs that do not take risk perception into account. Future studies will focus on modifying the BI mapping to consider direct agents' interactions, up-front cost of agent's decision, and upscaling the watershed ABM to the regional scale.
Between Tolerant Containment and Concerted Constraint: Managing Madness for the City and the Privileged Family:

How do public safety net and elite private mental health providers cope with a key dilemma since psychiatric deinstitutionalization—managing madness when people have the right to refuse care? I obs...
Risk of Water and Food-Borne Communicable Diseases in Travelers Entering Korea.

Objectives It was supposed to analyze status and affecting factors in water and food-borne communicable disease by screening entrants with diarrhea symptom at the point of entry in Korea. Methods Symptomatic travelers with water and food-borne communicable diseases who entered Korea were diagnosed by a health declaration and detection of causative agents in water and food using laboratory tests. Among those entered in 2017, the affecting factors in the incidence of communicable diseases among those who had diarrhea at the entry into Korea, were analyzed, with frequency and chi-square test. Results The number of travel entrants with gastrointestinal communicable diseases increased by 40.19% from 2013 to 2017. The percentage of causative agents of water and food-borne communicable diseases was the highest at 69.2% from July to September. The rate of detection of causative agents of communicable disease pathogens in travelers from Southeast Asia entering Korea was 70.2%, which was higher than people arriving from East Asia and Central Asia (57.5%; p < 0.001). Conclusion The positive ratio of causative agents of water and food-borne communicable diseases was high among travelers that had entered Korea from July to September, with a high number among entrants from Southeast Asia. Based on the positive detection of causative agents, the entry period and countries visited were statistically significant affecting factors (p < 0.001).
Decitabine Induces Responses in Patients with Myelodysplastic Syndrome (MDS) after Failure of Azacitidine Therapy.

Background The hypomethylating agents azacitidine and decitabine are active in MDS and approved in the U.S.A. for this indication. The comparative efficacy of these two agents is not established. Responses to one drug after treatment failure with the other may offer evidence for superior efficacy. Study Aims Evaluate the efficacy of decitabine in MDS after failure of azacitidine therapy. Study Group and Treatment Adults with MDS who have progressed or failed to respond after at least three courses of azacitidine were eligible. Other entry criteria were standard including performance status 0–2, normal liver, kidney, and cardiac functions, and informed consent. Patients received decitabine 20 mg/m2 IV/D x 5 every four weeks. Response was evaluated by the modified IWG criteria (Cheson, Blood 2006). Results Fourteen patients have been treated to date. Their median age was 74 years (range 58–85 years). Patients had received prior azacitidine for a median of 4 courses (range 1 to 9); number of azacitidine courses 3 or more in 12 patients (86%); hemoglobin less than 10 g/dL in 7 (50%); thrombocytopenia < 100 x 109/L in 11 (78%); chromosomal abnormalities in 6 (43%); marrow or peripheral blast 5% or more in 13 (93%). Overall, 5 patients (36%) achieved IWG response: CR in 3 (21%), PR in 1 (7%), marrow CR +/− other hematologic improvements (HI) in 1 (7%). Improvement of thrombocytopenia was noted in 2/5 patients (40%) with pretreatment platelets < 50 x 109/L. Median remission duration was 5.3 months; median survival was 6.0 months. Extramedullary toxicities were minimal. Conclusions Decitabine is active in MDS following failure of azacitidine therapy. Comparative randomized studies of decitabine versus azacitidine in MDS may be indicated.
Radial Forearm Free Tissue Transfer to Clival Defect.

Introduction Reconstruction of craniocervical junction (CCJ) defects after endoscopic endonasal skull base surgery (ESBS) remains challenging, despite advancements in vascularized intranasal and regional flaps. Microvascular free tissue transfers have revolutionized reconstruction in open skull base surgery but have been utilized rarely in ESBS. We describe the use of a radial forearm free flap (RFFF) for reconstruction of a recalcitrant CCJ defect after resection of a clival chordoma. Case Report A 54-year-old female who underwent ESBS for a clival chordoma complicated by a C1–C2 epidural abscess after proton beam therapy presented with pneumocephalus 4 years after her resection ( Fig. 1 ). At the CCJ, she developed a 1-cm skull-base defect. An occult cerebrospinal fluid (CSF) leak persisted despite an extracranial pericranial flap and a lateral nasal wall flap. Her definite reconstruction was a RFFF inset through a transmaxillary approach. Using a maxillary vestibular incision, anterior, lateral, and medial maxillotomies allowed the introduction of the flap into the nasal cavity and the passage of the RFFF pedicle across the posterior maxillary wall, into the premassateric space and to the facial vessels at the mandible. An endonasal inset supplemented with transoral suturing of the distal end of the flap to the posterior oropharynx halted further CSF egress. Vascularization of the flap was confirmed with intraoperative indocyanine green angiography and postoperative computed tomography (CT) angiography and magnetic resonance imaging (MRI). Conclusion A RFFF inset through a transmaxillary approach to the facial vessels has an adequate reconstructive surface and pedicle to cover the central and posterior fossa skull base after ESBS ( Fig. 2 ). The link to the video can be found at: https://youtu.be/rQ5vJKyD5qg .
Nonlinear Viscoelastic Response of Crumb Rubber Modified Asphalt Binder Under Large Strains

Agencies have been increasing their use of polymer modified asphalt binders in recent years to address performance issues and lengthen the useful life of their pavements. When deployed these materi...
STRESS INDUCED CARDIOMYOPATHY ANY STRESSOR CAN ACTUATE, EVEN WHEN SIMPLY INTUBATE: A CASE OF TEE INDUCED TAKOTSUBO

Mechanical support represents an evolving field of clinical research and practice. Impella is load and not rhythm dependent and it showed improvement in shock outcome compared with IABP A 72 YO F. with HTN, A-fib not on AC who presented with aphasia & Rt hemiparesis. A CT of the head showed MCA
On the shear dilation of polycrystalline lubricant films in boundary lubricated contacts.

Shearing of a solidified polycrystalline lubricant film confined between two solid surfaces has been studied by molecular dynamics simulations. In the case of a perfect commensurate contact, we observe interlayer slips within the film and shear-induced order-to-disorder transition of lubricant molecules around grain boundaries. This process is accompanied by the nucleation, propagation, and annihilation of dislocations in the solidified film, resulting in repeated dilation and collapse of the lubricant film during the stick–slip motion. In the case of an incommensurate contact, only slips at the lubricant–solid interface happen and no dilation of the lubricant film is observed during the stick–slip friction. These observations are consistent with recent surface force balance experimental measurements. In combination with our recent work [R. G. Xu and Y. S. Leng, Proc. Natl. Acad. Sci. U. S. A. 115, 6560 (2018)], this study provides a renewed picture on the physical property of nanoconfined lubricant films in boundary lubrication.
The Assessment of Supportive Accountability in Adults Seeking Obesity Treatment: Psychometric Validation Study

Background: Technology-mediated obesity treatments are commonly affected by poor long-term adherence. Supportive Accountability Theory suggests that the provision of social support and oversight toward goals may help to maintain adherence in technology-mediated treatments. However, no tool exists to measure the construct of supportive accountability. Objective: This study aimed to develop and psychometrically validate a supportive accountability measure (SAM) by examining its performance in technology-mediated obesity treatment. Methods: Secondary data analyses were conducted in 2 obesity treatment studies to validate the SAM (20 items). Study 1 examined reliability, criterion validity, and construct validity using an exploratory factor analysis in individuals seeking obesity treatment. Study 2 examined the construct validity of SAM in technology-mediated interventions involving different self-monitoring tools and varying amounts of phone-based interventionist support. Participants received traditional self-monitoring tools (standard, in-home self-monitoring scale [SC group]), newer, technology-based self-monitoring tools (TECH group), or these newer technology tools plus additional phone-based support (TECH+PHONE group). Given that the TECH+PHONE group involves more interventionist support, we hypothesized that this group would have greater supportive accountability than the other 2 arms. Results: In Study 1 (n=353), the SAM showed strong reliability (Cronbach α=.92). A factor analysis revealed a 3-factor solution (representing Support for Healthy Eating Habits, Support for Exercise Habits, and Perceptions of Accountability) that explained 69% of the variance. Convergent validity was established using items from the motivation for weight loss scale, specifically the social regulation subscale (r=0.33; P<.001) and social pressure for weight loss subscale (r=0.23; P<.001). In Study 2 (n=80), the TECH+PHONE group reported significantly higher SAM scores at 6 months compared with the SC and TECH groups (r2=0.45; P<.001). Higher SAM scores were associated with higher adherence to weight management behaviors, including higher scores on subscales representing healthy dietary choices, the use of self-monitoring strategies, and positive psychological coping with weight management challenges. The association between total SAM scores and percent weight change was in the expected direction but not statistically significant (r=−0.26; P=.06). Conclusions: The SAM has strong reliability and validity across the 2 studies. Future studies may consider using the SAM in technology-mediated weight loss treatment to better understand whether support and accountability are adequately represented and how supportive accountability impacts treatment adherence and outcomes. Trial Registration: ClinicalTrials.gov NCT01999244; https://clinicaltrials.gov/ct2/show/NCT01999244
Leveraging a Music Streaming Platform in Establishing a Novel Storage Covert Channel

Covert communication enables the hidden transfer of data. Unlike encrypted communication, where the goal is to make the transmitted data unreadable, covert communication aims to hide the existence of the communication. There have been research efforts on developing and preventing numerous types of channels. We present a novel storage covert channel by leveraging a music streaming platform and take an in depth look into its inner workings. The channel aims to enable data transmission between one sender and multiple receivers. The channel, presented in two different methods of encoding, utilizes a public music streaming platform playlists and encodes data by selectively adding music tracks. The first method of encoding leverages song names while the second uses data embedded within the song track id. We were successful in implementing both encoding schemes, thus demonstrating the covert channels’ feasibility.
The Four Square Step Test and its Use Clinically in Different Populations

This review will summarize and appraise the most recent literature that has been published on the Four Square Step Test (FSST) so that clinicians can make informed decisions about its appropriate use with patients. The FSST is a valid and reliable measure of dynamic balance that has been successfully utilized across age cohorts and in multiple patient populations including those with neurologic diagnoses, musculoskeletal pathologies, and lower limb amputations. Performance on the FSST correlates with the functioning of multiple body structures, processes, and systems and it may be useful in predicting the care needs of older adults. The FSST does have some limitations; however, and in order to address these limitations, alternative administrations have been developed. The initial literature on these variations shows promise in their ability to build on the clinical utility of the traditional FSST. The FSST is quick, easy, and inexpensive to administer. It has robust psychometric properties, and there is a rapidly growing body of literature on its use in diverse circumstances. When using the FSST with specific populations, clinicians should refer to the available literature to determine the appropriateness of the test, how to interpret scores, and the potential utility of alternative administration methods. Future research should continue to explore the utility of these alternative administrations, as well as the use of the FSST in combination with other balance and mobility measures, and the relationship between FSST score and various body structures, functions, and systems.
Educational Leaders’ Perceptions and Uses of School Climate Data:

National interest in using school climate as an accountability measure makes it important to understand how school leaders view and make use of school climate data. The purpose of this study was to...
Development of army relevant wearable Photonic Integrated Circuit (PIC) biosensors

Access to medical monitoring in the field is primarily limited to physical or electrical measurements such as temperature, heart rate or respiration that readout a soldier’s immediate health. The ability to monitor biomarkers in combination with these measurement can uncover pathways leading to a health event and catch problems before the onset of symptoms. Our goal is to develop a fieldable, wearable PIC device for continuously monitoring small molecules and proteins. Continuous monitoring of biomarkers and physiological analytes is necessary for detecting abnormal fluctuations from baseline and provides real-time responses of human performance or injury. Wearable sensors for continuous monitoring require a combination of traits not seen in sample-based sensor systems including compact size, reversibility and sample replenishment. To accomplish this, we combine our expertise in sensors and photonic integrated circuits to generate a refractive index sensor platform. This approach takes advantage of sensing components and PIC devices to increase their sensitivity and selectivity for biomarkers while maintaining a small footprint required for practicality in the field. Here we report progress in striving to achieve a wearable sensor for continuously monitoring analytes in blood and sweat.
The genome-wide rate and spectrum of EMS-induced heritable mutations in the microcrustacean Daphnia: on the prospect of forward genetics.

Forward genetic screening using the alkylating mutagen ethyl methanesulfonate (EMS) is an effective method for identifying phenotypic mutants of interest, which can be further genetically dissected to pinpoint the causal genetic mutations. An accurate estimate of the rate of EMS-induced heritable mutations is fundamental for determining the mutant sample size of a screening experiment that aims to saturate all the genes in a genome with mutations. This study examines the genome-wide EMS-induced heritable base-substitutions in three species of the freshwater microcrustacean Daphnia to help guide screening experiments. Our results show that the 10 mM EMS treatment induces base substitutions at an average rate of 1.17 × 10-6/site/generation across the three species, whereas a significantly higher average mutation rate of 1.75 × 10-6 occurs at 25 mM. The mutation spectrum of EMS-induced base substitutions at both concentration is dominated by G:C to A:T transitions. Furthermore, we find that female Daphnia exposed to EMS (F0 individuals) can asexually produce unique mutant offspring (F1) for at least 3 consecutive broods, suggestive of multiple broods as F1 mutants. Lastly, we estimate that about 750 F1s are needed for all genes in the Daphnia genome to be mutated at least once with a 95% probability. We also recommend 4-5 F2s should be collected from each F1 mutant through sibling crossing so that all induced mutations could appear in the homozygous state in the F2 population at 70-80% probability.
Drosophila Model for Gut-Mediated Horizontal Transfer of Narrow- and Broad-Host-Range Plasmids.

Horizontal gene transfer (HGT) is a driving force of microbial evolution. The gut of animals acts as a potent reservoir for the lateral transfer of virulence, fitness, and antimicrobial resistance genes through plasmids. Reduced-complexity models for the examination of host-microbe interactions involved in plasmid transfer are greatly desired. Thus, this study identifies the use of Drosophila melanogaster as a model organism for the conjugation of plasmids of various incompatibility groups in the gut. Enterobacteriaceae conjugation pairs were identified in vitro and used for oral inoculation of the Drosophila gut. Flies were enumerated for the donor, recipient, and transconjugant populations. Each donor-recipient pair was observed to persist in fly guts for the duration of the experiment. Gut concentrations of the donors and recipients were significantly different between male and female flies, with females generally demonstrating increased concentrations. Furthermore, host genetics significantly altered the concentrations of donors and recipients. However, transconjugant concentrations were not affected by host sex or genetics and were detected only in the IncPe and IncI1 plasmid groups. This study demonstrates Drosophila melanogaster as a model for gut-mediated plasmid transfer. IMPORTANCE Microbial evolution in the gut of animals due to horizontal gene transfer (HGT) is of significant interest for microbial evolution as well as within the context of human and animal health. Microbial populations evolve within the host, and factors from the bacteria and host interact to regulate this evolution. However, little is currently known about how host and bacterial factors regulate plasmid-mediated HGT in the gut. This study demonstrates the use of Drosophila and the roles of sexual dimorphism as well as plasmid incompatibility groups in HGT in the gut.
Abstract T P274: Stroke Mimics in Telestroke

Background and Issues: Wake Forest Baptist Medical Center in Winston-Salem, N.C. deployed a telestroke network system in January of 2010 to provide 24/7 access to a stroke specialist for rural communities. There are twelve hospitals in the network at the present time with tPA administration rate currently at 43%. The potential advantage of face-to-face examination is that it is potentially easier to identify stroke mimics. The frequency of false-positive diagnosis of ischemic stroke has been estimated at approximately 1-14%. It has been demonstrated that patients with mimics have a low tPA related complication rate but it is relevant that these patients have received an unnecessary and potentially harmful treatment. Methods: We reviewed the data on 436 patients who received telestroke consultations between 1/2010 and 9/2012. We retrieved information on the following: number of mimics, presenting complaints and clinical characteristics of patients and outcomes. Results: There were 49 drip and ship patients...
Accounting and Finance for the NonFinancial Executive: An Integrated Resource Management Guide for the 21st Century

THINKING FINANCE Financial Decision Making and Analysis What Can You Do About Your Departmental Costs How You Can Use Contribution Margin Analysis Are You Breaking Even? How to Make Short-Term, Nonroutine Decisions Financial Forecasting and budgeting Using Variance Analysis as a Financial Tool CRITICAL ASSET MANAGEMENT ISSUES Working Capital and Cash Management How to Manage Your Accounts Receivable How to Manage Inventory FINANCIAL DECISION MAKING FOR MANAGERS Understanding the Concept of Time Value Capital Investing Decisions How to Analyze and Improve Management Performance How to Evaluate Your Segment's Performance How Taxes Affect Business Decisions OBTAINING FUNDS What to Know About Short-Term Financing Looking at Term Loans and Leasing Deciding on Long-Term Financing DISSECTING FINANCIAL STATEMENT INFORMATION Understanding Financial Statement Information Recording Financial Information and Accounting Conventions Analyzing Financial Statement Information
An analysis of CCD camera noise and its effect on pressure sensitive paint instrumentation system signal-to-noise ratio

Quantitative pressure measurements can be acquired by pressure sensitive paint (PSP) instrumentation systems incorporating charge-coupled devices (CCD) for PSP photoluminescence image detection. However, intrinsic CCD noise corrupts the PSP image, manifesting in erroneous measurements of pressure and the corresponding coefficient of pressure (C/sub p/). This manifestation is analyzed and quantified in terms of PSP image signal-to-noise ratio (SNR). The image acquisition and processing requirements maximizing a PSP image's SNR are determined. Specific attention is given to the PSP image calibration or flat fielding for CCD scene noise. This algebraic calibration is standard practice in quantitative CCD imaging. However, when applied to PSP images, subtleties arise due to the relative motion between wind-on and wind-off images used in the PSP ratio method. By averaging images and calibrating them for scene noise before ratioing, these subtleties are addressed and the following are true. The PSP C/sub p/ uncertainty will be determined by the image least averaged. Therefore, the mean flat field image must be based on 5 and 50 times more samples than the mean raw PSP image to be within 10% and 1% of the theoretically minimum uncertainty, respectively.
Treatment outcomes and prognostic factors, including human papillomavirus, for sinonasal undifferentiated carcinoma: a retrospective review.

Background Sinonasal undifferentiated carcinoma (SNUC) is a high-grade, aggressive neoplasm. Low incidence and poor outcomes make identification of prognostic factors and treatment standardization difficult. Similarly, little is known regarding the association of human papillomavirus (HPV) with SNUC. Methods A retrospective review was conducted. Extracted information included treatment received, tumor recurrence, patient survival, p16 expression, and HPV status. The Kaplan–Meier method was used to estimate overall survival (OS) and disease-free survival (DFS). Survival trends were compared using the log-rank test. Results Nineteen patients received multimodality treatment for SNUC. Five-year OS and DFS rates were 45.2% and 50.7%, respectively, with no significant difference between treatment types. Tumors from 11 patients were p16-positive and 9 of these were also HPV-positive. Kaplan–Meier analysis demonstrated improved survival. Conclusion Our series demonstrates a higher prevalence of HPV in SNUC than previously reported. HPV-positive SNUCs may benefit from improved survival and should be investigated further in future studies. © 2014 Wiley Periodicals, Inc. Head Neck 37: 366–374, 2015
Environmental Justice and Patterns of State Inspections

Objective This article analyzes state patterns of environmental inspections to determine if the government enforces environmental laws equitably. Methods This article examines state inspections of the Resource Conservation and Recovery Act (RCRA) nationwide from 2002 to 2011. It uses negative binomial regression models to test for disparities in levels of inspections at the county level. Results Results indicate evidence of race-based disparities in levels of state inspections in counties with larger populations of African Americans. Results also suggest evidence of age-based disparities in levels of inspections, as well as disparities in socially disorganized counties. Conclusions Although the Environmental Protection Agency (EPA) has addressed class-based disparities in levels of inspections of the RCRA, the findings indicate that the EPA should examine its inspection efforts based on age and structural characteristics of communities.
Descartes y la escolástica

Descartes escribio que "no debemos nunca preguntar si algo existe al menos que ya conozcamos que es". Los comentaristas le han prestado poca atencion a esta doctrina. Se trata, sin embargo, de una pieza medular en la metafisica cartesiana. Ademas, contiene una clave para la comprension de las relaciones filosoficas entre Descartes y sus predecesores escolasticos. Este trabajo articula la doctrina esencialista de Descartes, contrastandola con el existencialismo de los aristotelicos. Finalmente, el trabajo responde afirmativamente a la pregunta, ?le fue fiel Descartes, en sus propios escritos y en particular en las Meditaciones Metafisicas, al orden esencialista del conocimiento?
A new distributed algorithm for integrated volt-VAR control in smart grids

The goal of this paper is to present a new and completely distributed scheme for voltage control using capacitor banks in advanced distribution systems. The distributed scheme makes use of intelligent agents, which possess three key characteristics, namely autonomy, local view, and decentralization. In this paper, the intelligent shunt capacity agent will serve as a means to regulate the voltage profile under different system conditions. The agent monitors local voltages through its sensor. In the case of a violation, the agent will decide autonomously to either take immediate action or communicate with other agents through peer-to-peer communication channels to work out the best switching setting. Three case studies are provided.
Rabbis and “Guerrilla Girls” A Bavli Motif of the Female (Counter) Voice in the Rabbinic Legal System

Normal 0 0 1 215 1227 10 2 1506 11.1539 0 0 0 Rabbinic Judaism created a system of laws and legal categories that generally functioned to put women at a social and material disadvantage. Intriguingly, then, rabbinic sources also include scattered stories of women in their own, rabbinic context(s) confronting and finding ways to maneuver within the details of those laws so as to attempt (and even to succeed) to secure a favorable result. Rachel Adler and Charlotte Fonrobert have used terms such as "trickster" and "ruse" to describe the character and actions of Yalta, the protagonist of one such story. Each has thus identified and highlighted a critical feature of this story that contributes to the subversive potential that a female figure like Yalta exhibits in this episode: both the (likely) ruse and the ability to function not just as an object but as a participant to some degree in rabbinic legal discourse. In this article, these criteria will be used to seek to identify other stories in the Bavli that might speak to this theme, and to analyze the presentation of female characters that come before legal authorities and the actions they take in the course of their cases. Put another way, can we identify other stories about other female characters that might function as tricksters and/or “legal guerrillas” (to use another of Adler's terms)? And if we can, what might this imply about rabbis and rabbinic culture that such episodes are incorporated, presumably by the rabbis themselves, into Talmudic literature?
On benchmarking the ORACLE parallel server on nCUBE2

Massively Parallel Processor (MPP) architectures have been proposed as a promising alternative to mainframe computers for the largest database and transaction processing tasks. An example of this trend is the implementation of ORACLE parallel database server on several massively parallel machines like Meiko, nCUBE2, and KSR. While many claims have been made for the performance of ORACLE on MPP platforms, few studies have been done to test the actual performance advantages and disadvantages. A benchmark study of the performance and scalability of the ORACLE Parallel Server v6.2 on nCUBE2 is reported here. The advantages of the stripe file system and the gigacache are also studied and displayed in the benchmark results.
Toe-extension myotonia in myotonic dystrophy type 1

Myotonia is a cardinal symptom of adult-onset myotonic dystrophy type 1 (DM1). Myotonia, delayed relaxation following contraction, is most prominent in the hand and forearm muscles. Two sisters with genetically confirmed DM1 exhibited toe-extension myotonia (video on the Neurology® Web site at [Neurology.org][1]) in contrast to toe-flexion myotonia that can occur in DM1. There was a typical warm-up phenomenon. A variant phenotype of Charcot-Marie-Tooth–like polyneuropathy1 was not present. Mutations in the CLCN1 gene encoding the skeletal muscle chloride channel, in addition to abnormal splicing, can enhance myotonia in DM type 2.2 However, in our patients sequencing of the CLCN1 gene did not show mutations. Acknowledgment: The authors thank Drs. Thornton and Moxley (University of Rochester, NY) for discussions; and Hirity Shimellis, Angela Kokkinis, and Dara Bakar for help with patient care and making of the video. [1]: http://neurology.org/lookup/doi/10.1212/WNL.0000000000001734
Virtualization in optical networks: From elastic networking level to sliceable equipment level

Virtualization in optical networks and its enabling technologies are presented from the viewpoints of elastic optical networking and sliceable equipment as a key to implementing increased agility and flexibility into the optical domain.
Microcontroller based efficiency-maximization for a brushless doubly-fed machine pump drive

A 60 HP brushless doubly-fed machine (BDFM) pump drive is to replace a wound rotor induction machine (WRIM) drive in a local waste-water treatment plant. This paper discusses a simple, microcontroller based search algorithm to maximize the efficiency of the BDFM pump drive. The algorithm minimizes the total input power that is supplied to the drive at any speed and load condition. This algorithm can be implemented on the same process controller as used for pump drive speed control. While the scheme is described for a pump drive application. It can be used for any BDFM adjustable speed drive. Control design and implementation details are presented. Experimental results based on a laboratory prototype illustrate speed control and efficiency maximization. >
Time-optimal control of higher-order systems

Practical extension of time-optimal control to systems of higher order than three has been limited primarily by difficulties in physically representing surfaces in a phase space of these higher dimensions. A method is presented here for obtaining the forcing function as a function of the state variables without requiring use of the phase space concept. On line solution of a set of transcendental equations is required. Results of a digital simulation of a fourth-order, real-root, single-degree-of-freedom system are presented. In a digital solution the system operates as a series of short open-loop control intervals. The effect of including derivatives of the input for prediction is shown for second-order model inputs.
Folding of intracellular retinol and retinoic acid binding proteins.

The folding mechanisms of cellular retinol binding protein II (CRBP II), cellular retinoic acid binding protein I (CRABP I), and cellular retinoic acid binding protein II (CRABP II) were examined. These β-sheet proteins have very similar structures and higher sequence homologies than most proteins in this diverse family. They have similar stabilities and show completely reversible folding at equilibrium with urea as a denaturant. The unfolding kinetics of these proteins were monitored during folding and unfolding by circular dichroism (CD) and fluorescence. During unfolding, CRABP II showed no intermediates, CRABP I had an intermediate with nativelike secondary structure, and CRBP II had an intermediate that lacked secondary structure. The refolding kinetics of these proteins were more similar. Each protein showed a burst-phase change in intensity by both CD and fluorescence, followed by a single observed phase by both CD and fluorescence and one or two additional refolding phases by fluorescence. The fluorescence spectral properties of the intermediate states were similar and suggested a gradual increase in the amount of native tertiary structure present for each step in a sequential path. However, the rates of folding differed by as much as 3 orders of magnitude and were slower than those expected from the contact order and topology of these proteins. As such, proteins with the same final structure may not follow the same route to the native state. Proteins 2001;43:292–302. © 2001 Wiley-Liss, Inc.
Ultra-high energy cosmic rays: Observational results

Abstract The study of ultra-high energy cosmic rays has experienced a jump in statistics as well as improved instrumentation. The number of detected cosmic rays has increased by more than a factor of ten over the past decade, and measurements are checked using multiple detection techniques. The energy spectrum clearly has a spectral hardening known as “the ankle” and also a “GZK-like” downturn above 10 19.5 eV. Evidence of trans-GZK arrival directions correlating with AGNs and/or the large-scale matter distribution within the GZK sphere has not been confirmed so far. More data are needed to verify and understand that anisotropy. A search for neutron fluxes from discrete sources in the Galaxy has yielded no detection, and the neutron flux upper limits constrain models for EeV proton production. Additional constraint has come from measuring the first harmonic in right ascension of the cosmic ray arrival directions, which has yielded upper limits below 2% at energies up to 2 EeV.
Clinical approaches to traumatized parents: psychotherapy in the intensive-care nursery.

Clinical approaches to parents who are traumatized by the birth of a premature or defective infant are described. Psychotherapy with parents in the intensive-care nursery relieves suffering and promotes growth and development of the vulnerable parent-infant relationship in this extraordinary setting. Crisis intervention seeks to re-establish parents' temporarily disrupted psychological equilibrium. Supportive psychotherapy helps parents establish and maintain adaptation at a new level. Insight-oriented psychotherapy brings into awareness past conflicts that are interfering with an optimal parent-infant relationship.
Number needed to treat estimates incorporating effects over the entire range of clinical outcomes: novel derivation method and application to thrombolytic therapy for acute stroke.

Background Number needed to treat (NNT) is a useful measure of a treatment's clinical benefit or harm. However, NNT estimates for treatments for neurologic conditions have previously been generated only for dichotomized functional outcomes, which may underestimate clinically relevant treatment effects. Objectives To develop a method for estimating NNTs for nonbinary outcomes from parallel design clinical trials and to illustrate its application to outcomes of fibrinolytic stroke therapy across the full range of the modified Rankin Scale (mRS) of disability. Methods Expert generation of joint distribution outcome tables in a model population affords a novel means to derive NNTs for nonbinary end points. Using mRS distributions from the National Institute of Neurological Disorders and Stroke–Tissue Plasminogen Activator trials, 10 neurologist and emergency physician acute stroke care experts independently specified the joint distribution of outcomes in model samples of 100 patients assigned to placebo and active therapy. Results The average estimated NNT for 1 additional patient to have a better outcome by 1 or more grades on the mRS as a result of treatment was 3.1 (95% confidence interval, 2.6-3.6). The estimated number needed to harm was 30.1 (95% confidence interval, 25.1-36.0). Expert estimates were robust across alternative stratifications of the mRS, with the NNT for benefit on 6- and 5-rank versions of 3.3 and 3.7 and the number needed to harm of 56.6 and 100.0, respectively. Conclusions Expert generation of joint distribution outcome tables enables NNT estimation across a full spectrum of nonbinary outcomes. For every 100 patients with acute stroke treated with tissue plasminogen activator, approximately 32 have a better final outcome and 3 have a worse final outcome as a result of treatment.