cssi/SciSciGPT-SciSciNet huggingface dataset:
Association of exhaled carbon monoxide with subclinical cardiovascular disease and their conjoint impact on the incidence of cardiovascular outcomes

Aims Whereas endogenous carbon monoxide (CO) is cytoprotective at physiologic levels, excess CO concentrations are associated with cardiometabolic risk and may represent an important marker of progression from subclinical to clinical cardiovascular disease (CVD). Methods and results In 1926 participants of the Framingham Offspring Study (aged 57 ± 10 years, 46% women), we investigated the relationship of exhaled CO, a surrogate of blood CO concentration, with both prevalent subclinical CVD and incident clinical CVD events. Presence of subclinical CVD was determined using a comprehensive panel of diagnostic tests used to assess cardiac and vascular structure and function. Individuals with the highest (>5 p.p.m.) compared with lowest (≤4 p.p.m.) CO exposure were more likely to have subclinical CVD [odds ratios (OR): 1.67, 95% CI: 1.32–2.12; P < 0.001]. During the follow-up period (mean 5 ± 3 years), 193 individuals developed overt CVD. Individuals with both high CO levels and any baseline subclinical CVD developed overt CVD at an almost four-fold higher rate compared with those with low CO levels and no subclinical disease (22.1 vs. 6.3%). Notably, elevated CO was associated with incident CVD in the presence [hazards ration (HR): 1.83, 95% CI: 1.08–3.11; P = 0.026] but not in the absence (HR: 0.80, 95% CI: 0.42–1.53; P = 0.51) of subclinical CVD ( P interaction = 0.019). Similarly, subclinical CVD was associated with incident CVD in the presence of high but not low CO exposure. Conclusion Our findings in a community-based sample suggest that elevated CO is a marker of greater subclinical CVD burden and, furthermore, a potential key component in the progression from subclinical to clinical CVD.
Video-assisted thoracoscopic surgery for complex mediastinal mass resections

Minimally invasive surgery has changed the way operative procedures are performed in many specialties. As surgeons have become progressively facile with these techniques, the opportunities to use them have expanded. In thoracic surgery, many surgeons now use minimally invasive techniques to resect small, uncomplicated pathologies of the mediastinum as well as to perform thymectomy for myasthenia gravis. Experience with these techniques has allowed new knowledge to be gained and expansion of the use of these techniques for more complicated mediastinal pathology. This keynote address will outline the instrumentation and techniques that we have adopted over a decade of using these techniques for more complicated mediastinal pathology.
Measuring Security

The field of computer and communications security begs for a foundational science to guide system design and to reveal the safety, security, and possible fragility of the complex systems we depend on today. To achieve this goal, we must devise suitable metrics for objectively comparing and evaluating the security of system designs and organizations.
Reading Instruction for Students With Learning Disabilities: An Observation Study Synthesis (1980–2014)

This article synthesizes observation studies investigating reading instruction for students with learning disabilities (LD) in Grades K–12. A systematic search of the literature between 1980 and 20...
Digital spread-spectrun receiver based on FPGA

The paper introduces a kind of digital spread spectrum receiver based on FPGA ,describes function models, programmable method and time relation. The receiver can accomplishes digital down-convertor, relevance addition, and offers interface with micro-processor. The digital spread spectrum receiving system combining this receiver with micro-processor has been used by some tele-measure system .The experimental result demonstrates that the capability of this receiver fulfills the index requirement.
Study on risk factors of osteoporotic vertebral fracture

[Objective]To investigate the risk factors of osteoporotic(OP) vertebral fracture in Shenzhen,and provide scientific basis for prevention of osteoporotic fracture.[Methods]A total of 302 cases of OP vertebral fracture were recruited as case group,268 individuals without OP vertebral fracture as control group.Self-designed questionnaire was used for investigation,and the results were analyzed by logistic regression.[Results] Multivariate logistic analysis showed the marriage status,age,level of education,animal protein intake,type of work might be risk factors of osteoporotic vertebral fracture(all P0.05).[Conclusion]OP fracture is affected by many factors,the appropriate measures can concentrate on diet,exericise and other aspects to reduce the incidence of OP fracture.Elderly people should pay more attention to the prevention of OP fracture.
Giving Voice to Emotion: Voice Analysis Technology Uncovering Mental States is Playing a Growing Role in Medicine, Business, and Law Enforcement

It's tough to imagine anything more frustrating than interacting with a call center. Generally, people don't reach out to call centers when they?re happy-they're usually trying to get help with a problem or gearing up to do battle over a billing error. Add in an automatic phone tree, and you have a recipe for annoyance. But what if that robotic voice offering you a smorgasbord of numbered choices could tell that you were frustrated and then funnel you to an actual human being? This type of voice analysis technology exists, and it's just one example of the many ways that computers can use your voice to extract information about your mental and emotional state-including information you may not think of as being accessible through your voice alone.
The podocyte and the proteoglycan.

proteoglycans (PGs) consist of a core protein and linear sugar side chains [glycosaminoglycans (GAGs)] attached to the core protein, e.g., agrin, perlecan, glypican, and syndecan. GAGs comprise repeating duplex sugar units made of an aminosugar (e.g., N -acetylglucosamine or N -acetylgalactosamine)
Emergence of Collagen Orientation Heterogeneity in Healing Infarcts and an Agent-Based Model

Spatial heterogeneity of matrix structure can be an important determinant of tissue function. Although bulk properties of collagen structure in healing myocardial infarcts have been characterized previously, regional heterogeneity in infarct structure has received minimal attention. Herein, we quantified regional variations of collagen and nuclear orientations over the initial weeks of healing after infarction in rats, and employed a computational model of infarct remodeling to test potential explanations for the heterogeneity we observed in vivo. Fiber and cell orientation maps were generated from infarct samples acquired previously at 1, 2, 3, and 6 weeks postinfarction in a rat ligation model. We analyzed heterogeneity by calculating the dot product of each fiber or cell orientation vector with every other fiber or cell orientation vector, and plotting that dot product versus distance between the fibers or cells. This analysis revealed prominent regional heterogeneity, with alignment of both fibers and cell nuclei in local pockets far exceeding the global average. Using an agent-based model of fibroblast-mediated collagen remodeling, we found that similar levels of heterogeneity can spontaneously emerge from initially isotropic matrix via locally reinforcing cell-matrix interactions. Specifically, cells that sensed fiber orientation at a distance or remodeled fibers at a distance by traction-mediated reorientation or aligned deposition gave rise to regionally heterogeneous structures. However, only the simulations in which cells deposited collagen fibers aligned with their own orientation reproduced experimentally measured patterns of heterogeneity across all time points. These predictions warrant experimental follow-up to test the role of such mechanisms in vivo and identify opportunities to control heterogeneity for therapeutic benefit.
When to Operate and What to Operate Upon

It is apparent that the results of spinal surgery are less than optimal. The three major causes appear to be as follows: Patient selection. There are some patients who, owing to psychological change or secondary gain, are unable to respond to correction of a spinal problem. This is probably a very small percentage of the 25 to 35 per cent failure rate listed in the literature. Many of these patients have had the wrong operation for an unknown structural diagnosis. It is too tempting and easy for the spinal surgeon to blame poor results on the psyche. Structural diagnosis. It has been 40 years since Dandy published a report on "the hidden disc," but the world of spinal surgery still has not recovered from it. Poor Dandy is also credited with introduction of the method of shaking the spinous process as a test for instability and hence fusion. It would seem obvious that any disc surgery based on a premise of exploration for a hidden problem is antiquated in the day of the CT scan. One should be further chagrined by decision making for fusion based on shaking the spine with a towel clip. It would defy any spinal surgeon to define in rational terms how much observed motion is "abnormal." Until a structural diagnosis is made on the basis of clinical and laboratory testing, there is no indication for surgery. This is the single most important factor in spinal surgery. The success rate will not change until this function is universally recognized. Proper operation. There is little room, in modern spinal surgery, for the surgeon who is a "one trick pony." Uniform application of an operative technique to a variety of deforming forces will result in a high failure rate. It is the duty of the spinal surgeon to have all the techniques available and be able to apply them with precision and skill. Specific surgical response must be made to a specific structural diagnosis. The foregoing three principles should greatly enhance surgical results.
Abrupt Climate Change and Pre-Columbian Cultural Collapse

Publisher Summary Holocene climate changes in the circum-Caribbean, and Andean Altiplano are inferred by using paleolimnological methods. Paleoenvironmental data provides a climatic context in which the Maya, and Tiwanaku cultures arose, persisted, and collapsed prior to European contact. In the circum-Caribbean, the arid late Pleistocene period was followed by a relatively moist early to middle Holocene period probably related to large differences between summer, and winter insolation. The earliest Maya settlement was associated with reduced seasonality, and regional drying. In the northern part of the Yucatan Peninsula, the climate became even drier during the Classic period. The Andean Altiplano experienced low seasonality, and dry conditions in the early, and middle Holocene. The southern basin of Lake Titicaca displayed a low stage. Chiripa culture developed, was associated with greater seasonality, increased moisture availability, and rising lake level. Tiwanaku culture depended on raised-field agricultural technology. A prolonged dry period began in the Altiplano, prompting abandonment of raised fields, and cultural decline. Climate changes in the Northern Hemisphere Maya lowlands, and the Southern Hemisphere Andean Altiplano were out of phase on millennial timescales, when climate was apparently forced by shifts in seasonal insolation driven by the precession of the Earth's orbit. Shorter frequency climate changes in the Maya, and Tiwanaku regions were driven by factors other than Milankovitch forcing. In both areas, population growth, and cultural development occurred under favorable conditions for agriculture. Paleoenvironmental data indicates cultural development is limited by climatic thresholds, and the abrupt, unpredictable climate changes disrupt agricultural production, and human populations.
Core Radiology: A Visual Approach to Diagnostic Imaging

Combining over 1200 clinical images, 300 color illustrations and concise, bulleted text, Core Radiology is a comprehensive, up-to-date resource for learning, reference and board review. The clearly-formatted design integrates the images and accompanying text, facilitating streamlined and efficient learning. All subjects covered by the American Board of Radiology Core Exam are included:Breast imaging, including interventions and MRINeuroimaging, including brain, head and neck, and spine Musculoskeletal imaging, including knee and shoulder MRIGenitourinary imaging, including pelvic MRIGastrointestinal imaging, including MRI and MRCPGeneral, vascular, gynecological and obstetrical ultrasoundNuclear imaging, including PET-CT and nuclear cardiologyThoracic imagingCardiovascular imaging, including cardiac CT and MRIPediatric imagingInterventional radiologyRadiological physics review, contrast media and reactions.Essential reading for radiology residents reviewing for boards, as well as practicing radiologists seeking a practical up-to-date guide to the field.
Control by coin flips: Mixed strategy for finite-horizon stochastic optimal control

It may sound counterintuitive that choosing control inputs randomly lowers cost in an optimal control problem. It can be the case in a nonconvex chance-constrained optimal control problem, including stochastic model predictive control (SMPC). This is because allowing mixed strategy convexifies a nonconvex problem; the expected cost and the probability of constraint violation of a mixed strategy control is a convex combination of pure strategy controls. Therefore the improvement in cost that mixed strategy control provides over pure strategy is equal to the duality gap. This paper presents an efficient method to compute an optimal mixed strategy solution through dual optimization. The focus of this paper is given to the solution method to finite-horizon, constrained stochastic optimal control problems, which are solved at each iteration of SMPC. We demonstrate the method on a chance-constrained trajectory planning problem with obstacles.
THE WORK OF GLEASON AND OF KOCHEN AND SPECKER

This chapter discusses the work of Gleason and of Kochen and Specker. Kochen and Specker claim to have found another proof that hidden-variables theories would all be impossible. It is a good introduction to the discussion of some conclusions for hidden-variables theory that can be drawn from the earlier and more general work of Gleason. Kochen and Specker ran into a paradox by making an assumption which at first sight seems harmless but which turned out to lead to contradictions. A proposition in quantum theory is a statement that a physical system is in a state corresponding to a Hilbert vector in some given subspace of Hilbert space. This subspace may be a single Hilbert vector or it could be a more-dimensional subspace spanned by several Hilbert vectors.
The Authority of Democracy

Once we recognize the unfeasibility of achieving unanimous consent to any nontrivial social arrangement, we might turn instead to majority consent. Can the agreement only of a majority of society’s members — whether broad agreement to have a government or agreement to have specific policies or personnel — confer authority on government?
A heterogeneous agent exchange rate model with speculators and non-speculators

Abstract This paper constructs a heterogeneous agent exchange rate model of speculators and non-speculators from a simple monetary framework. The model replaces rational expectations with an adaptive learning rule that forecasts future exchange rates with an econometric model, and assumes two types of market participants, speculators and non-speculators, that differ by their forecasting model. Speculators employ a correctly specified forecasting model, are relatively short-term oriented, and are subject to momentum and herding effects via an expectation shock; non-speculators utilize a simple forecasting model, have no incentive to be short-term oriented, and are not subject to herding effects. Parameters are calibrated and estimated using the method of simulated moments, and simulation results show that the model is able to replicate foreign exchange market stylized facts better than a model of representative agent rational expectations. Furthermore, the dynamics of the model are shown to derive from both agent heterogeneity and the expectation shock.
Public health and the economy could be served by reallocating medical expenditures to social programs

As much as 30% of US health care spending in the United States does not improve individual or population health. To a large extent this excess spending results from prices that are too high and from administrative waste. In the public sector, and particularly at the state level, where budget constraints are severe and reluctance to raise taxes high, this spending crowds out social, educational, and public-health investments. Over time, as spending on medical care increases, spending on improvements to the social determinants of health are starved. In California the fraction of General Fund expenditures spent on public health and social programs fell from 34.8% in fiscal year 1990 to 21.4% in fiscal year 2014, while health care increased from 14.1% to 21.3%. In spending more on healthcare and less on other efforts to improve health and health determinants, the state is missing important opportunities for health-promoting interventions with a strong financial return. Reallocating ineffective medical expenditures to proven and cost-effective public health and social programs would not be easy, but recognizing its potential for improving the public's health while saving taxpayers billions of dollars might provide political cover to those willing to engage in genuine reform. National estimates of the percent of medical spending that does not improve health suggest that approximately $5 billion of California's public budget for medical spending has no positive effect on health. Up to 10,500 premature deaths could be prevented annually by reallocating this portion of medical spending to public health. Alternatively, the same expenditure could help an additional 418,000 high school students to graduate.
Prognosis of Adolescent Migraine Headache

The prevalence and evolution over 5 years of migraine without aura (MWOA) and migraineous disorder (MD) in 64 adolescent patients (34 girls and 30 boys, mean age 17.3 +/-1.1 years) were studied at the Institute of Neuropsychiatry, University of Palermo, Italy.
Promoting the Selection of Healthy Food Through Menu Item Description in a Family-Style Restaurant

We describe an attempt to influence the selection of menu items in a family-style restaurant. Three different messages, varying in content and emphasis, were used to promote one food special each intervention day. One message emphasized that the specials were particularly healthful, being relatively low in fat, sodium, and cholesterol. A second message stressed flavor and added that the choice was healthful. A third, nonspecific message made no mention of taste or health factors, but simply noted that there was a daily special. Results indicated that restaurant patrons selected healthful specials when the message noted that the choice was healthful but emphasized flavor. Patrons were apparently more open to information about the palatability of the food than its healthfulness per se. These results have implications for point-of-purchase health promotion efforts in general, especially those involving food-labeling programs in restaurants and grocery stores.
Cellular conditions that modulate the fungicidal activity of occidiofungin.

Aims To identify cellular conditions that significantly alter susceptibility of Saccharomyces cerevisiae, Candida albicans, and Candida glabrata to the antimicrobial peptide, occidiofungin. Methods and Results Genetic and pharmacological approaches were used to determine a role for calcium signaling in occidiofungin sensitivity profiles for Saccharomyces cerevisiae, Candida albicans, and Candida glabrata strains of yeast. Minimum inhibitory concentration (MIC) and drop assays found that extracellular calcium resulted in a four-fold resistance, and this was independent of an intact calmodulin-calcineurin signaling pathway. A similar resistance was found in the presence of magnesium but not other cations. Occidiofungin was found to be ineffective against cells in a quiescent state when measured by MIC, drop assay, and short-term time-kill assays. A similar resistance pattern was detected for S. cerevisiae cultures pre-exposed to cycloheximide or placed in depleted media conditions. Conclusions Extracellular calcium results in fungal tolerance to occidiofungin bioactivity outside of the calmodulin-calcineurin pathway. In addition, the resistance of quiescent cells suggests that active cellular growth is a requirement for occidiofungin's mechanism of action. This article is protected by copyright. All rights reserved.
Reimagining the “America” in American Catholicism

Your faces bring back memories of thirty-six previous CTS convention banquets. The first was in 1979. It was held at Trinity College in Washington. I was a graduate student. Bill Cenkner was president. I'm here tonight, warts and all, where Bill stood in 1979. I think of Gerry Sloyan, Vera Chester, Dolores Greeley, Mary Lea Schneider, and the rest. To a much younger me they loomed larger than life. Tonight I want to thank you for the honor of serving briefly with them in the long line of our society's presidents. And a special thanks to my family, who made the trip to Newport to be here with us tonight.
Cost analysis of renewable energy-based microgrids

This paper analyzes the cost composition of microgrid construction as well as the influencing key factors. The Microgrid Cost Study aims at identifying the average cost of a typical microgrid project. The project is limited to the vicinity of U.S. and hence takes into account of only existing microgrid projects in U.S. The project's objective is to find cost of microgrid and its individual components for next 5 years. This will help in R&D for future microgrid projects as well as help investors/developers/researchers get an idea about the cost of their projects that they might want to start in near future.
Intraoperative intracardiac thrombosis in a liver transplant patient

A 66-year-old female with cryptogenic cirrhosis complicated by ascites, hepatic encephalopathy, variceal bleeding and malnutrition with MELD of 34 underwent orthotopic deceased donor liver transplantation performed with piggyback technique. Extensive eversion thromboendovenectomy was performed for a portal vein thrombus which resulted in an excellent portal vein flow. The liver graft was recirculated without any hemodynamic instability. Subsequently, the patient became hypotensive progressing to asystole. She was resuscitated and a transesophageal probe was inserted which revealed a mobile right atrial thrombus and an underfilled poorly contractile right ventricle. The patient was noted to be coagulopathic at the time. She became progressively more stable with a TEE showing complete resolution of the intracardiac thrombus.
The Duty to Rescue and Randomized Controlled Trials Involving Serious Diseases

During the recent Ebola epidemic, some commentators and stakeholders argued that it would be unethical to carry out a study that withheld a potential treatment from affected individuals with such a serious, untreatable disease. As a result, the initial trials of experimental treatments did not have control arms, despite important scientific reasons for their inclusion. In this paper, we consider whether the duty to rescue entails that it would be unethical to withhold an experimental treatment from patient-participants with serious diseases for which there are no effective treatments, even when doing so is scientifically necessary to test the effectiveness of the treatment. We argue that the duty to rescue will rarely apply. The context of medical research also throws new light on the content of the duty to rescue, since the interests of future patients—who stand to benefit from the fruits of medical research—are relevant to whether the duty applies.
Nowness and the Understandinsg of Time

The phrases ‘Absolute Becoming’, ‘Pure Becoming’, ‘Temporal Becoming’, and ‘Temporal Passage’ which figure so prominently in discussions about time seem to have the same halo of meanings associated with them. Those who say that they believe in the objective reality of Absolute Becoming (or Pure Becoming, etc.) maintain that it is a feature peculiar to time, which distinguishes it from any spatial dimension. They sometimes claim in addition that Absolute Becoming explains some of the facts or alleged facts about time which lack spatial analogue. One such fact is the curious tendency of causes to bring about effects later rather than earlier than themselves. Another is the ‘passage’ of time in contrast to the static character of space, which dynamism may or may not be the same as its supposed ‘arrow’ or ‘irreversibility’ or ‘anisotropy’.1 Then there are the supposed facts that future individuals cannot be referred to, or are not identifiable in quite the same fullblooded way that past individuals are, and that predictions are unlike retrodictions in being necessarily general in logical form, never singular.2 Add to these the past-directedness of memory and traces and the scarcity of future-directed analogues for both, and our relative ignorance of the future as compared to the past.
New Developments in Sports Concussion Management

This chapter presents a discussion of the evolution of neuropsychological testing of concussed athletes. The advantages of computerized assessment are presented, with special emphasis on the ImPACT test battery, a widely used instrument in clinical research and practice.
Homogeneous Feedback Stabilization

We address a special case of the general problem of finding continuous feedback laws (that lead to unique solutions) and asymptotically stabilize the origin of (in general) nonlinear smooth systems of the form $$\dot x = f(x) + ug(x)with x \in {R^n},u \in R$$ (1) The purpose of this note is to further popularize the use of feedback laws that are Δ-homogeneous (i.e. homogeneous w.r.t. a suitable family of dilations) for the global asymptotic stabilization of Δ-homogeneous control systems, and for the local asymptotic stabilization of general nonlinear systems approximated by homogeneous systems.
Mandatory Arbitration Stymies Progress Towards Justice in Employment Law: Where To, #MeToo?

Today our employment law provides workers with far more protection than once existed with respect to hiring, firing, salary, and workplace conditions. Despite these gains, continued progress towards justice is currently in jeopardy due to companies’ imposition of mandatory arbitration on their employees. By denying their employees access to court, companies are causing employment law to stultify. This impacts all employees, but particularly harms the most vulnerable and oppressed members of our society for whom legal evolution is most important. If companies can continue to use mandatory arbitration to eradicate access to court, where judges are potentially influenced by social movements, social movements will no longer be able to assist the overall progressive trend of our jurisprudence. While the phenomenon of mandatory employment arbitration is not new, recent Supreme Court opinions have encouraged an even greater number of employers to use this practice to force employees to take any disputes to arbitration, rather than to court. Focusing particularly on the #MeToo movement, this Article will consider this reality and its detrimental implications for the evolution of legal precedent affecting our most vulnerable employees.
Flat, Highly Connected Optical Network for Data Centers

A novel flat optical DC network approach using only low radix electrical switches and high data rate optical links is investigated. Compared to Clos, it provides resilience and ∼40% hardware savings with ∼60% higher throughput.
Central Place Indexing: Hierarchical Linear Indexing Systems for Mixed-Aperture Hexagonal Discrete Global Grid Systems

Hexagonal discrete global grid systems (DGGSs) with integer spatial indexes are a promising new approach to designing geospatial data structures and location reference systems. Central place indexi...
The Transonic-Flow Theories of High- and Low-Aspect-Ratio Wings

This paper reviews two theoretical developments in the three-dimensional (3-D) transonic flow studies, which represents an extension of the lifting-line and the slender-wing concepts in the classical theory [4.124, 4.125, 4.126] to the analyses of the lift-dominated, nonlinear mixed flows.
Needed: new authority to build public health system capacity for climate change health threats

Strong public health system capacity is essential to protection against climate change health threats. Taken as a whole, the United States (U.S.) public health system lacks the requisite capacity. Unlike some other countries, the U.S. federal government and most state and local governments give low priority to strengthening public health capacity even though states and localities have begun investing billions of dollars in strategies to protect physical infrastructure from climate change-related severe weather events. I recommend enactment of new legislative authority specifically to develop public health capacity more rapidly and completely. Doing so can give new impetus to construction of, ultimately, a national public health system able to protect all those who reside in the U.S. from climate change health threats and to serve as a model for building such system capacity globally.
The effect of water vapor on surface oxygen exchange kinetics of thin film (La,Sr)(Co,Fe)O3-δ

Abstract Oxygen reduction and transport in electrochemical applications are strongly affected by the reactant gas composition, including impurities such as water. Understanding the relationship between oxygen reactivity and humidity is key for attaining stability and high efficiency of solid oxide fuel cells, which are especially attractive for transportation applications as low emission power generation devices. Both short- and long-term effects of moisture have previously been associated with use of ambient air. To better understand these effects, we study oxygen exchange kinetics at the cathode surface and the cathode/electrolyte interface using La0.6Sr0.4Co0.2Fe0.8O3-δ (LSCF) epitaxial thin films as a model-surface system. In situ synchrotron X-ray techniques evaluate the oxygen reduction reaction (ORR) kinetics in response to environmental variables. The results suggest a clear enhancement of the ORR rate upon short term exposure of the perovskite-structured films to water. On the basis of these measurements, along with in situ X-ray characterization of Sr segregation and computational first-principles studies, we suggest a model for this increased ORR activity that may lead to further improvements by stabilizing active cathode surface configurations.
Telemedicine and Distance Learning for Obstetrician/Gynecologist Provider Education.

Tele-education is the use of communications technologies to distribute knowledge from one health care provider to another when distance separates providers. At the University of Arkansas for Medical Sciences, tele-education has been used for more than two decades to educate and support rural obstetrician/gynecologists throughout the state. Tele-education at University of Arkansas for Medical Sciences incorporates numerous interactive videoconferences and other digital portals and platforms. Continued provider education through tele-education increases access to quality care and evidenced-based practices for rural populations and is an effective strategy in the battle against health care disparities.
Dual-chambered venous access port as alternative access for extracorporeal apheresis therapy.

Purpose:To evaluate the use of a dual-chambered venous access port for extracorporeal apheresis therapy.Methods:This was a single-center retrospective analysis of all patients who received a dual-c...
Primary care physicians' attitudes and perceptions towards antibiotic resistance and outpatient antibiotic stewardship in the USA: a qualitative study.

Objectives At least 30% of outpatient antibiotic prescriptions are unnecessary. Outpatient antibiotic stewardship is needed to improve prescribing and address the threat of antibiotic resistance. A better understanding of primary care physicians (PCPs) attitudes towards antibiotic prescribing and outpatient antibiotic stewardship is needed to identify barriers to stewardship implementation and help tailor stewardship strategies. The aim of this study was to assess PCPs current attitudes towards antibiotic resistance, inappropriate antibiotic prescribing and the feasibility of outpatient stewardship efforts. Design Eight focus groups with PCPs were conducted by an independent moderator using a moderator guide. Focus groups were audio recorded, transcribed and coded for major themes using deductive and inductive content analysis methods. Setting Focus groups were conducted in four US cities: Philadelphia, Birmingham, Chicago and Los Angeles. Participants Two focus groups were conducted in each city—one with family medicine and internal medicine physicians and one with paediatricians. A total of 26 family medicine/internal medicine physicians and 26 paediatricians participated. Results Participants acknowledged that resistance is an important public health issue, but not as important as other pressing problems (eg, obesity, opioids). Many considered resistance to be more of a hospital issue. While participants recognised inappropriate prescribing as a problem in outpatient settings, many felt that the key drivers were non-primary care settings (eg, urgent care clinics, retail clinics) and patient demand. Participants reacted positively to stewardship efforts aimed at educating patients and clinicians. They questioned the validity of antibiotic prescribing metrics. This scepticism was due to a number of factors, including the feasibility of capturing prescribing quality, a belief that physicians will ‘game the system’ to improve their measures, and dissatisfaction and distrust of quality measurement in general. Conclusions Stakeholders will need to consider physician attitudes and beliefs about antibiotic stewardship when implementing interventions aimed at improving prescribing.
Rural Oral and Maxillofacial Surgeon Case Mix Leads to Lower Medicare Reimbursement.

Purpose A relative paucity of literature exists analyzing rural-urban differences in Medicare insurance claims by oral and maxillofacial surgeons (OMSs). The purpose of this study is to compare Medicare utilization, billing practices, and reimbursement rates between rural OMSs and their urban counterparts. Methods This cross-sectional study examines Medicare claims data from the 2017 Medicare Provider Utilization and Payment Data: Physician and Other Supplier Public Use File. The primary predictor variable was the provider Rural-Urban Commuting Area Code (rural vs urban). The primary outcome variable was the total Medicare standardized payment amount per OMS. Additional variables include total number of services provided, total unique Healthcare Common Procedure Coding System codes submitted, total submitted charge amount for all services, mean beneficiary hierarchical condition category, and the total Medicare allowed/payment amount for all services. Descriptive statistics were calculated and continuous variables were compared using nonparametric Mann-Whitney U tests. Results The analysis cohort had 921 OMSs who recorded 114,169 Part B services in 2017. Urban OMSs billed more services compared to rural OMSs, saw patients with a higher average hierarchical condition category score, and submitted more claims per beneficiary. The mean reimbursement-to-charge ratio was higher among rural OMSs, although the mean payment per service was higher among urban surgeons. Conclusions Rural OMSs bill fewer unique codes and treat less medically complex patients compared with their urban counterparts. Rural surgeons were reimbursed proportionally higher for their total submitted charges than urban surgeons; however, they were reimbursed less for each individual service provided. These differences may be attributable to the Centers for Medicare & Medicaid Services Multiple Procedure Payment Reduction policy and provider case mix.
Impacts of K-12 school reopening on the COVID-19 epidemic in Indiana, USA

Abstract In the United States, schools closed in March 2020 due to COVID-19 and have begun reopening as of August 2020, despite continuing transmission of SARS-CoV-2. To determine the impact of school reopening with varying levels of operating capacity and face-mask adherence, we used an agent-based model calibrated to and validated against multiple data types from the state of Indiana, USA. In our model, transmission can occur in schools, workplaces, community settings, and households, all of which are structured in a realistic way according to state geography and demography. Using this model, we quantified the burden of COVID-19 on K-12 students, teachers, their families, and the general population under alternative scenarios about school reopening. In our primary analysis, we considered three levels of school operating capacity (50%, 75%, and 100%) and three assumptions about face-mask adherence in schools (50%, 75%, and 100%). Under a scenario in which schools operate remotely, we projected 45,579 (95% CrI: 14,109-132,546) infections and 790 (95% CrI: 176-1680) deaths between August 24 and December 31. Reopening at 100% capacity with 50% face-mask adherence in schools resulted in a proportional increase of 42.9 (95% CrI: 41.3-44.3) times that number of infections and 9.2 (95% CrI: 8.9-9.5) times that number of deaths. In contrast, operating at 50% capacity with 100% face-mask adherence resulted in only an 11% (95% CrI: 5%-18%) increase in the number of infections compared to the scenario in which schools operate remotely. We conclude that reduced capacity and high face-mask adherence in schools substantially reduce the burden of COVID-19, both among those with direct ties to schools and across the state. As Indiana and other states proceed with school reopening, our results illustrate quantitatively the benefits of safety measures that schools are undertaking, underscoring their value for both schools and their communities.
The Erie County Poorhouse (1828–1926) as a Heterotopia: A Bioarchaeological Perspective

Employing Galtung’s concepts of cultural and structural violence and Foucault’s concept of heterotopia, we argue that the Erie County Poorhouse (ECPH), in industrial-era Buffalo, New York, served to intensify marginalization of societal Others. Mid- to late-nineteenth century American poorhouses may be understood as “heterotopias.” Foucault described heterotopias as real places that are like societal counter-sites and identified two main types: “crisis heterotopias” and “heterotopias of deviation.” Society’s definitions of crisis and deviance were shaped by contemporary cultural violences, in particular ideas about impairment and disability. Through diachronic analyses of the historical, skeletal, and archaeological records, we focus on the enactment of cultural and structural violences in the ECPH heterotopia. We conclude the ECPH did not simply transition from a heterotopia of crisis to a heterotopia of deviation. Instead, the ECPH functioned as a heterotopia of crisis and/or deviation for a person depending on their socially ascribed identities, simultaneously isolating Others in crisis, deviant Others, and those who were considered both in crisis and deviant.
Kinetic relations and local energy balance for LEFM from a nonlocal peridynamic model

A simple nonlocal field theory of peridynamic type is applied to model brittle fracture. The kinetic relation for the crack tip velocity given by Linear Elastic Fracture Mechanics (LEFM) is recovered directly from the nonlocal dynamics, this is seen both theoretically and in simulations. An explicit formula for the change of internal energy inside a neighborhood enclosing the crack tip is found for the nonlocal model and applied to LEFM.
Active Search Methods to Predict Material Failure Under Intermittent Loading in the Serebrinksy-Ortiz Fatigue Model.

The rainflow counting algorithm for material fatigue is both simple to implement and extraordinarily successful for predicting material failure times. However, it neglects memory effects and time-ordering dependence, and therefor runs into difficulties dealing with intermittent loads, especially those with long tailed distributions. In this report, we use the Serebrinsky-Ortiz model of material fatigue to introduce a partial analytical solution for deterministic intermittent loads, which greatly improves integration speed while still conservatively identifying early failures. Additionally, we apply recent advances in optimal experimental design both to gain insight into how rare events lead to extreme early material failure, and to estimate the long tail of the distribution of failure times.
Neural Granger Causality.

While most classical approaches to Granger causality detection assume linear dynamics, many interactions in applied domains, like neuroscience and genomics, are inherently nonlinear. In these cases, using linear models may lead to inconsistent estimation of Granger causal interactions. We propose a class of nonlinear methods by applying structured multilayer perceptrons (MLPs) or recurrent neural networks (RNNs) combined with sparsity-inducing penalties on the weights. By encouraging specific sets of weights to be zero---in particular through the use of convex group-lasso penalties---we can extract the Granger causal structure. To further contrast with traditional approaches, our framework naturally enables us to efficiently capture long-range dependencies between series either via our RNNs or through an automatic lag selection in the MLP. We show that our neural Granger causality methods outperform state-of-the-art nonlinear Granger causality methods on the DREAM3 challenge data. This data consists of nonlinear gene expression and regulation time courses with only a limited number of time points. The successes we show in this challenging dataset provide a powerful example of how deep learning can be useful in cases that go beyond prediction on large datasets. We likewise illustrate our methods in detecting nonlinear interactions in a human motion capture dataset.
Emerging variants of concern in SARS-CoV-2 membrane protein: a highly conserved target with potential pathological and therapeutic implications

Abstract Mutations in the SARS-CoV-2 Membrane (M) gene are relatively uncommon. The M gene encodes the most abundant viral structural protein, and is implicated in multiple viral functions, including initial attachment to the host cell via heparin sulfate proteoglycan, viral protein assembly in conjunction with the N and E genes, and enhanced glucose transport. We have identified a recent spike in the frequency of reported SARS-CoV-2 genomes carrying M gene mutations. This is associated with emergence of a new sub-B.1 clade defined by the previously unreported M:I82T mutation within TM3, the third of three membrane spanning helices implicated in glucose transport. The frequency of this mutation increased in the USA from 0.014% in October 2020 to 1.62% in February 2021, a 116-fold change. While constituting 0.7% of the isolates overall, M:I82T sub-B.1 lineage accounted for 14.4% of B.1 lineage isolates in February 2021, similar to the rapid initial increase previously seen with the B.1.1.7 and B.1.429 lineages, which quickly became the dominant lineages in Europe and California over a period of several months. A similar increase in incidence was also noted in another related mutation, V70L, also within the TM2 transmembrane helix. The rapid emergence of this sub-B.1 clade with recurrent I82T mutation suggests that this M gene mutation is more biologically fit, perhaps related to glucose uptake during viral replication, and should be included in ongoing genomic surveillance efforts and warrants further evaluation for potentially increased pathogenic and therapeutic implications.
Better for Investors than the Courts

Nearly a decade has passed since the U.S. Supreme Court handed down its decision in Shearson/American Express, Inc. v. McMahon, upholding the validity of pre-dispute arbitration agreements under the Securities Exchange Act between brokerage firms and their customers. Shortly thereafter, the high court in Rodriguez de Quijas v. Shearson/American Express, Inc., gave its approbation to the validity of such agreements under the Securities Act. This Article discusses McMahon, Rodriguez and their aftermath, and examines the arbitration process today. Both the federal and state court forums will be analyzed from the perspective of the prospective investor-litigant. The Article concludes by addressing whether investors in the brokerage firm setting are in a better or worse position by being relegated to arbitration rather than the courts.
It's Not You, It's Me: Learning to Navigate the Patient-Physician Relationship

In this essay, a medical student details how she struggled to let go of a patient with whom she connected throughout the patient's pregnancy during her second year of medical school. Although she learned in her preclinical "doctoring" courses how to build quick connections with patients, such training did not delve into how to manage meaningful, emotionally complex connections that may form with patients during longitudinal rotations or, as in this case, extracurricular activities. While primary care physicians may have decades of practice managing evolving longitudinal relationships, medical students who form strong connections with patients are just learning what it means to navigate those relationships, some of which come to an end. Reflecting on the end of this particular relationship helped the author appreciate the power of the longitudinal physician-patient relationship and taught her that taking care of patients also requires taking care of one's self.
Free Energy Simulations III

Welcome to this new special issue of Molecular Simulation on ‘Free Energy Simulations’, Volume III! Following up on the tremendous success of Volumes I and II of the ‘Free Energy Simulations’ serie...
Inverse mass cascade of self-gravitating collisionless flow and effects on halo deformation, energy, size, and density profiles.

Inverse mass cascade is a key feature of the intermediate statistically steady state of self-gravitating collisionless flow (SG-CFD). This paper focus on the effects of mass cascade on halo energy, momentum, size, and density. Halo with fast mass accretion has an expanding core. Mass cascade forms a new layer of mass that deforms the original halo and induces nonzero radial flow (outwards for core and inwards for outer regions). The inward/outward flow leads to an extra length scale (scale radius) that is not present in isothermal profile. Halo concentration $c=3.5$ can be derived for fast growing halos. For cusp-core controversy, a double-power-law density is proposed as a result of radial flow. The inner/outer density are controlled by halo deformation rate and halo growth, respectively. The slower deformation at center, the steeper density. For fast growing halos, radial flow at center is simply Hubble flow that leads to the existence of central core. Mass cascade leads to nonzero halo surface energy/tension and radial flow that enhances the random motion in outer region. An effective exponent of gravity $n_e=-1.3$ (not -1) is obtained due to halo surface energy. Evolution of halo size follows geometric Brownian motion and lognormal distribution. The Brownian motion of particles in randomly evolving halos leads to Fokker-Planck equations for particle distribution that is related to radial and osmotic flow. Complete solutions of particle distribution are presented based on a simple model of osmotic flow. The proposed model agrees with simulation for a wide range of halo group sizes. With reference pressure/density defined at center, equation of state can be established for relative pressure/density. The center pressure, density, and dispersion are presented. The core size $x_c$ is obtained where Hubble flow is dominant. Simple closures are proposed for self-consistent halo density.