cssi/SciSciGPT-SciSciNet huggingface dataset:
Tachycardic and non-tachycardic responses in trauma patients with haemorrhagic injuries.

Background Analyses of large databases have demonstrated that the association between heart rate (HR) and blood loss is weaker than what is taught by Advanced Trauma Life Support training. However, those studies had limited ability to generate a more descriptive paradigm, because they only examined a single HR value per patient. Methods In a comparative, retrospective analysis, we studied the temporal characteristics of HR through time in adult trauma patients with haemorrhage, based on documented injuries and transfusion of ≥3 units of red blood cells (RBCs). We analysed archived vital-sign data of up to 60 min during either pre-hospital or emergency department care. Results We identified 133 trauma patients who met the inclusion criteria for major haemorrhage and 1640 control patients without haemorrhage. There were 55 haemorrhage patients with a normal median HR and 78 with tachycardia. Median ΔHR was -0.8 and +0.7 bpm per 10 min, respectively. Median time to documented hypotension was 8 and 5 min, respectively. RBCs were not significantly different; median volumes were 6 (IQR: 4-13) and 10 units (IQR: 5-16), respectively. Time-to-hypotension and mortality were not significantly different. Tachycardic patients were significantly younger (P Conclusions The current analysis suggests that some trauma patients with haemorrhage are continuously tachycardic while others have a normal HR. For both cohorts, hypotension typically develops within 30 min, without any consistent temporal increases or trends in HR.
Integrative Body-Mind-Spirit (I-BMS) Interventions for Posttraumatic Stress Disorder (PTSD): A Review of the Outcome Literature

Background: A growing interest in integrative body-mind-spirit (I-BMS) approaches to treatment of PTSD has resulted in a significant increase in related research. Method: This study conducted a syn...
Computer Generation of Distributions on the M‐Sphere

A technique is developed for constructing algorithms to generate pseudo random vectors from families of distributions on the unit m‐sphere. The method is applied to the Fisher‐von Mises distribution to provide a generator which is easily programmed and very efficient. The Fisher–von Mises generator is then used in a brief Monte Carlo study on the validity of a test procedure developed by Stephens (1982).
High technology: miracle or malady for patient care

Trends in medicine in the United States today are toward a more widespread application of high technology equipment and procedures. The patient can perceive these new technologies as both miracles and maladies in their health care delivery. While a benefit to the treatment of the disease process is usually very clear, the impact on the person as a whole is often forgotten. The article is intended to focus on the impact of high technology on the patient as a person.
Rejecting, reframing, and reintroducing: trans people's strategic engagement with the medicalisation of gender dysphoria

This article uses ethnographic methods to explore how transgender people engage the medicalisation of transgender experience in a U.S. context under the purview of the American Psychiatric Association. Building on sociological literature related to medicalisation, this paper argues that the lived experience of medicalisation is a non-linear, complex process whereby individual engagement with medical authority is both empowering and constraining in the lives of trans people. Inductive qualitative analysis of 158 hours of participant observation and 33 in-depth interviews with members of a transgender community organisation revealed that transgender individuals (i) reject a medical frame for gender dysphoria, (ii) embrace and stress the importance of gender-affirming medical technologies for individual identity development and social interaction and (iii) strategically reintroduce medical logics and embrace medical authority in order to facilitate medical and social recognition, validation and acceptance.
Extranuclear DNA accumulates in aged cells and contributes to senescence and inflammation.

Systemic inflammation is central to aging-related conditions. However, the intrinsic factors that induce inflammation are not well understood. We previously identified a cell-autonomous pathway through which damaged nuclear DNA is trafficked to the cytosol where it activates innate cytosolic DNA sensors that trigger inflammation. These results led us to hypothesize that DNA released after cumulative damage contributes to persistent inflammation in aging cells through a similar mechanism. Consistent with this notion, we found that older cells harbored higher levels of extranuclear DNA compared to younger cells. Extranuclear DNA was exported by a leptomycin B-sensitive process, degraded through the autophagosome-lysosomal pathway and triggered innate immune responses through the DNA-sensing cGAS-STING pathway. Patient cells from the aging diseases ataxia and progeria also displayed extranuclear DNA accumulation, increased pIRF3 and pTBK1, and STING-dependent p16 expression. Removing extranuclear DNA in old cells using DNASE2A reduced innate immune responses and senescence-associated (SA) β-gal enzyme activity. Cells and tissues of Dnase2a- / - mice with defective DNA degradation exhibited slower growth, higher activity of β-gal, or increased expression of HP-1β and p16 proteins, while Dnase2a- / - ;Sting- / - cells and tissues were rescued from these phenotypes, supporting a role for extranuclear DNA in senescence. We hypothesize a direct role for excess DNA in aging-related inflammation and in replicative senescence, and propose DNA degradation as a therapeutic approach to remove intrinsic DNA and revert inflammation associated with aging.
Interlayer-Expanded V6O13·nH2O Architecture Constructed for an Advanced Rechargeable Aqueous Zinc-Ion Battery

Rechargeable aqueous zinc-ion batteries have been intensively studied as novel promising large-scale energy storage systems recently, owing to their advantages of high abundance, cost effectiveness, and high safety. However, the development of suitable cathode materials with superior performance is severely hampered by the sluggish kinetics of Zn2+ with divalent charge in the host structure. In the present work, a highly reversible aqueous Zn2+ battery is demonstrated in aqueous electrolyte using V6O13·nH2O hollow microflowers composed of ultrathin nanosheets. Benefiting from the synthetic merits of its favorable architecture and expanded interlamellar spacing that results from its structural water, the V6O13·nH2O cathode exhibits outstanding electrochemical performances with a high reversible capacity of 395 mAh g–1 at 0.1 A g–1, superior rate capability, and durable cycling stability with a capacity retention of 87% up to 1000 cycles. In addition, the reaction mechanism is significantly investigated in ...
Complications of Assisted Reproductive Technology.

Although only accounting for a small percentage of infants born in the United States each year, assisted reproductive technology (ART) has become a more common means of conception since the first in vitro fertilization baby was born in 1978. An understanding of the ART process, medications, and complications is becoming essential for emergency medicine practice. Much of the surveillance data focuses on ART complications that are likely to be less relevant in the acute care setting, but ovarian hyperstimulation syndrome, ectopic pregnancy, and ovarian torsion are 3 diagnoses with high potential morbidity and mortality that emergency physicians should not miss.
Evidence for three populations of the glucose transporter in the human erythrocyte membrane

Abstract Glucose transporter 1 (GLUT1) is one of 13 members of the human equilibrative glucose transport protein family and the only glucose transporter thought to be expressed in human erythrocyte membranes. Although GLUT1 has been shown to be anchored to adducin at the junctional spectrin-actin complex of the membrane through interactions with multiple proteins, whether other populations of GLUT1 also exist in the human erythrocyte membrane has not been examined. Because GLUT1 plays such a critical role in erythrocyte biology and since it comprises 10% of the total membrane protein, we undertook to evaluate the subpopulations of erythrocyte GLUT1 using single particle tracking. By monitoring the diffusion of individual AlexaFluor 488-labeled GLUT1 molecules on the surfaces of intact erythrocytes, we are able to identify three distinct subpopulations of GLUT1. While the mobility of the major subpopulation is similar to that of the anion transporter, band 3, both a more mobile and more anchored subpopulation also exist. From these studies, we conclude that ~65% of GLUT1 resides in similar or perhaps the same protein complex as band 3, while the remaining 1/3rd are either freely diffusing or interacting with other cytoskeletally anchored membrane protein complexes.
Object-oriented classic data structures for CS 2 in visual basic .net

For many years there has been substantial agreement that the content of the CS2 course should be a study of the classic data structures including, but not limited to, stacks, queues, trees, and tables. In recent years we have observed a move to the object-oriented programming paradigm for the CS2 course. At this point there is significant divergence as to the "best" programming language to use - C++, Eiffel, Java, Oberon, Python, or Scheme, to name a few. Although many agree that to be truly object-oriented, a programming language must support (1) encapsulation of attributes and behavior in a user-defined class specification, (2) instantiation of objects of pre-defined and user-defined classes, (3) polymorphism, and (4) inheritance. From a survey of recent texts for the CS2 course, it appears that there is heavy emphasis on encapsulation and instantiation with some treatment of inheritance and little treatment of polymorphism. There is also significant treatment of generic container classes supported by template classes if the supporting language is C++. If the supporting language is Java, then the container typically manages objects of the type Object. This paper makes a case that Visual Basic .NET could be considered a viable candidate for the CS2 course since it supports user-defined class specifications with the encapsulation of attributes and behavior, instantiation of objects of pre-defined and user-defined classes, polymorphism and inheritance. Additionally, there is full support for exception handling using the now, well-known, try/catch/finally semantics. Further, there is support for dynamic memory allocation and deallocation. And finally, the student or developer has full support for visual, event-driven, net-centric programming paradigm.This paper is a follow-up to a series of papers several years ago by the same author. These papers made a case for the use of Visual Basic in CS2 even though, at the time, Visual Basic was not yet fully object-oriented. This paper will present an implementation of a stack container ADT that is fully generic, that is, it may manage a collection of arbitrary objects that demonstrate polymorphic behavior.
Pressure Regulating Balloon Herniation: A Correctable Cause of Artificial Urinary Sphincter Malfunction.

Abstract Objective To report our experience with isolated pressure regulating balloon (PRB) replacement for artificial urinary sphincter (AUS) malfunction in the setting of PRB herniation. Methods A retrospective review of our large single-surgeon male AUS database was completed. We analyzed men with herniated PRBs palpable in the groin within an otherwise intact system. Patients with evidence of AUS fluid loss were excluded. PRBs were replaced in a submuscular location through a lower abdominal incision. Continence was defined as requiring ≤1 pad per day. Cystoscopic improvement of sphincter coaptation was confirmed intraoperatively. Results Of the 725 patients who underwent AUS surgery between 2011 and 2019, we identified 23 (3.2%) with PRB herniation and persistent or bothersome stress urinary incontinence who underwent isolated PRB replacement (median age 72 years, interquartile range 66-80). Four of the 23 patients were excluded from the analysis for subsequent explant unrelated to PRB replacement. At a mean follow-up of 21.7 months (range 2-99 months), 94.7% of patients (18/19) noted significant improvement in their stress urinary incontinence, and 78.9% of patients (15/19) achieved continence. Median time between AUS placement and PRB revision was 13 months (interquartile range 6-34 months). Conclusion PRB replacement appears to be a safe and effective salvage therapy for AUS patients with PRB herniation and persistent incontinence without mechanical failure. Intraoperative cystoscopic confirmation of enhanced sphincter coaptation appears to be a reliable predictor of treatment success.
Behavioral Intervention in Industry and Government

Although articles advocating the use of behavior modification procedures in industrial and business settings first appeared in the early 1960s, it was not until the late 1960s and early 1970s that successful reports for these procedures began to appear in the management and behavioral literature. These early reports, summarized by Hamner and Hamner (1976), described the successful use of various positive reinforcement procedures in diverse business settings, including Emery Air Freight, Michigan Bell, Connecticut General Life Insurance Company, General Electric, Standard Oil of Ohio, Weyerhaeuser Company, City of Detroit Garbage Collectors, B. F. Goodrich Chemical Company, and ACDC Electronics. Although suggestive, these reports lacked experimental rigor.
Public-private partnership for building a resilient broadband infrastructure in Puerto Rico

Abstract This article will explore the use of an innovative approach to a public-private partnership (PPP) to spur the deployment of broadband and create more resilient telecommunications networks in Puerto Rico. Such a partnership is a critical ingredient of the plan for rebuilding the telecommunications sector of Puerto Rico after the island was devastated by Hurricanes Irma and Maria in September 2017. The proposed partnership also has the potential for enabling the expansion of citizen access to broadband services throughout Puerto Rico. This work was done as part of the Congressionally mandated economic and disaster recovery plan for the island.
Using the ACA Advocacy Competencies as a Guide to Group Work for Supporting the Career Development of School-Aged African American Males

The career development needs of school-aged African American Male (AAM) students require advocacy from school counselors. Such advocacy must extend from direct group intervention with students to i...
An implementation science approach to geriatric screening in an emergency department.

BACKGROUND The Geriatric Emergency Department (ED) Guidelines recommend screening older adults during their ED visit for delirium, fall risk/safe mobility, and home safety needs. We used the Consolidated Framework for Implementation Research (CFIR) and the Expert Recommendations for Implementation Change (ERIC) tool for preimplementation planning. METHODS The cross-sectional survey was conducted among ED nurses at an academic medical center. The survey was adapted from the CFIR Interview Guide Tool and consisted of 21 Likert scale questions based on four CFIR domains. Potential barriers identified by the survey were mapped to identify recommended implementation strategies using ERIC. RESULTS Forty-six of 160 potential participants (29%) responded. Intervention Characteristics: Nurses felt geriatric screening should be standard practice for all EDs (76.1% agreed some/very much) and that there was good evidence (67.4% agreed some/very much). Outer setting: The national and regional practices such as the existence of guidelines or similar practices in other hospitals were unknown to many (20.0%). Nurses did agree some/very much (64.4%) that the intervention was good for the hospital/health system. Inner Setting: 67.4% felt more staff or infrastructure and 63.0% felt more equipment were needed for the intervention. When asked to pick from a list of potential barriers, the most commonly chosen were motivational (I often do not remember (n = 27, 58.7%) and It is not a priority (n = 14, 30.4%)). The identified barriers were mapped using the ERIC tool to rate potential implementation strategies. Strategies to target culture change were identifying champions, improve adaptability, facilitate the nurses performing the intervention, and increase demand for the intervention. CONCLUSION CFIR domains and ERIC tools are applicable to an ED intervention for older adults. This preimplementation process could be replicated in other EDs considering implementing geriatric screening.
Analytic electrostatic solution of an axisymmetric accelerator gap

Numerous computer codes calculate beam dynamics of particles traversing an accelerating gap. In order to carry out these calculations the electric field of a gap must be determined. The electric field is obtained from derivatives of the scalar potential, which solves Laplace's equation and satisfies the appropriate boundary conditions. An integral approach for the solution of Laplace equation is used in this work since the objective is to determine the potential and fields without solving on a traditional spatial grid. The motivation is to quickly obtain forces for particle transport, and eliminate the need to keep track of a large number of grid point fields. The problem then becomes one of how to evaluate the appropriate integral. In this work the integral solution has been converted to a finite sum of easily computed functions. Representing the integral solution in this manner provides a readily calculable formulation and avoids a number of difficulties inherent in dealing with an integral that can be weakly convergent in some regimes, and is, in general, highly oscillatory.
Using logical data protection and recovery to improve data availability

Data availability is crucial to overall application availability. This paper describes data failures and classifies them as either physical or logical. Physical data failures such as data loss and corruptions are introduced in the I/O layers; logical data failures are introduced in the application layer. Current data protection techniques are geared towards physical data failures. This paper reviews physical data protection techniques and their limitations. It then introduces the concept of logical data protection and shows how applications such as the Oracle database can use application knowledge to implement logical data protection and recovery that are more effective than conventional physical data availability technologies.
Control of bacteriophage P2 gene expression: analysis of transcription of the ogr gene.

Abstract The bacteriophage P2 ogr gene encodes an 8.3-kDa protein that is a positive effector of P2 late gene transcription. The ogr gene is preceded by a promoter sequence (Pogr) resembling a normal Escherichia coli promoter and is located just downstream of a late transcription unit. We analyzed the kinetics and regulation of ogr gene transcription by using an ogr-specific antisense RNA probe in an S1 mapping assay. During a normal P2 infection, ogr gene transcription starts from Pogr at an intermediate time between the onset of early and late transcription. At late times after infection the ogr gene is cotranscribed with the late FETUD operon; the ogr gene product thus positively regulates its own synthesis from the P2 late promoter PF. Expression of the P2 late genes also requires P2 DNA replication. Complementation experiments and transcriptional analysis show that a nonreplicating P2 phage expresses the ogr gene from Pogr but is unable to transcribe the late genes. A P2 ogr-defective phage makes an increased level of ogr mRNA, consistent with autogenous control from Pogr. Transcription of the ogr gene in the prophage of a P2 heteroimmune lysogen is stimulated after infection with P2, suggesting that Pogr is under indirect immunity control and is activated by a yet-unidentified P2 early gene product during infection.
A Refined Approximation of a Finite Capacity Polling System under ATM Bursty Arrivals

Abstract This paper is concerned with both the mean delay and the probability of cell loss that bursty arrivals incur in an ATM switching system which can be modeled as a finite capacity polling system with nonexhaustive cyclic service. The arrival process to each input port of the system is assumed to be bursty and is modeled by an Interrupted Bernoulli Process (IBP). A practical polling system with finite capacity, as the one we deal with here, does not lend itself to an exact solution. In this paper, we introduce an effective approach to provide an analytical approximation. This approach is validated extensively by comparing it against simulation results under different configurations. It is shown that both the mean delays and the cell loss probabilities obtained from this analysis provide highly accurate estimates.
Abstract T P293: Determinants of Early Withdrawal of Care in Patients Who Die During Index Hospitalization for Acute Ischemic Stroke

Introduction: CMS recently announced plans to report risk-standardized stroke mortality. Decisions to withdraw medical care after acute ischemic stroke are based on numerous factors, not just the severity of the incident stroke. Withdrawal of care decisions have the potential to confound these adjusted mortality rates. We investigated factors associated with early withdrawal of care in patients hospitalized with AIS. Methods: We used our institutional GWTG database (1474 consecutive stroke inpatients from 12/2009 - 12/2012) to identify 176 consecutive in-hospital mortalities; of these, 100 patients were transitioned to comfort care during hospitalization. Chart review was performed on these 100 patients to identify factors associated with early (< 5 days) withdrawal of care. Results: Seventy-eight patients (78%) had early withdrawal of care. Table 1 shows the comparison of patients with early (<5 days) versus late (≥ 5 days) withdrawal of care decisions. As shown, Early-CMO patients were younger, and less...
Spectroscopic studies of keto-enol equilibria-X

The tautomeric systems, o-(acetoacetyl)phenol, 2-(acetoacetyl)-1-naphthol, 2-(acetoacetyl)-4-methylphenol, salicyloylacetaldehyde and Schiff bases derived therefrom, using both normal and N15 labeled amines, have been investigated by PMR and IR spectroscopy. The ability of one acceptor group to simultaneously associate with two protons in strong hydrogen bonds is discussed.
Calculation of total inelastic-x-ray-scattering cross sections (dσdΩ) inel

A new method is proposed for the calculation of the total inelastic-scattering cross-section differential with respect to the solid angle for detection of scattered x rays from atomic or molecular targets within the Born approximation. The Born expression for the cross-section differential with respect to solid angle and energy loss is summed over energy loss for the cases of constant scattering angle and constant momentum transfer. The sums over final states required to derive the proposed formulas are carried out with an error of the order of the - 3.5 power of the maximum observable energy loss for both constant momentum transfer and scattering angle. The leading term in the expansion is the familiar Waller-Hartree result. All quantities involved can be calculated with a knowledge of the target ground-state electronic wave function. Problems encountered in the application of the theory to $\ensuremath{\gamma}$-ray scattering are discussed.
An Injury Prevention Strategy for Teen Restaurant Workers: Washington State's ProSafety Project

High levels of youth employment, workplace hazards, and characteristics unique to adolescents contribute to a relatively high incidence of injuries among teens in the restaurant industry. This article discusses the ProSafety model of injury prevention among teen restaurant workers. Through integration with an existing career and technical education program, the ProSafety project seeks to prevent occupational injuries among the teen worker population through classroom safety education and internship skills reinforcement. ProSafety is the product of an innovative collaboration with occupational health nurses, business professionals, educators, and government. Its approach is derived from Social Cognitive Theory, is consistent with key values and strategies of occupational health nurses, and provides lessons for practitioners seeking to reduce occupational injuries in food service or among other populations of adolescent workers.
Word Order, Grammatical Function, and Referential Form: On the Patterns of Anaphoric Reference in Finnish

Research on reference resolution has shown that there exists a connection between the form of a referring expression and the accessibility/salience of its referent. More specifically, the most salient referents – i.e. those currently at the center of attention and most prominent at that point in the discourse – are referred to with the most reduced referring expressions. This raises the question: What kinds of factors influence a referent’s salience, i.e. make it a good candidate to be referred to with a reduced anaphoric expression? This paper focuses on two factors which have been claimed to influence referent salience: (1) grammatical/syntactic role and (2) word order. These issues are addressed from the perspective of Finnish, a highly inflected, flexible word order language which has canonical SVO order and two kinds of third person anaphors: the gender-neutral pronoun han ‘s/he’ and the demonstrative tama ‘this.’ In this paper, I present the results of three psycholinguistic experiments investigating the referential properties of these two anaphors, and show that han and tama differ in their referential properties and are sensitive to different kinds of factors. The results indicate that instead of trying to define the referential properties of these forms according to a unified notion of salience, we should investigate how different factors may be relevant for different referential expressions. The implications that these findings have for our view of how referential systems work are also discussed.
Relative Importance of Personality Dimensions for Expatriate Selection: A Policy Capturing Study

Policy capturing was used to examine relative importance placed by managers on the Big Five personality factors (Emotional Stability, Extraversion, Openness to Experience, Agreeableness, and Conscientiousness) in the context of expatriate selection. Ninety‐six managers with expatriate staffing and management experience made judgments about 32 expatriates based on characteristics associated with the Big Five. Judgments were made about (a) completion of overseas assignment, (b) adjustment, (c) interpersonal relations with host‐country nationals, and (d) overseas job performance. Across all four decisions, the raters tended to use the cues (i.e., the Big Five personality factors) in a similar manner. Conscientiousness was perceived to be the most important personality factor for all four judgments examined. Openness to Experience was perceived to be important for completion of overseas assignment. These results from policy capturing are compared and contrasted with those from criterion‐related validity studi...
Equity Trading in the 21st Century: An Update

This paper updates our previous study, "Equity Trading in the 21st Century", which presented results about US equity market quality. Despite many complaints in the national media, various measures of market quality indicate that US markets continue to be very healthy. Trade transaction cost estimates have stayed low and market depth and execution speeds remained high. New findings that measure the total transaction cost of executing very large block orders indicate that improvements in market quality also have benefited large institutional traders. While still high, both the number of quotes per trade and per minute have declined substantially from their peaks in 2008. Intraday volatility is below the levels of the pre-electronic 1990s. Although market quality is quite good, it could be enhanced. We discuss some current concerns about maker/taker pricing, dark pools, high frequency trading, tick sizes, designated dealers, transaction taxes, IPOs, and market stability.
Expression and purification of human heat-shock transcription factor 1.

Abstract Heat-shock factor 1 (HSF1) is a 57-kDa cytoplasmic protein which binds to the promoters of heat-shock genes and activates transcription during heat shock. We describe here the expression and purification of the 529 amino acids form of human HSF1. We designed a new and complete purification protocol involving ammonium sulfate precipitation, heparin–Sepharose affinity, and ion-exchange chromatography, which allows the purification of large amounts of pure and active recombinant protein. HSF1 isolated by this method is pure as that assessed by SDS–PAGE and reverse-phase HPLC. The purified protein is recognized by specific anti-HSF1 antibodies, binds to heat-shock elements, and activates the promoter of the heat-shock protein 70A gene in vitro.
Modified two-stage ileal pouch-anal anastomosis: equivalent outcomes with less resource utilization.

A three-stage operative approach to ileal pouch-anal anastomosis is usually undertaken in patients presenting with severe colitis. Increasingly, however, we have performed a two-stage modified ileal pouch-anal anastomosis (colectomy followed by ileal pouch-anal anastomosis without ileostomy). The present study sought to evaluate the safety, results, cost, and length of hospital stay using this modified approach compared to that of the traditional three-stage ileal pouch-anal anastomosis. Clinical and financial data were gathered by retrospective review of patients undergoing ileal pouch-anal anastomosis at our institution since 1995. Complications were defined as any event prolonging hospitalization or requiring readmission and were included in the analysis up to six months after final surgery. Functional performance was assessed as of the last clinic visit. Data were compared with Student’s t-test and chi-squared analysis. Multivariate analysis was also used to assess risk factors. A total of 23 patients who underwent the two-stage modified procedure and 31 patients who had the three-stage procedure were identified. The two groups were found to be statistically comparable in terms of patient age, gender, duration of illness, and preoperative hematocrit. Follow-up was shorter in the modified group because of its more recent introduction (9.7 months vs. 30.5 months mean follow-up). Ninety-five percent of patients were on immunosuppressive medication before colectomy, but all were off it before the reconstruction. clinical outcomes after ileal pouch-anal anastomosis were equivalent in terms of the number of bowel movements, prevalence of fecal incontinence, and the use of hypomotility medications. No patients with the two-stage modified procedure had anastomotic complications requiring stoma creation. One patient in the three-stage group required re-creation of a stoma after stoma closure for perianal complications suggesting Crohn’s disease. Total hospital cost was significantly less in the modified group: $27,270 vs. $38,184 (P = 0.0119). Length of stay was also shorter in the two-stage modified group although missing absolute statistical significance (21.0 days vs. 26.0 days, P = 0.0882). Interval ileal pouch-anal anastomosis reconstruction without a stoma (two-stage modified procedure) after colectomy is functionally equivalent to the traditional three-stage protocol in terms of clinical outcome. However, it has the advantage of overall lower hospital costs and probably a shorter length of hospital stay.
Molecular classification of head and neck squamous cell carcinomas using patterns of gene expression

The prognostication of head and neck squamous cell carcinoma (HNSCC) is largely based upon the tumor size and location and the presence of lymph node metastases. Here we show that gene expression patterns from 60 HNSCC samples assayed on cDNA microarrays allowed categorization of these tumors into four distinct subtypes. These subtypes showed statistically significant differences in recurrence-free survival and included a subtype with a possible EGFR-pathway signature, a mesenchymal-enriched subtype, a normal epithelium-like subtype, and a subtype with high levels of antioxidant enzymes. Supervised analyses to predict lymph node metastasis status were approximately 80% accurate when tumor subsite and pathological node status were considered simultaneously. This work represents an important step toward the identification of clinically significant biomarkers for HNSCC.
Use of an ureteroileocecal appendicostomy urinary reservoir in patients with recurrent pelvic malignancies treated with radiation.

Abstract Objective . Evaluation of a modified right colon urinary reservoir in a heavily radiated patient population undergoing pelvic exenteration. Methods . A retrospective chart review was performed on all patients with recurrent gynecologic, colorectal, and urological tumors who underwent total pelvic or anterior exenteration and urinary diversion from 3/01 to 7/03 using an ureteroileocecal appendicostomy urinary reservoir. Results . Fourteen patients were identified over the study interval. The mean age of the patients was 53 years (range, 22–78 years). All patients received external beam, intracavitary, or a combination of both radiation treatment modalities to the pelvis preoperatively. Eight patients received intraoperative radiation therapy (IORT) at a mean dose of 16.25 Gy (range, 12.5–17.5 Gy). The primary sites of disease were as follows: cervix, five; prostate, three; uterus, two; colon/rectum two; and one each for vulva and bladder. Complete stomal continence was achieved in all patients after a median follow-up of 10 months (range, 2–31 months). Two patients experienced a traumatic disruption of the stomal-skin anastomosis in the early postoperative period (postoperative days 7 and 14). One late complication related to the ureterointestinal anastomosis was observed and consisted of an anastomotic stricture managed conservatively. One patient experienced an entero-pouch fistula following re-exploration for an acute postoperative hemorrhage. Conclusion . The early outcomes using the ureteroileocecal appendicostomy urinary reservoir in heavily radiated patients demonstrate the technical feasibility of this design as both minimal early stoma and ureterointestinal complications may occur. Longer postoperative follow-up will be required to address the late outcomes of this procedure and its ultimate use in this population.
Cationic Reduction of Bastadin-4 to Bastadin-5. Preparation of 5-[2H]-Bastadin-5 by Site-Specific Isotopic Labeling

A chemoselective conversion of bastadin-4 to the important Ca2+ channel modulator bastadin-5 (1a) has been achieved using cationic hydrogenation (Et3SiH, TFA, 60%). Specifically deuterated bastadin-5 (1b, >95 at. %) was prepared following this method and the simplified 1H NMR H-5/H2-6 spin system of 1b exploited to study temperature-dependent macrocyclic ring dynamics.
Scintigraphic features of duplex kidneys on DMSA renal cortical scans

The spectrum of manifestations of duplex kidneys on 99mTc-dimercaptosuccinic acid (DMSA) renal cortical scans and correlating findings on other imaging modalities are presented. Relevant embryology of the duplex systems and technical aspects of DMSA scintigraphy are reviewed.
Beneficial Effects of Insulin-like Growth Factor I on Epithelial Structure and Function in Parenterally Fed Rat Jejunum

Abstract BACKGROUND & AIMS: The functional significance of intestinal hyperplasia stimulated by insulin-like growth factor (IGF)-I is unclear and has not been studied in a model of mucosal atrophy induced by total parenteral nutrition (TPN). The aim of this study was to determine how IGF-I affects intestinal structure and epithelial function in the absence of luminal nutrition caused by TPN. METHODS: Rats were maintained with TPN with or without IGF-I (800 micrograms/day), and jejunal histology and epithelial ion transport were measured after 5 days. In a third TPN group without IGF-I, a short-term dose of IGF-I was added during in vitro flux chamber experiments. RESULTS: Rats given TPN with IGF-I had greater jejunal mucosal weight, greater protein and DNA content, and increased villus height and crypt depth compared with rats given TPN only. TPN increased ionic permeability and ion transport responses to secretory and absorptive agents. IGF-I in vivo reversed most of these changes; IGF-I in vitro enhanced sodium-dependent glucose absorption but had no other effects. CONCLUSIONS: Coinfusion of recombinant human IGF-I with TPN solution stimulates intestinal hyperplasia and attenuates transport changes induced by TPN. The latter effect seems to be primarily associated with the growth state of the epithelium. (Gastroenterology 1996 Dec;111(6):1501-8)
Infant Mental Health and Biological Risk.

Abstract Parents seldom seek help directly for infant mental health problems. Parents enter the health care system seeking advice for identified or presumed biological problems in their infants. Many of these biological problems, however, have major psychosocial components of importance to infant mental health. It is important that physicians deal directly with the psychosocial issues and avoid converting them into biological medical problems unintentionally. Three common types of problems and appropriate methods of management are discussed to ensure special recognition and effective handling by the physician of psychosocial problems and the promotion of mental health. The problems discussed are the following: (1) Infants seen with defined medical conditions that generally have associated psychosocial problems including child abuse. (2) Infants seen who have fully recovered from critical illnesses but are considered “at risk” for later developmental disability. (3) Infants seen with normal variations of behavior that are misinterpreted by their parents or physicians as due to a medical problem. In infancy medical and psychosocial issues are so closely interwoven that it is critical that physicians learn to recognize the major psychosocial consequences of primary medical problems and the medical manifestations of primary psychosocial problems and their management.
The First Non-Traditional Doctor of Pharmacy Graduates: Their Perceptions of Library Services

Abstract In June 2004, fourteen students graduated from the first completely online degree program at The Ohio State Universitythe Non-Traditional PharmD (Doctor of Pharmacy) program. The program was implemented as a response to the American Council on Pharmaceutical Education requiring this degree for entry into pharmacy practice. This article reports on the development of the program, and it includes information gleaned from interviews with six of the graduates. Topics included the services that graduates used most, how they applied their new information seeking skills, the difficulties they had in using the library, and their suggestions for improvement. Importantly, the students were comfortable using the digital resources and felt they could not have completed the degree without online access to library resources.
Lung Cancer in Patients With Immunodeficiency Syndrome

We report adenocarcinoma of the lung in seven patients with human immunodeficiency virus (HIV) infection. We compared age, clinical findings and survival data with a sex-matched control group of HIV-negative patients with adenocarcinoma of the lung. Median age of HIV-infected patients with lung cancer was lower than in control patients with lung cancer. The HIV-infected patients had more systemic symptoms and abnormal physical findings than control subjects. Both groups had smoking histories. Laboratory data were similar but control subjects had lower blood oxygen tensions than did HIV patients; HIV patients had more abnormalities on chest roentgenograms and computed tomography scans than did control subjects. All HIV-infected patients were stage IV. Median survival was 4 weeks. For control patients, 50 percent had stage IV disease; median survival was 25.5 weeks. Thus, patients with HIV infection develop lung cancer at a younger age than sex-matched control subjects and undergo a more fulminant course with shortened survivals.
Long live structural biology

Two camps continue to evolve in the field of structural biology--a 'systems-oriented' camp, which studies proteins or complexes carefully one system at a time, and a 'discovery-oriented' one, which studies proteins of entire families, pathways or genomes. The end goals of both camps are the same: to decipher the atomic-resolution structures and mechanisms of biological macromolecules and understand them in the context of the living cell.
On the minimization of the product of the powers of several integrals

This paper considers the minimization of the product of the powers ofn integrals, each of which depends on a functiony(x) and its derivative $$\dot y(x)$$ . The necessary conditions for the extremum are derived within the frame of the Mayer-Bolza formulation of the calculus of variations, and it is shown that the extremal arc is governed by a second-order differential equation involvingn undetermined multipliers related to the unknown values of the integrals. After the general solution is combined with the definitions of the multipliers and the end conditions, a system ofn+2 algebraic equations is obtained; it involvesn+2 unknowns, that is, then undetermined multipliers and two integration constants. The procedure discussed here can be employed in the study of shapes which are aerodynamically optimum at supersonic, hypersonic, and free-molecular flow velocities, that is, wings and fuselages having the maximum lift-to-drag ratio or the minimum drag. The problem of a slender body of revolution having the minimum pressure drag in Newtonian hypersonic flow is developed as an example. First, a general solution is derived for any pair of conditions imposed on the length, the thickness, the wetted area, and the volume. Then, a particular case is treated, that in which the thickness and the wetted area are given, while the length and the volume are free; the shape minimizing the pressure drag is a cone.
The Army High Performance Computing Research Center

The US Army High Performance Computing Research Center (AHPCRC) provides nationwide leadership in high performance computing (HPC) research. Its supercomputing resources are maintained and operated by the Minnesota Supercomputer Center, Inc. AHPCRC researchers are developing novel techniques and advanced algorithms and applying them to physical problems, as well as evaluating and using advanced computing platforms for HPC applications. The Center trains future scientists and engineers by sponsoring computer science educational research at the undergraduate, MS, PhD, and postdoctoral levels. It provides a framework for HPC technology transfer and infrastructure support to Army laboratories by conducting joint research projects between Army scientists and Center researchers; by jointly supervising the staff scientists placed by the Center at the Army laboratories; and by encouraging visits between Army scientists and Center researchers. Finally, the AHPCRC provides a state-of-the-art HPC environment to its academic partners, to Army and Defense Department scientists, and to industrial and international collaborators. >
Effect of postoperative epidural analgesia on morbidity and mortality after total hip replacement surgery in medicare patients.

Background and Objectives The effect of postoperative epidural analgesia (vs. systemic analgesia) on patient outcomes is unclear. Available randomized controlled trials (RCTs) have focused on the intraoperative period and not properly examined the effect of postoperative epidural analgesia (EA) on outcomes. Methods A 5% nationally random sample of Medicare beneficiaries from 1994 to 1999 was analyzed to identify patients undergoing total hip arthroplasty (Common Procedural Terminology [CPT] code 27130, 27132, 27134, 27137, 27138). Patients were divided into 2 groups depending on the presence or absence of postoperative EA based on the CPT coding (01996). The rate of major morbidity (acute myocardial infarction, deep venous thrombosis, pulmonary embolism, angina, respiratory failure, heart failure, cardiac dysrhythmias, pneumonia, pulmonary edema, sepsis, acute renal failure, paralytic ileus, acute cerebrovascular event) and death at 7 and 30 days after the procedure were compared. Multivariate regression analysis was performed to determine if the presence of postoperative (EA) had an independent effect on mortality or major morbidity. Data were reported as an odds ratio with 95% confidence intervals (CI) when appropriate. Results The unadjusted 7- and 30-day death rate was significantly lower for EA versus no EA (1.9/1000 [95% CI: 0.2-3.6] vs. 3.9/1000 [95% CI: 3.0-6.2] at 7 days [P = .04] and 5.8/1000 [95% CI: 2.9-8.7] vs. 9.9/1000 [95% CI: 8.6-11.3] at 30 days [P = 0.01]). However, multivariate regression analysis revealed that there was no difference between the groups with regard to mortality or major morbidity with the exception of an increase in deep venous thrombosis in patients who received EA. Conclusions The use of postoperative EA was not associated a lower incidence of mortality and major morbidity in Medicare patients undergoing total hip arthroplasty. However, the results should be interpreted with caution because of limitations in using the Medicare claims data for analysis. Further trials using other properly conducted and designed studies (e.g., RCTs) would be ideal to validate these results.
One-sided bifurcation points

is to show that the degree at y of the map f for a fixed value of p is nonzero, and then use the invariance under homotopy of the degree to show that the degree has the same value as p is varied. To use this procedure it is necessary to prove that the degree is defined for the values of p considered. We consider (Section 2) the case in which the degree is not defined for a fixed value p,-, . We assume that the degree at y is not defined because a single point p on the boundary of the set relative to which the degree is taken is mapped into y and we require that a simple geometric condition at p be satisfied. Then we prove that the degree is nonzero if TV > CL,, or if TV < p,, . This result is easily applied to bifurcation point theory and we describe applications to functional equations (Section 3) and periodic solutions of ordinary differential equations (Section 4). The advantages of using this result are that it is not necessary to compute a topological degree (often a very difficult problem) and the result can be applied even if the topological degree (more precisely, the index of the bifurcation point) is zero. The latter advantage is illustrated by an example in Section 4. The disadvantage of the method is, of course, the fact that only solutions “on one side” of p = cl0 are obtained, i.e., we obtain one-sided bifurcation points. The one-sided bifurcation points which we study can be regarded as generalizations of the bifurcation points of two dimensional autonomous systems of ordinary differential equations in which a stable critical point divides into a critical point and a limit cycle as a parameter h varies. This