cssi/SciSciGPT-SciSciNet huggingface dataset:
Association of Dual Eligibility for Medicare and Medicaid With Heart Failure Quality and Outcomes Among Get With The Guidelines-Heart Failure Hospitals.

Importance The Centers for Medicare & Medicaid Services uses a new peer group–based payment system to compare hospital performance as part of its Hospital Readmissions Reduction Program, which classifies hospitals into quintiles based on their share of dual-eligible beneficiaries for Medicare and Medicaid. However, little is known about the association of a hospital’s share of dual-eligible beneficiaries with the quality of care and outcomes for patients with heart failure (HF). Objective To evaluate the association between a hospital’s proportion of patients with dual eligibility for Medicare and Medicaid and HF quality of care and outcomes. Design, Setting, and Participants This retrospective cohort study evaluated 436 196 patients hospitalized for HF using the Get With The Guidelines–Heart Failure registry from January 1, 2010, to December 31, 2017. The analysis included patients 65 years or older with available data on dual-eligibility status. Hospitals were divided into quintiles based on their share of dual-eligible patients. Quality and outcomes were analyzed using unadjusted and adjusted multivariable logistic regression models. Data analysis was performed from April 1, 2020, to January 1, 2021. Main Outcomes and Measures The primary outcome was 30-day all-cause readmission. The secondary outcomes included in-hospital mortality, 30-day HF readmissions, 30-day all-cause mortality, and HF process of care measures. Results A total of 436 196 hospitalized HF patients 65 years or older from 535 hospital sites were identified, with 258 995 hospitalized patients (median age, 81 years; interquartile range, 74-87 years) at 455 sites meeting the study criteria and included in the primary analysis. A total of 258 995 HF hospitalizations from 455 sites were included in the primary analysis of the study. Hospitals in the highest dual-eligibility quintile (quintile 5) tended to care for patients who were younger, were more likely to be female, belonged to racial minority groups, or were located in rural areas compared with quintile 1 sites. After multivariable adjustment, hospitals with the highest quintile of dual eligibility were associated with lower rates of key process measures, including evidence-based β-blocker prescription, measure of left ventricular function, and anticoagulation for atrial fibrillation or atrial flutter. Differences in clinical outcomes were seen with higher 30-day all-cause (adjusted odds ratio, 1.24; 95% CI, 1.14-1.35) and HF (adjusted odds ratio, 1.14; 95% CI, 1.03-1.27) readmissions in higher dual-eligible quintile 5 sites compared with quintile 1 sites. Risk-adjusted in-hospital and 30-day mortality did not significantly differ in quintile 1 vs quintile 5 hospitals. Conclusions and Relevance In this cohort study, hospitals with a higher share of dual-eligible patients provided care with lower rates of some of the key HF quality of care process measures and with higher 30-day all-cause or HF readmissions compared with lower dual-eligibility quintile hospitals.
Dietary intake patterns among adults with inflammatory bowel disease in the United States, 2015.

Background Dietary behavior and nutrient intake patterns among U.S. men and women with inflammatory bowel disease (IBD) are unclear at the population level. Methods This cross-sectional study compared dietary intake patterns among U.S. adults (aged ≥18 years) with and without IBD in the 2015 National Health Interview Survey (N = 33,626). Age-standardized weighted prevalences for intake of fruits, vegetables, dairy, whole grain bread, dietary fiber, calcium, total added sugars, sugar-sweetened beverages (SSBs), processed meat, and supplement use were compared between adults with and without IBD by sex. Results In 2015, an estimated 3 million adults (1.3%) reported IBD. Compared with adults without IBD, adults with IBD were more likely to be older, non-Hispanic white, not currently working, former smokers, and former alcohol drinkers. Overall, dietary behaviors were similar among adults with and without IBD. However, adults with IBD were more likely to take vitamin D supplements (31.5% vs 18.8%) and consume dietary fiber <16.7 grams(g)/day, the amount that 50% of U.S. adults consumed (51.8% vs 44.1%), than those without IBD. Compared with their counterparts, men with IBD were more likely to consume vegetables ≥1 time/day (84.9% vs 76.0%) and take any supplement (59.6% vs 46.0%); women with IBD were more likely to have SSBs ≥2 times/day (26.8% vs 17.8%) and total added sugars ≥14.6 teaspoons(tsp)/day, the amount that 50% of U.S. adults consumed (55.3% vs 46.7%). Conclusions Adopting a healthy diet, especially limiting added sugars intake among women with IBD, might be important for the overall health.
P07 A single-centre prospective observational study comparing proactive with reactive therapeutic drug monitoring (TDM) in two cohorts of children with inflammatory bowel disease (IBD)

Background Primary non-response (PNR) and secondary loss of response (LoR) to anti-TNF therapy are a significant challenge in up to 45% of patients with IBD. Therapeutic drug monitoring (TDM) refers to the practice of measuring anti-TNF trough level and anti-drug antibody to guide clinical decisions. Reactive TDM is performed in response to a disease flare, whereas proactive TDM consists of periodic TDM to allow treatment optimization and prevention of possible flares. In the main, GI centres recommend the use of TDM as opposed to an empirical management of patients on anti-TNF. However, there are a limited number of studies that have addressed whether proactive TDM leads to improved clinical outcomes in comparison to reactive TDM. Aim The aim of this study was to investigate if proactive TDM improves patient disease management by reducing the risk of treatment failure due to LoR and/or development of anti-drug antibody. Patients and Methods We conducted a single-centre prospective observational study to accrue data on proactive TDM between June 2019 and June 2020. We compared this group to a historical cohort of patients with IBD treated at the same centre using reactive TDM between 2014 and 2017. Results 30 children with IBD (16 M, mean age at diagnosis 11.47 years ± SD 2.93, median 12, range 3–16) started on anti-TNF treatment between June 2019 and June 2020, were prospectively recruited (current follow-up duration: average 7.1 months ± SD 3, median 6.4, range 3.1–13). 10 had ulcerative colitis (UC), 19 had Crohn’s (CD) and one had IBD-U CD-like. 37 children (20 M), 6 with UC and 31 with CD, were included in the retrospective cohort managed with reactive TDM. (Table 1). More patients in the proactive TDM cohort (22/30) were managed by escalating the IFX regime (i.e. 10 mg/Kg 8 – 6 or 4 weekly) compared to the reactive TDM cohort (14/37) (chi-square 8.396, P 0.00376). In the cohort managed with reactive TDM, a higher number of patients developed high titre anti-IFX antibody (> 50 U/ml) post induction (12/37 vs 3/30) (chi-square 4.798, P 0.0285). The need for switching to different biologics was significantly higher in the reactive TDM cohort (22/37) compared to the proactive TDM cohort (1/30) (chi-square 23.15, P Conclusions The introduction of proactive TDM resulted in a significant reduction of patients requiring switch of their primary biologic and saw an increase in mean trough levels due to timely dose escalation. The results of this study are early indicators that proactive TDM offers a better method of managing children with IBD on IFX therapy compared to reactive TDM with the potential of additional clinical benefits such as reducing the risk of developing adverse drug reactions due to high antibody titres.
Replicability of leptin associations with testosterone, estradiol, follicle-stimulating hormone, and luteinizing hormone in healthy Ache men of Paraguay: A multiple daily assessment.

Objective Associations between leptin and male reproductive hormone levels have been reported in men. However, few of these investigations have focused on associations in healthy men without obesity or overweight or nonindustrial societies. Methods We test hypotheses that leptin is associated with testosterone, estradiol, luteinizing hormone (LH), and follicle-stimulating hormone (FSH) within healthy Ache men, an indigenous nonindustrialized South American community using archived data. Results Archived data of serum FSH, LH, leptin, and salivary testosterone and estradiol levels collected from healthy Ache men (n = 17, mean age = 37.1 ± 14.2) on two separate days revealed leptin was correlated with FSH (D1 p = .07, D2 p = .009) and PM testosterone (TsalPM, D1 p = .05, D2 p = .05). However, controlling for age, associations with FSH were not significant. Mean comparisons and linear regression of values over 2 days resulted in leptin (t = 0.08, p = .94, r2 = .58, p = .0009), LH (t = 1.16, p = .26, r2 = .11, p = .27), FSH (U = 131.5, p = .88, r2 = .63, p = .0002), AM testosterone (TsalAM, t = 4.0, p = .001, r2 = .02, p = 0.75), and TsalPM (t = 2.99, p = .01, r2 = .56, p = .01). Conclusion We conclude (a) FSH, TsalPM, and leptin levels within individual men are relatively invariant over a span of days; (b) despite small sample sizes, results suggest ecological and lifestyle variation can contribute to variation in leptin associations with male reproductive hormones.
Insurance Status and Travel Distance to Single Treatment Facility Predictive of Mastectomy.

Abstract Background We evaluated the impact of insurance status and travel distance on the receipt of total mastectomy without reconstruction (TM) compared to breast conserving surgery with radiation (BCT) for early-stage breast cancer (BC) patients who received care at a single facility. We hypothesized that, lack of insurance and increased travel distance would be predictive of TM over BCT and disparities would vary by different races and/or ethnicities. Methods Using the National Cancer Database from 2010-2017, we examined surgical patients with stage I or II BC, who received care at one facility. Chi-square tests examined subgroup differences by BCT or TM. Multivariable logistic regressions evaluated patient, facility, and pathologic factors associated with the receipt of TM over BCT for the entire cohort and by races and/or ethnicities. Results Of the 284,202 patients, 70.1% received BCT while 29.9% received TM. After adjustment travel distance > 60 miles to a treatment facility, and non–insured patients were more likely to receive TM over BCT, when compared to travel distance 60 miles were 65.4% more likely to receive TM over BCT compared to those traveling Conclusions Despite treatment at one facility, increased travel distance and insurance status are independently predictive of the receipt of TM over BCT in patients with early-stage BC. While travel distance is particularly impactful for African Americans, the impact of not having insurance on surgical treatments is universal across all races and/or ethnicities.
Arrhythmia Classification Using Hybrid Feature Selection Approach and Ensemble Learning Technique

Early diagnosis of arrhythmia is very significant because the symptoms are not always prominent and may go unnoticed until a deteriorating heart health condition is reached. Due to progress in machine learning techniques and the availability of a larger dataset, it is now possible to analyze and propose better techniques to detect cardiac arrhythmia. This paper presents a new hybrid approach that uses feature selection followed by ensemble classification for the diagnosis of arrhythmia. The feature selection algorithm provides a list of strongly correlated features with arrhythmia and at the same time making sure to use minimum redundant information. Using the arrhythmia dataset from UCI for training and testing purposes, the performance of the proposed hybrid approach had 77.27% accuracy and 76% precision. This outperformed the eight individual estimators used in this paper for comparison.
Preservation of vapor samples on adsorbent alumina capillaries and implications for field sampling.

Abstract Dynamic vapor microextraction (DVME) is a vapor preconcentration method that employs a capillary trap coated with an adsorbent, followed by solvent elution to recover the sample. DVME has been developed for applications in the laboratory, including highly precise vapor pressure measurements, and in the field. When vapor collection is conducted outside the laboratory, samples must almost always undergo some interval of storage representing the time between collection and analysis. This interval may be hours, days, or longer, depending on the situation. Regardless, in all situations there must be confidence that the integrity of the samples is maintained until processing and analysis. In this paper, we present results of two studies that tested the stability of a 50% weathered gasoline headspace sample on alumina PLOT (porous layer open tubular) capillaries stored at room temperature for periods from 24 h up to 20 wk. We used principal component analysis (PCA) to reduce the dimensionality of the chromatographic and mass spectral data and elucidate trends in stability with respect to the complex sample's range of hydrocarbon classes and molecular weights. Both analyses identified changes over storage periods of six weeks or more. The hydrocarbon class analysis, which used selected ion monitoring (SIM) data as input, proved more sensitive to changes over shorter storage periods. Sample integrity was preserved for at least 24 h, but losses, especially of high-volatility compounds, occurred by 168 h (7 d). Near total loss of sample occurred by 20 wk. These findings, which are specific to the sample, adsorbent, and storage conditions, will guide choices in experimental and instrumental design to ensure that data from future field studies is reliable.
Systematic review of structural and functional neuroimaging studies of cannabis use in adolescence and emerging adulthood: evidence from 90 studies and 9441 participants.

Cannabis use peaks in adolescence, and adolescents may be more vulnerable to the neural effects of cannabis and cannabis-related harms due to ongoing brain development during this period. In light of ongoing cannabis policy changes, increased availability, reduced perceptions of harm, heightened interest in medicinal applications of cannabis, and drastic increases in cannabis potency, it is essential to establish an understanding of cannabis effects on the developing adolescent brain. This systematic review aims to: (1) synthesize extant literature on functional and structural neural alterations associated with cannabis use during adolescence and emerging adulthood; (2) identify gaps in the literature that critically impede our ability to accurately assess the effect of cannabis on adolescent brain function and development; and (3) provide recommendations for future research to bridge these gaps and elucidate the mechanisms underlying cannabis-related harms in adolescence and emerging adulthood, with the long-term goal of facilitating the development of improved prevention, early intervention, and treatment approaches targeting adolescent cannabis users (CU). Based on a systematic search of Medline and PsycInfo and other non-systematic sources, we identified 90 studies including 9441 adolescents and emerging adults (n = 3924 CU, n = 5517 non-CU), which provide preliminary evidence for functional and structural alterations in frontoparietal, frontolimbic, frontostriatal, and cerebellar regions among adolescent cannabis users. Larger, more rigorous studies are essential to reconcile divergent results, assess potential moderators of cannabis effects on the developing brain, disentangle risk factors for use from consequences of exposure, and elucidate the extent to which cannabis effects are reversible with abstinence. Guidelines for conducting this work are provided.
Coupon-Based Qualification of Bonded Composite Repairs for Pressure Equipment

Bonded composite repairs are increasingly installed on degraded pressure equipment and are frequently treated as permanent repairs. These repairs are installed on both external and internal corrosion defects. For external corrosion, the repair is assumed to halt further corrosion and therefore prevents further metal loss. However, for internal corrosion the damage process can continue and eventually lead to complete loss of the pressure vessel wall. In this scenario, the bonded repair failure mode switches from a tensile-based failure to an interfacial fracture scenario. As such, the current repair codes require the characterization of the interfacial fracture energy of the repair for input into a fracture-mechanics-based design approach. Currently these characterizations are performed on test vessels with a simulated through-wall defect. In this paper we describe a simple coupon-based test using a width-tapered-double-cantilevered beam specimen. Using fracture energy values derived from this test we can successfully predict the failure pressure of pressure vessels with simulated through-wall defects.
On Word-Level Parallelism in Fault-Tolerant Computing

In this paper we present several simulations of operational PRAM on PRAM with memory or processor faults. Their common property is that they rely on the ability of performing standard boolean or arithmetic operations on words consisting of many bits.
Why Statistics Matter

More care should be taken in presenting important statistics. Error and uncertainty in economic data renders it noisy As the noise in reported date increases, it interferes with the detection and interpretation of movements in the true value of the underlying data. Indeed, a noisy series is especially problematic when it is used to design, implement and interpret monetary policy.
Regulation of heat shock protein 47 and type I procollagen expression in avian tendon cells

Heat shock protein 47 (Hsp47) is a collagen-binding stress protein that acts as a collagen-specific molecular chaperone during the biosynthesis and secretion of procollagen. Type I collagen is a major component of tendons. Coexpression of genes for both proteins has been reported in various tissues, where many growth factors likely regulate their expressions in different ways. Here we describe the effects of increased temperature, mechanical stress and growth factors on Hsp47 and type I procollagen expression in embryonic chicken tendon cells. The expression of Hsp47 mRNA at 45°C increased within 60 min and returned to baseline in 4 h after the temperature decreased to 37°C. Our data also show that transforming growth factor β1 (TGF-β1) is another regulator of Hsp47 expression as the addition of TGF-β1 led to a moderate increase in the expression of Hsp47 mRNA. TGF-β2 and TGF-β3 exerted only a small effect; epidermal growth factor and tumor necrosis factor α (TNF-α) had none. TGF-β1 increased type I procollagen mRNA expression and TNF-α reduced this expression. TGF-β1 delayed the degradation of Hsp47 mRNA after heat shock likely via post-transcriptional regulation of the Hsp47 gene. We also report that mechanical stress increased Hsp47 mRNA expression and Hsp47 protein synthesis. Induction of Hsp47 protein expression by heat shock, mechanical stress and TGF-β1 was likely achieved through activation and translocation of heat shock transcription factor 1 into the nucleus. Our data indicate that TGF-β1 is a major regulator of both procollagen and Hsp47 genes.
Polysomnographic Values In Children Undergoing Puberty: Pediatric Vs. Adult Respiratory Rules in Adolescents

POLYSOMNOGRAPHY IS THE GOLD STANDARD FOR THE ASSESSMENT OF CHILDREN WITH SUSPECTED SLEEP DISORDERED BREATHING.1–3 BECAUSE OF wellrecognized differences in epidemiology4 and pathophysiology5–9 of sleep disordered breathing in children and adults, respiratory events in children should be scored using pediatric respiratory criteria.10 However, there is little information as to which respiratory rules should be used for scoring polysomnograms in adolescents between 13 and 18 years of age. Even the recently published “American Academy of Sleep Medicine manual for the scoring of sleep and associated events” states that there is no consensus for this age group.3 Adolescence is a dynamic transition process from childhood to adulthood. It is characterized by simultaneous but asynchronous development that starts with puberty, the onset of which is variable,11–14 and ends with adulthood.15 Therefore, it is reasonable to infer that respiratory polysomnographic scoring criteria and normal reference values would transition from pediatric to adult during adolescence. We present this cross-sectional study primarily aimed at examining the evolvement of respiratory events with Tanner stage in a population of 68 children aged 8–18 years, recruited as part of a research study directed at investigating the effects of puberty on upper airway dynamics during sleep.16 Because of the lack of data regarding which respiratory rules to use in children aged 13–18 years, we further analyzed a subset of 32 subjects within this age group to identify a possible rationale for the use of pediatric or adult scoring criteria in children approaching adulthood. We rescored the respiratory events of these subjects according to the new American Academy of Sleep Medicine guidelines for children and adults.
A low cost digital implementation of feed-forward neural networks applied to a variable-speed wind turbine system

This paper presents a low cost hardware implementation of feed-forward neural networks using VHDL techniques. The design is based on the stochastic theory to achieve the nonlinear sigmoid function with reduced digital logic resources. The large parallel neural network structure is therefore implemented on a low cost FPGA device with high fault tolerance capability. The method is applied to a neural network based wind speed sensorless control of a small wind turbine system. The experimental results confirmed the validity of the developed Stochastic-ANN-FPGA implementation. The general implementation method can be extended to other power electronics applications with different feed-forward ANN structures.
Normal Aging of Compounded Rubber

Abstract Nine compounds were chosen for an investigation of “normal aging” under various conditions and after different times of storage. The report is divided into three parts: (I) aging of cured test slabs stored under different atmospheric conditions, including wet and dry; (II) aging of rubber under strain; (III) comparative aging of cured and uncured rubber. Tables and curve sheets selected from a large mass of data are given to illustrate how these nine rubber compounds age. THE aging of rubber products is the net resultant of chemical reactions and changes of a physico-chemical nature. It has long been recognized that conditions of storage have an important influence on the normal aging of rubber products. Rubber products stored in a warm place deteriorate more rapidly than when stored in a cold place, and it probably was recognition of this fact that led to the development of the Geer accelerated-aging test, which accelerates aging solely by increasing the temperature during storage. Oxygen is als...
Spiral Blanket: An Innovative Idea for a Solid Wall Blanket with Potential for High Neutron Wall Loading

The Advanced Power Extraction (APEX) program is exploring concepts for blanket designs that can enhance the potential of fusion while using both liquid and solid walls. In that context, an innovative blanket design of dry solid wall configuration, with potential for high neutron wall loading has been proposed. The blanket utilizes nanocomposited ferritic (NCF) steel structure (designated 12YWT), which has a maximum operating temperature of 800 deg. C. The cooling/breeding material is Flibe (Li{sub 2}BeF{sub 4}), a low viscosity version of this molten salt, which has a melting temperature of 465 deg. C and is compatible with ferritic steels up to 700 deg. C. The dimensions for this study have been taken from ARIES-AT. The blanket module, which extends 0.3 m in the toroidal direction at mid-plane, is equipped with spiraling discs ramping from the bottom to the top. The coolant enters on the bottom at 500 deg. C, then travels on the spiral discs, from the rear of the module to the front, then back to the rear, all the way to the top where it exits from the module at 590 deg. C. On its way up, the coolant velocity is amplified at the first wall (FW) bymore » centrifugal action, providing a high heat transfer coefficient for dissipating the high surface heating. The 3 mm thick FW is scalloped with semicircular projections inclined in the flow direction. This facilitates unimpeded smooth flow at the FW, while at the same time stiffening the FW against pressure, obviating the need for welded reinforcements. The discs are made of two halves assembled together with a Be pebble bed enclosed as a neutron multiplier. Preliminary neutronics analysis for the outboard blanket has shown a local tritium breeding ratio (TBR) of 1.36, and an energy multiplication (M) of 1.26 including contribution from a secondary module, using natural Li. The pressure drop of 0.56 MPa in the module produces a modified primary bending stress of 124 MPa where the allowable stress for this material at 750 deg. C is 142 MPa. Without optimization, this blanket is capable of dissipating an average neutron wall loading of 6.4 MW/m{sup 2}, with a peak value of 9.6 MW/m{sup 2} and a peak surface heating of 1.3 MW/m{sup 2}. The coolant picks up energy in the secondary blanket exiting the reactor at 600 deg. C. Assuming the use of a supercritical steam power cycle, an efficiency of 48% can be expected.« less
Pathway of Chitin Synthesis and Cellular Localization of Chitin Synthetase in Mucor rouxii

Abstract Cell-tree extracts of Mucor rouxii contain enzymes which synthesize uridine diphosphate N-acetyl-d-glucosamine from N-acetyl-d-glucosamine. Procedures are described to prepare radiolabeled UDP-GlcNAc using cell-free extracts or living cells of this fungus. This sugar nucleotide serves as the precursor for chitin synthesis. Free N-acetyl-d-glucosamine is a strong activator of chitin synthesis. Chitin synthetase activity is found in the different particulate fractions of the cell. The cell walls are particularly rich in chitin synthetase activity. Autoradiographic studies showed that chitin synthetase is localized preferentially in the apical region of hyphal walls. This is also the region of chitin deposition in vivo. The total chitin synthetase content of a culture was shown to increase concomitantly with cell growth and with the total hexosamine content of the cells.
Party Position Change in American Politics: Coalition Group Incorporation

If a man does not make new acquaintance as he advances through life, he will soon find himself left alone. A man, Sir, should keep his friendship in constant repair. Dr. Johnson, quoted in Boswell's Life of Samuel Johnson Although much of politicians' energies are devoted to retaining support from their traditional backers, this is not all they do. Attempts to win over new allies are also important, if less frequent endeavors. One of the major causes of party position change is the attempt by party elites to bring a new group into their coalition. This process differs in some important respects from the dynamics of coalition maintenance discussed in Chapter 2. Two well-known instances I explore in this chapter are the cases of abortion and gun control. Since the 1970s the abortion issue has become very prominent in national politics. The debate has become increasingly partisan, with Republicans tending ever more toward the “pro-life” side and Democrats to the “pro-choice” one. Many scholars (Abramowitz 1994; Adams 1997; Cook, Jelen, and Wilcox 1998; Layman 2001) have examined the relationship between attitudes on abortion and partisanship and voting behavior. Yet most research is focused on mass responses to cues from political elites such as members of Congress, among whom positions on abortion have increasingly become a function of party affiliation. It remains to be shown how this elite polarization developed.
Llamas, Weavings, and Organic Chocolate: Multicultural Grassroots Development in the Andes and Amazon of Bolivia

"Llamas, Weavings, and Organic Chocolate: Multicultural Grassroots Development in the Andes and Amazon of Bolivia. Kevin Healy. Notre Dame, IN: University of Notre Dame Press, 2001. 482 pp.
Increased Body Mass Index Is Associated with Congestive Heart Failure and Mortality in Adult Fontan Patients.

OBJECTIVE Obesity affects adults with congenital heart disease (CHD). The effect of an increased body mass index (BMI) with respect to morbidity and mortality has not been evaluated in adults with complex CHD. Our objective was to evaluate the effects of increased BMI on heart failure and mortality in univentricular patients who had undergone Fontan palliation. METHODS A query of Fontan patients' first appointments at the Washington University Center for Adults with CHD between 2007 and 2014 yielded 79 patients. BMI status as normal (<25 kg/m(2) ), overweight (≥25, <30 kg/m(2) ), and obese (≥30 kg/m(2) ) was established at the patient's first appointment. We analyzed demographics, diuretic requirements, New York Heart Association (NYHA) class, and laboratory values using Student's two-sample t-test and Fisher's exact test. Mortality was assessed via survival curves, and hazard ratios were compiled with proportional hazard modeling. RESULTS The recent average BMI was significantly greater in patients with NYHA classes II-IV (29.3 ± 9 kg/m(2) ) compared with asymptomatic patients (24.8 ± 5.1 kg/m(2) , P = .006). Additionally, the average BMI of patients with a high diuretic requirement (≥40 mg/day IV furosemide equivalent) was obese, at 32.15 ± 9.1 kg/m(2) , compared with 25.91 ± 7.3 kg/m(2) for those on no or lower doses of diuretics (P = .009). Eighteen of the 79 patients met an endpoint of death, hospice placement, or cardiac transplant by the study conclusion. Kaplan-Meier analysis from time of first appointment until recent follow-up revealed a significant association between time to combined endpoint and BMI class. Cox proportional hazard modeling with age adjustment yielded a hazard ratio of 3.2 (95% CI 1.096-9.379) for obesity upon first presentation to an adult CHD clinic. CONCLUSIONS In patients with univentricular hearts and Fontan palliation, obesity is associated with symptomatic heart failure and mortality.
Secondary gliosarcoma: a review of clinical features and pathological diagnosis.

Object Although secondary gliosarcoma after treatment of primary glioblastoma multiforme has been described, little is known of these rare tumors. In this article the authors review the literature on secondary gliosarcoma, with attention to clinical course and pathological features. Methods A PubMed search of the key word intracranial “gliosarcoma” with and without “radiation” or “radiotherapy” in humans was performed. The 204 citations yielded were screened for relevancy to gliosarcomas that occur after treatment of previous intracranial neoplasms. Results A search of the literature yielded 24 relevant articles, combined for a total of only 12 cases of secondary gliosarcoma and 12 cases of radiation-induced gliosarcoma. Of the 12 cases of secondary gliosarcoma, all were previously treated with surgery and radiotherapy (mean dose 50.7 Gy), with a mean survival of 13 months since time of gliosarcoma diagnosis (range 6.9–19.4 months). In the cases of radiation-induced gliosarcoma, the mean dose of previous ...
Henoch-Schönlein purpura : When and how to treat

The many facets of Henoch-Schonlein purpura are described with emphasis on the gastrointestinal and renal manifestations. The controversy surrounding management of children with abdominal pain and nephritis is discussed with a review of the current literature to support recommendations for treatment options.
The Crisis in Antibiotic Resistance

The synthesis of large numbers of antibiotics over the past three decades has caused complacency about the threat of bacterial resistance. Bacteria have become resistant to antimicrobial agents as a result of chromosomal changes or the exchange of the exchange of genetic material via plasmids and transposons. Streptococcus pneumoniae, Streptococcus pyogenes, and staphylococci, organisms that cause respiratory and cutaneous infections, and members of the Enterobacteriaceae and Pseudomonas families, organisms that cause diarrhea, urinary infection, and sepsis, are now resistant to virtually all of the older antibiotics. The extensive use of antibiotics in the community and hospitals has fueled this crisis. Mechanisms such as antibiotic control programs, better hygiene, and synthesis of agents with improved antimicrobial activity need to be adopted in order to limit bacterial resistance.
Stain for histamine in mast cells in fixed tissue.

A technique is described for staining histamine in mast cells of tissues fixed in alcohol. The method employs cold ethanol fixation, xylene clearing, paraffin embedding, and staining of the sections with 1% o-phthalaldehyde in ethyl benzene in a humid chamber.
CMAC-based adaptive critic self-learning control

A technique that integrates the cerebellar model articulation controller (CMAC) into a self-learning control scheme developed by A.G. Barto et al. (IEEE Trans. Syst. Man., Cybern., vol.SMC-13, p.834-46, Sept./Oct. 1983) is presented. Instead of reserving one input line (as a memory) for each quantized state, the integrated technique distributively stores learned information; this reduces the required memory and makes the self-learning control scheme applicable to problems of larger size. CMAC's capability with regard to information interpolation also helps improve the learning speed. >
The relaxation response: Reducing stress and improving cognition in healthy aging adults☆

Aging adults are vulnerable to the effects of a negative emotional state. The relaxation response (RR) is a mind-body intervention that counteracts the harmful effects of stress. Previous studies with relaxation techniques have shown the non-pharmacological benefit of reducing stress and improving the memory of healthy older adults. Our pilot study evaluated whether a RR training program would decrease anxiety levels, improve attention, declarative memory performance and/or decrease salivary cortisol levels in healthy older adults. Fifteen adults participated and were randomly assigned to a RR training or control groups. Mean age was 71.3 years and mean education level was 17.9 years. Reaction time on a simple attention/psychomotor task was significantly improved (p<0.0025) with RR training, whereas there was no significant improvement on complex tasks of attention, verbal, or visual declarative memory tests. Self-reported state anxiety levels showed a marginally significant reduction (p<0.066). All subjects' salivary cortisol levels were within low-normal range and did not significantly change. Our 5-week program in highly educated, mobile, healthy, aging adults significantly improved performance on a simple attention task.
Use of Cognitive Capacity in Reading: Effects of Some Content Features of Text.

Use of cognitive capacity was measured during reading of text in six experiments. Content features of the texts were varied. A secondary task technique was used to measure use of capacity. In all experiments, capacity was filled more completely while reading narrative text than while reading expository text. The finding was generalized over two pools of passages, over two modalities of secondary task probes— auditory and tactile—and over two secondary tasks—simple reaction time and choice reaction time. Three hypotheses for the narrativity effect were investigated. Not supported were an hypothesis based on the interest value of the passages and the hypothesis that difficult to comprehend passages induced problem solving cognitive operations that filled capacity. The results were consistent with a comprehensibility hypothesis, which states that when more meaning is produced in the reader's cognitive system while reading a text, more cognitive capacity is filled by reading it. Narrative passages produce mor...
New measures improve the accuracy of the directed-lie test when detecting deception using a mock crime.

The present study tested the accuracy of probable-lie and directed-lie polygraph tests. One hundred and twenty men and women were recruited from the general community and paid $30 to participate in a mock crime experiment. Equal numbers of males and females were assigned to either the guilty or innocent condition with equal numbers in each group receiving either a probable-lie or a directed-lie polygraph test resulting in a 2 × 2 design with two experimental factors (test type and deceptive condition). Half of the participants were guilty and half were innocent of committing a mock theft of $20 from a purse. All participants were paid a $50 bonus if they could convince the polygraph examiner that they were innocent. There were no significant differences in decision accuracy between probable-lie and directed-lie tests, but respiration measures were more diagnostic for the probable-lie test. New physiological measures, skin potential excursion and a new respiratory measure improved the accuracy of the directed-lie test such that 86% of the innocent participants and 93% of the guilty participants were correctly classified.
Low temperature relaxation of residual stress in Ti¿6Al¿4V

Abstract Isothermal tests were performed on Ti–6Al–4V to observe time-dependent changes in the lattice parameter of the α (hexagonal close-packed) and β (body-centered cubic) phases. Synchrotron-based experiments show contraction in β at temperatures below 550 °C, and expansion at higher temperatures. Contraction results from annealing of preexisting residual stresses, while expansion results from V diffusion when the α → β phase transformation becomes kinetically active.
Incomplete Wood–Ljungdahl pathway facilitates one-carbon metabolism in organohalide-respiring Dehalococcoides mccartyi

The acetyl-CoA "Wood-Ljungdahl" pathway couples the folate-mediated one-carbon (C1) metabolism to either CO2 reduction or acetate oxidation via acetyl-CoA. This pathway is distributed in diverse anaerobes and is used for both energy conservation and assimilation of C1 compounds. Genome annotations for all sequenced strains of Dehalococcoides mccartyi, an important bacterium involved in the bioremediation of chlorinated solvents, reveal homologous genes encoding an incomplete Wood-Ljungdahl pathway. Because this pathway lacks key enzymes for both C1 metabolism and CO2 reduction, its cellular functions remain elusive. Here we used D. mccartyi strain 195 as a model organism to investigate the metabolic function of this pathway and its impacts on the growth of strain 195. Surprisingly, this pathway cleaves acetyl-CoA to donate a methyl group for production of methyl-tetrahydrofolate (CH3-THF) for methionine biosynthesis, representing an unconventional strategy for generating CH3-THF in organisms without methylene-tetrahydrofolate reductase. Carbon monoxide (CO) was found to accumulate as an obligate by-product from the acetyl-CoA cleavage because of the lack of a CO dehydrogenase in strain 195. CO accumulation inhibits the sustainable growth and dechlorination of strain 195 maintained in pure cultures, but can be prevented by CO-metabolizing anaerobes that coexist with D. mccartyi, resulting in an unusual syntrophic association. We also found that this pathway incorporates exogenous formate to support serine biosynthesis. This study of the incomplete Wood-Ljungdahl pathway in D. mccartyi indicates a unique bacterial C1 metabolism that is critical for D. mccartyi growth and interactions in dechlorinating communities and may play a role in other anaerobic communities.
Rates of dissociation and recombination of the subunits of bovine thyrotropin.

Abstract The rates of dissociation and recombination of the subunits of bovine thyrotropin have been measured under a variety of conditions using the fluorescence probe 1,8-anilinonaphthalenesulfonate. The method is based on the fact that the native hormone strongly enhances the fluorescence of 1,8-anilinonaphthalenesulfonate whereas the subunits have very little effect. The hormone can be easily dissociated into subunits, either in dilute acid (pH m ) urea solutions at pH 8.O. The rate of dissociation is first order with time and increases strongly with increasing temperature. The hormone is very stable in alkali, showing little tendency to dissociate below pH 12. After dissociation in acid, the subunits can be recombined between pH 7 and 9 at a rate which increases with increasing temperature and subunit concentration. The recombination is intermediate between first and second order suggesting a two-step mechanism: association of the subunits followed by a first-order refolding process in which the subunits acquire the tertiary structure characterisitc of the native hormone. Difference absorption measurements indicate that the dissociation is accompanied by the exposure of a substantial fraction of the 16 tyrosine residues to the more polar aqueous environment, suggesting major conformational changes in one or both subunits.
Cloning of mouse c-ros renal cDNA, its role in development and relationship to extracellular matrix glycoproteins

Cloning of mouse c- ros renal cDNA, its role in development and relationship to extracellular matrix glycoproteins. Renal organogenesis ensues following reciprocal interactions between the uninduced metanephric mesenchyme and the ureteric bud. Conceivably, the presence of ligands or growth factors on a given cell type, and expression of receptors, including receptor proto-oncogenes, on the other cell type of different lineage would facilitate such epithelial-mesenchymal interactions. During these interactions, other macromolecules, such as extracellular matrix (ECM) proteins, present at the epithelial-mesenchymal surface, also play a role in the kidney morphogenesis. In this study the proto-oncogene, c- ros , was cloned and sequenced; its role in the metanephric development was examined, and correlated with the changes in the expression of ECM proteins. The mouse c- ros renal cDNA, belonging to phosphotyrosine kinase (PTK) receptor family, had a translation product of 2340 amino acids. The extracellular domain had 32 N-linked glycosylation sites and 30 cysteine residues. The transmembrane segment had a hydrophobicity approaching ˜ 3.5. Multiple phosphorylation sites, typical of a PTK catalytic unit, were present in the cytoplasmic domain. The 3′ noncoding region did not contain any A(U) n A mRNA instability motifs. The c- ros mRNA was highly expressed on the ureteric bud branches and their tips and on the developing glomeruli. Competitive RT-PCR analyses revealed the c- ros expression was the highest at 13th day of gestation, and it declined to very low levels during the neonatal period. Exposure of metanephric kidneys to c- ros antisense-oligonucleotide, derived from the PTK domain, caused dysmorphogenesis of the kidney and loss of c- ros expression on the ureteric bud branches. Concomitant with the reduced c- ros gene expression, a decreased expression of ECM glycoproteins, in particular the proteoglycans, was observed. These findings suggest that the c- ros plays a role in the metanephric development, and its effects may be modulated by the ECM macromolecules present at the epithelial-mesenchymal interface.
The Influence of Online Gambling Environments on Self-Control

Abstract Online gambling has become a fast growing but controversial industry. This article summarizes two studies that investigate characteristics of Internet gambling environments that lead to problems with self-control. In-depth interviews with both online and casino gamblers reveal that their experiences are categorized differently in an online context, causing some informants to undertake less monitoring of spending. They also use their physical environment to impose boundaries. Next, an experiment investigates two characteristics of online gambling environments: the use of intangible currency and rapid sequential choice. Both traits negatively affect people's ability to maintain an accurate, in-the-moment account balance across a sequence of gambles. These studies suggest several policy and consumer welfare implications.
Facile production of native-like κ-bungarotoxin in yeast: An enhanced system for the production of a neuronal nicotinic acetylcholine receptor probe

Abstract Research on the mammalian central nervous system has been hindered by the limited number and meager supply of naturally occurring toxins that can be used as pharmacological reagents. The κ-neurotoxins in particular are not found abundantly in nature and are difficult to obtain and isolate in quantities sufficient for research purposes. Here we report the expression and isolation of relatively large quantities of the κ-neurotoxin, κ-bungarotoxin, in an active form using a yeast, Pichia pastoris , expression system. The resultant product of the expression system has a short amino-terminal amino acid extension relative to venom-derived κ-bungarotoxin, but is equivalent to the native toxin in physical and biological properties, as judged by the CD spectra, the ability to form dimers in solution, and the activity on chick ciliary ganglia. The yeast system produces approximately 0.2 mg from a 2 liter culture and the purification takes approximately 2 days. In contrast, E. coli , the only other available expression system for this toxin, produces one-fifth to one-half as much active material from a 5 liter high-density fermentation and the resulting protein takes over a week to purify. No high mol. wt disulfide-bonded aggregates were found in the yeast expression system product, indicating that the product is that of a biologically assisted folding process. This has significant implications not only for the efficient production of native toxin but also for the production of mutant proteins to study the structure-function relationship in these proteins.
A unifying framework for linear estimation: Generalized partitioned algorithms

In this paper, generalized partitioned algorithms are presented that serve as the unifying framework for linear filtering and smoothing. The fundamental and all encompassing nature of the generalized partitioned algorithms (hereon denoted GPA) is clearly demonstrated by showing that the GPA contain as special cases important generalizations of past well-known linear estimation algorithms, as well as whole families of such algorithms, of which all previously obtained major filtering and smoothing algorithms are special cases. Specifically, generalized partitioned filtering and smoothing algorithms are given in terms of integral expressions, that are theoretically interesting, computationally attractive, as well as provide a unification of all previous approaches to linear filtering and smoothing, and clear delineation of their inter-relationships. In particular, the GPA for filtering are shown to contain as special cases families of filtering algorithms which constitute generalizations of the Kalman-Bucy, and Chandrasekhar algorithms as well as of the previously obtained partitioned algorithms of Lainiotis. These generalizations pertain to arbitrary initial conditions and time-varying models. Further, the GPA for smoothing are shown to contain two families of generalized backward and forward smoothing algorithms valid for arbitrary boundary conditions, of which all previous backward and forward algorithms are special cases. It is also shown that the GPA may also be given in terms of an imbedded generalized Chandrasekhar algorithm with the consequent computational advantages. Furthermore, the GPA are shown to serve as the basis of computationally effective, fast, and numerically robust algorithms for the numerical implementation of the estimation formulas. A particularly effective doubling algorithm is also given for calculating the steady-state filter. The partitioned numerical algorithms are given exactly in terms of a set of elemental solutions which are both simple as well as completely decoupled, and as such computable in either a parallel or serial processing mode. Moreover, the overall solution is given by a simple recursive operation on the elemental solutions.