cssi/SciSciGPT-SciSciNet huggingface dataset:
A single center observational study on emergency department clinician non-adherence to clinical practice guidelines for treatment of uncomplicated urinary tract infections.

The Emergency Department (ED) is a frequent site of antibiotic use; poor adherence with evidence-based guidelines and broad-spectrum antibiotic overuse is common. Our objective was to determine rates and predictors of inappropriate antimicrobial use in patients with uncomplicated urinary tract infections (UTI) compared to the 2010 International Clinical Practice Guidelines (ICPG). A single center, prospective, observational study of patients with uncomplicated UTI presenting to an urban ED between September 2012 and February 2014 that examined ED physician adherence to ICPG when treating uncomplicated UTIs. Clinician-directed antibiotic treatment was compared to the ICPG using a standardized case definition for non-adherence. Binomial confidence intervals and student’s t-tests were performed to evaluate differences in demographic characteristics and management between patients with pyelonephritis versus cystitis. Regression models were used to analyze the significance of various predictors to non-adherent treatment. 103 cases met the inclusion and exclusion criteria, with 63.1 % receiving non-adherent treatment, most commonly use of a fluoroquinolone (FQ) in cases with cystitis (97.6 %). In cases with pyelonephritis, inappropriate antibiotic choice (39.1 %) and no initial IV antibiotic for pyelonephritis (39.1 %) where recommended were the most common characterizations of non-adherence. Overall, cases of cystitis were no more/less likely to receive non-adherent treatment than cases of pyelonephritis (OR 0.9, 95 % confidence interval 0.4–2.2, P = 0.90). In multivariable analysis, patients more likely to receive non-adherent treatment included those without a recent history of a UTI (OR 3.8, 95 % CI 1.3–11.4, P = 0.02) and cystitis cases with back or abdominal pain only (OR 11.4, 95 % CI 2.1–63.0, P = 0.01). Patients with cystitis with back or abdominal pain only were most likely to receive non-adherent treatment, potentially suggesting diagnostic inaccuracy. Physician education on evidence-based guidelines regarding the treatment of uncomplicated UTI will decrease broad-spectrum use and drug resistance in uropathogens.
Percutaneous Plating of Weber B Fibular Fractures.

The purpose of the present study was to describe a minimally invasive percutaneous technique for plating Weber B distal fibular fractures and to evaluate its efficacy by measuring patient outcomes and hardware removal rates. The data from 17 patients undergoing percutaneous plating of a distal fibular (Weber B) fracture were prospectively studied. A 4- to 6-hole semitubular plate with 3 screws was used for percutaneously plating. The Roles and Maudsley score was used to assess the patients' activity level. All fibular fractures had healed clinically and radiographically by 8 weeks after surgery. The postoperative Roles and Maudsley scores had improved significantly. The time required to return to activity was 4.3 ± 2.0 months. Hardware removal was required in 3 patients during the study period, which had an average of almost 4 years postoperatively. The results of the present study have demonstrated that percutaneous plating is an effective surgical option for treating Weber B distal fibular fractures.
Missed opportunities to transition from nebulizers to inhalers during hospitalization for acute asthma: A multicenter observational study.

ABSTRACTObjective: Hospitalizations for acute asthma are thought to be highly preventable through the use of efficacious medications, though many patients have poor metered-dose inhaler (MDI) techniques, thus lessening these medications' real-world effectiveness. Teaching MDI techniques during hospitalization may therefore lead to improved outcomes. However, MDIs may be underutilized to deliver short-acting β-agonists (SABAs) in the inpatient setting, despite equivalent efficacy to nebulizer delivery. We sought to characterize delivery methods of SABAs among hospitalized patients with acute asthma to understand if there are missed opportunities for self-management education. Methods: In this secondary analysis of a cross-sectional 25-center chart review study of children and adults (ages 2–54 years) hospitalized for acute asthma across 18 states (2012–2013), we studied SABA therapy delivery methods during hospitalization and receipt of action plans and follow-up visits. Unadjusted associations were analyz...
Lignocentric analysis of a carbohydrate-producing lignocellulosic biorefinery process

A biologically-based lignocellulosic biorefinery process for obtaining carbohydrates from raw biomass was investigated across six diverse biomasses (three hardwoods & three nonwoods) for the purpose of decoding lignin's influence on sugar production. Acknowledging that lignin could positively alter the economics of an entire process if valorized appropriately, we sought to correlate the chemical properties of lignin within the process to the traditional metrics associated with carbohydrate production-cellulolytic digestibility and total sugar recovery. Based on raw carbohydrate, enzymatic recovery ranged from 40 to 64% w/w and total recovery ranged from 70 to 87% w/w. Using nitrobenzene oxidation to quantify non-condensed lignin structures, it was found that raw hardwoods bearing increasing non-condensed S/V ratios (2.5-5.1) render increasing total carbohydrate recovery from hardwood biomasses. This finding indicates that the chemical structure of hardwood lignin influences the investigated biorefinery process' ability to generate carbohydrates from a given raw hardwood feedstock.
Genome-wide screen for genes involved in eDNA release during biofilm formation by Staphylococcus aureus

Staphylococcus aureus is a leading cause of both nosocomial and community-acquired infection. Biofilm formation at the site of infection reduces antimicrobial susceptibility and can lead to chronic infection. During biofilm formation, a subset of cells liberate cytoplasmic proteins and DNA, which are repurposed to form the extracellular matrix that binds the remaining cells together in large clusters. Using a strain that forms robust biofilms in vitro during growth under glucose supplementation, we carried out a genome-wide screen for genes involved in the release of extracellular DNA (eDNA). A high-density transposon insertion library was grown under biofilm-inducing conditions, and the relative frequency of insertions was compared between genomic DNA (gDNA) collected from cells in the biofilm and eDNA from the matrix. Transposon insertions into genes encoding functions necessary for eDNA release were identified by reduced representation in the eDNA. On direct testing, mutants of some of these genes exhibited markedly reduced levels of eDNA and a concomitant reduction in cell clustering. Among the genes with robust mutant phenotypes were gdpP, which encodes a phosphodiesterase that degrades the second messenger cyclic-di-AMP, and xdrA, the gene for a transcription factor that, as revealed by RNA-sequencing analysis, influences the expression of multiple genes, including many involved in cell wall homeostasis. Finally, we report that growth in biofilm-inducing medium lowers cyclic-di-AMP levels and does so in a manner that depends on the gdpP phosphodiesterase gene.
Psychosocial Perspectives on Emotions: The Role of Identity in the Aging Process

Publisher Summary This chapter offers important insights into the functions of emotions throughout the adult years and particularly in old age. The chapter outlines several broad areas in relation to identity and aging, highlighting the role of emotions within identity and as the outcome of interactions between self and experiences. Within the traditional framework of Erikson's life span psychosocial development theory, emotions are viewed as both the stimulus for movement from one crisis transition to the next, and as the products of successful crisis negotiations. Although multiple sets of changes are theorized to move the individual along the epigenetic trajectory, the maturation of new emotions or the ability to take a more mature perspective on affectively laden experiences can propel the individual into a new set of psychosocial issues. The successful resolution of a psychosocial crisis, in turn, can have an emotional component that accompanies the emergence of greater differentiation within the ego.
Small-molecule inhibitors directly target CARD9 and mimic its protective variant in inflammatory bowel disease

Advances in human genetics have dramatically expanded our understanding of complex heritable diseases. Genome-wide association studies have identified an allelic series of CARD9 variants associated with increased risk of or protection from inflammatory bowel disease (IBD). The predisposing variant of CARD9 is associated with increased NF-κB–mediated cytokine production. Conversely, the protective variant lacks a functional C-terminal domain and is unable to recruit the E3 ubiquitin ligase TRIM62. Here, we used biochemical insights into CARD9 variant proteins to create a blueprint for IBD therapeutics and recapitulated the mechanism of the CARD9 protective variant using small molecules. We developed a multiplexed bead-based technology to screen compounds for disruption of the CARD9–TRIM62 interaction. We identified compounds that directly and selectively bind CARD9, disrupt TRIM62 recruitment, inhibit TRIM62-mediated ubiquitinylation of CARD9, and demonstrate cellular activity and selectivity in CARD9-dependent pathways. Taken together, small molecules targeting CARD9 illustrate a path toward improved IBD therapeutics.
Introduction to Social Media, Activism, and Organizations:

Social media have become increasingly pervasive. However, the literature on social movements and social media has not fully grasped just how much social media have fundamentally changed the landsca...
Determination of adsorption and desorption of DNA molecules on freshwater and marine sediments.

Aims Free DNA and its adsorption by sediment in the aquatic environment lead to ambiguity in the identification of recent faecal pollution sources. The goal of this study was to understand the mechanisms of DNA adsorption and desorption on aquatic sediment under various conditions using quantitative polymerase chain reaction (qPCR). Methods and results Both raw sewage (RS) DNA and purified PCR product (PPP) were used in adsorption and desorption experiments; autoclaved freshwater and marine sediments served as sorbents. Thirty-six hours were needed for adsorption to reach equilibrium. More DNA was adsorbed on both sediments in stream water than in 5 mmol l-1 NaCl and DNA adsorption increased in the presence of Ca2+ and Mg2+ . Successive desorption experiments showed that between 5% and 22% of adsorbed DNA was desorbed. Conclusions Organic matter and clay played a significant role in determining the DNA adsorption capacity on sediment. The data suggest the presence of multilayer adsorption. DNA molecules on sediments were mostly adsorbed through ligand binding rather than electrostatic binding. Significance and impact of the study Quantitative polymerase chain reaction assays provide a better way to investigate the DNA adsorption and desorption mechanisms by sediment. DNA desorption can potentially complicate the outcomes of microbial source tracking studies.
PERFORMANCE IMPROVEMENT AND OUTCOMES IN HYPERTENSION MANAGEMENT PHASE II

Hypertension diagnosis and management is essential in the prevention of cardiovascular morbidity and mortality. Despite its prevalence with 1 in 3 American adults affected, only half have it controlled. As a result, there has been a call by private and government agencies to identify best practices
Translocation 10;17 in clear cell sarcoma of the kidney: A first report

This is the first report of a t(10;17) as the unique cytogenetic finding in one case of a rare childhood tumor, clear cell sarcoma of the kidney (CCSK). This observation is discussed in relation to the cytogenetics of Wilms' tumors, of which CCSK is a variant.
Healthcare Reform and its Potential Impact on Academic Women's Healthcare Practice and Training

When comprehensive health reform is enacted, the practice of medicine and medical training will change in a more major way than following any failed short-term fixes. This chapter emphasizes changing roles of faculty in scholarly activity and in training the next generation of women’s health practitioners.
Elusive search for effective provider interventions: a systematic review of provider interventions to increase adherence to evidence-based treatment for depression.

Depression is a common mental health disorder for which clinical practice guidelines have been developed. Prior systematic reviews have identified complex organizational interventions, such as collaborative care, as effective for guideline implementation; yet, many healthcare delivery organizations are interested in less resource-intensive methods to increase provider adherence to guidelines and guideline-concordant practices. The objective of this systematic review was to assess the effectiveness of healthcare provider interventions that aim to increase adherence to evidence-based treatment of depression in routine clinical practice. We searched five databases through August 2017 using a comprehensive search strategy to identify English-language randomized controlled trials (RCTs) in the quality improvement, implementation science, and behavior change literature that evaluated outpatient provider interventions, in the absence of practice redesign efforts, to increase adherence to treatment guidelines or guideline-concordant practices for depression. We used meta-analysis to summarize odds ratios, standardized mean differences, and incidence rate ratios, and assessed quality of evidence (QoE) using the GRADE approach. Twenty-two RCTs promoting adherence to clinical practice guidelines or guideline-concordant practices met inclusion criteria. Studies evaluated diverse provider interventions, including distributing guidelines to providers, education/training such as academic detailing, and combinations of education with other components such as targeting implementation barriers. Results were heterogeneous and analyses comparing provider interventions with usual clinical practice did not indicate a statistically significant difference in guideline adherence across studies. There was some evidence that provider interventions improved individual outcomes such as medication prescribing and indirect comparisons indicated more complex provider interventions may be associated with more favorable outcomes. We did not identify types of provider interventions that were consistently associated with improvements across indicators of adherence and across studies. Effects on patients’ health in these RCTs were inconsistent across studies and outcomes. Existing RCTs describe a range of provider interventions to increase adherence to depression guidelines. Low QoE and lack of replication of specific intervention strategies across studies limited conclusions that can be drawn from the existing research. Continued efforts are needed to identify successful strategies to maximize the impact of provider interventions on increasing adherence to evidence-based treatment for depression. PROSPERO record CRD42017060460 on 3/29/17
Aversion-Avoidance Processes In Network Genesis And Evolution: The Case Of The Neurotic Ego

Field research indicates that the network positions actors occupy are determined, at least in part, by the particular traits of those actors. In particular, actors who are high in neuroticism (i.e....
Active Facebook use and mood: When digital interaction turns maladaptive

Abstract Despite the prevalence of Facebook use, its psychological impact remains unclear. Recent evidence suggests that active Facebook use (i.e., peer interaction) is more adaptive than passive use (i.e., browsing content), predicting increases in affective well-being and social connectedness. However, how individual differences in cognition and belonging may influence these relationships has been largely unexamined, limiting conclusions on whether these findings extend to vulnerable individuals. The present study sought to address this gap by investigating whether active Facebook use loses its benefits in the presence of social-cognitive vulnerabilities (i.e., rumination, interpretation bias, thwarted belongingness) that may be especially relevant to the digital context. Although active Facebook use was associated with feeling better after Facebook use and with perceiving more positive Facebook interactions, cognitive biases and thwarted belongingness predicted feeling worse after active Facebook use and reporting less positive interactions. Additionally, interpretation bias and thwarted belongingness together predicted feeling worse after one style of active Facebook use, through perceptions of less positive interactions. These findings suggest that beyond how one uses Facebook, the individual factors one brings to the Facebook experience may influence perceptions of interpersonal experiences in the digital space and contribute to low mood, rendering even active Facebook use maladaptive.
Analysis of Low Probability of Intercept Radar Signals Using the Reassignment Method

Digital intercept receivers are currently moving towards classical time-frequency analysis techniques for analyzing low probability of intercept radar signals. Although these techniques are an improvement over existing Fourier-based techniques, they still suffer from a lack of readability, due to poor time-frequency localization and cross-term interference, which may lead to inaccurate detection and parameter extraction. In this study, the reassignment method, because of its ability to smooth out cross-term interference and improve time-frequency localization, is proposed as an improved signal analysis technique to address these deficiencies. Simulations are presented that compare time-frequency representations of the classical time-frequency techniques with those of the reassignment method. Four different low probability of intercept waveforms are analyzed (two frequency modulated continuous wave waveforms and two frequency shift keying waveforms). The following metrics are used for analysis evaluation: Percent detection, number of cross-term false positives, lowest signal-to-noise ratio for signal detection, processing time, percent error of: Carrier frequency, modulation bandwidth, modulation period, time-frequency localization (x and y direction) and chirp rate. Experimental results demonstrate that the ‘squeezing’ and ‘smoothing’ qualities of the reassignment method improve readability over the classical time-frequency analysis techniques and consequently, provide more accurate signal detection and parameter extraction in all but one of the metrics categories.
Cracking the Cell Death Code

Cell death is an invariant feature throughout our life span, starting with extensive scheduled cell death during morphogenesis and continuing with death under homeostasis in adult tissues. Additionally, cells become victims of accidental, unscheduled death following injury and infection. Cell death in each of these occasions triggers specific and specialized responses in the living cells that surround them or are attracted to the dying/dead cells. These responses sculpt tissues during morphogenesis, replenish lost cells in homeostasis to maintain tissue/system function, and repair damaged tissues after injury. Wherein lies the information that sets in motion the cascade of effector responses culminating in remodeling, renewal, or repair? Here, we attempt to provide a framework for thinking about cell death in terms of the specific effector responses that accompanies various modalities of cell death. We also propose an integrated threefold "cell death code" consisting of information intrinsic to the dying/dead cell, the surroundings of the dying cell, and the identity of the responder.
Ex Vivo Mechanical Tests and Multiscale Computational Modeling Highlight the Importance of Intramural Shear Stress in Ascending Thoracic Aortic Aneurysms.

Ascending thoracic aortic aneurysms (ATAAs) are anatomically complex in terms of architecture and geometry, and both complexities contribute to unpredictability of ATAA dissection and rupture in vivo. The goal of this work was to examine the mechanism of ATAA failure using a combination of detailed mechanical tests on human tissue and a multiscale computational model. We used (1) multiple, geometrically diverse, mechanical tests to characterize tissue properties, (2) a multiscale computational model to translate those results into a broadly usable form, and (3) a model-based computer simulation of the response of an ATAA to the stresses generated by the blood pressure. Mechanical tests were performed in uniaxial extension, biaxial extension, shear lap, and peel geometries. ATAA tissue was strongest in circumferential extension and weakest in shear, presumably because of the collagen and elastin in the arterial lamellae. A multiscale, fiber-based model using different fiber properties for collagen, elastin, and interlamellar connections was specified to match all of the experimental data with one parameter set. Finally, this model was used to simulate ATAA inflation using a realistic geometry. The predicted tissue failure occurred in regions of high stress, as expected; initial failure events involved almost entirely interlamellar connections, consistent with arterial dissection - the elastic lamellae remain intact, but the connections between them fail. The failure of the interlamellar connections, paired with the weakness of the tissue under shear loading, is suggestive that shear stress within the tissue may contribute to ATAA dissection.
Medicalization in the Media: News Coverage of a New and Uncertain Diagnosis

The concept of orthorexia nervosa emerged in 1997 to describe a pathological obsession with healthy eating. Before any consensus was reached by the medical community, orthorexia started to appear i...
(CuxZn1-x)0.456In1.084Ge0.46O3 (0 ≤ x ≤ 1): A Complex, Ordered, Anion-Deficient Fluorite with Unusual Site-Specific Cation Mixing.

The anion-deficient fluorite-related family of materials exhibits a number of commercially useful properties arising from the specific arrangement of anion vacancies in each structure. One recently reported member, Zn0.456In1.084Ge0.46O3, is the only known example with its particular complex structure in which cation coordinations span one 4-coordinate (4b), two 6-coordinate (8e and 16f), and one 8-coordinate (4a) site. A new, complete, solid solution (CuxZn1–x)0.456In1.084Ge0.46O3, (0 ≤ x ≤ 1) has been discovered via the isovalent substitution of Cu2+ for Zn2+, significantly expanding the known phase space of this structure. Synchrotron X-ray data confirm the ZIGO structure over the entire composition range. Inclusion of Cu in the structure is found to occur exclusively at the 16f site, increasing the number of cations mixed on that site from three to four, while all others remain singly occupied, including the other 6-coordinate (8e) position. Furthermore, transmission electron microscopy investigations...
Hydroxylation and Cation Segregation in (La0.5Sr0.5)FeO3−δ Electrodes

Simultaneously achieving high activity and stability is the primary challenge when engineering (electro)catalysts. Transition metal perovskite oxides are employed as air electrodes for solid-oxide ...
Diagnostic Imaging of Ulnar Collateral Ligament Injury: A Systematic Review:

Background:Ulnar collateral ligament (UCL) injuries can be debilitating in overhead athletes. Accurate diagnosis is important; however, several imaging modalities are available for the assessment o...
Spectral Content in a Supersonic Backward-Facing Step Flow

Backward-facing step (BFS) configurations are relevant to many aerospace applications. An understanding of the underlying dynamics of such flows can aid in developing suitable control strategies. T...
Results of a Preceptor Improvement Project.

Background and objectives The majority of medical students receive some of their training with a community preceptor. Nearly all of these preceptors are motivated by a desire to give back to their profession through teaching and they want to learn how to teach more effectively. Designing effective educational programs to improve preceptor teaching is important to upholding the quality of medical education. Methods We designed an educational program consisting of readings, short videos, handouts and posters, as well as one-on-one sessions with a trained standardized medical student. The standardized student visited the community physician's office both before and after the preceptor engaged with the educational materials related to a subject area of the preceptor's choosing. We assessed the preceptor's teaching using three tools: self-evaluation, student reporting of observed behaviors, and an overall rating of teaching effectiveness. Results Thirteen preceptors took part in this the educational intervention. Per the self-assessment, preceptors showed improved teaching competency for all items on the questionnaire, with 12 of the 21 items (57%) showing statistically significant results (Pl.05). The standardized student reported that preceptors used more of eight desired teaching behaviors in the second mock preceptor encounter than they used in the first, with a mean increase of 1.46 (P=.001). Overall teaching effectiveness scores increased, with a mean increase of 1.15 (P=.001) on the 10-point scale. Moreover, all participants indicated they were either satisfied or highly satisfied with the program and that they would recommend this program to a colleague. Conclusions Our preceptor-improvement intervention led to demonstrable improvement in preceptor teaching, as measured by preceptor evaluation and evaluation by the standardized student. More research is needed to see if these results can be replicated and, in particular, to determine which aspects of the intervention were most useful.
Noise and Jitter Characterization of High-Speed Interfaces in Heterogeneous Integrated Systems

Heterogeneous integration allows multiple silicon dies of various technologies and complexity to communicate efficiently using second-level interconnects, interposers, in a single package. The interposer also provides a low-impedance power delivery path between multiple independent power domains. Although the channels are very short and the signal integrity is not a challenge, the huge increase in the transient current of multiple dies and the unique clocking architecture makes the supply noise and timing jitter the limiting factors in designing high-performance multidie systems. In this article, accurate analysis and characterization techniques of noise and jitter in multidie interfaces are presented. Power supply noise and empirically derived jitter models are correlated with measurements and detailed transistor-level circuit simulations, respectively.
Improved Antibiotic Prescribing Practices for Respiratory Infections Through Use of Computerized Order Sets and Educational Sessions in Pediatric Clinics.

Background Computerized clinical decision support systems (CDSS) have shown promising effectiveness in improving outpatient antibiotic prescribing. Methods We developed an intervention in the form of EPIC (Verona, WI, USA) order sets comprised of outpatient treatment pathways for 3 pediatric bacterial acute respiratory infections (ARIs) coupled with educational sessions. Four pediatric clinics were randomized into intervention and control arms over pre- and postimplementation study periods. In the intervention clinics, education was provided in between the 2 study periods and EPIC order sets became available at the beginning of the postimplementation period. The primary end point was the percentage of first-line antibiotic prescribing, and the secondary end points included antibiotic duration and antibiotic prescription modification within 14 days. Results A total of 2690 antibiotic prescriptions were included. During the pre-implementation phase, there was no difference in first-line antibiotic prescribing (74.9% vs 77.7%; P = .211) or antibiotic duration (9.69 ± 0.96 days vs 9.63 ± 1.07 days; P > .999) between the study arms. Following implementation, the intervention clinics had a higher percentage of first-line antibiotic prescribing (83.1% vs 77.7%; P = .024) and shorter antibiotic duration (9.28 ± 1.56 days vs 9.79 ± 0.75 days; P < .001) compared with the control clinics. The percentage of modified antibiotics was small in all clinics (1.1%-1.6%) and did not differ before and after the intervention (for all statistical comparisons, P ≤ .354). Conclusions A computerized CDSS involving treatment pathways in the form of order sets coupled with educational sessions was associated with a higher percentage of first-line antibiotic prescribing and shorter antibiotic duration for the outpatient treatment of pediatric bacterial ARIs.
Space and Time

Here, formal tools are used to pose and answer several philosophical questions concerning space and time. The questions involve the properties of possible worlds allowed by the general theory of relativity. In particular, attention is given to various causal properties such as “determinism” and “time travel”.
Dermatology on American Indian and Alaska Native Reservations

American Indians (AI) and Alaska Natives (AN) experience some of the most severe healthcare disparities and worst health outcomes of any population in the developed world. American Indians and Alaska Natives from federally recognized tribes have a legal right to healthcare provided by the Indian Health Service (IHS). The IHS serves approximately 2.2 million AI/AN from 574 federally recognized tribes. Sixty-four percent of the population served by the IHS lives on reservations or in rural communities, mostly in the western US and Alaska. Although the IHS’s mission is to provide health services to all members of federally recognized tribes, the IHS is a severely underfunded federal health program. Because of funding shortfalls, the IHS focuses its efforts on primary and emergency care services, some specialty services, and limited prescription drug coverage. Despite the low rates of access to dermatologic care, AI/AN may suffer from a significant skin disease burden, and sometimes from more severe skin diseases, such as acne, skin cancers, photodermatoses, skin disorders related to rheumatologic and metabolic diseases, coccidioidomycoses, and environmentally related diseases. The health inequities that AN/AI face are not only due to the quality of health care available to this population, but also stem from many practical, infrastructural and socioeconomic factors. These social determinants of health include geographic hurdles; poverty; economic, employment and educational opportunities; safe communities and suitable housing; lack of basic community infrastructure; underrepresentation in the US physician workforce; and an inadequate health system to meet individual and tribal health needs. To optimally address these shortfalls in access to dermatology services, dermatologists must respect tribal sovereignty, understand the limitations of the IHS, and understand how to build and participate in sustainable practices for AI/AN.
The Effectiveness of Active Learning in Histotechnology and Parasitology Techniques-based Laboratory Courses

Active learning, a learning style that incorporates hands-on activities that allow the learner to interact with the course material, has been shown to improve student learning outcomes. While labs ...
Water Marketing as an Adaptive Response to the Threat of Climate Change

Demographic changes and existing water use patterns have placed tremendous pressures upon water supplies, particularly in the West. Global climate change will exacerbate pressures on water resources. The gradual warming of the atmosphere is certain to change the distribution and availability of water supplies, with potentially severe consequences for freshwater supplies. While climate change will have a significant impact on water resources through changes in the timing and volume of precipitation, altered evaporation rates, and the like, the precise nature, magnitude, timing, and distribution of such climate-induced changes are unknown. This uncertainty complicates the task of water managers who are already faced with escalating demands. This article argues that climate change, and its projected effects on water use and supply, calls for a fundamental reexamination of water institutions. In particular, this article suggests that market-based institutions are well suited to address the additional pressures on water supplies due to climate change. Many aspects of water markets, including their flexibility, decentralized nature, and ability to create and harness economic incentives, make them particularly well suited to address the uncertain water forecast. A gradual shift toward water marketing and market pricing will improve the management of water supplies, ensure more efficient allocation of available water supplies and encourage cost-effective conservation measures.
Umbral de desfibrilación elevado: ¿los vectores de desfibrilación son importantes?: Are Defibrillation Vectors Important?

Resumen es: La evaluacion del umbral de desfibrilacion (UDF) es una practica habitual en la mayoria de los implantes de cardiodesfibriladores implantables (CDI)....
A simple deblocking algorithm for JPEG compressed images using overcomplete wavelet representations

This paper introduces a new approach to deblocking of JPEG compressed images using overcomplete wavelet representations. By exploiting cross-scale correlations among wavelet coefficients, edge information in the JPEG compressed images is extracted and protected, while blocky noise in the smooth background regions is smoothed out in the wavelet domain. Compared with the iterative methods reported in the literature, our simple wavelet-based method has much lower computational complexity, yet it is capable of achieving the same PSNR improvement as the best iterative method, and giving visually very pleasing images as well.
Advances in Equation‐Of‐State Measurements in Sam‐85

This paper describes the techniques we have developed over the past 5 years in measuring P-V-T relationships for mantle minerals at simultaneously high pressure and temperature, using a DIA type, cubic-anvil, high-pressure apparatus (SAM-85). Specific problems encountered in such experiments include (1) pressure and temperature generation and characterization, (2) nonhydrostatic stress, (3) pressure difference in a multiphase mixture, (4) overlapped diffraction lines caused by low symmetry, and (5) metastability issues. Solutions to each problem are discussed.
Massive stars as important contributors to two micron light

Near infrared light at 2 micrometers is relatively insensitive to the presence of hot young stars and dust in galaxies, and there has been recent interest in using it as a mass tracer in spiral galaxies. I present evidence that young, cool supergiant stars, whose presence is indicated by strong CO absorption in a 2.36 micrometer bandpass, dominate the 2 micrometer light from active star forming regions in the galaxy NGC 1309. The galaxy's quiescent regions, in contrast, do not show evidence of young supergiants. It follows that the 2 micrometer light comes from different stellar populations in different places, and large changes in the 2 micrometer surface brightness need not imply correspondingly large features in the galaxy's mass distribution.
Tandem attenuators control expression of the Salmonella mgtCBR virulence operon

The mgtCBR operon from Salmonella enterica serovar Typhimurium specifies the virulence protein MgtC, the Mg2+ transporter MgtB and the regulatory peptide MgtR. The mgtCBR transcript includes a long leader region harbouring two short open reading frames (ORFs). Translation of these ORFs is anticipated to impact the formation of particular stem-loop structures and control transcription of the coding region by an attenuation-like mechanism. We previously reported that ORF mgtM enables Salmonella to promote transcription of the mgtC and mgtB coding regions when experiencing a rise in cytoplasmic ATP levels. We now show that the proline codon-rich ORF mgtP mediates an increase in transcription of the mgtC and mgtB coding regions under conditions predicted to decrease the levels of proline-charged tRNAPro. The high ATP and low proline signals act independently in an additive form. Replacing conserved mgtP proline codons with codons specifying other amino acids abolished the response to proline limitation but had no effect on the response to ATP. Substitution of conserved adenine nucleotides in mgtM abolished the response to ATP but had no effect in the response to proline limitation. This provides a singular example of a leader mRNA with tandem attenuators responding to different signals.
MILITIAS AT THE MILLENNIUM

Critically important to Neil Smelser's theory of collective behavior is the idea that people join radical social movements because they experience strain. A social movement arises to reassure participants that something is being done to redress the underlying source of strain. Militia presence and activity on the Internet (especially Usenet) is a phenomenon that can be studied within Smelser's framework. Militia watchers contend that those who join the militias have experienced the kinds of strain to which Smelser refers. The purpose of this article is to analyze the content of Internet traffic of U.S. militias in order to test the thesis outlined above. It uses militia Web sites and militia messages posted to Usenet (N = 1,196) as primary data to test Smelser's theory. Information was gathered on 171 men and women from 28 U.S. militias who posted messages to Usenet from 1998–2001. Based on the militiamen/women studied, Smelser's thesis is generally confirmed. Most experienced some form of social stress or strain prior to or during the time that they were in the militia, and most conditions for social movement development as specified by Smelser were met and confirmed by the data.
Minimum energy in abrasive processes

Abstract An investigation is described of the relationship between the grinding energy and the energy required for melting of the workpiece. For a wide range of metals, the minimum specific grinding energy is generally found to be slightly larger than the energy required to melt a unit volume of material. On the basis of a model of grinding energy partition, it is concluded that the specific shearing energy for chip formation during grinding approaches the specific melting energy, which is the maximum allowable value. It is proposed that such a large shearing energy is attained in grinding because of the severe constraint due to having large negative rake angles on the abrasive grains.
Autism and epistemology III: Child development, behavioral stability, and reliability of measurement.

Early diagnosis and treatment of autism increases the likelihood that symptoms associated with the disorder can be alleviated. However, the behaviors of both typically and atypically developing young infants and toddlers are quite variable and often change as these children age. Studies have shown that this is the case for same-aged children who are diagnosed with autistic disorder (AD) or other Pervasive Developmental Disabilities (PDDs). Therefore, an early accurate assessment of AD or PDD may be problematic. Moreover, instruments used to make the diagnosis may not be as reliable as desired. Statistics employed to evaluate diagnostic accuracy and behavioral stability of instruments' or clinicians' assessments suggest that their diagnoses have been only moderately successful. In addition, the statistics themselves have limitations that would suggest that the measures of diagnostic accuracy and behavioral stability implemented may not be as effective as they would seem. A resolution to these problems is proposed. © 2012 Wiley Periodicals, Inc.
Active living in small town America: an approach to parks and recreation planning and design

In addressing the rapid transformation of small towns in the USA, the crucial relationship between healthy living and the built environment is often understated. This paper focuses on responsive pl...
Aging by one who is aging

My purpose is to discuss issues of aging from the point of view of one who has reached that state. Most research and discussion is done by younger people, who look from the outside in, and although they understand and can analyse what is going on, they cannot understand it from experience. The process that takes place is a slow one. One hardly notice’s a change day by day. One’s mind always sees oneself as younger, full of vitality, and quite able to cope with anything. It is not the sense that the adolescent has of immortality, rather it is a sense of sureness that comes from long experience. Suddenly one notes what people call senior moments, where one forgets names and facts, only to have it return later. Then, you start losing things. They could be left anyplace in the house, in the office, or the car. You soon get comments from your spouse, wondering if you should buy radio locators that are sold by Sharper Image. You say no, but you really would like to say yes. That would be admitting a deficit! You’ve always felt that you were physically fit, indeed cardiac non-impaired. You don’t puff when you climb the steps, or when you take long walks. However, you notice that it’s hard to twist tops off the jar, and that it requires help from spouse or friends. You join an exercise class, and because you’re dyslexic you discover that when others move their right hand and left leg, you move your left hand and right leg. However, you feel comfortable with the Y. It is a neighbourhood place and friendly. You make friends there, most are almost your age, although Dan who was in his mid-80s claims seniority. Ah! Ha! Suddenly your sight dims and you …
Spatio-temporal Trend Analysis of Spring Arrival Data for Migratory Birds

There is increasing interest in spatio-temporal analysis of environmental and ecological responses to changes in the climate due to the recent concerns about climate change. In this work, we propose a spatio-temporal modeling framework for analyzing environmental and ecological data while accounting for spatial and temporal structure, as well as climate effects. As an example, we consider data on bird migration in the United States and analyze the spring arrival dates of Purple Martins between historical data (1905–1940) from the North American Bird Phenology Program and recent data (2001–2010) from the Purple Martin Conservation Association. The proposed approach allows researchers to compare mean arrival dates while accounting for spatial and temporal variability. Our results for Purple Martins showed statistically significant earlier spring arrivals in parts of United States over the recent years. The proposed approach provides a useful tool for statistical analysis of spatio-temporal data related to s...
Comparison of total protein and enzyme levels in successive regenerations of venom from individual coralsnakes

Coralsnakes produce highly potent neurotoxic venoms, but little is known about variations in specific enzyme components within a species or from one replenishment of venom to the next within the same animal. Since published studies are often conducted using venom pools from multiple snakes, individual differences are masked and variations among individual snakes and between subsequent venom regenerations from the same snake have rarely been documented. This study involves the analysis and comparison of four successive venom collections from each of nine individual coralsnakes in order to detect these differences. Significant variation was found within the successive re-synthesis of venom components. Even greater differences were observed between the venoms from similar individual snakes. Since studies of variation in enzymatic activity would be significant only if they were above these normal variations, it is important to be aware of these differences. These results suggest the importance of understanding the variations present within and between individuals of the same species when interpreting the potential significance of differences found as the result of genetic, environmental or ecological factors.
A cycle of plasma testosterone in the human male

The object of the study was to assess the lability of testosterone levels in plasma of normal human males over a long period of time and to search for periodicities in changing levels. Blood samples obtained from 20 healthy young men every second day for 2 months were assayed for total testosterone concentration by radioligand saturation analysis with late-pregnancy plasma. The flucturations of plasma testosterone levels over the total time span were substantial for most individuals; the coefficients of variation ranged from 14 to 42% (median 21%). The presence of periodic functions in these fluctuations was tested by 4 different, relatively independent methods. Close agreement among at least 3 analytic methods was found for 12 out of the 20 subjects. These 12 subjects had cycles of plasma testosterone levels with periods ranging between 8-30 days, with a cluster of periods around 20-22 days. The majority of such cycles were significant at least at the 5% level. The mean amplitudes of these cycles ranged from 9 to 28% of the subjects' mean testosterone levels (average 17%).
Combined laparoscopic-endoscopic gastrostomy.

Since the first report of successful percutaneous endoscopic gastrostomy placement by Gauderer and Ponsky in 1981 [Surg. Gynecol. Obstet. 152: 83–85], many modifications of the original technique have been published. Each reports easier and safer placement of the gastrostomy tube, but all have the same inherent flaw: Access to the gastric lumen is accomplished by a blind needle puncture of the anterior abdominal wall. A new technique, utilizing a newly available microendoscope (Origin Medsystems), is described. Using the microendoscope, direct visualization of the stomach and left upper quadrant of the abdomen allows safer access to the gastric lumen for subsequent tube placement without the need for additional incisions or punctures. The procedure can still be performed with local infiltrative anesthesia and systemic intravenous sedation.
Assessment of the economic costs of damage caused by air-pollution

Cost-benefit analysis is one of the fundamental tools for the development of economic instruments for pollution control. The costs of various abatement measures are reasonably well characterised. However, assessment of the economic costs of pollutant impacts is less well developed. This paper reports on two studies carried out for DGXII of the European Commission, the ExternE-Project and the Green Accounting Research Project. Both studies have been performed by international, multi-disciplinary research teams.
Skeletal Growth Factors Regulate the Synthesis of Insulin-like Growth Factor Binding Protein-5 in Bone Cell Cultures

Skeletal cells secrete insulin-like growth factors (IGFs) I and II and six known IGF binding proteins (IGFBPs). IGFBP-5 stimulates bone formation, and its synthesis correlates with changes in osteoblast cell growth. We tested the effects of basic fibroblast growth factor (bFGF), transforming growth factor β1 (TGF β1), and platelet-derived growth factor (PDGF) BB on IGFBP-5 expression in cultures of osteoblast-enriched cells from 22-day-old fetal rat calvariae (Ob cells). Treatment of Ob cells with bFGF, TGF β1, and PDGF BB caused a time- and dose-dependent decrease in IGFBP-5 mRNA levels and inhibited IGFBP-5 polypeptide levels in the extracellular matrix. The effects of bFGF, TGF β1, and PDGF BB on IGFBP-5 transcripts were independent of cell division and were observed in the presence and absence of hydroxyurea. bFGF, TGF β1, and PDGF BB did not modify the decay of IGFBP-5 mRNA in transcriptionally arrested Ob cells, and they inhibited IGFBP-5 heterogeneous nuclear RNA and the rate of IGFBP-5 transcription. In conclusion, bFGF, TGF β1, and PDGF BB inhibit IGFBP-5 expression in Ob cells independently of their mitogenic activity and through mechanisms that involve decreased transcription.