cssi/SciSciGPT-SciSciNet huggingface dataset:
Ground‐based frequency‐modulated continuous wave radar measurements in wet and dry snowpacks, Colorado, USA: an analysis and summary of the 2002–03 NASA CLPX data

Ground-based frequency-modulated continuous wave (FMCW) radar measurements made throughout the 2002-03 NASA Cold Lands Processes (CLPX) mission in Colorado, USA, were designed to study the major electromagnetic transitions within the alpine snowpack over a wide range of conditions, and their effect on measurements made with different active radar measurement parameters. Measurements during 2002 determined that measurements at C-, X-, and Ku-band frequencies were necessary to retrieve the most snowpack information in a wide range of conditions. Measurements at four different incidence angles indicated that the snowpack layering was still visible at 15° but that the rough surface scattering of the snow-ground interface dominated the signal above 30° incidence. Measurements during 2003 were focused on characterizing the microwave response at C-, X-, and Ku-band frequencies at four different sites with different snowpack conditions, indicating that the optimal measurement parameters vary with snowpack conditions. Measurements at different bandwidths illustrate the effect of bandwidth on vertical resolution. This ground-truth data will help interpretation of air- and space-borne active and passive microwave radar measurements that were made coincident with this study. In addition, this work may help guide future researchers when choosing FMCW radar measurement parameters, depending on the type of snowpack information their study requires.
A beam-steerer using reconfigurable PBG ground plane

Phased arrays with reduced cost and increased power handling capability are important for commercial applications. In this paper, we demonstrate beam-steering arrays using reconfigurable periodic structures in the ground plane without solid-state phase shifters. A linearly discrete beam-steering of 35/spl deg/ in steps of approximately 6/spl deg/ has been achieved at a fixed frequency of 5.6 GHz. The main beam power varied less than 2 dB over the whole range of beam-steering. A frequency-dependent beam-steering of 15/spl deg/ is also achieved from 5 GHz to 6 GHz.
IN VITRO ROOT INDUCTION IN WEEDY AMARANTHUS SPECIES TO OBTAIN MITOTIC CHROMOSOMES

Mitotic chromosome analysis has proven to be an important tool in monitoring the potential for genetic exchange among related plant species. One major obstacle to using mitotic chromosome analysis in any species is obtaining large numbers of clear, well-spread metaphase chromosomes necessary to perform cytological techniques such as chromosome banding and fluorescent in situ hybridization. The ability to obtain good chromosome spreads is in part determined by the number and morphology of the roots, which contain the metaphase tissue. Many Amaranthus species produce very thin, delicate roots. The technique used in the process described herein provides for much more substantial roots, allowing for higher probability of obtaining well-spread metaphase chromosomes. Seeds were planted in a soilless mixture, and then cuttings and leaves were taken from the plants. The cuttings were sterilized and placed in Murashige and Skoog (MS) media, while leaf tissue was analyzed by flow cytometry, both pre- and post-propagation, to obtain DNA contents. No changes in DNA content were observed. The in vitro procedure produced significantly larger roots than were produced in soilless mix. Furthermore, all of the in vitro roots observed had 32 chromosomes of normal morphology. In vitro root propagation allowed large numbers of roots to be obtained from a single plant, thereby resulting in increased probability of obtaining cells with metaphase chromosomes that reflected the original plants' chromosome numbers and therefore may be used for molecular cytogenetic analysis.
Nonsurgical scar management of the face: does early versus late intervention affect outcome?

Special emphasis is placed on the clinical management of facial scarring because of the profound physical and psychological impact of facial burns. Noninvasive methods of facial scar management include pressure therapy, silicone, massage, and facial exercises. Early implementation of these scar management techniques after a burn injury is typically accepted as standard burn rehabilitation practice, however, little data exist to support this practice. This study evaluated the timing of common noninvasive scar management interventions after facial skin grafting in children and the impact on outcome, as measured by scar assessment and need for facial reconstructive surgery. A retrospective review of 138 patients who underwent excision and grafting of the face and subsequent noninvasive scar management during a 10-year time frame was conducted. Regression analyses were used to show that earlier application of silicone was significantly related to lower Modified Vancouver Scar Scale scores, specifically in the subscales of vascularity and pigmentation. Early use of pressure therapy and implementation of facial exercises were also related to lower Modified Vancouver Scar Scale vascularity scores. No relationship was found between timing of the interventions and facial reconstructive outcome. Early use of silicone, pressure therapy, and exercise may improve scar outcome and accelerate time to scar maturity. (J Burn Care Res 2013;34:569–575)
Helminths of the Lizards, Bipes biporus (Bipedidae), Callisaurus draconoides, Uta stansburiana (Phrynosomatidae), Aspidoscelis hyperythrus, and Aspidoscelis maximus (Teiidae) from Baja California del Sur, Mexico

The gastrointestinal helminths from 5 species of lizards from Baja California del Sur were examined: Bipes biporus (Bipedidae), Callisaurus draconoides, Uta stansburiana (Phrynosomatidae), Aspidoscelis hyperythrus, and Aspidoscelis maximus (Teiidae). The helminth community of lizards from Baja California del Sur is dominated primarily by generalist helminths that also parasitize lizard species in other localities. This may reflect the geological history of Baja California, which was formerly attached to the mainland of western Mexico. We report 6 new helminth host records and 2 new locality records.
Filter Bank Multicarrier Modulation: A Waveform Candidate for 5G and Beyond

Recent discussions on viable technologies for 5G emphasize on the need for waveforms with better spectral containment per subcarrier than the celebrated orthogonal frequency division multiplexing (OFDM). Filter bank multicarrier (FBMC) is an alternative technology that can serve this need. Subcarrier waveforms are built based on a prototype filter that is designed with this emphasis in mind. This paper presents a broad review of the research work done in the wireless laboratory of the University of Utah in the past 15 years. It also relates this research to the works done by other researchers. The theoretical basis based on which FBMC waveforms are constructed is discussed. Also, various methods of designing effective prototype filters are presented. For completeness, polyphase structures that are used for computationally efficient implementation of FBMC systems are introduced and their complexity is contrasted with that of OFDM. The problems of channel equalization as well as synchronization and tracking methods in FBMC systems are given a special consideration and a few outstanding research problems are identified. Moreover, this paper brings up a number of appealing features of FBMC waveforms that make them an ideal choice in the emerging areas of multiuser and massive MIMO networks.
The Design and Test of a New Volume Coil for High Field Imaging

A major problem in the development of high field (> 100 MHz) large volume (> 6000 cm3) MR coils is the interaction of the coil with the subject as well as the radiation loss to the environment. To reduce subject perturbation of the coil resonance modes, a volume coil that uses an array of freely rotating resonant elements radially mounted between two concentric cylinders was designed for operation at 170 MHz. Substantial electromagnetic energy is stored in the resonant elements outside the sample region without compromising the efficiency of the overall coil. This stored energy reduces the effect of the subject on the circuit and maintains a high Q, facilitating the tuning and matching of the coil. The unloaded Q of the coil is 680; when loaded with a head, it was 129. The ratio of 5.3 of the unloaded to loaded Q supports the notion that the efficiency of the coil was maintained in comparison with previous designs. The power requirement and signal-to-noise performance are significantly improved. The coil is tuned by a mechanism that imparts the same degree of rotation on all of the elements simultaneously, varying their degree of mutual coupling and preserving the overall coil symmetry. A thin radiofrequency shield is an integral part of the coil to reduce the radiation effect, which is a significant loss mechanism at high fields. MR images were collected at 4T using this coil design with high sensitivity and B1 homogeneity.
Utilizing deep neural nets for an embedded ECG-based biometric authentication system

This work presents a low-power, embedded ECG pattern recognition system for the purpose of biometric authentication. We believe that ECG coupled with a secondary biometric marker such as fingerprint will play a key role in wearable security as wearables' popularity continues to grow. The key objective of this work is to implement a system that is reliable, robust, and fast while maintaining a low area and power footprint. A streamlined approach was devised that utilized neural networks to both identify QRS complex segments of the ECG signal and then perform user authentication on these segments. When tested on 90 individuals, the system is able to achieve 99.54% accuracy for QRS complex identification, and, on average, 99.85% sensitivity, 99.96% specificity, and 0.0582% EER for user identification. When implemented on an Artix-7 FPGA, the entire design occupies 1,712 slices (5%) and 978.7 KB of memory and dissipates 31.75 mW of total chip dynamic power when running at 12.5 MHz.
UTP activates small-conductance Ca2+-activated K+ channels in murine detrusor PDGFRα+ cells

Purines induce transient contraction and prolonged relaxation of detrusor muscles. Transient contraction is likely due to activation of inward currents in smooth muscle cells, and prolonged relaxat...
Open Theism and Other Models of Divine Providence

In this paper I define ‘open theism’ as a version of ‘broadly classical theism’ distinguished by commitment to a causally, epistemically, and providentially open future. After clarifying open theism, I then compare and contrast the open theistic model of divine providence with its chief competitors: theological determinism, Molinism, and process theism.
Comparative Studies of Socialization: A Review Essay

THEORY 313 METHODOLOGY 314 STUDIES IN SOCIAL STRUCTuRE Demography and Ecology 315 Community Studies 318 Stratification and Social Mobility .. 319 Institutional Structure Family 321 Education 322 Religion 323 Economy, Occupations ........ ....... 325 Polity 327 Medical and Welfare ......... ........ 329 Ethnic Minority Institutions 332 STUDIES IN SOCIAL PSYCHOLOGY Socialization ....... 332 Attitudes and Opinions ..... 333 STUDIES IN SOCIAL PROBLEMS, SOCIAL AND CULTURAL CHANGE Social Conflict ....... 334 Deviant Behavior ...... 338 Crime and Delinquency 339 Social Movements and Collective Behavior. 340 Cultural Change 341 APPLICATIONS OF SOCIOLOGY ...... ........ 343 THE DISCIPLINE Other Places 344 Texts and Readers 346
Effect on institutional revenue of clinical pharmacy services in an ambulatory care clinic

There is currently a need to focus on how pharmacists can be incorporated into a sustainable practice while generating revenue for an institution. An institutional perspective on cost has not yet been evaluated for ambulatory clinical pharmacy services. A long-standing ambulatory care clinic at the
Resistivity as a Tool for Characterizing Point Defects in Nonstoichiometric Metallic Ceramics

Compounds of IVb and Vb transition metals and carbon are electronically conductive, hard materials that crystallize in the NaCl structure but are very nonstoichiometric (carbon-poor), as in TiCx, where x is the carbon/metal ratio and is less than unity. Carbon atom vacancies are randomly located in the fcc carbon sublattice and act as scattering centers for conduction electrons. Data on the electrical resistivity as a function of the concentration of these point defects could be used in the opposite sense~i.e., to determine the defect concentration, (1-x), through a measurement of resistivity. The chemical composition (carbon/metal ratio) is then given directly by x. The random vacancies can be ordered by slow cooling from high temperatures, thereby eliminating the residual resistivity. The carbon/metal ratios of these ordered phases are either 3:4, 5:6 or 7:8 and thus can specify the chemical composition precisely.
Virulence of Streptococcus mutans: biochemical and pathogenic characteristics of mutant isolates.

SummaryThe in vitro dextran-sucrase activities and adherence to glass of S. mutans 6715 and PS14 wild types and mutants were quantitated and compared with their in vivo cariogenicity in young, gnotobiotic rats. In general, S. mutans PS14 mutants B414 and B421 and 6715 mutant C4 demonstrated less dextran-sucrase activity and adherence than parental strains and caused fewer carious lesions in gnotobiotic rats. Rats monoinfected with either PS14 mutants B414 or B421 had less plaque and viable S. mutans in plaque than rats infected with parental strain. Both S. mutans 6715 mutants C211 and C229, demonstrated greater enzyme activity and adherence than the parental strain and produced more carious lesions.
A One-Step Strategy for End-Functionalized Donor–Acceptor Conjugated Polymers

A modular and robust method for preparing end-functionalized donor–acceptor (D–A) narrow bandgap conjugated polymers is reported that avoids multistep reactions and postpolymerization modification. The strategy is well-controlled and affords functional materials with predictable molecular weight and high end-group fidelity. To exemplify this synthetic strategy, narrow bandgap conjugated polymers based on PDPP2FT were prepared that contain perylene diimide (PDI) units at the chain-ends. Monte Carlo simulations confirm the high degree of chain-end functionalization while photoluminescence studies reveal the unique photophysical properties of the end-functional polymers with efficient charge transfer occurring between the main polymer chain and PDI end-groups that results exclusively from their covalent linkage.
Investigation of the prevalence of enterovirus carriers among healthy children and their guardians during HFMD outbreaks

Objective To ascertain the prevalence of enterovirus carriers among healthy children under five years of age and their guardians in order to analyze the prevalence of virus carriers among healthy people and their role in the transmission of HFMD.Methods Fecal specimens were collected from children and their guardians by random sampling of urban nurseries and kindergartens and rural villages in Sishui County and Jiaxiang County in the early stages of an HFMD outbreak(March-April),at the peak of the outbreak(June-July),and in the later stages of the outbreak(October-November) in 2010.Enterovirus nucleic acids were detected by real-time PCR.Results The prevalence of enterovirus carriers among healthy people was 20.10% at the peak of the HFMD outbreak,14.56% in the early stages of the outbreak,and 8.29% in the later stages of the outbreak.The prevalence of enterovirus carriers was higher among children under five years of age than among adults.The highest prevalence of enterovirus carriers was among children under three years of age.According to real-time PCR,177 fecal specimens tested positive for human enteroviruses,and 99.44%(176/177) were identified as other enterovirus infections.None of the specimens tested positive for EV71,though one sample tested positive for CoxA16.Conclusion There was a considerable prevalence of enterovirus carriers among healthy children under five years of age and their guardians,and this was especially true in summer.There were rather low rates of positivity for EV71 and CoxA16.This means that healthy people who test positive for enterovirus nucleic acids may have nothing to do with the spread of HFMD.
Diagnostic Quality of Magnetic Resonance Imaging Interpretation for Peripheral Nerve Sheath Tumors: Can Malignancy Be Determined?

Background Optimal management of peripheral nerve sheath tumors including neurofibromas, schwannomas, and malignant peripheral sheath tumors (MPNSTs) is predicated on knowing the specific pathology. Magnetic resonance imagining (MRI) has the potential to provide insight in the tumor type, yet imprecision in diagnosis remains. We assessed the accuracy of preoperative imaging diagnoses by comparing them with postoperative histopathologic diagnoses. We specifically focus on erroneous diagnosis of MPNSTs. Methods We reviewed all pathologically confirmed cases of nerve sheath tumors treated at our institution retrospectively from 2007 to 2015. Pre- and postoperative imaging data were reviewed for imaging-based diagnosis and compared with postresection pathologic diagnosis. Results The study included 127 patients: 82 diagnosed with neurofibroma, 17 with schwannoma, 24 with MPNST, and 4 with other histology types. A mean age of 40.8 ± 20.4 years, mean tumor size of 4.3 ± 3.6 cm, and mean follow-up of 29.1 ± 21.6 months were recorded. A family history of neurofibromatosis type 1 (NF1) was seen in 58 patients (46%). A discordant diagnosis from preoperative imaging and postoperative pathology was found in 65 individuals (51%). Most discordant diagnoses (n = 34) were inconclusive interpretation of preoperative imaging; however, 10 patients were diagnosed with a benign or unknown lesion on preoperative imaging but had an MPNST on histopathology. Patients with MPNST were more likely than those with benign pathologies to have larger lesions (7.6 ± 4.8 cm versus 3.5 ± 3.3 cm; p = 0.004); however, a statistically acceptable threshold value could not be found to separate benign from malignant lesions. Clinical factors, such as NF1 status, did not meaningfully improve preoperative diagnosis. Conclusions These results suggest that routine MRI is insufficient to guide surgical decision making reliably. Additional imaging techniques may be necessary to delineate the radiologic features of nerve sheath tumors to determine pathology more precisely.
The importance of safe space and student voice in schools that serve minoritized learners

This article is based on an ethnography conducted over a six year period that used participant observation, photography, focus groups, and interviews to discover and describe the emergent school culture and the lived experiences of female secondary students in an all-girls college preparatory school. This article shares the story of a group of women educators who created a novel school culture, and the female students who meet them there, to disrupt and transform the dailiness of sexism, racism, and classism. Through a commitment to building a supportive school culture that includes developing robust relationships and forefronting the voices of women, this community of learners is working in a very socially just way so as to confront the past and interrupt the present, and revolutionize future trajectories of historically minoritized peoples.
New advances in compiling CNF to Decomposable Negation Normal form

We describe a new algorithm for compiling conjunctive normal form (CNF) into Deterministic Decomposable Negation Normal (d-DNNF), which is a tractable logical form that permits model counting in polynomial time. The new implementation is based on latest techniques from both the SAT and OBDD literatures, and appears to be orders of magnitude more efficient than previous algorithms for this purpose. We compare our compiler experimentally to state of the art model counters, OBDD compilers, and previous CNF2dDNNF compilers.
Coherent Optical Spectroscopy and Control of Excitonic States in Single Quantum Dots

The optical properties of semiconductor quantum dots (QD's) have been studied intensively in the past a few years. One of the most recent areas of progress is seen in the success of removing the inhomogeneous broadening and isolating the responses from single QD's using high spatial resolution techniques(l,2).
Application of biomechanics to the fencing lunge

For at least 100 years, the manner of execution of the fencing lunge has remained essentially unchanged. Other than empirical refinements made to suit individual styles, very little research has been done on fencing techniques in general or on the lunge in particular. Yet, the lunge is one of the most important movements in fencing and is given great emphasis by fencing teachers.
FORCES: feedback and control for occupants to refine comfort and energy savings

Humans spend 90% of their lives inside buildings, but often the Heating, Ventilation, and Air Conditioning (HVAC) systems of commercial buildings do not properly maintain occupant comfort. Use of feedback through comfort voting applications has been shown to improve the quality of service, but the effects of application feedback and user interface design has not been investigated. In this work, we present several methods of feedback that use data presentation and environmental interaction in comfort voting applications. Through a 40 week user study of 61 University employees across 3 buildings, we show that feedback systems can be used to increase user satisfaction with thermal conditions from 33.9% to 93.3% and reduce energy consumption up to 18.99% compared to a system without voting. In addition, we find that by including a drifting control strategy, we find energy savings up to 37% can be realized without a significant reduction in satisfaction.
Bully Prevention: Creating Safe and Inclusive Environments for Youth

Bullying is a major issue facing youth of all ages, backgrounds, and walks of life. In fact, 30% of youth report experiencing bullying on a monthly basis (Nansel, Overpeck, Pilla, Ruan, Simons-Murton & Scheidt, 2001). As a consequence, these youth are at much greater risk for a host of mental and physical problems (Ttofi & Farrington, 2008). Parents, teachers, educators and youth advocates all agree that this issue merits time and attention, yet many professionals are at a loss for understanding the issue or what resources might be most effective with their young audience. With the increased rates of bullying behaviors and growing research about effective prevention and intervention strategies, youth development professionals need guidance for creating and sustaining bully prevention efforts. The purpose of this article is to highlight the growing research on bully prevention and provide information for practitioners working to create safe and inclusive environments for youth.
Continuous Infusion Cyclophosphamide as Salvage Therapy for Relapsed or Refractory Multiple Myeloma.

Abstract 4942 Background Patients with relapsed or refractory multiple myeloma (MM) are resistant to most therapies. In this study, we assess the efficacy and tolerability of continuous infusion (CI) cyclophosphamide in a group of heavily pre-treated patients with relapsed/refractory MM. Methods Charts of all patients treated with CI cyclophosphamide for relapsed/refractory MM between 01/2003 and 12/2008, at the Hospital of University of Pennsylvania, were identified and reviewed. Patients who had received at least one cycle of CI cyclophosphamide were included for the analysis. The dose of cyclophosphamide ranged between 200-300 mg/m2/day CI for 4 days. Duration of each cycle was planned at 28 days. Response was assessed using the international uniform response criteria for MM. Toxicity was assessed using the National Cancer Institute Common Toxicity Criteria, version 4. Results We treated 24 patients with CI cyclophosphamide. The median age was 60.5 years (range 33-75 years) and 66% were male. Patients had received a median of 5 prior regimens (range 2.0 to 11.0) and the median duration of time from diagnosis to treatment with CI cyclophosphamide was 5 yrs (range 0.38-22 yrs). Cyclophosphamide was started in 19 patients for management of progressive disease, and in 5 patients for lack of response or adverse effects from prior therapies. Prior therapies included: bortezomib (in all patients), lenalidomide (in 96% of patients) and autologous stem cell transplant (ASCT - once in 46%, and twice in 29%) among others. The median number of cyclophosphamide cycles administered until the time of last follow up was 4.0 (range 1.0-43.0). Treatment was ongoing in 4 patients at the time of last follow up, and two patients with stable disease were being observed without therapy. Median overall survival for all patients was 22.3 months (95% CI 10.04-34.53) and median progression free survival (PFS) was 7.4 months (95%CI 4.12-10.69). Partial response was noted in 4 patients, who had a median duration of response of 4.2 months and median time to best response of 0.8 month. Disease was stabilized in 14 additional patients. Disease progressed despite therapy in 6 patients, and in 4 of those progressive disease was evident from cycle one. Cytopenias were noted in 8 patients, with 4 related to the treatment with cyclophosphamide, but in only one case did this lead to discontinuation of therapy. Conclusion In our experience with 24 patients, monthly cycles of continuous infusion cyclophosphamide was a safe and effective method of treating relapsed or refractory multiple myeloma resulting in a prolonged progression free survival in very heavily pretreated patients. Disclosures No relevant conflicts of interest to declare.
The economics of commodity market manipulation: A survey

Manipulation has been a vexing subject in commodity futures markets from the mid-19th century. The economics literature has identified several kinds of manipulation, including market power manipulation, trade-based manipulation, and manipulation by fraud. Furthermore, this literature has identified how these various forms of manipulation can occur, their effects on prices and quantities, and in some cases, their welfare effects. In contrast to the economics literature, manipulation jurisprudence and regulation has often been confused and ineffective, in large part because it has not adequately incorporated the lessons of economics.
Reliability and Maintenance

Reliability is the characteristic that decides how effectively a system operates over a certain period of time. More specifically, reliability refers to the likelihood that a system will perform up to its specifications for an expected period of time. In many applications, it is critical to measure and predict the reliability of a product, process, or system. Reliability tactics are used to improve the system’s performance. Maintenance is the process that keeps a system operational and reduces the variability and failure in its operational availability, performance, and quality. Maintenance can also be used to increase the reliability of a system. There are two types of maintenance: preventive and breakdown. Preventive maintenance is a process that ensures a system stays operational, while breakdown maintenance is performed after the system has failed and needs to be repaired or replaced. Maintenance tactics include implementing preventive maintenance and decreasing repair requirements.
Could knee inflammatory synovitis be induced by pembrolizumab

Pembrolizumab, a selective anti-PD-1 humanized monoclonal antibody, reactivates T cells to fight cancer. Immune-related adverse events such as autoimmune colitis, pneumonitis, hepatitis, nephritis, hypophysitis, and thyroiditis may occur during, or weeks to months after therapy. Pemprolizumab-induced synovitis is rarely reported. With the wide use of immunotherapy to treat cancers, physicians need to be aware of this rare immune-related adverse event and provide immediate treatment to avoid permanent joint damage.
High-Speed Wideband Voltage-Controlled Oscillator via an Injection-Locked Laser

We demonstrate a microwave voltage-controlled oscillator able to synthesize a wide range of frequencies in the GHz regime based on an optically injected semiconductor laser. The ability to understand and experimentally characterize the entire injection-locking domain is crucial for the realization and optimization of such a device. This characterization facilitates the identification of steady-state bias conditions, which lead to microwave oscillations. More importantly, it also identifies a regime in which the oscillation frequency can be tuned solely by adjusting the optically injected power, a parameter, which can easily be changed on a nanosecond time scale. In this letter tuning from 6–16 GHz is demonstrated, while tuning rates of ~ $1\times 10^{18}$ Hz/sec are achieved using a < 1 V drive signal, resulting in a voltage-controlled oscillator with rapid tuning speed when compared with conventional, e.g., YIG-based, oscillators.
A backstepping controller for voltage source inverter with inductor current and output current observers

The nonlinearities of the load current in power systems are increasing with the growing number of electronic devices with rectifiers at the front end of their power supply. Therefore designing an inverter that can overcome these nonlinearities in the output current and generate an AC output voltage within the desired Total Harmonic Distortion (THD) level is critical to meeting the power quality requirements defined by international standards. In this paper, a backstepping controller combined with two novel current observers is proposed for the control of a single-phase H-Bridge inverter. A Lyapunov stability analysis is utilized to demonstrate system stability. Simulation results validate the performance of the control scheme in the presence of both linear and nonlinear loads in terms of meeting the tracking objective as well as the THD requirements of IEEE 519 and EN 50160.
Thirty-Day Readmissions for Critical Limb Ischemia: Ready for a New Quality Metric?

Article, see p 167 Since Charles Dotter performed the first balloon angioplasty for critical limb ischemia (CLI),1 there have been myriad advances in the treatment of patients with peripheral arterial disease. Primary and secondary prevention measures, supervised exercise programs, and revascularization strategies, including surgical, endovascular, and hybrid approaches, have dramatically evolved, leading to improved patient outcomes. CLI represents the most complex and advanced stage of peripheral arterial disease and is associated with considerable morbidity and mortality and significant consumption of healthcare resources, particularly during admissions and subsequent readmissions.2 The initiation of the Hospital Readmission Reduction Program in 2012, as a part of the Affordable Care Act, heralded an era of cost consciousness and quality metrics, with a particular emphasis on hospital readmissions as a quality and performance metric for hospitals.3 Although the 30-day readmission metric may not necessarily reflect the actual quality of care delivered during the index admission, financial penalties against hospitals with excessive readmissions within 30 days of discharge for Medicare beneficiaries have led to intense scrutiny of in-hospital patient care, postdischarge planning, and drivers of readmissions. Initially, conditions known to have a high risk of readmissions such as congestive heart failure, myocardial infarction, and pneumonia were targeted. Given its high readmission prevalence, CLI may soon become a target of the Hospital Readmissions Reduction Program. Further data on the incidence, predictors, and reasons for 30-day readmission after hospitalization for CLI can assist policy makers in designing quality metrics and reimbursement policies as payment reforms are being implemented. In this issue of the Circulation , Kolte et al4 attempt to address these issues by conducting a thorough examination of unplanned readmissions in 60 998 index hospitalizations with a primary diagnosis of CLI during which patients underwent endovascular or surgical therapy (revascularization and/or amputation) in the 2013 …
Thromboprophylaxis in Spinal Surgery.

Study Design.Systematic review and meta-analysis.Objective.Determine the incidence of deep vein thrombosis (DVT) and pulmonary embolism (PE) in spinal surgery patients receiving no thromboprophylaxis, mechanoprophylaxis, and chemoprophylaxis.Summary of Background Data.The incidence of thromboembolic
Iron speciation in peats: chemical and spectroscopic evidence for the co-occurrence of ferric and ferrous iron in organic complexes and mineral precipitates

Abstract The speciation of iron (Fe) in organic matter (OM)-rich environments under in situ variable redox conditions is largely unresolved. Peatlands provide a natural setting to study Fe–OM interactions. Utilizing chemical, spectroscopic and theoretical modeling approaches, we report the chemical forms, oxidation states and local coordination environment of naturally occurring Fe in the vertically redox-stratified Manning peatlands of western New York. In addition, we report dominant carbon, sulfur and nitrogen species that can potentially stabilize the various Fe species present in these peatlands. Our results provide clear direct and indirect evidence for the co-occurrence of ferrous (Fe2+) and ferric (Fe3+) iron species in peats under both oxic and anoxic conditions. Iron is mostly present within the operationally defined organic and amorphous (i.e., short range ordered, SRO) fractions; ferric iron primarily as magnetically isolated paramagnetic Fe3+ in Fe(III)-organic complexes, but also in mineral forms such as ferrihydrite; ferrous iron in tetrahedral coordination in Fe(II)-organic complexes with minor contribution from pyrite. All of the Fe species identified stabilize Fe(III) and/or Fe(II) in anoxic and oxic peats. Fundamental differences are also observed in the relative proportion of C, S and N functionalities of OM in oxic and anoxic peats. Aromatic C C, ester, phenol and anomeric C (R O C O R), as well as thiol, sulfide and heterocyclic N functionalities are more prevalent in anoxic peats. Collectively, our experimental evidence suggests iron forms coordination complexes with O-, S- and N-containing functional groups of OM. We posit the co-occurrence of organic and mineral forms of Fe(II) and Fe(III) in both oxic and anoxic peat layers results from dynamic complexation and hydrolysis-precipitation reactions that occur under variable redox conditions. Our findings aid in understanding the crucial role OM plays in determining Fe species in soils and sediments.
The profound impact of combined severe acidosis and malperfusion on operative mortality in the surgical treatment of type A aortic dissection.

Abstract Objectives Surgery for type A aortic dissection is associated with a high operative mortality, and a variety of predictive risk factors have been reported. We hypothesized that a combination of risk factors associated with organ malperfusion and severe acidosis that are not currently documented in databases would be associated with a level of extreme operative risk that would warrant the consideration of treatment paradigms other than immediate ascending aortic surgery. Methods Charts of patients undergoing repair of acute type A aortic dissection between January 1, 1996, and May 1, 2016, were queried for preoperative malperfusion, preoperative base deficit, pH, bicarbonate, cardiopulmonary resuscitation, severe aortic insufficiency, redo status, and preoperative intubation. Multivariable logistic analyses were considered to evaluate interested variables and operative mortality. Results Between January 1, 1996, and May 1, 2016, 282 patients underwent surgical repair of type A aortic dissection. A total of 66 patients had a calculated base deficit −5 or greater. Eleven of 12 patients (92%) with severe acidosis (base deficit ≥−10) with malperfusion had operative mortality. No patient with severe acidosis with abdominal malperfusion survived. Multivariable analyses identified base deficit, intubation, congestive heart failure, dyslipidemia/statin use, and renal failure as predictors of operative death. The most significant predictor was base deficit −10 or greater (odds ratio, 9.602; 95% confidence interval, 2.649-34.799). Conclusions The combination of severe acidosis (base deficit ≥−10) with abdominal malperfusion was uniformly fatal. Further research is needed to determine whether the identification of extreme risk warrants consideration of alternate treatment options to address the cause of severe acidosis before ascending aortic procedures.
Robotic, Laparoscopic, or Open Hysterectomy: Surgical Outcomes by Approach in Endometrial Cancer.

Abstract Study Objectives To compare patient outcomes by surgical approach in the management of endometrial cancer (EC) in Washington State from 2008 to 2013. Design Population-based retrospective cohort study (Canadian Task Force classification II-2). Setting Washington State. Patients EC patients treated with robotic-assisted surgery (RAS), laparoscopy (LS), or laparotomy (XLAP). Interventions Comprehensive Hospital Abstract Reporting System to identify patients and assess the association of surgical approach with length of stay, readmissions, and perioperative complications. Measurements and Results We identified 3712 cases of EC managed with either RAS, LS, or XLAP. Mean length of stay was not clinically different for RAS (1.5 days) and LS (1.6 days) but was 2.31 days longer for XLAP compared with LS (p Conclusions RAS is as an alternative to LS in the treatment of EC and is preferable to XLAP. The use of RAS resulted in fewer early readmissions compared with LS and resulted in an increased proportion of cases via minimally invasive surgery.
Does initial dosing of levothyroxine in infants with congenital hypothyroidism lead to frequent dose adjustments secondary to iatrogenic hyperthyroidism on follow-up?

Background Congenital hypothyroidism (CH) is the most common preventable cause of intellectual disability. The recommended starting dose of levothyroxine (LT4) is between 10 and 15 μg/kg, an extremely wide range. We hypothesized that a sizable proportion of newborns treated for CH at the higher end of the dosage range become biochemically hyperthyroid at a follow-up visit. Methods This study is a retrospective chart review of infants with CH between 2002 and 2012. Results Of the 104 patients included in this analysis, the average age at diagnosis was 11 days and the average starting dose of LT4 was 12±2.5 μg/kg. At follow-up, 36.5% required a dose reduction because of iatrogenic hyperthyroxinemia, 51% required no dose adjustment and 12.5% required a dose increase due to an elevated thyroid stimulating hormone (TSH). The starting doses of LT4 for those requiring a dose reduction, those not requiring an adjustment and those requiring an increase in the dose were 13.2±2.4, 11.5±2.1 and 10.3±2.6 μg/kg/day, respectively (p≤0.0001). Of the 34% of infants treated with an initial dose of >12.5 μg/day, 57.1% required a dose reduction at follow-up, compared to 26.1% of those whose initial starting dose was ≤12.5 μg/kg/day (p=0.007). Conclusions Following the guidelines for initiating therapy for CH, 36.5% of the infants required a dose reduction for iatrogenic hyperthyroxinemia. These infants received a higher dose of LT4 than the infants who either required no adjustment or required an increase in the dose. A narrower range for initial dosing in CH may be appropriate.
Multivariate Analysis of Water Quality and Benthic Macrophyte Communities in Florida Bay, USA Reveals Hurricane Effects and Susceptibility to Seagrass Die-Off.

Seagrass communities, dominated by Thalassia testudinum, form the principal benthic ecosystem within Florida Bay, Florida USA. The bay has had several large-scale seagrass die-offs in recent decades associated with drought and hypersaline conditions. In addition, three category-5 hurricanes passed in close proximity to the bay during the fall of 2005. This study investigated temporal and spatial trends in macrophyte abundance and water quality from 2006 to 2013 at 15 permanent transect sites, which were co-located with long-term water quality stations. Relationships, by year and by transect location (basin), between antecedent water quality (mean, minimum and maximum for a 6-month period) and benthic macrophyte communities were examined using multivariate analyses. Total phosphorus, salinity, pH, turbidity, dissolved inorganic nitrogen (DIN), DIN to phosphate ratio (DIN:PO4-3), chlorophyll a, and dissolved oxygen correlated with temporal and spatial variations in the macrophyte communities. Temporal analysis (MDS and LINKTREE) indicated that the fall 2005 hurricanes affected both water quality and macrophyte communities for approximately a 2-year period. Spatial analysis revealed that five basins, which subsequently exhibited a major seagrass die-off during summer 2015, significantly differed from the other ten basins in macrophyte community structure and water quality more than 2 years before this die-off event. High total phosphorus, high pH, low DIN, and low DIN:PO4-3, in combination with deep sediments and high seagrass cover were characteristic of sites that subsequently exhibited severe die-off. Our results indicate basins with more mixed seagrass communities and higher macroalgae abundance are less susceptible to die-off, which is consistent with the management goals of promoting more heterogeneous benthic macrophyte communities.
Rethinking Digital Repositories and the Future of Open Access

Over the last two years, changes in the legal publishing arena involving digital repository platforms have raised concerns about the future of open access. In the summer of 2016, Elsevier, a leading commercial publishing company, acquired SSRN (the Social Science Research Network), including its Legal Scholarship Network. Elsevier’s move concerned many legal scholars and law librarians, who feared that the open access policies of the SSRN platform would disappear. Slightly more than a year later, concerns intensified when Elsevier purchased bepress, developer of the Digital Commons platform used by many academic law libraries for their digital repositories, as well as for hosting their law reviews and journals. While there has been no indication that the open access initiatives of these platforms will be altered, the possibility that a future need for profits could jeopardize free and open access remains a real fear in the legal scholarly community.
The cognitive complexity of a provider order entry interface.

Computer-based provider order entry (POE) can reduce the frequency of preventable medical errors. However, overly complex interfaces frequently pose a challenge to users and impede clinical efficacy. We present a cognitive analysis of clinician interaction with a commercial POE system. Our investigation was informed by the distributed resources model, a novel approach designed to describe the dimensions of user interfaces that introduce unnecessary cognitive complexity. This approach characterizes the relative distribution of user’s internal representations and external representations embodied in the system or environmental artifacts. The research consisted of two component analyses: a modified cognitive walkthrough evaluation and a simulated clinical ordering task performed by seven physicians. The analysis revealed that the configuration of resources placed unnecessarily heavy cognitive demands on the user, especially those who lacked a robust conceptual model of the system. The resources model was also used to account for patterns of errors produced by clinicians.
Regulation of Death Receptors by Synthetic Retinoids

The term retinoids refers to an entire group of natural and synthetic retinol (vitamin A) metabolites and analogs. They exert profound effects on growth, differentiation, and apoptosis of many cell types (1). Thus, they play important roles in regulating, among other things, embryonic development, hematopoiesis, bone formation, glucose and lipid metabolism, and carcinogenesis (1). Currently, retinoids are used clinically in the treatment of skin disorders such as acne and psoriasis, and in the prevention or treatment of certain types of cancer, such as the treatment of acute promyelocytic leukemia (APL) and cutaneous T-cell lymphoma, reversal of premalignant lesions, and inhibition of the development of second primary tumors (2,3).
Alternative solvents for cellulose derivatives

Abstract Identification of alternative solvents for processing of cellulosic polymers is of interest in a number of industrial applications, ranging from fibers to films. In this study, miscibility of cellulose acetate, cellulose triacetate, cellulose acetate butyrate, cellulose propionate and ethyl cellulose in `carbon dioxide+acetone' and `carbon dioxide+ethanol' binary fluid mixtures have been investigated. Data are reported at 3% by mass polymer concentration in two binary solvent fluid mixtures containing 30% and 70% by mass carbon dioxide. Demixing pressures are reported in the temperature range from 60 to 175°C. Complete miscibility of the polymers was achieved at all pressures in carbon dioxide+ethanol mixtures containing 30% carbon dioxide, while in mixture containing 70% carbon dioxide, miscibility required pressures greater than 20 MPa. Higher pressures were required for miscibility in carbon dioxide+acetone mixtures with pressures being greater than 5 MPa and greater than 35 MPa for mixtures containing 30 and 70% carbon dioxide, respectively. The solutions all displayed LCST (lower critical solution temperature) behavior, with demixing pressures increasing with temperature. The relative ease of miscibility of the polymers followed essentially the same order in either the ethanol or acetone fluid mixtures, with demixing pressures increasing as ethyl cellulose
Teaching NeuroImages: Scleral thickening and optic disc edema from glycosaminoglycan deposition in Hunter syndrome

A 43-year-old man with a history of Hunter syndrome presented to the neuro-ophthalmology clinic with decreased peripheral vision. Computerized visual field testing revealed bilateral ring scotomas. The right optic disc was flat and there was left optic disc edema. Optical coherence tomography revealed disc edema of the left nerve, inner microcystic changes in the nasal fovea of the left eye, and parafoveal atrophy of the outer retinal layers in both eyes. MRI demonstrated posterior ocular globe thickening likely secondary to glycosaminoglycan deposition in the sclera (figure), known to occur in Hunter syndrome.1 The mechanism of the optic disc edema in our patient could have been from compression of the optic nerve at the scleral opening.
Race, Social Contract Theory, and Social Darwinism

This chapter builds upon critical theory from Chap. 1 to investigate racial theory in the historical context, which is connected with colonialism and economic plundering by Spanish powers in Latin America. Social contract thinkers such as John Locke and Rousseau will be explicated in dealing with their theory of freedom, democracy, and slavery. Then I focus on social Darwinism as a cardinal principle underlying colonialism and racial development. I include a theological, ethical reflection of social contract morality, racism, and justice to develop postcolonial political theology.