cssi/SciSciGPT-SciSciNet huggingface dataset:
Clinical Problem-Solving in Tracheoesophageal Puncture Voice Restoration

The medical management of advanced laryngeal cancer is shifting toward radiation with/without chemotherapy as a frontline treatment, resulting in an overall decreased incidence of total laryngectomy. When total laryngectomy is performed, these surgical procedures are often performed in larger teaching hospitals. Speech-Language Pathologists employed in smaller community hospitals typically have less experience in working with laryngectomized patients. In such circumstances, the management of those who undergo tracheoesophageal (TE) puncture voice restoration may confront problems that can be quite challenging. In order to comprehensively evaluate and treat those who have received TE voice restoration, the speech clinician must be knowledgeable about the types and applications of various voice prostheses available, as well as that pertaining to troubleshooting problems associated with prosthetic leakage and aphonia. This chapter discusses a range of problems associated with a TE puncture voice restoration and provides a systematic approach to assessment and potential solutions to manage these problems.
Does Helping-at-the-Nest Help? The Case of the Acorn Woodpecker

Cooperative breeding groups often involve “helpers-at-the-nest”; indeed, such behavior typically defines this intriguing breeding system. In few cases, however, has it been demonstrated that feeding nestlings by helpers, rather than some other behavior associated with helpers’ presence, leads to greater reproductive success. One prediction of the hypothesis that feeding behavior per se is responsible for the fitness benefits conferred by helpers is that there should be close congruence between the patterns of helping-at-the-nest and the fitness effects of helpers. Here we look for such a relationship in the cooperatively breeding acorn woodpecker (Melanerpes formicivorus) in order to begin to identify the behaviors of helpers that drive the increased fitness benefits they confer. In terms of young fledged, a helper male confers approximately the same fitness benefits to a group as does a helper female; more dramatically, the effects of helper males increases with increasing food supply, most importantly the prior year’s acorn crop on which this species depends, whereas that of helper females does not. These patterns do not match the nest-feeding patterns of helpers, which are greater for females than males and do not increase with a larger acorn crop the prior autumn. In contrast, the proportion of time helpers spend tending acorn-storage facilities (granaries) and are present in or near their home territory is greater for males than females and, at least for males, positively related to the size of the acorn crop. These results fail to support the hypothesis that the primary benefit conferred by helpers is feeding young in the nest; rather, they suggest that behaviors such as territorial defense and predator detection are more important. Understanding exactly what those behaviors are in this, and most other cooperatively breeding systems, remain to be determined.
Comment on Significance Testing.

This article comments on, and extends, Vacha-Haase and Nilsson's (1998) discussion of significance testing. The author recommends policies for reporting significance tests.
Charm Physics at Fermilab E791

Experiment 791 at Fermilab's Tagged Photon Laboratory has just accumulated a high statistics charm sample by recording 20 billion events on 24000 8mm tapes. A 500 GeV/c pi- beam was used with a fixed target and a magnetic spectrometer which now includes 23 silicon fixed target and a magnetic spectrometer which now includes 23 silicon microstrip planes for vertex reconstruction. A new data acquisition system read out 9000 events/sec during the part of the Tevatron cycle that delivered beam. Digitization and readout took 50 uS per event. Data was buffered in eight large FIFO memories to allow continuous event building and continuous tape writing to a wall of 42 Exabytes at 9.6 MB/sec. The 50 terabytes of data buffered to tape is now being filtered on RISC CPUs. Preliminary results show D0 --> K- pi+ and D+ --> K- pi+ pi+ decays. Rarer decays will be pursued.
A Quality Improvement Intervention Bundle to Reduce 30-Day Pediatric Readmissions.

Introduction Pediatric hospital readmissions can represent gaps in care quality between discharge and follow-up, including social factors not typically addressed by hospitals. This study aimed to reduce the 30-day pediatric readmission rate on 2 general pediatric services through an intervention to enhance care spanning the hospital stay, discharge, and follow-up process. Methods A multidisciplinary team developed an intervention bundle based on a needs assessment and evidence-based models of transitional care. The intervention included pre-discharge planning with a transition coordinator, screening and intervention for adverse social determinants of health (SDH), medication reconciliation after discharge, communication with the primary care provider, access to a hospital-based transition clinic, and access to a 24-hour direct telephone line staffed by hospital attending pediatricians. These were implemented sequentially from October 2013 to February 2017. The primary outcome was the readmission rate within 30 days of index discharge. The length of stay was a balancing measure. Results During the intervention, the included services discharged 4,853 children. The pre-implementation readmission rate of 10.3% declined to 7.4% and remained stable during a 4-month post-intervention observation period. Among 1,394 families screened for adverse SDH, 48% reported and received assistance with ≥ 1 concern. The length of stay increased from 4.10 days in 2013 to 4.30 days in 2017. Conclusions An intervention bundle, including SDH, was associated with a sustained reduction in readmission rates to 2 general pediatric services. Transitional care that addresses multiple domains of family need during a child's health crisis can help reduce pediatric readmissions.
Águas de Março

Water has always been integral to the development of societies. Most early cultures from Mesopotamia to the Indus Valley and the Yellow and Yangtze Rivers evolved and developed around water sources...
IRON MAN WITH A FAILING HEART

Elite endurance athletes expose the cardiovascular system to repeated hemodynamic stress which results in adaptations that permit athletes to achieve and maintain a supranormal cardiac output. The development of heart failure in an athlete may be insidious due to high functional capacity at baseline
Longitudinal resident coaching in the outpatient setting: A novel intervention to improve ambulatory consultation skills

Direct observation with feedback to learners should be a mainstay in resident education, yet it is infrequently done and its impact on consultation skills has rarely been assessed. This project presents the framework and implementation of a longitudinal low-frequency, high-intensity direct observation and coaching intervention, and elaborates on insights learned. Internal medicine interns at one residency training program were randomized to an ambulatory coaching intervention or usual precepting. Over one year, coached interns had three complete primary care visits directly observed by a faculty clinician-coach who provided feedback informed by a behavior checklist. Immediately after each of the coached patient encounters, interns completed a structured self-assessment and coaches led a 30-minute feedback session informed by intern self-reflection and checklist items. Interns with usual precepting had two mini-CEX observations over the course of the year without other formal direct observation in the ambulatory setting. As part of the post-intervention assessment, senior faculty members blinded to intervention and control group assignments evaluated videotaped encounters. Coached interns completed an average of 21/23 behaviors from the checklist, while interns from the control group completed 18 (p < 0.05). The median overall grade for coached interns was B+, compared to B−/C+ for controls (p < 0.05). Coaching interns longitudinally using a behavior checklist is feasible and associated with improved consultation performance. Direct observation of complete clinical encounters followed by systematic coaching is educationally valuable, but time and resource intensive.
Improving Optimal Power Flow Approximations With Resistive Aware Linear Formulations

Many recent works have attempted to introduce novel linear approximations to the Alternate Current (AC) Optimal Power Flow (OPF), with the aim to comprehensively account for grid resistances. This work updates some promising previous set-ups and offers a non-exhaustive, yet concise assessment among the former, DC, Decoupled and recent resistive-aware linear approximations to the OPF. A novel metric for the performance of the approximations to the AC OPF - the feasibility gap - is introduced.
Hepatectomy for Solitary Hepatocellular Carcinoma: Resection Margin Width Does Not Predict Survival.

The survival benefit of negative margins for hepatocellular carcinoma (HCC) has been demonstrated. However, there is no consensus regarding the optimal resection margin width. We assessed the impact of hepatic resection margin width for solitary HCC on overall (OS), recurrence-free (RFS), and liver-specific recurrence-free survival (LSRFS). Clinicopathologic data were retrospectively collected for solitary HCC patients who underwent a negative margin hepatectomy (1992–2015). Margin width was categorized in tertiles as “narrow” (≤ 0.3 cm), “intermediate” (0.31–1.0 cm), or “wide” (> 1.0 cm). Survival was compared among groups. Of the 178 included patients, most were male (76%); median age, MELD score, and tumor size were 63 years, 8, and 5.2 cm, respectively; 93% were Child-Pugh class A. Median margin width was 0.5 cm. Median follow-up and OS were 47.8 months and 76.7 months, respectively. There was no significant survival difference among narrow, intermediate, and wide margin groups with a median OS of 53 months (IQR 21–not reached [NR]), 74 months (IQR 14–138), and 97 months (IQR 37–142) (p = 0.87), respectively. Median RFS was 33.0 months; again, there was no difference among narrow, intermediate, and wide margin groups with a median of 31 months (IQR 18–NR), 45 months (IQR 14–NR), and 27 months (IQR 11–NR), respectively (p = 0.66). Median LSRFS was 63.0 months (IQR 14–NR) with no difference among groups (p = 0.87). In multivariate analyses, margin width was not associated with OS (p = 0.77), RFS (p = 0.74), or LSRFS (p = 0.92). Findings were similar in all subgroups analyzed (≤ 5 cm, > 5 cm, microvascular invasion, T1, T2/T3, anatomical or non-anatomical resection, major or minor hepatectomy). Narrow margins appear to be oncologically safe and the feasibility of achieving wide margins should not determine resectability.
Desiring intimacy and building community: young, gay and living with HIV in the time of PrEP.

The negative effects of stigma on men living with HIV within gay communities are well-documented. However, few studies have examined the experience of intimacy for men living with HIV as a conseque...
Emotion-Performance Relationships in the Acquisition and Adaptation of a Complex Skill: Are Relationships Dynamic and Dependent on Activation Potential?

Although the importance of emotions to self-regulation has been noted in the extant literature, little empirical research has examined how fluctuations across a range of emotions are related to per...
Timing and Type of Venous Thromboembolic Prophylaxis in Isolated Severe Liver Injury Managed Non-Operatively

The optimal timing and type of pharmacological venous thromboembolic prophylaxis (VTEp) after severe liver injury selected for nonoperative management (NOM) are controversial. The aim of this study was to assess the effect of timing and type of VTEp in severe liver injuries selected for NOM. ACS-TQIP database study (2013–17) including patients with blunt isolated severe liver injuries (AIS ≥ 3), selected for NOM, who received VTEp with either unfractionated heparin (UH) or low-molecular-weight heparin (LMWH). Patients who underwent laparotomy or angiointervention within 24 h or prior to the initiation of VTEp were excluded. The study population was stratified according to the timing of VTEp ≤ 48 h (EP) and > 48 h (LP) groups. Univariate and multivariate analyses were used to identify differences between the groups. A total of 4074 patients was included in the study. 2004 (49.2%) received EP and 2070 (50.8%) LP. Patients with more severe injuries were more likely to receive LP than an EP [ISS 24 (19–29) vs 22 (17–27), p < 0.001]. On multivariate analysis (correcting for age, gender, comorbidities, blood pressure, GCS, ISS, type of VTEp), LP was identified as an independent risk factor for thromboembolic events (OR 1.52, p = 0.032) and mortality (OR 2.49, p = 0.031). LMWH was independently associated with lower mortality (OR 0.36, p = 0.007), compared to UH. EP did not increase the risk of laparotomy or angiointervention after starting VTEp, compared to LP (p = 0.992). Early VTEp (≤ 48 h) is safe and independently associated with fewer thromboembolic events and a lower mortality after isolated severe liver injuries managed nonoperatively. LMWH was independently associated with improved outcomes when compared with UH.
Toward a Situational Approach to Understanding Middle Woodland Societies in the North American Midcontinent

Elaborate Middle Woodland (ca. cal 200 BC–cal AD 500) mounds and exotic artifacts traded over long distances provide evidence for institutions that helped coordinate the gathering of large communal...
Association of quantitative measures of effusion-synovitis and hoffa-synovitis with radiographic and pain progression: Data from the FNIH OA biomarkers consortium

Abstract Objective To validate a semi-automated software method of quantifying knee osteoarthritis (KOA) related effusion-synovitis (ES) and Hoffa-synovitis (HS) on MRI. Materials and methods 301 subjects were randomly selected from the FNIH sub cohort, a nested case control study within the Osteoarthritis Initiative (OAI), and distributed into 4 groups based on pain and radiographic progression. Measurements of ES and HS volume were made by 2 readers. Criterion validation was assessed through comparison with the MRI Osteoarthritis Knee Score (MOAKS) and the Spearman correlation coefficient r value. Reader reliability was measured on a subset of 30 subjects and intra-class correlation coefficients (ICCs). Clinical validity was assessed based on case control status using logistic regression and the area under the curve (AUC). Results ES volume was highly correlated with MOAKS Scores (r ​= ​0.74), as was the HS measure but to a lesser extent (r ​= ​0.55). For ES, the intra-reader and intra-reader precision ICCs were 0.83 and 0.95 respectively and 0.98 and 0.96 for HS. For clinical validity, we found similar AUC values when comparing the software method to MOAKS. The average reader time was less than 15 ​min per knee for both ES and HS. Conclusion We have demonstrated the validity of an efficient, accurate, and rapid ES and HS measurement method for KOA using MRI. To our knowledge, this is the first such software to measure both ES and HS. This method will offer an objective and efficient tool for clinical trials and other epidemiologic studies of KOA.
Household low pile carpet usage was associated with increased serum PFAS concentrations in 2005–2006

Abstract Background Per- and polyfluoroalkyl substances (PFAS) are ubiquitous in the serum of the general US population. Food, drinking water, consumer products, dust, and air have been assessed as PFAS exposure sources for humans. The effects of various types of carpeting on serum PFAS concentrations have been less studied, despite the known use of PFAS in stain-resistant carpet treatments. Objective This study aimed to examine the associations between serum PFAS concentrations and type of residential flooring among the general US population aged 12 years and older using the 2005–2006 National Health and Nutrition Examination Survey (NHANES). Methods We used multiple linear regressions adjusted for complex survey design and relevant covariates to analyze the relations between serum PFAS concentrations and type of floor covering (smooth surface, low pile carpet, medium to high pile carpet, and combination of carpet and smooth surface), as well as other potential exposure factors. We used multiple imputation to address missing values. Results We found significantly higher serum concentrations of perfluorohexane sulfonic acid (PFHxS) and 2-(N-methyl-perfluorooctane sulfonamido) acetic acid (MeFOSAA) in US residents residing in homes with low pile carpeting compared with those residing in homes with smooth surface. We concluded that among US residents aged 12 years and older residing in homes with low pile carpeting in the home in 2005–2006, on average 24% and 19% of the PFHxS and MeFOSAA body burdens, respectively, could be attributed to carpeting. We found associations between other types of floor covering (medium to high pile carpet, combination of carpet and smooth surface) and some PFAS concentrations compared with the smooth surface, but these results were less consistent and generally not statistically significant. Additionally, a group Wald Chi-squared test showed a significant result for PFOS, indicating different contributions of various types of flooring to PFOS serum concentration. Significance Our results are representative of the general US population at the time of the survey, and potentially informative regarding ongoing PFAS exposure from a variety of sources including carpeting.
FDA expedited approval and implications for rational formulary and health plan design.

DISCLOSURES: No funding supported this commentary. The authors are employed by Humana, Inc. Shrank reports board of directors work for GetWell Network and NCQA. The other authors have nothing to di...
Concentration of Travel Demand in Space and Time

The concentrations of people and their activities (density) in space and in time are a natural consequence of human behavior in urban areas.
Second Order Godunov Schemes for 2D and 3D MHD Equations and Divergence-Free Condition

A finite difference scheme for 1D, 2D and 3D magnetohydrodynamical (MHD) equations is proposed in this paper. The approximate MHD Riemann solver developed in the scheme is based on characteristic formulations. Both the conservation laws for mass, momentum, energy and magnetic field, and the divergence-free condition for the magnetic field are exactly satisfied in the proposed scheme. The scheme is second order accurate in both space and time, and is simple compared to existing Godunov schemes for MHD flows. The correctness and robustness of the scheme are shown through numerical examples. The approach proposed in this paper to maintain the divergence-free condition may be applied to other dimensionally split and unsplit Godunov schemes for MHD flows.
In Vitro Approaches to Positional Specification in the Retinal-Tectal System

Publisher Summary This chapter discusses three in vitro approaches to positional specification in the retinal–tectal system. The first in vitro analysis of retinal–tectal interactions is directed at ascertaining whether positional specification of retinal axons for a particular tectal region is reflected in the adhesive preferences of individual cells. It was reported that the induced capping of lectin receptors on trypsin-dispersed embryonic cells could be specifically inhibited by components that accumulate in organ culture medium. Thus, supernatants obtained from neural-retina and cerebral-lobe organ cultures inhibit capping of concanavalin A receptors on trypsin dissociated cells of only the homologous type. The most compelling theoretical framework from which the topographic specificity of retinal axons for the tectum has been considered is that of Sperry who suggests that the orderly projection of retinal axons onto the tectum is due to at least two complementary gradients of cytochemical affinities between retinal axons and tectal surface, the two gradients being oriented perpendicular to each other. Data accumulated in three different laboratories suggest a definite correlation between selective adhesion and positional specification of retinal axons.
Splanchnic Hemodynamics in Cirrhotic Patients with Esophageal Varices and Gastrointestinal Bleeding

Twenty cirrhotic patients with esophageal varices and an episode of gastrointestinal bleeding within the previous week underwent hemodynamic studies which used an indicator dilution technique based on selective catheterization of the splanchnic arteries and hepatic vein. Portasystemic shunting of splenic arterial flow averaged 95% (range 80 to 100%) in 17 patients with proved variceal bleeding, but only 8% in 3 who bled from another site. Superior mesenteric shunting averaged 70% (range 27 to 100%) in those who bled from varices, and no shunting was detectable in the nonvariceal bleeders. In at least 4 patients shunting was essentially complete from both beds. In 11 others, however, more than one-third of mesenteric flow still perfused the liver. The pressure gradient from the wedge to free position in the hepatic vein and the hepatic blood flow bore no relationship to the degree of shunting. These data indicated the variability of the splanchnic hemodynamic pattern that may exist in alcoholic patients with esophageal varices. If hemodynamic factors are important in determining the response to surgery, indicator dilution studies to quantitate portasystemic shunting may be a vital part of preoperative evaluation.
Enlarging the Societal Pie: A Cognitive Perspective

Based on contemporary research in decision making, negotiation, and cognitive psychology, we offer a cognitive perspective to explain the failure of governments to create what Stiglitz (1998) calls near-Pareto improvements. We examine the role of human judgment in the failure to find wise tradeoffs across diverse applications of government decision-making, including organ donation systems, endangered species protection, interstate competition, overfishing, and free trade. Our tools for analyzing these failures reflect the difficulty people have trading small losses for large gains, and include the omission bias, status-quo bias, the fixed-pie approach to negotiations, unwillingness to solve social dilemmas, ignoring secondary effects, and discounting the future. Collectively, we seek to offer a new approach for understanding suboptimality in government decision making.
Studies on the mechanism of action of calciferol. V. Turnover time of chick intestinal epithelial cells in relation to the intestinal action of vitamin D.

Abstract Autoradiography following administration of 3 H-thymidine, has been employed to study the total transit time of intestinal epithelial cells from (1) vitamin D deficient; (2) vitamin D replete; (3) normal chicks. The turnover time of ileal epithelial cells is 90–98 h for the three groups. Treatment with vitamin D for more than 110 h results in an increase in villus length so that the villus of normal chicks is 30% longer than that of vitamin D deficient chicks. Since the total transit times were only slightly different in these groups, the rates of migration are 7.0 × 10 −3 cm/h for the normal as compared with 5.9 × 10 −3 cm/h for vitamin D replete and 4.3 × 10 −3 in the vitamin D deficient groups. A comparison between the intestinal epithelial cell turnover time found in the present study and previous data concerning the time course of vitamin D mediated intestinal responses is compatible with the induction hypothesis for vitamin D action and implies that the active metabolite of vitamin D, 1,25-dihydroxyvitamin D, can exert its action only on cells well advanced in their migration up the villus.
Studies on the Dissociation of Flavin Adenine Dinucleotide from Metalloflavoproteins

Abstract Treatment of milk xanthine oxidase and chicken liver xanthine dehydrogenase with high concentrations of salts for several hours resulted in the loss of reactivity toward O2 and NAD, respectively. Oxidation of xanthine by either enzyme in the presence of electron acceptors such as dichlorophenol indophenol was unimpaired under these conditions, in the presence of 3 m KI. Prolonged treatment of xanthine oxidase and xanthine dehydrogenase with 3 m KI followed by extensive dialysis in 0.5 m KCl yielded flavin-free metalloproteins which had the absorption characteristics of their iron-sulfur chromophore. Both flavin-free enzymes showed markedly enhanced rates of electron transfer to cytochrome c and nitroblue tetrazolium compared to the native enzymes. The cytochrome c activity of flavin-free xanthine oxidase, in contrast to the same activity of native xanthine oxidase, was completely insensitive to superoxide dismutase. Prior reduction of the enzymes with their electron donor substrates resulted in a dramatic increase in the lability of FAD in the presence of 3 m KI. Thus, in the case of xanthine dehydrogenase reduced with NADH, the FAD was nearly completely dissociated in less than 5 min compared to the several hours required with the native enzyme. The flavin-free enzymes prepared by the modified procedure were much more stable, and showed superior ability to be reconstituted with FAD.
Community-based interventions to reduce low income, African American women's risk of sexually transmitted diseases: a randomized controlled trial of three theoretical models

A community-based sample of disadvantaged African American women (n = 445) was recruited to participate in 1 of 3 theoretically driven experimental interventions based on either the theory of gender and power, social learning theory, or cognitive behavioral theory. Intervention outcomes were compared with a waiting list control condition. From baseline to postintervention, women in the experimental interventions showed differential change on cognitive indices (knowledge and attitudes) and skill acquisition (partner negotiation skills, correct condom application, lubricant selection, and information-provision to social networks) whereas control participants were unchanged. Women in the 3 experimental interventions also completed follow-up assessments for 1 year following the interventions. In all 3 experimental conditions, condom use increased relative to the control group and there were no differences between the experimental interventions. Women who participated in one of the theoretically grounded interventions continued to increase condom use over the following year. Women entering new relationships reported significantly more condom use than did women who remained in ongoing relationships. The findings suggest that intervention models that have proven effective for women who engage in high-risk behavior may be less effective for women in established relationships for whom risk is primarily derived from the extrarelationship behavior of their partners.
Two-channel decentralized controller design with integral action

Stabilizing controller design with integral action is considered for linear time-invariant, multi-input multi-output, two-channel decentralized systems with stable plants. Design for reliable stabilization with integral action is also considered, where the goal is to maintain closed-loop stability and integral action in the active channel when both controllers act together and when each controller acts alone.
Deus in machina religion, technology, and the things in between, Stolow, Jeremy

(2014). Deus in machina religion, technology, and the things in between, Stolow, Jeremy. Material Religion: Vol. 10, No. 4, pp. 528-529.
Papierkrieg und -frieden in Heidelberg

Auf einer Romantik-Tagung in Heidelberg komme ich mir vor wie Jeremy Bentham in der Universitat London, oder vielmehr wie die Leiche Benthams: die namlich wurde noch viele Jahre nach seinem Tod, professionell einbalsamiert und professoral gekleidet, im Rollstuhl in Fakultatssitzungen gefahren, wahrend der Pedell todernst ankundigte: „Professor Bentham, anwesend, aber nicht stimmberechtigt.“ Oder in der Lokalsprache: ich komme mir vor wie Voss in Heidelberg, den Goethe lieber auf dem Blocksberg gesehen hatte. Und damit ware ich schon beim Thema: bei den manchmal skurrilen Kontroversen um Volksdichtung im Jahrzehnt nach dem Wunderhorn.
In-hospital outcomes after hemiarthroplasty versus total hip arthroplasty for isolated femoral neck fractures

Background: Previous studies suggest total hip arthroplasty may have some benefits compared to hemi-arthroplasty for displaced intracapsular femoral neck fractures in patients more than 60 years of age. The primary research question of our study was whether in-hospital adverse events, post-operative length of stay (LOS) and mortality in patients 60 year of age or older differed between total hip and hemi-arthroplasty for femoral neck fracture. Methods: We obtained data on 82951 patients more than 60 years of age with an isolated femoral neck fracture treated with either hemi-arthroplasty or total hip arthroplasty in 2009 or 2010 from the National Hospital Discharge Survey (NHDS) database. The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9, CM) was used to code diagnoses, comorbidities, complications, and procedures. Results: Controlling for demographics and comorbidities, patients treated with hemi-arthroplasty had a 40% (95% CI 1.4-1.5) higher risk of adverse events compared to patients treated with a total hip arthroplasty. Length of stay and in-hospital mortality did not differ between these groups. Conclusions: The observed advantage for total hip arthroplasty might reflect greater infirmity in hemi-arthroplasty patients that was not accounted for by ICD-9 codes alone.
The Complement Profile in Babesiosis

Rats have been infected with Babesia rodhaini, a protozoan agent that induces immune complex disease. Assays for complement have revealed depletion of C2, C3, C4, C5, and whole complement in the course of infection. No evidence of depletion in the alternative (properdin) pathway was found. These findings are consistent with the conclusion that the classical complement pathway is activated during the course of the protozoan infection.
Time-resolved immunofluorometric assay and specimen storage conditions for measuring urinary gonadotropins.

We optimized storage conditions and validated a sensitive immunofluorometric assay (IFMA) for urinary gonadotropins. Assay linearity and parallelism for luteinizing hormone (LH) and follicle-stimulating hormone (FSH) was observed to 0.04 IU/L. Urinary LH and FSH were unaffected by changes of osmolarity from 0.5 to 3.0 mOsm/kg, and from pH 4.5 to 10.5. Serum and urine measurements of the hormones correlated well over a wide range of values: for LH, R2 = 0.94, P 80% recovery of LH and FSH after 51 weeks; this was comparable with recovery for acetone extracts of urine. Untreated urine showed loss of activity by 4 weeks of storage. Preserving urine specimens with glycerol is a simple method of storage for longitudinal study and compares favorably with acetone extraction. IFMAs can measure urinary gonadotropins reproducibly over a wide range of pH and osmotic conditions.
One-way spatial integration of hyperbolic equations

In this paper, we develop and demonstrate a method for constructing well-posed one-way approximations of linear hyperbolic systems. We use a semi-discrete approach that allows the method to be applied to a wider class of problems than existing methods based on analytical factorization of idealized dispersion relations. After establishing the existence of an exact one-way equation for systems whose coefficients do not vary along the axis of integration, efficient approximations of the one-way operator are constructed by generalizing techniques previously used to create nonreflecting boundary conditions. When physically justified, the method can be applied to systems with slowly varying coefficients in the direction of integration. To demonstrate the accuracy and computational efficiency of the approach, the method is applied to model problems in acoustics and fluid dynamics via the linearized Euler equations; in particular we consider the scattering of sound waves from a vortex and the evolution of hydrodynamic wavepackets in a spatially evolving jet. The latter problem shows the potential of the method to offer a systematic, convergent alternative to ad hoc regularizations such as the parabolized stability equations.
Supporting the virtual design studio through social programming environments

Incorporating alternative pedagogies into computing education has the potential to promote better engagement, outcomes, and retention than traditional methods. A limiting factor of many alternative pedagogies is that they target in-class activities, which constitute a small percentage of computing students' overall time. To achieve a more significant impact, we argue that computing educators need to find ways to innovate students' out-of-class activities as well. Inspired by the studio-based model used in architecture, we introduce the idea of social programming environments, which aim to simulate the design studio experience by enabling students to maintain an awareness of their peers' programming activities and to ask for and receive help.
On propagation of shear crippling (kinkband) instability in a long imperfect laminated composite cylindrical shell under external pressure

Abstract A fully nonlinear analysis for prediction of shear crippling (kinkband) type propagating instability in long thick laminated composite cylindrical shells is presented. The primary accomplishment of the present investigation is prediction of equilibrium paths, which are often unstable, in the presence of interlaminar shear deformation, and which usually deviate from the classical lamination theory (CLT)-based equilibrium paths, representing global or structural level stability. A nonlinear finite element methodology, based on a three-dimensional hypothesis, known as layerwise linear displacement distribution theory (LLDT) and the total Lagrangian formulation, is developed to predict the aforementioned instability behavior of long laminated thick cylindrical shell type structures and evaluate failure modes when radial/hydrostatic compressive loads are applied. The most important computational feature is the successful implementation of an incremental displacement control scheme beyond the limit point to compute the unstable postbuckling path. A long (plane strain) thick laminated composite [90/0/90] imperfect cylinder is investigated with the objective of analytically studying its premature compressive failure behavior. Thickness effect (i.e. interlaminar shear/normal deformation) is clearly responsible for causing the appearance of limit point on the postbuckling equilibrium path, thus lowering the load carrying capability of the long composite cylinder, and localizing the failure pattern, which is associated with spontaneous breaking of the periodicity of classical or modal buckling patterns. In analogy to the phase transition phenomena, Maxwell construction is employed to (a) correct the unphysical negative slope of the computed equilibrium paths encountered in the case of thicker cylinders modeled by the finite elements methods that fall to include micro-structural defects, such as fiber waviness or misalignments, and (b) to compute the propagating pressure responsible for interlaminar shear crippling or kinkband type propagating instability. This type of instability triggered by the combined effect of interlaminar shear/normal deformation and geometric imperfections, such as fiber misalignment, appears to be one of the dominant compressive failure modes for moderately thick and thick cylinders with radiusto-thickness ratio below the corresponding critical value. A three-dimensional theory, such as the LLDT, is essential for capturing the interlaminar shear crippling type propagating instability.
Supersymmetric subconstituents and the problem of mass

Abstract We assume that two mechanisms operate to protect the masslessness of fermions in a subconstituent theory: (a) the matching of chiral anomalies, (b) the combination of supersymmetry and the spontaneous breaking of a flavor symmetry. In a toy supersymmetric hyperchromodynamical model based on SU(10) hypercolor we illustrate the interplay of these mechanisms.
Seismic characterization of fractured reservoirs by focusing Gaussian beams

ABSTRACTNaturally fractured reservoirs occur worldwide, and they account for the bulk of global oil production. The most important impact of fractures is their influence on fluid flow. To maximize oil production, the characterization of a fractured reservoir at the scale of an oil field is very important. For fluid transport, the critical parameters are connectivity and transmittivity plus orientation. These can be related to fracture spacing, compliance, and orientation, which are the critical seismic parameters of rock physics models. We discovered a new seismic technique that can invert for the spatially dependent fracture orientation, spacing, and compliance, using surface seismic data. Unlike most seismic methods that rely on using singly scattered/diffracted waves whose signal-to-noise ratios are usually very low, we found that waves multiply scattered by fractures can be energetic. The direction information of the fracture multiply scattered waves contains fracture orientation and spacing informati...
Association between adherence to diuretic therapy and health care utilization in patients with heart failure.

Study Objective. To determine the relationship between adherence to diuretic therapy and health care utilization. Design. Prospective, observational study. Setting. University-affiliated medical center. Patients. Forty-two patients with heart failure. Intervention. Electronic monitoring of adherence to diuretic therapy (percentage of diuretic prescription container openings) and to scheduling (percentage of container openings within a specific time). Measurements and Main Results. All patients were prescribed a diuretic, most commonly furosemide (88%). Patients varied widely in adherence to therapy (μ = 72% ± 30%) and to scheduling (μ = 43% ± 30%). Education was a predictor of drug-taking adherence (p=0.0062) but not of scheduling adherence. Log-linear models revealed that poor scheduling adherence was associated with increased cardiovascular-related hospitalizations (χ2 11.63, p=0.0006) and predicted more heart failure-related hospitalizations (χ2 4.04, p=0.0444). In contrast, neither measure was significantly associated with cardiovascular- or heart failure-related emergency department visits. We found a moderate correlation between scheduling adherence and taking adherence (r = 0.6513). Conclusion. Patients taking a greater proportion of diuretic agents on schedule may decrease the risk of cardiovascular- and heart failure-related hospitalizations. If these findings are confirmed by a larger study, interventions to improve adherence and patient health outcomes should consider the timing of doses as well as the number of daily doses of a diuretic.
Urinary chloride excretion distinguishes between renal and extrarenal metabolic alkalosis

The aetiology of normotensive hypokalaemic metabolic alkalosis is sometimes not obtainable from the history. Observations in adults indicate that the urinary chloride excretion is low in metabolic alkalosis of extrarenal origin. The chloride/creatinine ratio in random urines was therefore compared in 283 healthy children and in eight paediatric patients with metabolic alkalosis. The urinary chloride/creatinine ratio was reduced in four patients with metabolic alkalosis of extrarenal origin and within reference values or above in four patients with metabolic alkalosis of renal origin. The study confirms that urinary chloride/creatinine ratio discriminates between extrarenal and renal forms of metabolic alkalosis.
An outpatient model of integrated diabetes treatment and education: functional, metabolic, and knowledge outcomes.

A cohort of 137 itisulin-ti-eated adults with diabetes was evaluated at enrollment in a diabetes education and care program; 69 completed follow-up evaluations (mean=11.2 months) to ascertain clinical outcomes. Factors that predicted change in metabolic, functional, and knowledge status were identified. The metabolic status of this cohort also was compared with a similar group of patients from a health maintenance organization (HMO) in a neighboring state. The mean HbA1c decreased from 9.97% at enrollment to 7.53% at follow-up. Functional status scores did not improve from baseline to follow-up. The relationship between knowledge and metabolic control differed for subjects with diabetes of long duration and short duration. A predictor of improved HbA1c was baseline HbA1c. A predictor of improved symptom score included white race or Hispanic origin. Patients who attended this program had better metabolic outcomes than the comparison group of patients.
Vacuum polarization at the chronology horizon of the Roman spacetime.

Hawking has speculated that his chronology protection conjecture is always enforced, i.e., closed timelike curves (CTC's) are always prevented from forming, by a divergent vacuum polarization of quantum fields at any chronology horizon where the CTC's try to form. In this paper, this enforcement mechanism is explored in a spacetime that has been carefully designed to make the mechanism very weak, and therefore very ineffective. The chosen spacetime (due to Roman) is one in which two wormholes move at high speed past each other. Each wormhole has time hooked up synchronously in its own rest frame, so every CTC must traverse both wormholes at least once before returning to its starting point. It is shown that by choosing the wormholes' impact parameter to be arbitrarily large compared to their throat radii, the divergence of the vacuum polarization can be arbitrarily weak. This weakness might (as Kim and Thorne have argued) enable quantum gravity to cut off the divergence, thereby permitting the CTC's to form. Alternatively (as Thorne has subsequently suggested), the quantum-gravity cutoff might be delayed by the same mechanism that weakens the vacuum polarization, thereby enabling the polarization always to grow strong enough to enforce chronology protection.
Design considerations for CMOS and GaAs OTAs: frequency response, linearity, tuning, and common-mode feedback

High-performance operational transconductance amplifiers (OTAs) are important in the design of high-frequency analog transconductance-C (gm-C) filters. Critical design considerations for OTAs are frequency response, linearity, tuning, output impedance, power supply rejection (PSR), and common-mode rejection (CMR). In CMOS technology, satisfactory OTA design techniques are available, except that the linear input range often is relatively small and the frequency response of the OTA is limited by the intrinsic speed of transistors. In this paper, a new approach is developed to increase the linear input range, and a trade-off between linearity and input range is discussed. A CMOS OTA with less than ±0.4% linearity error over a very large input range is given as a design example. To achieve a very high frequency response, 1μm depletion-mode GaAs MESFETs with high intrinsic speed are used to replace MOSFETs. Simple ac compensation, a new technique for output impedance enhancement, and a new tuning method for OTAs with all N-channel devices are used to design a GaAs OTA with very small parasitics and f−3dB=7 GHz. To improve PSR and CMR, fully balanced structures are used for the OTAs. Design considerations for the interaction of the operation of common-mode feedback (CMF) and tuning are discussed, and improved CMF circuits are proposed. Using the GaAs OTA and considering the frequency limitations imposed by parasitics, the design of a high order ladder filter with 300MHz cutoff frequency is presented as an application.
Pregnancy after uterine artery embolization

Abstract BACKGROUND: Uterine artery embolization is an increasingly popular alternative to hysterectomy and myomectomy as a treatment for uterine leiomyoma. Whether this procedure is safe for women desiring future fertility is controversial. CASES: A primigravida who had previously undergone uterine artery embolization had premature rupture of membranes at 24 weeks. She had a cesarean delivery at 28 weeks, which was followed by uterine atony requiring hysterectomy. A primigravida who had previously undergone uterine artery embolization delivered appropriately grown dichorionic twins at 36 weeks. An analysis of the 50 published cases of pregnancy after uterine artery embolization revealed the following complications: malpresentation (17%), small for gestational age (7%), premature delivery (28%), cesarean delivery (58%), and postpartum hemorrhage (13%). CONCLUSION: Women who become pregnant after uterine artery embolization are at risk for malpresentation, preterm birth, cesarean delivery, and postpartum hemorrhage.
Audit firm characteristics and Type II errors in the going concern opinion

Abstract According to SAS No. 59 (AICPA, 1988), auditors must modify their audit reports for uncertainties that may affect a company's ability to continue in existence. Using both auditor and company characteristics in a logistic regression model, we examine whether Big Six (now Big Five) (industry specialist) auditors are more likely to issue a going concern opinion on the financial statements immediately preceding bankruptcy than non-Big Six (non-specialist) auditors. We further partition the sample of bankrupt firms into groups based on probability of bankruptcy, default status, and events occurring after the date of the audit report. These partitions allow us to examine whether Big Six (industry specialist) auditors systematically outperform non-Big Six (non-specialist) auditors in issuing a going concern opinion in situations in which going concern assessment is more difficult. Our findings provide no evidence that Big Six (industry specialist) auditors outperform non-Big Six (non-specialist) auditor...
A convenient synthesis of 1,2-difluoro-1, 2-dideoxyhexoses using xenon fluoride

Abstract A method for the addition of fluorine to the double bond in acetylated glycals using XeF2 in the presence of BF3 has been shown to provide a convenient route for the synthesis of acetylated 1, 2-dideoxy-1, 2-difluorosugars. The reagent attacks the double bond predominantly from the least hindered side to give a cis adduct, but the reaction also provided other isomers which have been separated by chromatography and their stereo-chemistry determined by 19F NMR spectroscopy. The proposed mechanism of the reaction involves an initial electrophilic attack by the reagent on C-2 followed by a nucleophilic attack on C-1. Deacetylation of the adducts gave 1, 2-dideoxyl-1, 2-difluorosaccharides, which are of interest in biochemical studies. A crystalline 2-deoxy-2- l -fucose was prepared by selective hydrolysis of the anomeric fluorine atom of 1, 2-dideoxy-1, 2-difluoro- l -fucose.
Kinetics, mechanism, and computational studies of rhenium-catalyzed desulfurization reactions of thiiranes (thioepoxides).

The oxorhenium(V) dimer {MeReO(edt)}2 (1; where edt = 1,2-ethanedithiolate) catalyzes S atom transfer from thiiranes to triarylphosphines and triarylarsines. Despite the fact that phosphines are more nucleophilic than arsines, phosphines are less effective because they rapidly convert the dimer catalyst to the much less reactive catalyst [MeReO(edt)(PAr3)] (2). With AsAr3, which does not yield the monomer, the rate law is given by v = k[thiirane][1], independent of the arsine concentration. The values of k at 25.0 °C in CDCl3 are 5.58 ± 0.08 L mol-1 s-1 for cyclohexene sulfide and ca. 2 L mol-1 s-1 for propylene sulfide. The activation parameters for cyclohexene sulfide are ΔH⧧ = 10.0 ± 0.9 kcal mol-1 and ΔS⧧ = −21 ± 3 cal K-1 mol-1. Arsine enters the catalytic cycle after the rate-controlling release of alkene, undergoing a reaction with the ReVII(O)(S) intermediate that is so rapid in comparison that it cannot be studied directly. The use of a kinetic competition method provided relative rate constants ...