cssi/SciSciGPT-SciSciNet huggingface dataset:
Postoperative delirium and short-term cognitive dysfunction occur more frequently in patients undergoing valve surgery with or without coronary artery bypass graft surgery compared with coronary artery bypass graft surgery alone: results of a pilot study

Objective The authors tested the hypothesis that patients undergoing valve repair or replacement surgery with or without coronary artery bypass graft (CABG) surgery using cardiopulmonary bypass (CPB) had a greater incidence of postoperative delirium and cognitive dysfunction compared with patients undergoing CABG surgery alone. Design Prospective study. Setting Veterans Affairs medical center. Participants Forty-four age- and education-balanced male patients (≥55 years of age) undergoing elective cardiac surgery with CPB (n = 22 valve ± CABG surgery and n = 22 CABG surgery alone) and nonsurgical controls (n = 22) were recruited. Interventions None. Measurements and Main Results Delirium was assessed with the Intensive Care Delirium Screening Checklist before and for 5 consecutive days after surgery. Recent verbal and nonverbal memory and executive functions were assessed using a psychometric test battery before and 1 week after cardiac surgery or at 1-week intervals in nonsurgical controls. Intensive care unit stay, hospital stay, and 30-day readmission were significantly ( p = 0.03, p = 0.01, and p = 0.04, respectively) longer in patients undergoing valve surgery ± CABG surgery versus CABG surgery alone. Postoperative delirium occurred more frequently ( p = 0.01) in patients undergoing valve ± CABG surgery versus CABG surgery alone. Overall cognitive performance (composite z score) after surgery also was impaired significantly ( p = 0.004) in patients undergoing valve ± CABG surgery compared with CABG surgery alone. The composite z score after surgery decreased by at least 1.5 standard deviations in 11 patients (50%) versus 1 patient (5%) without valve surgery compared with nonsurgical controls ( p = 0.001, Fisher's exact test). The presence of delirium predicted a composite z score decrease of 1.2 points (odds ratio = 0.30; 95% confidence interval, 0.13-0.68). Conclusions The results indicated that patients undergoing valve surgery with or without CABG surgery have a higher incidence of postoperative delirium and cognitive dysfunction 1 week after surgery compared with those undergoing CABG surgery alone.
Synthetic Speech Intelligibility: Comparison of Native and Non-native Speakers of English

This study sought to determine the intelligibility of DECTalkTMsynthesized speech to both native and non-native speakers of English. The ability of the groups to understand DECTalk sentences delivered both in quiet and at a signal-to-noise (S/N) ratio of +10 dB was investigated. Results suggested that non-native speakers made significantly more errors transcribing DECTalk sentences than did native speakers. DECTalk was found to be significantly less intelligible in noise than in quiet for both groups, but non-native speakers experienced significantly more difficulty understanding DECTalk in noise than did native speakers. Implications of these findings and the need for further research are discussed.
Cognitive feedback for use with FES upper extremity neuroprostheses

The development of two sensory substitutions systems that provide cognitive feedback for FES (functional electrical stimulation) hand-grasp-restoration neuroprostheses is described. One system uses an array of five electrodes to provide machine status information and a spatially encoded representation of the command signal that a quadriplegic individual generates to achieve proportional grasp control. Only one electrode site is active at any given instant, and a second informational channel is superimposed on the spatial position channel by modulating the frequency of the stimulus pulses. The frequency-modulated feedback channel signals six levels of force developed at the finger tips during prehension activities. The second sensory system is an integral part of an implanted FES system and utilizes a single subdermally placed electrode to display machine status information and a five-level frequency code for feedback of the user-generated grasp control signal. The multielectrode feedback system was implemented for laboratory studies using surface-mounted electrodes, although its design will ultimately incorporate subdermal electrodes to provide a highly cosmetic and unencumbering system. >
ENSO Prediction with Markov Models: The Impact of Sea Level

Abstract A series of seasonally varying linear Markov models are constructed in a reduced multivariate empirical orthogonal function (MEOF) space of observed sea surface temperature, surface wind stress, and sea level analysis. The Markov models are trained in the 1980–95 period and are verified in the 1964–79 period. It is found that the Markov models that include seasonality fit to the data better in the training period and have a substantially higher skill in the independent period than the models without seasonality. The authors conclude that seasonality is an important component of ENSO and should be included in Markov models. This conclusion is consistent with that of statistical models that take seasonality into account using different methods. The impact of each variable on the prediction skill of Markov models is investigated by varying the weightings among the three variables in the MEOF space. For the training period the Markov models that include sea level information fit the data better than ...
Characteristics of depressed and nondepressed women with physical disabilities.

Objectives To describe the characteristics of depressed versus nondepressed women with disabilities. Design Survey. Setting Women were recruited through private and public health clinics and various community organizations. Participants A sample of 443 predominantly ethnic-minority women, ages 18 to 83 years, with physical disabilities. Interventions Not applicable. Main outcome measure Beck Depression Inventory-II (BDI-II). Results Approximately half (51%) of the sample had scores in the mildly depressed range or higher on the BDI-II. Women classified as depressed were more likely to have multiple sclerosis, to be younger, or to have a shorter duration of disability. Only 44% of the women with scores exceeding the BDI-II cutoff for significant depressive symptomatology had received recent treatment for depression, with Hispanic women being the least likely to report receiving treatment. Depressed women reported significantly more health conditions, reflecting common symptoms of depression, conditions linked with depression in the general population, conditions known to be secondary to the primary condition, and conditions known to be common side effects of medications. Depression was not related to functional limitations. Conclusions Depression is a serious mental health problem facing many women with physical disabilities that does not appear to be adequately addressed by health care professionals.
High-Risk Situations: Relapse as a Dynamic Process

Publisher Summary This chapter provides a basic overview of the dynamic model of relapse as well as discussion of the aspects of the model that are directly relevant to clinical practice. The dynamic model of relapse is almost wholly encompassed by a circle labeled high-risk situations. The two circles, tonic and phasic processes, are important for the timing of a lapse-relapse sequence. The model itself incorporates several interacting relapse risk factors, which are each predictive of the transgressive behavior as well as each other. Feedback loops are used to characterize the bidirectional relationship between cognitions and lapse, as well as affective state and lapse. Coping is shown as directly interrelated with lapse. The difference between a feedback loop and interrelatedness in the model is primarily a consideration of the distinction between the two processes. The sudden gains and quantum changes are also elaborated.
Evaluation of data quality of multisite electronic health record data for secondary analysis

Currently, a large amount of data is amassed in electronic health records (EHRs). However, EHR systems are largely information silos, that is, uses of these systems are often confined to management of patient information and analytics specific to a clinician's practice. A growing trend in healthcare is combining multiple databases to support epidemiological research. The College Health Surveillance Network is the first national data warehouse containing EHR data from 31 different student health centers. Each member university contributes to the data warehouse by uploading select EHR data including patient demographics, diagnoses, and procedures to a common server on a monthly basis. In this paper, we focus on the data quality dimensions from a subsample of the data comprised of over 5.7 million patient visits for approximately 980,000 patients with 4,465 unique diagnoses from 23 of those universities. We examine the data for measures of completeness, consistency, and availability for secondary use for epidemiological research. Additionally, clinical documentation practices and EHR vendor were evaluated as potential contributors to data quality. We found that overall about 70% of the data in the data warehouse is available for secondary use, and identified clinical documentation practices that are correlated to a reduction in data quality. This suggests that automated quality control and proactive clinical documentation support could reduce ad-hoc data cleaning needs resulting in greater data availability for secondary use.
Television as a Sex Educator

Let me begin with a flat assertion: Television plays an important role in the sex education of today’s American youth. Although the broad implications of that claim are incontestable, the scientific evidence for specific effects is still somewhat limited. Therefore, to establish the validity of the broad claim, it is first necessary to look at television from a larger perspective before examining some of the more direct research evidence.
Anterior Dislocation of a Total Knee Prosthesis with Vascular Compromise: A Case Report.

Dislocation of a total knee prosthesis is a very infrequent, but potentially catastrophic, complication. Vascular compromise is an uncommon consequence of dislocation of a total knee prosthesis. Our literature review revealed only one case of anterior dislocation causing vascular compromise that resulted in an above-the-knee amputation1. We report the traumatic anterior dislocation of a previously well-functioning total knee prosthesis, which caused popliteal artery compromise. This dislocation was successfully treated with vascular bypass, fasciotomies, and delayed revision arthroplasty. The patient was informed that data concerning his case would be submitted for publication, and he provided consent. A seventy-seven-year-old man presented with left knee pain. He had previously been diagnosed with primary osteoarthritis and had had unsuccessful nonoperative management. Physical examination revealed an antalgic gait, with the patient favoring the left lower extremity; he also had a partially correctable varus deformity. The left knee ligaments were stable. Active knee motion was −5° of extension to 115° of flexion. Radiographs showed tricompartmental osteoarthrosis (Fig. 1). Fig. 1 Preoperative weight-bearing radiograph showing medial and lateral compartment osteoarthrosis and varus alignment of the left knee. The patient underwent a left total knee arthroplasty. At the time of surgery, the posterior cruciate ligament (PCL) was competent, so a cruciate-retaining implant was utilized (Duracon; Stryker, Mahwah, New Jersey). A 15-mm patellar osteotomy was performed (Fig. 2). The knee ligaments remained stable and the patient had matched flexion-extension gaps. The patient was rehabilitated and recovered uneventfully. After two years of follow-up, he had no symptoms. He was able to return to work and perform all desired recreational activities. Fig. 2 Postoperative weight-bearing radiograph of the left knee six weeks after the total knee arthroplasty. The patient presented to the emergency department twenty-seven months following the total knee arthroplasty. An obese relative had fallen onto the anterior aspect of the …
APSA-PSA (UK) Collaborate over French Politics

Since 2000, the French Politics Groups of APSA and PSA have been working in close collaboration, thanks to PSA/APSA financial support and the leadership of Robert Elgie (Dublin City University), Andrew Appleton (Washington State University), and Amy Mazur (Washington State University). The major goal of this collaboration is to strengthen the study of French Politics by bringing together research communities on both sides of the Atlantic.
A Review of Instrumental Data for Drug Analysis, Vol.

This book is a reference book consisting of chromatographic and spectral data on 300 selected compounds. For each drug there is a monograph that lists the chemical title, molecular formula and weight, synonyms and tradenames, use, and chemical structure. For each drug, ultraviolet, nuclear magnetic resonance, infrared, and mass spectroscopy spectra and tabulations of gas chromatographic and high pressure liquid chromatographic data where available are included. The drugs are presented in alphabetical order. Two appendices are included; one is the listing of Kovats indices obtained using a 1.2-m by 6.35-mm (4-ft by 1/4-in.) 3% OV-1 on Chromosorb WHP 80–100 mesh column. The second appendix is a listing of the ultraviolet maxima in 0.2N sulfuric acid, basic and ethanolic solutions, respectively.
Abstract 5243: The novel calcium-dependent direct binding of S100B to p90 ribosomal S6 kinase (RSK) decreases MAP kinase-mediated RSK activation in malignant melanoma.

Proceedings: AACR 104th Annual Meeting 2013; Apr 6-10, 2013; Washington, DC S100B is an effective and extensively used prognostic marker for melanoma, with increasing serum S100B being predictive of disease stage, increased recurrence, and low overall patient survival. Establishing the mechanism by which S100B alters cell signaling provides insight into how it may facilitate the progression of melanoma and aid in developing new pharmacological drugs to inhibit cancer advancement. To evaluate specific roles for S100B in malignant melanoma, our S100B knock-down and over-expression studies established a correlation between S100B expression and cell viability. ERK phosphorylation was also found to correlate with S100B levels. We have discovered RSK, a downstream ERK target, as a novel binding partner of S100B. RSK is known to regulate MAPK signaling in melanoma but the mechanism is unclear. We observed an inverse relationship between activated and phosphorylated RSK and S100B levels. We used a Ca2+-binding mutant of S100B (E31A + E72A) to demonstrate that the S100B-RSK interaction was calcium-dependent. Pull-down experiments revealed the C-terminal domain of RSK to be necessary for S100B binding. In vitro, S100B was found to reduce ERK-dependent phosphorylation of RSK at Thr573. Our cellular fractionation and immuno-fluorescence studies showed that S100B protein prevented nuclear localization of phosphorylated RSK. These data are consistent with a mechanism in which elevated S100B binds directly to RSK in a calcium-dependent manner, preventing ERK-mediated phosphorylation of RSK and inhibiting RSK localization to the nucleus. We have identified the S100B-RSK interaction as a novel drug target in melanoma cells. We are currently screening compounds for inhibitors of the S100B-RSK interaction. Citation Format: Adam D. Pierce, Kira G. Hartman, David Weber. The novel calcium-dependent direct binding of S100B to p90 ribosomal S6 kinase (RSK) decreases MAP kinase-mediated RSK activation in malignant melanoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 5243. doi:10.1158/1538-7445.AM2013-5243
Adhesion between epithelial cells and T lymphocytes mediated by E-cadherin and the alpha E beta 7 integrin.

IN contrast to sessile cell types, lymphocytes migrate through the vasculature to become diffusely distributed in tissues or organized in lymphoid structures. A complex array of adhesion molecules including selectins, integrins and their counter-receptors mediate lymphocyte homing and migration into tissues and may be constitutively expressed or induced1,2. However, the molecules that mediate the tissue-specific retention of lymphocytes within the parenchyma have not been identified. Along the epithelium at the basolateral surface of enterocytes, intestinal intraepithelial lymphocytes are found. These T cells of the mucosal immune system serve as a model for the tissue-specific compartmentalization of lymphocytes. We investigated whether the localization of these intestinal intra-epithelial lymphocytes could be mediated by specific interactions between adhesion molecules expressed selectively on this subpopu-lation of T cells and tissue-restricted adhesion molecules on epi-thelial cells. Here we show that heterotypic adhesive interactions between epithelial cells and intraepithelial lymphocytes in vitro are mediated by E-cadherin and the αEβ7 integrin.
Appropriate Use of Nomograms to Guide Prostate Cancer Treatment Selection

For decades physicians have attempted to accurately predict post-treatment outcomes before performing prostate cancer interventions. Use of basic clinical factors, such as clinical T-stage, biopsy Gleason sum, and pretreatment prostate specific antigen, has allowed some level of prediction of pathologic and clinical outcomes. However, these basic tables and risk stratification schema provide a broad range of potential outcomes. The rapid growth of retrospective research in prostate cancer has yielded an abundance of additional potential prognostic factors that may influence outcomes of interest; however, incorporating and understanding the significance of these ever-expanding factors is difficult for even the most experienced physicians. Nomograms incorporate these factors (including treatment-specific) and assign them relative weights to provide a probability of the outcome of interest on a graphical scale. They distill large numbers of data into a manageable format and provide the probability of outcomes on a continuous scale rather than in categoric groups. However, because they require a computation to generate a probability, they are not amenable to memorization, which decreases ease of use. Furthermore, these numbers still have associated confidence intervals and the models are largely derived from retrospective data, which have inherent drawbacks. Clinicians and patients should still exercise due diligence when interpreting the results of these nomograms, and these prediction tools should not serve as a stand-alone substitute for clinical decision-making.
Real Money Trade Model in Virtual Economies

The most interesting real estate transaction has been executed after a several months long auctioning process in December 15, 2004, a sale of a whole island at a rather incongruent price of 26,500 USD, BBC reports. The peculiar part of the deal is the location of the island; it is not situated in a lush Mediterranean climate or off the costs of Florida but in a rather constrained space of a few mainframe servers of MindArk company in Gothenburg, Sweden. It is a virtual property coded in the massively-multiplayer online role-playing game (MMORPG) game Project Entropia which can be used only by virtual personages, the so-called avatars existing as human user's digital extensions, but at the same time that property can be traded using real money. Virtual economies traded in the real world or so to speak virtual economy spillover into the real world (i.e. real money trade) resulting from the trade of these properties is not small by any standards and is estimated to be $880 millions in 2005 and rapidly growing. The owners of those virtual worlds, most often medium to very large companies, themselves face the consequences of sprouting economic relationships based on their product, either by embracing them as MindArk did or by banning them as Blizzard did in their hugely successful MMORPG World of Warcraft. What are the causes for this virtual economy's spillover into the real one? Why does it happen in the first place? The answers to these questions may not only be the analysis of the current situation of the economies in the virtual worlds but also serve as a direction for further analysis of emergent Homo Economicus Virtualis. My thesis will explore two cases of virtual world economies in detail and examine the real money trade creation in those economies using abductive approach. The study will base itself on the information recollected using online interviews and surveys of the active population inhabiting the two virtual economies. Various secondary sources will be analyzed and existing theoretical frameworks will be used in the thesis. Consequently, theoretical virtual economy real money trade model based on the digital assets growth dynamics in the challenge level framework will be inferred and outlined. In the end, suggestions for the further research will be presented.
New PMT-Quadrant-Sharing shallow block detector development for high performance TOF PET applications

The time-of-flight (TOF) technology is being adopted by more and more human PET systems in recent years. The most important specification for a TOF PET system is the time resolution. Among many factors that affect the time resolution, one of the most important factors is the block detector design. The PMT-Quadrant-Sharing (PQS) block design has several advantages over non-PQS detector block for TOF purposes. First, the cancellation of external light guide in PQS design enable more optical photons to travel to the PMT cathodes resulted in higher photoelectron number which is critical for time resolution. Second, optical photons' travel distance from the scintillator to PMT cathode is shorter for PQS block compared to non-PQS block, which could reduce the time distribution of the transition time for light photons. Those factors will improve the time resolution for PQS block in TOF applications. In this study, we developed two high performance, lower-cost and high-resolution PQS block detectors for TOF PET purposes. The blocks have an area of 39×39 mm2 and two dimensions in length: 12 mm and 15 mm. The matrix of both blocks is 16×16 using 2.4×2.4 mm2 LYSO crystals, which can achieve a sub 3-mm intrinsic resolution in a typical human PET geometry that is significantly higher than any other similar systems, together with a 400-500 ps time resolution possibility. Two sets of masks are developed and good decoding map are achieved. Peak-tovalley ratio is 2.6 for the 12-mm block and 2.1 for the 15mm block. The energy resolution is 12.3% and 14.8% for the 12-mm and 15-mm block respectively. Two PET modules consisting of 7 blocks each are constructed. PET tomographic results are obtained by the coincidence data from these two modules and the rotation of the object placed between the modules. The performance measurements demonstrate the successful development of two large area shallow block detectors with high spatial resolution and time resolution which will be the ideal candidates for the construction of high-performance low-cost TOF PET systems.
First personal modes of presentation and the structure of empathy

AbstractI argue that we can understand the de se by employing the subjective mode of presentation or, if one’s ontology permits it, by defending an abundant ontology of perspectival personal properties or facts. I do this in the context of a discussion of Cappelen and Dever’s recent criticisms of the de se. Then, I discuss the distinctive role of the first personal perspective in discussions about empathy, rational deference, and self-understanding, and develop a way to frame the problem of lacking prospective access to your future self as a problem with your capacity to imaginatively empathize with your (possible) future selves.
No Child Left Behind: What About Refugees?

As populations migrate and seek refuge around the world, educators in receiving countries need information about how to provide meaningful education experiences. Refugee children have higher rates of school dropout and are faced with many challenges, such as acculturation stress, poverty, poor housing, dangerous neighborhoods, and psychological disorders. The purpose of this article is to examine the research and current status of U.S. school system supports for the education of refugee children and to provide suggestions based on evidence-based practice for refugee children's success. The authors provide a historical overview of policies and provisions of refugee education, an assessment of multiple factors affecting refugee children's adjustment and success at school, and a review of evidence-based practice for refugee children.
Chance-Constrained AC Optimal Power Flow for Distribution Systems With Renewables

This paper focuses on distribution systems featuring renewable energy sources (RESs) and energy storage systems, and presents an AC optimal power flow (OPF) approach to optimize system-level performance objectives while coping with uncertainty in both RES generation and loads. The proposed method hinges on a chance-constrained AC OPF formulation, where probabilistic constraints are utilized to enforce voltage regulation with prescribed probability. A computationally more affordable convex reformulation is developed by resorting to suitable linear approximations of the AC power-flow equations as well as convex approximations of the chance constraints. The approximate chance constraints provide conservative bounds that hold for arbitrary distributions of the forecasting errors. An adaptive strategy is then obtained by embedding the proposed AC OPF task into a model predictive control framework. Finally, a distributed solver is developed to strategically distribute the solution of the optimization problems across utility and customers.
Lowest-cost network node identification for data caching for information centric networks

We present the lowest-path cost to destination scheme for identification of the most suitable node for data caching. The scheme identifies the network node that yields the lowest-cost path for delivering data to demanding users. This scheme is applied to information centric networks (ICN) that consider two different data consumption modes: frequently and sporadically. We consider the use of Software-Defined Networking (SDN) to realize the distribution of data on identified network nodes and enable routing towards ICN caching nodes. We apply two different methods to evaluate the path costs: Dijkstra algorithm and Integer Linear Programming (ILP). Our results show that both adopted schemes provide similar results, converging into the identification of the same ICN caching nodes. We provide example of different scenarios and resulting costs. We also apply the proposed scheme to identify a stand-by node in case the most economical nodes fails, using the proposed scheme. We show that there is a trade-off between the extent of demand and the location of routers in the network.
Experimental investigation of fan-folded piezoelectric energy harvesters for powering pacemakers.

This paper studies the fabrication and testing of a magnet free piezoelectric energy harvester (EH) for powering biomedical devices and sensors inside the body. The design for the EH is a fan-folded structure consisting of bimorph piezoelectric beams folding on top of each other. An actual size experimental prototype is fabricated to verify the developed analytical models. The model is verified by matching the analytical results of the tip acceleration frequency response functions (FRF) and voltage FRF with the experimental results. The generated electricity is measured when the EH is excited by the heartbeat. A closed loop shaker system is utilized to reproduce the heartbeat vibrations. Achieving low fundamental natural frequency is a key factor to generate sufficient energy for pacemakers using heartbeat vibrations. It is shown that the natural frequency of the small-scale device is less than due to its unique fan-folded design. The experimental results show that the small-scale EH generates sufficient power for state of the art pacemakers. The 1 cm3 EH with tip mass generates more than of power from a normal heartbeat waveform. The robustness of the device to the heart rate is also studied by measuring the relation between the power output and the heart rate.
Distributed belief averaging using sequential observations

This paper considers a distributed belief averaging problem with sequential observations in which a group of n > 1 agents in a network, each having sequentially arriving samples of its belief in an online manner, aim to reach a consensus at the average of their beliefs, by exchanging information only with their neighbors. The neighbor relationships among the n agents are described by a time-varying undirected graph whose vertices correspond to agents and whose edges depict neighbor relationships. A distributed algorithm is proposed to solve this problem over sequential observations with O(1/t) convergence rate. Extensions to the case of directed graphs are also detailed.
Steady progress toward a malaria vaccine

Purpose of reviewGreat progress has been made in reducing malaria morbidity and mortality, yet the parasite continues to cause a startling 200 million infections and 500 000 deaths annually. Malaria vaccine development is pushing new boundaries by steady advancement toward a licensed product.Recent
Role of Complement in Infectious Diseases

Publisher Summary This chapter discusses the interaction of complement with microorganisms. It discusses the microbial antigens capable of activating complement and the localization of complement components on the microbial surface. The chapter describes the capacity of complement to opsonize organisms for phagocytosis, to cause direct microbial killing, and to effect bloodstream clearance of microorganisms. It reviews the role of complement in mediating some of the pathophysiological consequences of microbial infection. Bacteremia, fungemia, and parasitemia are serious consequences of localized and systemic infection that often lead to intravascular activation of complement. In particular, clinical and experimental bacteremia and endotoxemia due to gram-negative organisms leads to the activation of the alternative complement pathway. Complement depletion is more extensive in bacteremia associated with shock than in normotensive bacteremia. It is unclear whether the anaphylatoxic molecules C3a and C5a generated during complement activation participate in development of shock or are simply a manifestation of more extensive infection leading to generation of other vasoactive substances causing shock. Intravascular C5a production is probably a major factor in the neutropenia associated with sepsis and is seen in experimental animals injected intravascularly with bacteria.
Trends in treatment strategies for suspected bacterial endophthalmitis.

Purpose To describe how vitreoretinal specialists have incorporated the Endophthalmitis Vitrectomy Study (EVS) findings into current practice, to highlight divergences from the EVS recommendations, and address the role of microbial culture in guiding additional treatments. Methods This is a cross-sectional survey of vitreoretinal specialists regarding indications used for performing a pars plana vitrectomy (PPV), selection of antibiotics for treatment, utilization of cultures, and treatment strategies for treatment-refractory patients with bacterial endophthalmitis. Results Of 681 physicians contacted, 149 (21.9%) responded. For patients with visual acuity of light perception or less, 75% of respondents utilized PPV. Intravitreal vancomycin and ceftazidime were used by 100% and 96% of participants respectively. Vitreal cultures were obtained more than 50% of the time by 86.5% of participants, and were used to influence retreatment less than 50% of the time by 77.8% of respondents. For patients with worsening clinical signs 48 hours after initial treatment, 69.8% of participants performed PPV with intravitreal antibiotics. Conclusions Although most respondents followed the EVS guidelines, a minority deviated, and the majority generalized their strategy to other forms of endophthalmitis. There is significant variation in retreatment strategies, and while cultures are frequently obtained to help guide these treatments, they are utilized infrequently.
Becoming an Hispanic-Serving Research Institution: Involving Graduate Students in Organizational Change.

The changing demographics of higher education have led to an increase in the number and type of Hispanic-Serving Institutions (HSIs). As research universities continue to see a rise in the enrollment of Latino/a students, a better understanding of the implications of this change within the existing institutional context will be essential to best serve this growing community of students. We position our study within a tradition of organizational culture theory that points to the importance of organizational actors’ interpretations, perspectives, and actions in order to understand an organization’s general behavior and change. By acknowledging the importance of graduate students within research universities, we focus on their perspectives at an Emerging Hispanic-Serving Research Institution (HSRI) and ask, “What are the organizational culture implications of an HSI designation for a research university?” Our analysis revealed four important themes: communicating institutional pride as an HSRI, engaging the benefits of an HSRI, operationalizing a serving mission, and involving graduate students as institutional actors at HSRIs. Institutional recommendations that follow from our findings include providing clear communication regarding HSI status, objectives, and commitment; assessing the campus climate; and increasing graduate student involvement as key leaders within HSRIs.
Critical Factors to Practicing Medical Acupuncture in Family Medicine: Patient and Physician Perspectives.

Introduction Although an increasing number of physicians are completing medical acupuncture training, only half of those physicians are able to successfully incorporate acupuncture into practice. We conducted a qualitative study to identify the factors and barriers that can enhance and impede physicians' delivery of and patients' engagement in medical acupuncture within the family medicine clinic. Methods We conducted interviews with 15 family physicians and 17 patients in a US family medicine clinic that has integrated medical acupuncture into its practice. Audio recordings were transcribed and analyzed by 2 members of the study team in ATLAS.ti, using the constant comparative method. Results We identified 3 physician themes of factors/barriers that impact delivery/engagement: 1) patients' aversion to needles, 2) time challenges, and 3) access to resources. We identified 3 additional themes from patient interviews: 1) appointment access; 2) wanting noninvasive, no side effects alternative; and 3) openness to anything. Discussion The factors and barriers reported by physicians/patients help illustrate conditions needed to enhance physicians' ability to provide acupuncture and patients' willingness to engage and sustain it. Participants' experiences help to illustrate strategic approaches to managing these barriers-strategies that can be used by other individuals/institutions to enhance care delivery and patient engagement.
The Exoskeletons in our Closets: A synthesis of research from the ‘Arthropods of our Homes’ project in Raleigh, NC

The history of people living with insects, spiders and their relatives is long, probably as long as humans have been using fixed domiciles (e.g., caves). Studies of caves inhabited by prehistoric people 26,000 years ago suggest arthropod pests already lived alongside our ancestors in those caves (Araujo et al. 2009). Arthropods are also both abundant and diverse in domestic archaeological sites from agricultural civilizations in Egypt, Israel and Europe (Switzerland and Greenland). Arthropods are especially common in association with stored food products and livestock (Panagiotakopulu 2001; Overgaard Nielsen, Mahler, and Rasmussen 2000; Kislev, Hartmann, and Galili 2004).
Bluetongue virus-17 fusion protein NS1 expressed in Escherichiacoli by pUC vectors

Abstract The cDNA coding for the major nonstructural protein, NS1, of bluetongue serotype 17 (BTV-17) was cloned previously. Using pUC plasmids, we have successfully expressed the NS1 protein in Escherichia coli as a lacZ-NS1 fusion protein. The recombinant NS1 protein reacted with rabbit anti-BTV-17 antiserum, and was thus immunologically indistinguishable from the native BTV-17 NS1 protein. This was the first bluetongue viral protein to be produced in a bacterial system.
Of Transgression and Forgiveness

Philosophers, theologians, and lawyers concern themselves with the ethics of conflict resolution and the pragmatics of forgiveness. So do writers of literature. Ariel Dorfman's Death and the Maiden, a play set in the context of post-Pinochet Chile about the reaction of a woman to a chance encounter with the man whom she believes tortured her during the period of the army's rule, explores the ethics of revenge by dramatizing the struggle between the woman and her husband, a member of the national reconciliation board. It raises the question what is the proper response to one who has intentionally harmed you before plunging us into the psyche of the torturer, a doctor whose participation in the torture sessions transforms him from healer to sadistic torturer and rapist who acts because he finds himself in a situation in which he is free to cast aside all the restraints that civilization has constructed to keep us from that terrible freedom. The play forces us to confront not merely the question of what a "proper" response to having been tortured might be but also to consider how being tortured changes one. The central figure's husband repeatedly is forced to acknowledge the gap between his wife and himself-he escaped torture and remains a "liberal" desiring to achieve a peaceful reconciliation between the tortured and the torturers; she is filled with rage and desires vengeance (23-6, 33-42). To what extent is the individual psychological response shaped both by cultural expectations and by individual experiences? What kinds of psychologies are constituted by particular cultures and economic configurations? The larger movement that contains questions about the possibilities for individual and communal forgiveness is the quest for justice, in the course of which we will also touch on questions of transgression, punishment and responsibility. This essay starts with an analysis of Lone Star. The movie combines several cinematic genres: it is a western, a police procedural, and partakes of some of the conventions of film noir. In the second section of the essay, I examine an essay by Emmanuel Levinas on the Talmudic responsibility to forgive. Levinas, who died recently, was a Lithuanian Jewish philosopher engaged in the centuries long attempt to join the rigor of Athens with the ethical concerns of Jerusalem. Here I will interrogate Levinas' struggle to forgive Heidegger his Nazi politics as he feels Talmudically bound to do so. The last part of the essay returns to fiction and looks at The Reader, a German attempt to consider German responsibility for the Holocaust.
Real-Time Monitoring of Cation Dissolution/Deintercalation Kinetics from Transition-Metal Oxides in Organic Environments.

The future of high-voltage rechargeable batteries is closely tied to the fundamental understanding of the processes that lead to the potential-dependent degradation of electrode materials and organic electrolytes. To date, however, there have been no methods able to provide quantitative, in situ and in real time information about the electrode dissolution kinetics and concomitant electrolyte decomposition during charge/discharge. We describe the development of such a method, which is of both fundamental and technological significance. Our novel approach enables simultaneous and independent measurements of transition-metal cation dissolution rates from different oxide hosts (Co3+/4+ or Cr3+/4+), deintercalation kinetics of working cations (Mg2+), and the relative rate of electrolyte decomposition.
How is neighborhood social disorganization associated with diabetes outcomes? A multilevel investigation of glycemic control and self-reported use of acute or emergency health care services.

Diabetes management is influenced by a number of factors beyond the individual-level. This study examined how neighborhood social disorganization (i.e., neighborhoods characterized by high economic disadvantage, residential instability, and ethnic heterogeneity), is associated with diabetes-related outcomes. We used a multilevel modeling approach to investigate the associations between census-tract neighborhood social disorganization, A1c, and self-reported use of acute or emergency health care services for a sample of 424 adults with type 2 diabetes. Individuals living in neighborhoods with high social disorganization had higher A1c values than individuals living in neighborhoods with medium social disorganization (B = 0.39, p = 0.01). Individuals living in neighborhoods with high economic disadvantage had higher self-reported use of acute or emergency health care services than individuals living in neighborhoods with medium economic disadvantage (B = 0.60, p = 0.02). High neighborhood social disorganization was associated with higher A1c values and high neighborhood economic disadvantage was associated with greater self-reported use of acute or emergency health care services. Controlling for individual level variables diminished this effect for A1c, but not acute or emergency health care use. Comprehensive approaches to diabetes management should include attention to neighborhood context. Failure to do so may help explain the continuing disproportionate diabetes burden in many neighborhoods despite decades of attention to individual-level clinical care and education. For this study, we used baseline data from a larger study investigating the impacts on patient-centered outcomes of three different approaches to self-monitoring of blood glucose among 450 adults with non-insulin dependent type 2 diabetes living in North Carolina. This study was registered as a clinical trial on 1/7/2014 ( https://clinicaltrials.gov/ct2/show/NCT02033499 ).
The Results of Randomized Controlled Trials in Emergency Medicine Are Frequently Fragile.

Study objective Randomized controlled trials govern evidence-based clinical practice, and it is therefore critical that their results be robust. We aim to investigate the fragility of randomized controlled trials in emergency medicine by determining how often significance would be nullified with small changes in outcomes using the fragility index. Methods We conducted a methodological systematic review of randomized controlled trials in emergency medicine published in the top 10 general medicine journals and the top 10 emergency medicine journals. Inclusion criteria required that trials be emergency medicine studies structured with a 2-arm or 2-by-2 factorial design and report at least 1 statistically significant dichotomous outcome. Results A total of 180 trials met inclusion criteria. The median fragility index across all trials in emergency medicine was 4 (interquartile range [IQR] 2 to 10) and the median sample size was 140 (IQR 69.5 to 286). For trials from general medicine journals (n=32), the median fragility index was 9 (IQR 4 to 16.5) and the median sample size was 415.5 (IQR 219.5 to 901); for trials from emergency medicine journals (n=148), the median fragility index was 4 (IQR 1 to 9) and the median sample size was 119 (IQR 60 to 227.25). One third of all trials (62/180) had a loss to follow-up that was greater than or equal to the fragility index. There was a modest correlation between fragility index and total number of events ( r =0.36; 95% confidence interval [CI] 0.23 to 0.48) and a weak correlation between fragility index and total sample size ( r =0.26; 95% CI 0.12 to 0.39). There was no correlation between fragility index and either P value ( r =–0.14; 95% CI –0.28 to –0.006) or Science Citation Index ( r =0.07; 95% CI –0.08 to 0.22). Conclusion The statistical significance of the results of randomized controlled trials in emergency medicine was often contingent on a small number of events. Until frequentist interpretation of clinical trials is replaced with Bayesian analysis, the fragility index may have utility as a tool to aid clinicians in assessing the robustness of randomized controlled trials in emergency medicine when considered in conjunction with the fragility quotient and other reported metrics.
Predicting Polygenic Risk of Psychiatric Disorders.

Abstract Genetics provides two major opportunities for understanding human disease—as a transformative line of etiological inquiry and as a biomarker for heritable diseases. In psychiatry, biomarkers are very much needed for both research and treatment, given the heterogenous populations identified by current phenomenologically based diagnostic systems. To date, however, useful and valid biomarkers have been scant owing to the inaccessibility and complexity of human brain tissue and consequent lack of insight into disease mechanisms. Genetic biomarkers are therefore especially promising for psychiatric disorders. Genome-wide association studies of common diseases have matured over the last decade, generating the knowledge base for increasingly informative individual-level genetic risk prediction. In this review, we discuss fundamental concepts involved in computing genetic risk with current methods, strengths and weaknesses of various approaches, assessments of utility, and applications to various psychiatric disorders and related traits. Although genetic risk prediction has become increasingly straightforward to apply and common in published studies, there are important pitfalls to avoid. At present, the clinical utility of genetic risk prediction is still low; however, there is significant promise for future clinical applications as the ancestral diversity and sample sizes of genome-wide association studies increase. We discuss emerging data and methods aimed at improving the value of genetic risk prediction for disentangling disease mechanisms and stratifying subjects for epidemiological and clinical studies. For all applications, it is absolutely critical that polygenic risk prediction is applied with appropriate methodology and control for confounding to avoid repeating some mistakes of the candidate gene era.
Recipients of the 2014 Early Career Investigator Awards

This is the ninth year of competition for ATVB Early Career Investigator Awards. The Awards recognize articles published in ATVB in 2013 that were submitted by new investigators and judged to be the most outstanding in the Atherosclerosis/Lipoprotein, Thrombosis, and Vascular Biology sections of the journal. The 3 awards are named after Dr Daniel Steinberg, who devised a method to determine the site of degradation of the proteins and lipids of …