cssi/SciSciGPT-SciSciNet huggingface dataset:
Cervicitis in Adolescents: Do Clinicians Understand Diagnosis and Treatment?

Background Cervicitis is widespread, but no studies have examined cervicitis in accordance with established guidelines for diagnosis and treatment. Study objectives were to describe adherence to Centers for Disease Control and Prevention guidelines for diagnosis and treatment of cervicitis within an adolescent population and to compare factors associated with adherence to guidelines in a primary care setting and the Emergency Department.
Estimation for rotational processes with one degree of freedom--Part I: Introduction and continuous-time processes

A class of bilinear estimation problems involving single-degree-of-freedom rotation is formulated and resolved. Continuous-time problems are considered here, and discrete-time analogs will be studied in a second paper. Error criteria, probability densities, and optimal estimates on the circle are studied. An effective synthesis procedure for continuous-time estimation is provided, and a generalization to estimation on arbitrary Abelian Lie groups is included. Applications of these results to a number of practical problems including frequency demodulation will be considered in a third paper.
Adaptation of the Mayo primary biliary cirrhosis natural history model for application in liver transplant candidates

The Mayo natural history model has been used widely as a tool to estimate prognosis in patients with primary biliary cirrhosis (PBC), particularly liver transplant candidates. We present an abbreviated model in which a tabular method is used to approximate the risk score, which may be incorporated in the minimal listing criteria for liver transplant candidates. Data used in the development and validation of the original Mayo model were derived from 418 patients with well-characterized PBC. To construct an abbreviated risk score in a format similar to that of Child-Turcotte-Pugh score, 1 to 3 cut-off criteria were determined for each variable, namely age (0 point for /=63 years), bilirubin (0 point for 6.4 mg/dL), albumin (0 point for >4.1, 1 for 2.8 to 4.1, and 2 for <2.8 g/dL), prothrombin time (1 point for normal and 2 for prolonged) and edema (0 point for absent and 1 for present). The intervals between these criteria were chosen in a way to enable a meaningful classification of patients according to their risk for death. This score is highly correlated with the original risk score (r = 0.93; P <.01). The Kaplan-Meier estimate at 1 year was 90.6% in patients with a score of 6. The abbreviated risk score is a convenient method to quickly estimate the risk score in patients with PBC. An abbreviated score of 6 may be consistent with the current minimal listing criteria in liver transplant candidates.
Impact of Climate Change on Elder Health

Demographers predict human life expectancy will continue to increase over the coming century. These forecasts are based on two critical assumptions: advances in medical technology will continue apace and the environment that sustains us will remain unchanged. The consensus of the scientific community is that human activity contributes to global climate change. That change will degrade air and water quality, and global temperature could rise 11.5°F by 2100. If nothing is done to alter this climatic trajectory, humans will be confronted by a broad spectrum of radical environmental challenges. Historically, children and the elderly adults account for most of the death toll during times of severe environmental stress. This article makes an assessment from a geriatric viewpoint of the adverse health consequences that global climate change will bring to the older segments of future populations in the United States.
Production of extracellular Cu complexing ligands by eucaryotic phytoplankton in response to Cu stress

Organic chelators that are thought to be of recent biological origin control copper speciation in seawater. Previous studies have often resolved these copper binding ligands into two classes, class 1 ligands (conditional stability constants 10 12 ‐10 14 M 21 ) and class 2 ligands (conditional stability constants 10 9 ‐10 12 M 21 ). At present the sources and structures of these chelators are unknown. Previous work has shown that in response to copper toxicity, cultures of the marine cyanobacteria Synechococcus spp. produce a strong ligand, similar in binding strength to class 1 ligands. We extended this work by surveying a suite of copper-stressed marine eucaryotic phytoplankton for the production of copper binding ligands. Most eucaryotic species we studied did not produce ligands with the binding strength of class 1 ligands, but many produced class 2 ligands. A marine dinoflagellate Amphidinium carteraewas found to produce very strong ligands; however, the low abundance of dinoflagellates in the open ocean may mean that this source of class 1 ligands is more important in coastal waters. This survey shows that there are many biological sources of copper binding ligands, but that procaryotes such as cyanobacteria are more plausible sources of class 1 ligands in the open ocean than eucaryotes. There is now considerable evidence to suggest that the distribution and speciation of trace metals in the upper water column play an important role in the species composition and physiology of phytoplankton assemblages (Sunda 1994). The chemical speciation of trace metals is important because only certain forms of a given metal are biologically available. In the upper water column, speciation of many biologically active trace metals is controlled by complexation with strong organic ligands (Bruland et al. 1991 and references therein). Complexation of the metal by an organic ligand generally lowers biological availability because the free metal ions are the most biologically available forms (Sunda 1994; Campbell 1995). In addition, complexation may play an important role in the geochemical cycling of these elements in the upper ocean. For many elements, concentrations of these ligands are highest in the euphotic zone and decline to non-detectable levels in the deep waters (Bruland et al. 1991; Rue and Bruland 1995). This distribution suggests that the ligands are of recent biological origin and are not refractory compounds. However, their biological function, if any, is unknown. Complexation is particularly important for Cu, an essential micronutrient that is also toxic. Field studies in coastal
A fully-integrated 3-level DC/DC converter for nanosecond-scale DVS with fast shunt regulation

In recent years, chip multiprocessor architectures have emerged to scale performance while staying within tight power constraints. This trend motivates per-core/block dynamic voltage and frequency scaling (DVFS) with fast voltage transition. Given the high cost and bulk of off-chip DC/DC converters to implement multiple on-chip power domains, there has been a surge of interest in on-chip converters. This paper presents the design and experimental results of a fully integrated 3-level DC/DC converter [1] that merges characteristics of both inductor-based buck [2–4] and switched-capacitor (SC) converters [5]. While off-chip buck converters show high conversion efficiency, their on-chip counterparts suffer from loss due to low quality inductors. With the help of flying capacitors, the 3-level converter requires smaller inductors than the buck converter, reducing loss and on-die area overhead. Compared to SC converters that need more complex structures to regulate higher than half the input voltage, 3-level converters can efficiently regulate the output voltage across a wide range of levels and load currents. Measured results from a 130nm CMOS test-chip prototype demonstrate nanosecond-scale voltage transition times and peak conversion efficiency of 77%.
Factors influencing child welfare employee's turnover: Focusing on organizational culture and climate

Abstract Organizational culture and climate have been studied within the context of understanding the effectiveness of business and for-profit organizations. But these organizational factors have not been seriously considered in the social welfare literature, particularly in the child welfare area, even though Glisson and his colleagues have studied organizational culture and climate. This paper addresses this void through a systematic examination of organizational culture and climate and their effects on employee turnover in child welfare. To do this, it uses mainly the workforce retention study survey data that the New York State Social Work Education Consortium (SWEC) conducted and collected in 2002 and 2003. Organizational culture is classified into achievement/innovation/competence (AIC), cooperation/supportiveness/responsiveness (CSR), and emphasis on rewards (ER), while organizational climate into role clarity (RC), personal accomplishment (PA), emotional exhaustion (EE), and workloads (WL). It employs a logistic regression model (LRM) in analyzing an individual child welfare worker's intention to leave the current job. Empirical findings indicate that organizational culture and climate are the significant factors to explaining an employee's intention to leave. In particular, ER in organizational culture is significant, implying that child welfare employees with clearer and more effective incentives and rewards for job performance have less intention to leave than those with less clear and effective incentives and rewards. EE in organizational climate is significant, implying that employees with higher levels of emotional energy have less intention to leave than those with lower levels of energy. These findings suggest that child welfare organizations can improve organizational culture and climate by supporting ER and reducing EE.
Implementation of blended instruction: A case study of secondary Family and Consumer Sciences

This qualitative study focused on the use of blended instruction as a method for teaching Family and Consumer Sciences Education (FCS). Blended instruction uses the best features of face-to-face and online instruction to create a rich learning environment. The study employed a descriptive case format to explore the perceptions of six FCS instructors and eight secondary FCS students who were engaged in the process of utilizing or learning how to use a blended instruction format. A review of the collected data indicated that, if the funding, training and continuing technology support is in place, then FCS instructors and students will come to experience a positive learning experience utilizing blended instruction. Schools in the study that struggled to provide these supports had students who were slower to achieve a perceived level of success using a blended instruction format. Blended learning has the potential to become the next cutting-edge use of technology not only in FCS but also Career and Technical Education (CTE) as well as general education classes. The researcher encourages the field of education, especially FCS and CTE, to explore further how the use of blended instruction can better facilitate instruction in a world that is increasingly becoming technologically advanced. The possibilities are only limited by the creativity and abilities of the FCS instructors who serve students for whom technology will become an embedded way of life and existence.
Solving airline crew scheduling problems by branch-and-cut

The crew scheduling problem is one that has been studied almost continually for the past 40 years but all prior approaches have always approximated the problem of finding an optimal schedule for even the smallest of an airline's fleets. The problem is especially important today since costs for flying personnel of major U.S. carriers have grown and now often exceed $1.3 billion a year and are the second largest item next to fuel cost of the total operating cost of major U.S. carriers. Thus even small percentage savings amount to substantial dollar amounts. We present a branch-and-cut approach to solving to proven optimality large set partitioning problems arising within the airline industry. We first provide some background related to this important application and then describe the approach for solving representative problems in this problem class. The branch-and-cut solver generates cutting planes based on the underlying structure of the polytope defined by the convex hull of the feasible integer points and incorporates these cuts into a tree-search algorithm that uses automatic reformulation procedures, heuristics and linear programming technology to assist in the solution. Numerical experiments are reported for a sample of 68 large-scale real-world crew scheduling problems. These problems include both pure set partitioning problems and set partitioning problems with side constraints. These "base constraints" represent contractual labor requirements and have heretofore not been represented explicitly in the construction of crew schedules thus making it impossible to provide any measure of how far the obtained solution was from optimality. An interesting result of obtaining less costly schedules is that the crews themselves are happier with the schedules because they spend more of their duty time flying than waiting on the ground.
Wind-Driven Motions in the Northeast Pacific as Measured by Lagrangian Drifters

Abstract Analysis is presented of the time-dependent motion of 47 surface drifters in the northeast Pacific during fall 1987 and 16 drifters in fall and winter 1989/90. The drifters were designed at 15-m depth and were designed to have wind-produced slips less than 2 cm s−1 for wind speeds up to 20 m s−1. The coherence of velocity and local wind is presented for motions with periods between 1 day and 40 days. For periods between 5 and 20 days, drogue motion at 15-m depth is found to be highly coherent with local wind with an average phase of 70° to the right of the rotating wind vector. These results differ from analyses of FGGE-type drifters as reported by McNally et al. and Niiler in the same area. A model of wind-produced slip as a function of drifter design is used to provide a possible explanation of the differences. A linear regression, which accounts for 20%–40% of the current variance, gives water motion al 0.5% of wind speed and 68° to the right of the wind vector. Assuming an Ekman-type balance,...
THE DETERMINANTS OF CAPITAL STRUCTURE IN REAL ESTATE INVESTMENT TRUSTS

In this paper, I attempt to explain REITs borrowing behavior. With the absence of tax-deductibility advantage, several non-tax-driven benefits of leverage induce REITs managers to issue debt. Accordingly, I diagnose the relative importance of several non-tax-driven benefits of leverage in deriving the capital structure decisions of REITs. Consistent with the pecking order theory of leverage, REITs with higher existing investment use more debt; REITs with higher profitability issue less debt; and REITs with higher expected investment use less debt. I conclude that REITs managers issue debt mainly to avoid issuing equity and to maximize wealth of existing
A case-based approach for teaching professionalism to residents with online discussions

Introduction: Programs must demonstrate that their residents are taught and assessed in professionalism. Most programs struggle with finding viable ways to teach and assess this critical competency. UTHSCSA Family and Community Medicine Residency developed an innovative option for interactive learning and assessment of residents in this competency which would be transferrable to other programs and specialties. Methods: The innovative approach uses an asynchronous online format on Blackboard. Threaded discussions on Blackboard require thoughtful reflective writing after case assessment and critical evaluation of other resident posts. Participation, content and progress of all resident postings are monitored by administrative staff and faculty. Faculty can further engage the residents at any point to deepen the discussion and learning. Results: 100% of all senior residents attained the required learning objectives. All were actively engaged in the assignments. Six cases have been developed using a Learning Matrix to demonstrate evaluation areas from the specialty specific competencies. Written feedback from residents verified the validity of case content in context of their current clinical practice. Postings by residents have provided value and insight for the faculty to access the professional development of our Family Medicine residents. The Clinical Competency Committee evaluates all third year residents using this information specific to the professionalism milestones. By using an asynchronous online approach to case discussion, all residents are involved with all aspects of this curriculum. Conclusions: More specific measurable learning outcomes are possible using this approach. Resident participation and engagement is easier to track and monitor than a lecture-based format and easier to capture valuable data than relying on evaluation feedback. Our Annual Review process will identify areas for improvement in the existing cases and help create supplemental cases based on a needs assessment by the faculty. Keywords: Milestones; Professionalism; Residency; e-learning
RELATIVE RATES OF OXIDATION OF PALMITATE-1-C14 BY WHITE BLOOD CELLS, RED CELLS AND PLATELETS OF RATS.

SummaryFatty acid oxidation by blood cells in vitro has been studied by incubation of 10-times diluted blood of the rat with pal-mitate-1-C14, followed by determination of C14O2 evolved. A modification of the method was introduced for separation of white cells, platelets and red cells by differential centrifu-gation, in order to increase the accuracy of the determinations. The effect of diluted plasma on rate of palmitate-1-C14 oxidation and action of plasma albumin were taken into consideration. Experimental data indicate that a major portion of the total palmi-tate-l-C14 oxidation in vitro per unit volume of blood is attributable to white cells and platelets, whereas palmitate-1-C14 oxidation by red cells is very limited and probably occurs only in the youngest circulating cells. On a per cell basis, white cells oxidize pal-mi tate-l-C14 at a rate which is about 60 times greater than that of platelets and about 800 times greater than that of red cells with reticulocytes.
Interdiffusion and Stress Evolution During Solid-State Amorphization in Ni-Hf Thin-Film Diffusion Couples

Using a combination of x-ray diffraction and curvature measurements, the stress evolution during solid-state amorphization in a Ni-Hf diffusion couple has been monitored. In contrast to the Co-Hf system, no dissolution of Ni in Hf is observed. During interdiffusion, the growing amorphous layer develops a large tensile stress, which subsequently relaxes by creep. Irradiation of the diffusion couple leads to an increase in tensile stress, and a further increase following a subsequent anneal. Composition measurements by Rutherford backscattering spectrometry indicate absence of an effect of the stress variations on the effective interdiffusion coefficient.
Enoxaparin and Antifactor Xa Levels in Acute Burn Patients

Altered pharmacokinetics in critically ill patients have been shown to result in inadequate enoxaparin dosing for venous thromboembolism (VTE) prophylaxis. In the burn unit, routine monitoring of antifactor Xa levels was implemented to ensure adequate VTE prophylaxis. The purpose of this study was to examine the appropriateness of enoxaparin dosing for VTE prophylaxis in this specialized patient population. The authors reviewed patients with acute burn injury from June 1, 2009, to October 20, 2009, who had enoxaparin therapy monitored with antifactor Xa levels. Data collection occurred prospectively. Thirty-eight patients received enoxaparin subcutaneously for prophylaxis of VTE and had antifactor Xa levels measured. Thirty (79%) patients had initial antifactor Xa levels less than 0.2 U/ml. Enoxaparin dosages were subsequently increased as needed to achieve antifactor Xa levels of 0.2 to 0.4 U/ml. Eight of 38 patients never achieved goal antifactor Xa level before enoxaparin was discontinued. The median final dose required to achieve an antifactor Xa level within therapeutic range was 50 mg every 12 hours (range 30-70 mg). In linear regression, final enoxaparin dose correlated with TBSA. Two patients had clinically significant thromboembolic events. There were no documented episodes of significant hemorrhage, thrombocytopenia, or heparin-associated allergy. The low antifactor Xa levels observed in this study demonstrate that standard dosing of enoxaparin for VTE prophylaxis is inadequate for patients with acute burns. In these patients, both a higher initial enoxaparin dose and routine monitoring of antifactor Xa levels are recommended.
Ion Implantation Damage in Aluminum Studied by Quantitative Electron Chanelling and Tem.

Electron chanelling linewidth changes in aluminum have been measured as a function of dose for boron and aluminum ion implantation. Weak beam TEM observations assist interpretation of the results by showing the nature and degree of the damage. For self implantation, a linear relationship between dose, linewidth, and dislocation density has been found up to 3×1017ions/cm2. For boron implantation, a new point-like defect appears at the higher boron concentrations, giving a much slower increase of chanelling linewidth with dose above l×1016 ions/cm2. Boron interaction with the damage stabilizes higher damage acumilations than for sel f-i mpl antati on.
How to use psychiatry well: religious communities, medicalization, and the person

How do members of religious communities determine when medicalization—the use of medical models to account for forms of experience and behavior previously understood using religious and spiritual categories—is appropriate? Psychiatry, as a discipline, lacks any consensual, conceptually valid method by which to demarcate the boundaries of its professional and clinical domain: although psychiatry understands itself as the medical discipline dedicated to the prevention, diagnosis, and treatment of “mental disorders”, psychiatry’s most widely accepted definition of “mental disorder” is both practically impotent and conceptually flawed. Psychiatry, therefore, lacks internal conceptual resources adequate to resist inappropriate medicalization. Considered as a social process, however, medicalization is rarely unidirectional: it frequently involves collaboration between clinicians and the individuals and communities affected by a new medical diagnosis or category. This has historically been true of the medicalization of forms of life previously regarded as religious or spiritual matters, as is made clear by the examples of the medicalization of problem drinking, the medicalization of emotional disturbances, and the medicalization of post-combat suffering. Religious communities, therefore, must discern for themselves when psychiatric medicalization is appropriate and when it is not. Four guiding questions can aid religious communities in developing a prudential approach to using psychiatry in the service of the person.
Relational vulnerability and the research process with former prisoners in Athens, Georgia (USA)

AbstractA host of power relations are structurally imposed upon the imprisoned and these produce vulnerabilities that require considerable energy and attention. This paper argues, however, that ‘vulnerable populations’ is a politically reactive legal category in the context of research with prisoners. In turn, this form of categorical vulnerability is often misaligned with ‘actually existing vulnerability’ or 'relational vulnerability' in the context of prison life. Substantive ethical, methodological and practical problems result from this misalignment, as I illustrate through the case of my research with former prisoners in Athens, Georgia. I seek to prove two claims in support of my central argument. First, actually existing vulnerability is fundamentally relational and it involves the researcher, the researched, collaborators, and (often distant) people and social structures that were not necessarily directly involved in the research process. Second, vulnerability is a spatially and temporally conting...
Pediatric obesity pharmacotherapy: current state of the field, review of the literature and clinical trial considerations

Despite the increasing number of medications recently approved to treat obesity among adults, few agents have been formally evaluated in children or adolescents for this indication. Moreover, there is a paucity of guidance in the literature addressing best practices with regard to pediatric obesity pharmacotherapy clinical trial design, and only general recommendations have been offered by regulatory agencies on this topic. The purposes of this article are to (1) offer a background of the current state of the field of pediatric obesity medicine, (2) provide a brief review of the literature summarizing pediatric obesity pharmacotherapy clinical trials, and (3) highlight and discuss some of the unique aspects that should be considered when designing and conducting high-quality clinical trials evaluating the safety and efficacy of obesity medications in children and adolescents. Suggestions are offered in the areas of target population and eligibility criteria, clinical trial end-point selection, trial duration, implementation of lifestyle modification therapy and recruitment and retention of participants. Efforts should be made to design and conduct trials appropriately to ensure that high-quality evidence is generated on the safety and efficacy of various medications used to treat pediatric obesity.
Regulation of function and expression of P-selectin

P-selectin is an adhesion receptor for leukocytes that is expressed on activated platelets and endothelial cells. The surface expression of P-selectin is tightly regulated through signals in the cytoplasmic domain that mediate sorting into secretory granules, internalization into coated pits, and targeting to lysosomes for degradation. Like the other selectins, P-selectin binds sialylated, fucosylated carbohydrate ligands such as sialyl Lewis x. However, it binds with much higher affinity to PSGL-1, a sialomucin-like glycoprotein on myeloid cells. Binding of PSGL-1 to P-selectin may be essential for leukocytes to roll on P-selectin-expressing cells under shear forces.
Competency-based Professional Development

ABSTRACTProfessional development can be a challenge for LIS professionals upon leaving graduate school and entering the work force. Engaging in an ongoing self-assessment of core competencies can assist LIS professionals in meeting their career goals. The Multi-Subject Learning Survey (MSLS) was administered to practicing librarians for a self-assessment of their abilities. Responses were analyzed through SPSS software to ascertain levels of ability in eight categories. A t test was performed for any significant differences between the groups of librarians. The survey was effective in identifying skills for improvement. Potential use by administrators for professional development and career planning were identified.
The Implications of Computer‐Mediated Communication (CMC) for Social Support Message Processing and Outcomes: When and Why Are the Effects of Support Messages Strengthened During CMC?

Widespread use of computer-mediated communication (CMC) for exchanging social support has raised questions about the support-related implications of CMC. This study drew from the dual-process theory of supportive message outcomes and examined the implications of CMC for support message processing and outcomes. We hypothesized that the reduced social cues in CMC would encourage greater elaboration on support message content and lead support messages to have a greater impact than in face-to-face interaction. The results of the experiment showed that, although the support message was held constant, participants in the CMC condition reported the strongest motivation to receive support, engaged in the greatest level of message elaboration, and experienced the most beneficial changes in worry and uncertainty discrepancy.
Abstract P104: Serum 25-hydroxyvitamin D Levels and Incidence of Atrial Fibrillation: The Atherosclerosis Risk in Communities Study

Introduction: Low levels of serum 25-hydroxyvitamin D [25(OH)D] have been associated with an increased risk of cardiovascular disease (CVD). However, few studies have examined the association of 25(OH)D with atrial fibrillation (AF). Hypotheses: Individuals with clinically deficient serum 25(OH)D levels (<20 ng/mL) will have an increased risk for AF, and the association will be stronger among whites than blacks. Methods: The Atherosclerosis Risk in Communities (ARIC) study is a biracial, community-based cohort in the United States. A total of 12,300 ARIC participants (77% white, 57% women, mean age 57) with available 25(OH)D levels, and who were free of AF at baseline (1990-92), were followed through 2011. Total serum 25(OH)D was measured in stored samples at baseline using LCMS and adjusted for month of blood draw to account for seasonal differences in 25(OH)D levels. Incident AF cases were identified from electrocardiograms, hospital discharge codes, and death certificates. Multivariable Cox models were used to estimate hazard ratios and 95% confidence intervals for AF associated with serum 25(OH)D levels by clinical cut-points. Interactions by age, race, and sex were tested. Results: During a median follow-up of 20 years, there were 1,706 incident AF events. Those with deficient 25(OH)D levels ( 30 ng/mL) after adjustment for demographics (Table, model 1). Additional adjustment for cardiovascular risk factors and history of CVD attenuated the associations (Table, models 2 and 3). A significant interaction with age (p=0.01), but not with race or sex (p >0.40), was identified, with an inverse association between serum 25(OH)D in younger but not older individuals (Table). Conclusions: After accounting for traditional cardiovascular risk factors, low serum 25(OH)D was not associated with risk of incident AF in this community-based population. However, an apparent association in younger individuals (47-57) warrants further investigation. ![][1] [1]: /embed/graphic-1.gif
Teaching Microarchitecture through Metaphors

Students traditionally learn microarchitecture by studying textual descriptions with diagrams but few analogies. Several popular textbooks on this topic introduce concepts such as pipelining and caching in the context of simple paper-only architectures. While this instructional style allows important concepts to be covered within a given class period, students have difficulty bridging the gap between what is covered in classes and real-world implementations. Discussing concrete implementations and complications would, however, take too much time. In this paper, we propose a technique of representing microarchitecture building blocks with animated metaphors to accelerate the process of learning about complex microarchitectures. We represent hardware implementations as road networks that include specific patterns of traffic flow found in microarchitectural behavior. Our experiences indicate an 83% improvement to understanding memory system microarchitecture. We believe the mental models developed by these students will serve them in remembering microarchitectural behavior and extend to learning new microarchitectures more easily.
Vocal Health Education and Medical Resources for Graduate-Level Vocal Performance Students

Summary Objective/Hypothesis Most agree that education about vocal health and physiology can help singers avoid the development of vocal disorders. However, little is known about how this kind of education is provided to singers as part of their formal training. This study describes the amount of instruction in these topics provided through graduate-level curricula, who provides this instruction, and the kinds of affiliations such graduate singing programs have with medical professionals. Study Design This is an online survey of music schools with graduate singing programs. Methods Survey questions addressed demographics of the programs, general attitudes about vocal health instruction for singers, the amount of vocal health instruction provided and by whom it was taught, perceived barriers to including more vocal health instruction, and any affiliations the voice program might have with medical personnel. Results Eighty-one survey responses were received. Instruction on vocal health was provided in 95% of the schools. In 55% of the schools, none of this instruction was given by a medical professional. Limited time in the curriculum, lack of financial support, and lack of availability of medical professional were the most frequently reported barriers to providing more instruction. When programs offered more hours of instruction, they were more likely to have some of that instruction given by a medical professional ( P = 0.008) and to assess the amount of instruction provided positively ( P = 0.001). Conclusion There are several perceived barriers to incorporating vocal health education into graduate singing programs. Opportunity exists for more collaboration between vocal pedagogues and medical professionals in the education of singers about vocal health.
Clinical and imaging predictors of management in retained products of conception

To determine if clinical and ultrasound (US) imaging features help predict management in clinically suspected retained products of conception (RPOC). 334 patients sonographically evaluated for RPOC were included in this IRB-approved retrospective study. Of the 334 patients, 176 had sonographic diagnosis of RPOC and comprised the final study group. Patients were managed expectantly, medically, or surgically in accordance with clinical judgment of treating physicians. Pelvic sonograms were retrospectively reviewed for endometrial stripe thickness and vascularity was graded on a 0–3 scale based on appearance relative to myometrium (Grade 0: no vascularity, Grade 1: minimal vascularity, Grade 2: moderate vascularity, Grade 3: marked vascularity). Clinical and imaging predictors of management were evaluated in univariate and multivariate analysis. Mean patient age was 29.6 years and mean gestational age was 17.4 weeks. Most (74.4%) women presented with vaginal bleeding. 83 patients (47.2%) were treated conservatively with expectant management, 42 (23.8%) were treated medically, and 51 (29.0%) required surgical intervention. Mean endometrial stripe thickness was 21.3 mm. 47 women (26.7%) had vascularity score of 0; 50 (28.4%) had score 1; 52 (29.6%) had score 2; and 27 (15.3%) had score 3. In univariate analysis, serum hemoglobin (Hb) (p < 0.0001), endometrial stripe thickness on US (p < 0.005), presenting symptoms (p = 0.03), and US vascularity score (p < 0.005) were statistically significant predictors of final management. In multivariate logistic regression, serum Hb (OR 0.69, 95% CI 0.55–0.86, p < 0.0009), endometrial stripe thickness (OR 1.08, 95% CI 1.04–1.12, p < 0.0001), and US vascularity score (OR 1.77, 95% CI 1.16–2.70, p < 0.01) were statistically significant predictors of need for surgery. Serum Hb, endometrial stripe thickness, and US vascularity score were significant predictors of clinical management, particularly the need for surgical intervention, in women with clinically suspected RPOC.
Assessment of quality of life in inoperable malignant dysphagia: A review of patients' perception of palliative treatment.

A41 Esophageal carcinoma is one of the most common cancers in the world and is a major cause of morbidity and death in the United States. Surgery has curative potential in a proportion of patients with esophageal cancer, but is associated with a high rate of morbidity and mortality even in specialized centers. Once recurrent most treatment goals related to these patients will be palliative in nature, and quality of life (QOL) assessment is crucial for the evaluation of health care outcome. The objective of this study was to review the different methods used in reported investigations on the physical and psychosocial correlates of palliative treatment of esophageal cancer during the last ten years. One hundred and eighty one reports searched in PubMed on palliative treatment and quality of life in esophageal cancer patients were reviewed. Four QOL instruments were identified and evaluated with respect to definitions, measurement and findings. Analysis reveals that no one instrument was ideal for assessing palliative intervention for head and neck cancer. However, the EORTC (European Organization for Research and Treatment of Cancer), and the SF36 were the most frequently used on the published reports. Despite a growing awareness and interest in QOL of esophageal cancer patients as seen in more recent prospective studies, definitive validation of patient assessment to date has been limited in scope with both problems and promise seen in most reports. In general, palliative longitudinal studies are almost non-existent with little known about the impact or comorbidity of smoking and alcohol use upon the disease progression and correlation with QOL.
Technology-Based Interventions and Trainings to Reduce the Escalation and Impact of Alcohol Problems

There has been a rapid increase in the development of technological innovations to reduce the escalation and impact of alcohol problems among adolescents and adults. Technology-based interventions offer the possibility of reaching individuals who otherwise might not seek treatment, (e.g., those in remote areas, those not perceiving a need for treatment, or others who may resist treatment). This article describes four case examples of technology-based interventions for risky drinking: 1) a freely available and interactive website that provides individualized feedback and information on risky drinking patterns; 2) a brief intervention for adolescents that provides individualized feedback to teens regarding their alcohol use; 3) a computer-delivered screening and brief intervention for alcohol use among pregnant women, and 4) a simulation program for training social workers in screening and brief intervention. These case examples highlight how technology may have a role in addressing the Alcohol Misuse Grand Challenge.
Analysis of pelvic fracture pattern and overall orthopaedic injury burden in children sustaining pelvic fractures based on skeletal maturity.

AbstractPurposeThe purpose of this study was to review pelvic fractures and concomitant orthopaedic injuries in children who have a patent triradiate cartilage (TRO) compared with children whose triradiate cartilage has closed (TRC). We hypothesise that these injuries will differ, leading to correlated alterations in management.Patients and MethodsUsing a database, we retrospectively reviewed patients aged below 18 years with pelvic fractures presenting to our Level 1 trauma center. Radiographs and CT scans were reviewed to identify orthopaedic injuries and categorise pelvic injuries using the modified Torode classification between the two groups.ResultsA total of 178 patients met inclusion criteria (60 TRO and 118 TRC). Mean age ± SD for TRO and TRC groups were 8 ± 4 years and 16 ± 2 years, respectively. TRO patients were more likely to present as a pedestrian struck by a vehicle (odds ratio (OR) 6.0; p < 0.001) and less likely to present after a motor vehicle collision (OR 0.2; p < 0.001). TRO patients ...
Care disparities: moving from gray to black and white.

Equity in the delivery of health care is one of the principal domains of health care quality as defined by the Institute of Medicine (IOM) ([1][1]). Despite this, more than 100 studies have demonstrated racial differences in cardiovascular care in the U.S. These pervasive findings have prompted the
A Rich Cluster Redshift Survey for Large-Scale Structure Studies

We have used the MX multifiber spectrometer on the Steward 2.3m measuring redshifts of up to 25 galaxies in each of about 90 Abell cluster fields with richness class R ≥ 1 and mag10 ≤ 16.8 (estimated z ≤ 0.12) and no more than one previously-measured redshift. This work has resulted in a deeper, more complete sample for two-point correlation and other studies of large-scale structure. To date, we have collected such data for 110 clusters (a few not in our sample). For most, we have seven or more cluster members with redshifts, enough to add significantly to the available sample of cluster velocity dispersions for other studies of cluster properties.
Gender Diversity in General Surgery Residency Leadership

Objective This study aimed to evaluate the proportion and characteristics of women who serve in general surgery program director (PD) and associate program director (APD) positions in the United States. Design General surgery programs (n = 276) and directors were identified using the Association for Program Directors in Surgery website; information was cross-referenced with American Medical Association FREIDA and Accreditation Council for Graduate Medical Education databases, current to July 1, 2017. Each program's website was accessed to determine the gender and academic ranking of faculty. Results Results reveal a preponderance of men in PD and APD positions. Women accounted for 18.4% (n = 51) of the 276 PD positions, with more women in APD positions (29.6%). There was no correlation between gender of PD and the corresponding APD, (χ2 = 0.68, p = 0.41; Phi coefficient = −0.0695). Of those with academic appointments, men who were PDs were more likely to be full professors when compared to women PDs (38.5% vs 24.1%, respectively). The median number of days since appointment to PD was similar in both groups (1461 days for men vs 1377 for women, p = 0.18), although more men have held PD positions longer. Programs with a higher proportion of women faculty were more likely to have a woman PD (p = 0.0397), but not those with more women residents (p = 0.225) or a woman Department Chair (p = 0.56). Conclusions Among general surgery program directorship, men continue to hold more positions of educational leadership, although the trend appears to be shifting toward a more equal balance, particularly in those programs with proportionately more women faculty. This discrepancy may be due to academic rank or length of tenure. As more women hold academic positions in the field of general surgery, an increase in the representation of this group in leadership is anticipated. Although senior leadership (PD) positions remain disproportionately held by men, APD positions are filled by a greater percentage of women than academic surgical faculty, although the absolute percentage remains less than 50%. Educational leadership may be a viable path to academic leadership for both women and men.
Abstract TP119: Feasibility of Automated Analysis of Dual-Venc 4d Flow Mri to Assess Hemodynamics in Patients With Intracranial Atherosclerotic Disease

Purpose: Advanced imaging and automated image processing techniques were used to demonstrate the feasibility of 4D flow MRI as a clinical tool for assessment of intracranial hemodynamics in patient...
Rouleaux and saline replacement.

CONCLUSIONS Rouleaux is a phenomenon that commonly occurs in patients who have an increased number of circulating protein macromolecules. It is a benign, in vitro reaction that appears microscopically as red blood cells (RBCs) line up against each other; many liken the RBC aggregation to "stacked coins." This unexpected reactivity may cause confusion in direct agglutination testing such as reverse blood typing and crossmatching. Saline replacement is the established method to resolve rouleaux. True agglutination will remain when plasma is replaced with saline for resuspension of the RBC button. Rouleaux will no longer be seen when the plasma proteins are removed.
Sub-optimal switching in anti-lock brake systems using approximate dynamic programming

Optimal scheduling in an anti-lock brake system of ground vehicles is performed through approximate dynamic programming for reducing the stopping distance in severe braking. The proposed optimal scheduler explicitly incorporates the hybrid nature of the anti-lock brake system and provides a feedback solution with a negligible computational burden in control calculation. To this goal, an iterative scheme, called the value iteration algorithm, is used to derive the infinite horizon solution to the underlying Hamilton–Jacobi–Bellman equation. Performance of the proposed method in control of the brake system is illustrated using both linear-in-parameter neural networks and multi-layer perceptrons. Simulation results demonstrate potentials of the method.
Solution-Processable α,ω-Distyryl Oligothiophene Semiconductors with Enhanced Environmental Stability

We describe the rational design of oligothiophene semiconductors to facilitate solution-based fabrication of environmentally stable organic field-effect transistors (OFETs). Ultrathin films of α,ω-distyryl quaterthiophene (DS4T), pentathiophene (DS5T), and sexithiophene (DS6T) were prepared via solution processing to probe the effect of styryl end groups, oligomer length, and thin film structure on air stability. These films were prepared via solution deposition and thermal annealing of precursors featuring thermally labile ester solubilizing groups. A detailed study of the thin film structure was performed using atomic force microscopy (AFM), near-edge X-ray absorption fine structure (NEXAFS) spectroscopy, and grazing incidence X-ray diffraction (GIXD). Functional OFETs were obtained for DS5T and DS6T and have, respectively, hole mobilities of 0.051 and 0.043 cm2/(V s) and on/off ratios of 1 × 105 to 1 × 106, whereas DS4T OFETs failed to function because of poor film continuity. The effect of both short-...
Arabs in Israel (1980)

Emphasizing the importance of temporal considerations, as discussed in this volume’s introductory chapter, the present chapter summarizes the circumstances of Israel’s Arab citizens in the 1970s and reviews the historical trajectory of experience and reaction that brought them to the situation and to the challenges they faced at that time. The discussion of these challenges includes consideration of the actions of, and the relationships with, the Israeli state. Particular attention is given to the tying of Israel’s national identity and political mission to the religion of the country’s Jewish majority, which makes Israel’s Arab citizens a religious minority in a Non-Secular state, as this minority group type is described and defined in the introductory chapter. The results of the historical trajectory of Israel’s Arab citizens and of this minority’s unavoidably inferior political status are discussed with respect to economic underdevelopment, land alienation, constraints on political mobilization, and continuity and change in social and cultural orientations.
Configurable Reference RF Source and its Radiated Emission Model for Site Correlation

This paper presents a configurable radio frequency reference noise source and its radiated emission (RE) simulation model. This noise source is representative of actual PLC and IO products with a High Speed Gigabit backplane. It is designed to produce a reference noise signature from 30 MHz to 6GHz with radiated emission levels close to the class A electromagnetic radiation disturbance limits of CISPR 11 and CISPR 22. A radiated emission model of this noise source was established to investigate design factors. Multiple emissions scans were performed in two separate semi-anechoic chambers located in different facilities in order to test the repeatability of this noise source. Measurement results indicated that the noise source has very good repeatability and that it can serve as a reference noise source. The results were also used to evaluate the maturity of the simulation technology, as well as, to quantify the difference between chambers.
Efficiencies and Pareto efficiencies of set-valued mappings on ordered spaces

In this paper, we extend the concepts of the maximal and minimal efficiencies of nonempty subsets with respect to a convex cones in topological vector spaces to maximum, minimum, maximal and minima...