cssi/SciSciGPT-SciSciNet huggingface dataset:
Interannual variation in soil CO2 efflux and the response of root respiration to climate and canopy gas exchange in mature ponderosa pine

We examined a 6-year record of automated chamber-based soil CO 2 efflux (F s ) and the underlying processes in relation to climate and canopy gas exchange at an AmeriFlux site in a seasonally drought-stressed pine forest. Interannual variability of F s was large (CV = 17%) with a range of 427g C m -2 yr -1 around a mean annual F s of 811 g C m -2 yr -1 . On average, 76% of the variation of daily mean F s could be quantified using an empirical model with year-specific basal respiration rate that was a linear function of tree basal area increment (BAI) and modulated by a common response to soil temperature and moisture. Interannual variability in F s could be attributed almost equally to interannual variability in BAI (a proxy for above-ground productivity) and interannual variability in soil climate. Seasonal total F s was twice as sensitive to soil moisture variability during the summer months compared with temperature variability during the same period and almost insensitive to the natural range of interannual variability in spring temperatures. A strong seasonality in both root respiration (R r ) and heterotrophic respiration (R h ) was observed with the fraction attributed to R r steadily increasing from 18% in mid-March to 50% in early June through early July before dropping rapidly to 10% of F s by mid-August. The seasonal pattern in R r (10-day averages) was strongly linearly correlated with tree transpiration (r2 = 0.90, P<0.01) as measured using sap flux techniques and gross ecosystem productivity (GEP, r2 = 0.83, P<0.01) measured by the eddy-covariance approach. R r increased by 0.43 g C m -2 day -1 for every 1g C m -2 day -1 increase in GEP. The strong linear correlation of R r to seasonal changes in GEP and transpiration combined with longer-term interannual variability in the base rate of F s , as a linear function of BAI (r2 = 0.64, P = 0.06), provides compelling justification for including canopy processes in future models of F s .
Barter's Back! Internet Barter: The Recent Resurgence of an Ancient Practice

A barter transaction allows for two parties to exchange goods or services without using money. Direct barter is often referred to as the “double coincidence of wants” and requires that each of the two parties involved in the transaction each have a good satisfying a specific need of the other party. This results in high transaction costs, primarily associated with the search to find the “double coincidence” necessary for a direct barter transaction. There is an additional cost due to the uncertainty of the value of the goods traded. This cost is primary associated with the need for the receiving party to use the traded good or to trade it in another transaction. Indirect barter uses an intermediary good in the exchange, such as a trade token. The prevalence of barter is expected to be limited due to high transaction costs because the time and effort involved in the transactions would be costly. However, the use of barter appears to be increasingly on the rise. A major contributing factor to this growth is the use of existing and emerging electronic commerce technologies, such as search engines and transaction processing systems, that may be used over a global network of hundreds of millions of users. This paper gives an overview to barter, gives some examples of Internet-based barter networks, and introduces likely characteristics of electronic based barter market mechanisms. Future research in this area will include economic modeling of electronic commerce based barter systems and the explicit design of online barter market mechanisms.
Lateral n-channel inversion mode 4H-SiC MOSFETs

Advances in MOS devices on silicon carbide (SiC) have been greatly hampered by the low inversion layer mobilities. In this paper, the electrical characteristics of lateral n-channel MOSFETs fabricated on 4H-SiC are reported for the first time. Inversion layer electron mobilities of 165 cm/sup 2//V/spl middot/s in 4H-SiC MOSFETs were measured at room temperature. These MOSFETs were fabricated using a low temperature deposited oxide, with subsequent oxidation anneal, as the gate dielectric.
Global MHD Simulations of Space Plasma Environments: Heliosphere, Comets, Magnetospheres of Planets and Satellites

Magnetohydrodynamics (MHD) provides an approximate description of a great variety of processes in space physics. Accurate numerical solutions of the MHD equations are still a challenge, but in the past decade a number of robust methods have appeared. Once these techniques made the direct solution of MHD equations feasible, a number of global three-dimensional models were designed and applied to many space physics objects. The range of these objects is truly astonishing, including active galactic nuclei, the heliosphere, the solar corona, and the solar wind interaction with planets, satellites, and comets. Outside the realm of space physics, MHD theory has been applied to such diverse problems as laboratory plasmas and electromagnetic casting of liquid metals. In this paper we present a broad spectrum of models of different phenomena in space science developed in the recent years at the University of Michigan. Although the physical systems addressed by these models are different, they all use the MHD equations as a unifying basis.
Simple and Hierarchical Models for Stochastic Test Misgrading

The test misgrading is treated in this paper as a stochastic process. Three characteristic values, the expected number of misgradings, the expected inter-occurrence time of misgradings, and the expected waiting time for the nth misgrading, are discussed based on a simple Poisson model and a hierarchical Beta-Poisson model. Regular tests for classroom teaching and the Test of Written English (TWE) in the Test of English as a Foreign Language (TOEFL) are illustrated as examples in the model construction. TEST rnisgrading is a fundamental problem in educational and psychological measurement. Even for well designed tests such as the Test of Written English (TWE) in the Test of English as a Foreign Language (TOEFL) (Educational Testing Service, 1992), scoring errors might still be unavoidable in a long-time hand-grading process (Braun, 1988). The expected number of misgradings is an important index for a test score evaluation. The expected interoccurrence time of misgradings is another reference index for administrators who need to set a time table for a test grading. Because there is no expected misgrading happening in the interoccurrence time, a reasonable waiting time for a short break is desired to be longer than the inter-occurrence time. On the other hand, given a time table, a researcher might want to know how many misgradings occurred before the short break. In general, the answer should come from a comparison between the expected waiting time for the nth misgrading and the waiting time for the short break. Hence, the information of interest for a test grading is three-fold:
N-dimensional perfect pipelining

Introduces a technique to parallelize nested loops at the fine grain level. It is a generalization of perfect pipelining which was developed to parallelize a single-nested loop at the fine grain level. The authors explain their method, contrast it with other techniques, show the effect of their technique on some real examples, and briefly discuss an architecture best suited for exploiting this parallelism. >
Free Will and Theodicy in Augustine: An Exposition and Critique

Not only for Augustine, but for virtually all Christian theologians, the doctrine of free will is of critical importance for theodicy. The reason for this is easy to state: these theologians trace either all (as in the case of Augustine) or much evil to human sin, which in turn is understood as an abuse of the free will with which human beings were endowed by their Creator. Augustine sums it very well: ‘… all that we call evil is either sin or punishment for sin’. The argument of this paper is that, unfortunately, Augustine's statements about free will are not adequate to the great theological burden placed upon them. Such a critical judgement is of considerable consequence for Christian theology generally, since Augustine exercised such an enormous formative influence upon later thinkers.
Rethinking of computation for future-generation, knowledge-rich speech recognition and understanding

A new trend is emerging in the semiconductor industry that future computation speedups will likely come more from parallelism than from having faster individual computing elements. Most algorithm designers for the current, HMMbased speech recognition systems, which have the recognition performance significantly lower than that of human, have not embraced this trend. This is partly attributed to the state-of-the-art sequential algorithms that have involved extremely clever schemes to speed up singleprocessor performance developed and matured over many years. This invited presentation advances two arguments. First, much more powerful speech systems in the future generations will likely approach human performance with new architectures that integrate rich knowledge sources and overcome the reasonably well understood limitations of the current HMM-based systems. Second, the success of the above endeavor will require complete rethinking of computation issues, likely disposing of the traditional thinking of HMM-centric sequential processing and embracing parallel computing in the new architectures mimicking key aspects of the human speech processing system. Four case studies are provided in this paper extracted from some recent influential work that may shape the foundation of this potentially active research area.
Joint Effects of Parity, Age, and Season of Kidding on Milk and Fat Yields in Dairy Goats

Abstract Dairy Herd Improvement 305-day lactation records of 120 days or more were examined for joint effects of parity, age, and season of kidding on milk and fat yields in Alpine, Saanen, and Toggenburg goats. Parity classifications were first, second, third, and fourth or greater. Seasons of kidding were December through March and April through July. Data were analyzed within geographical regions: 1) western coastal states plus their bordering inland states and 2) northeastern and north central states. There were 6,187 records from 1 covering 1970 to 78 and 4,350 records from 2 covering 1969 to 78. In both regions, parity contrasts across age-season were large, generally significant, and indicated the need to consider parity in addition to age and season in developing age correction factors for dairy goat lactations. Previous lactation experience, seasonal breeding patterns, and onset of estrus may contribute to parity and age relationships with milk and fat yields. Repeatabilities of milk and fat yields were .45 and .43 for region 1 and .48 and .45 for region 2.
[(TptBu, Me)CrR]: A New Class of Mononuclear, Coordinatively Unsaturated Chromium(II) Alkyls with cis-Divacant Octahedral Structure

Reaction of CrCl2 with TptBu, MeK yielded [TptBu, MeCr(3-tBu, 5-MepzH)Cl] (1) and [TptBu, MeCrCl] (2), while the same reaction in the presence of pyridine gave 1 and [TptBu, MeCr(py)Cl] (3). Alkylation of 3 with Grignard reagents produced the chromium(II) alkyls [TptBu, MeCrR] (4, R = Et; 5, R = Ph; 6, R = CH2SiMe3), which reversibly added to pyridine to form the five-coordinate adducts [TptBu, MeCr(py)R] (7, R = Et; 8, R = Ph; 9, R = CH2SiMe3). 1, 2, 4, and 5 were structurally characterized by X-ray diffraction. The four-coordinate molecules 2, 4, and 5 adopt a highly unusual cis-divacant octahedral coordination geometry, while 1 is the first five-coordinate TptBu, Me-complex of a first-row transition metal. Despite their coordinative unsaturation, chromium alkyls 4-6 do not polymerize ethylene, or even react with it. This observation is inconsistent with the catalytic activity commonly ascribed to divalent chromium in heterogeneous polymerization catalysts. Attempts to oxidize 4-6 (e.g., with [Cp2Fe]BPh4) to cationic chromium(II) alkyls failed, yielding [TptBu, MeCr(thf)][BPh4] (10) instead.
A microfluidic platform for chemical stimulation and real time analysis of catecholamine secretion from neuroendocrine cells

Release of neurotransmitters and hormones by calcium-regulated exocytosis is a fundamental cellular process that is disrupted in a variety of psychiatric, neurological, and endocrine disorders. As such, there is significant interest in targeting neurosecretion for drug and therapeutic development, efforts that will be aided by novel analytical tools and devices that provide mechanistic insight coupled with increased experimental throughput. Here, we report a simple, inexpensive, reusable, microfluidic device designed to analyze catecholamine secretion from small populations of adrenal chromaffin cells in real time, an important neuroendocrine component of the sympathetic nervous system and versatile neurosecretory model. The device is fabricated by replica molding of polydimethylsiloxane (PDMS) using patterned photoresist on silicon wafer as the master. Microfluidic inlet channels lead to an array of U-shaped “cell traps”, each capable of immobilizing single or small groups of chromaffin cells. The bottom of the device is a glass slide with patterned thin film platinum electrodes used for electrochemical detection of catecholamines in real time. We demonstrate reliable loading of the device with small populations of chromaffin cells, and perfusion/repetitive stimulation with physiologically relevant secretagogues (carbachol, PACAP, KCl) using the microfluidic network. Evoked catecholamine secretion was reproducible over multiple rounds of stimulation, and graded as expected to different concentrations of secretagogue or removal of extracellular calcium. Overall, we show this microfluidic device can be used to implement complex stimulation paradigms and analyze the amount and kinetics of catecholamine secretion from small populations of neuroendocrine cells in real time.
A Perspective for Understanding Moral Commitment

For an exchange to occur in a commercial setting between a salesperson and a customer is one thing; for an exchange to occur ina health care setting bewteen a physician and a patient is another matter. Traditional marketing exchange literature is mostly concerned about discrete relationships in commercial settings. Such concern has encouraged a narrow view of loyalty toward the customer. This paper borrows ideas from marketing and other related sources, and examines the physician's commitment to the patient, stressing in the process the importance of moral commitment.
'Who's in Charge?': Proposals to Clarify Gubernatorial Inability to Govern and Succession

As New York moves through a period of turmoil in the Governor’s office, it is appropriate to consider the New York Constitution’s requirements for Gubernatorial succession. Under Article IV, section 5 of the New York Constitution, the Lieutenant Governor assumes power upon the death or resignation of the Governor. However, the Lieutenant Governor also assumes power when the Governor is “absent from the state” and remains in power until the Governor’s return. Since 1982, there have been studies performed by the New York state Law Revision Commission to address concerns over the meaning of this phrase among many other issues, such as inability to govern, or filling the vacancy of the Office of Lieutenant Governor.This article provides proposals to remedy the possible confusion that could arise from gubernatorial succession and would promote stability in uncertain times.
Caspases – Key Players in Apoptosis

Caspases are the terminal proteases involved in apoptosis, as well as being involved in inflammation. The apoptotic caspases can be classified as either initiator or effector caspases based on both their position in the caspase cascade and their activation mechanism. Initiator caspases require dimerization to be activated, and cleavage of a loop called the intersubunit linker stabilizes the active enzyme. Effector caspases, on the other hand, are found as dimers in the cell and cleavage of the intersubunit linker is the key step in their activation.
NF1 germline mutation differentially dictates optic glioma formation and growth in neurofibromatosis-1

Neurofibromatosis type 1 (NF1) is a common neurogenetic condition characterized by significant clinical heterogeneity. A major barrier to developing precision medicine approaches for NF1 is an incomplete understanding of the factors that underlie its inherent variability. To determine the impact of the germline NF1 gene mutation on the optic gliomas frequently encountered in children with NF1, we developed genetically engineered mice harboring two representative NF1-patient-derived Nf1 gene mutations (c.2542G>C;p.G848R and c.2041C>T;p.R681X). We found that each germline Nf1 gene mutation resulted in different levels of neurofibromin expression. Importantly, only R681X(CKO) but not G848R(CKO), mice develop optic gliomas with increased optic nerve volumes, glial fibrillary acid protein immunoreactivity, proliferation and retinal ganglion cell death, similar to Nf1 conditional knockout mice harboring a neomycin insertion (neo) as the germline Nf1 gene mutation. These differences in optic glioma phenotypes reflect both cell-autonomous and stromal effects of the germline Nf1 gene mutation. In this regard, primary astrocytes harboring the R681X germline Nf1 gene mutation exhibit increased basal astrocyte proliferation (BrdU incorporation) indistinguishable from neo(CKO) astrocytes, whereas astrocytes with the G848R mutation have lower levels of proliferation. Evidence for paracrine effects from the tumor microenvironment were revealed when R681X(CKO) mice were compared with conventional neo(CKO) mice. Relative to neo(CKO) mice, the optic gliomas from R681X(CKO) mice had more microglia infiltration and JNK(Thr183/Tyr185) activation, microglia-produced Ccl5, and glial AKT(Thr308) activation. Collectively, these studies establish that the germline Nf1 gene mutation is a major determinant of optic glioma development and growth through by both tumor cell-intrinsic and stromal effects.
Democracy and Corruption in Mali: The Case for Election Campaign Finance Reform

Corruption, especially political corruption, is widespread and systemic, including Mali. Last years occupation of northern Mali by Islamist militias and the subsequent intervention by French and ECOWAS forces, not to mention political instability in the capital, captured the news cycles. But corruption, especially political corruption, remains a serious underlying problem. Indeed, aspects of the recent military and political crises are related to problems of corruption in government and the military. This paper will argue that, under Malis democratic regime, 1991-2012, corruption, especially political corruption, instead of getting better, actually got worse when compared with the previous single-party government of the UDPM. After analysis of some of the major forms of corruption commonplace in Mali today, a series of recommendations will be offered that could lead to a path of reform. These recommendations will deal specifically with electoral reform, especially campaign finance reform. Admittedly, election reform is only one of many areas of Malian governance where reform is indicated, but I will argue that it is a good place to begin what could become a comprehensive program of political reform. Research for this paper is based on fieldwork, including interviews, conducted in Mali in 2012, as well as on journalistic and secondary sources.
A location service for partial spatial replicas implementing an R-tree in a relational database

As parallel computing has become increasingly common, the need for scalable and efficient ways of storing and locating data has become increasingly acute. For years, both grid and cloud computing have distributed data across machines and even clusters at different geographic locations (sites). However not all sites need all of the data in a particular data set, or have the (perhaps specialized) processing capabilities required. These facts challenge the conventional wisdom that we should always move the computation to the data rather than the data to the computation. Sometimes the data actually required is small. In other cases, the site with specialized processing capabilities (such as a GPU equipped cluster) cannot handle the demands placed on it unless a way is found to let that cluster select the data that is actually needed, even if it is not stored locally. Our system finds partial spatial replicas that intersect with a region of interest.The work is intended to be a key component of a distributed spatial data system.Address the unique problems of accessing subsets of very large spatial datasets.Store R-tree in a relational database and investigate its design and performance.R-tree prefetching, query aggregation and use of a Morton curve in the R-tree.
Do online readiness surveys do what they claim? Validity, reliability, and subsequent student enrollment decisions

Online readiness surveys are commonly administered to students who wish to enroll in online courses in college. However, there have been no well-controlled studies to confirm whether these instruments predict online outcomes specifically (as opposed to predicting course outcomes more generally). This study used a sample of 24,006 students to test the validity and reliability of an online readiness survey similar to those used in practice at a majority of U.S. colleges. Multilevel models were used to determine if it was a valid predictor of differential online versus face-to-face course outcomes while controlling for unobserved heterogeneity among courses taken by the same student. Student self-selection into online courses was also controlled using student-level covariates. The study also tested the extent to which survey score correlated with subsequent decisions to enroll in an online course. No aspect of the survey was a significant predictor of differential online versus face-to-face performance. In fact, student characteristics commonly collected by institutional research departments were better predictors of differential online versus face-to-face course outcomes than the survey. Furthermore, survey score was inversely related to subsequent online enrollment rates, suggesting that the use of online readiness surveys may discourage some students from enrolling in online courses even when they are not at elevated risk online. This suggests that institutions should be extremely cautious about implementing online readiness surveys before they have been rigorously tested for validity in predicting differential online versus face-to-face outcomes. Online readiness surveys as currently implemented may have no predictive validity.Student characteristics may identify students at-risk online better than surveys.Readiness surveys may discourage the wrong students from enrolling online.Colleges should test readiness surveys for predictive validity before implementation.Colleges may want to consider alternatives to online readiness surveys.
Impact of probiotic supplements on microbiome diversity following antibiotic treatment of mice

Shifts in microbial populations of the intestinal tract have been associated with a multitude of nutritional, autoimmune, and infectious diseases. The limited diversity following antibiotic treatme...
Jurisdiction Over Foreign Merchant Ships in the Territorial Sea: An Analysis of the Geneva Convention on the Law of the Sea*

The conclusion of the United Nations Conference on the Law of the Sea in 1958 has occasioned many commentaries by authorities on international law. Scant attention, however, has been paid to that part of the Conference dealing with jurisdiction over foreign merchant ships in the territorial sea. This is surprising in view of the centuries-old controversy affecting the interests of a vast number of ship-owners and seafarers. Indeed, the importance of the width of the territorial sea would not have assumed such serious proportions but for the fact that its determination would secure for the coastal states jurisdiction over a specific portion of the sea.
Photo Quiz: A Man with Fever and Cough

A 40-year-old man with no significant past medical history developed fever, dry cough, night sweats, chills, and malaise 1 week after hiking in the mountains in Michigan. He visited his primary care physician (PCP) and was treated with oral azithromycin for 5 days with no improvement. The patient
The Influence of Web-Writing Styles on Reader' Mental Text Representation

The increasingly popular avenue of web-based distance education places high demand on distance educators to format web pages that facilitate learning. Guidelines regarding appropriate writing styles for web-based distance education, however, do not currently exist. The purpose of this study is to investigate the effects of four different writing styles on the reader's mental representation of web text. Participants will study hypertext written in one of four web-writing styles (e.g., concise, scannable, objective, and combined) and then be given a cued association task intended to measure participants' mental representations of the studied information. It is hypothesized that the scannable and combined styles will bias readers to scan rather than elaborately read which may result in less dense mental representations relative to the objective and concise writing styles. Further, the use of more descriptors in the objective writing style will lead to better integration of ideas and more dense mental represe...
Filling the Holes: Work Schedulers as Job Crafters of Employment Practice in Long-Term Health Care

Although work schedulers serve an organizational role influencing decisions about balancing conflicting stakeholder interests over schedules and staffing, scheduling has primarily been described as an objective activity or individual job characteristic. The authors use the lens of job crafting to examine how schedulers in 26 health care facilities enact their roles as they "fill holes" to schedule workers. Qualitative analysis of interview data suggests that schedulers expand their formal scope and influence to meet their interpretations of how to manage stakeholders (employers, workers, and patients). The authors analyze variations in the extent of job crafting (cognitive, physical, relational) to broaden role repertoires. They find evidence that some schedulers engage in rule-bound interpretation to avoid role expansion. They also identify four types of schedulers: enforcers, patient-focused schedulers, employee-focused schedulers, and balancers. The article adds to the job-crafting literature by showing that job crafting is conducted not only to create meaningful work but also to manage conflicting demands and to mediate among the competing labor interests of workers, clients, and employers.
Influence of newly-designed assembled structure on explosion field

Aiming at effective resistance to blast waves and the flying debris,a newly-designed assembled structure with double armor plates was put forward.Rules of explosion field including four kinds of bomb weights and two kinds of distances between the bomb and the assembled structure were studied by numerical simulation with the Arbitrary Lagrangian-Eulerian(ALE) algorithm,and the characteristics of the explosion field and the pressure distribution were obtained.The interaction of the blast waves and the assembled structure were analyzed.Simulation results were compared with the values calculated with empirical formula and TM5-855-1.It indicates that the peak values of the overpressure within the scope of thirty centimeters of horizontal line at the center of the bombs before the structure increase,while the bomb weight and the distance have little influence on the former scope,that as the bomb weight and the distance increase,the scope over the structure within which the overpressure is deduced decreases,and that as the bomb weights increase and the distance decreases,the scope above the structure within which the overpressure is enlarged increases.
Increased capillary permeability induced by human follicular fluid: a hypothesis for an ovarian origin of the hyperstimulation syndrome

Objective To examine the effect of follicular fluid (FF) and peritoneal fluid (PF) from patients undergoing assisted reproductive technology procedures on endothelial barrier function. This was determined in vitro by measuring the permeability of filter-grown bovine aortic endothelial cell monolayers to a permeability marker. Design Endothelial cells obtained from bovine thoracic aortas were treated with collagenase solution and plated on millicell filters, on which they formed confluent monolayers. Flux rate was determined at 60 minutes by measuring the radioactive tracer ( 3 H mannitol) permeating from the apical to the basolateral part of the filter. Fifty-eight samples of FF and PF, both from stimulated and natural cycles were analyzed and grouped according to the number of eggs retrieved. Follicular fluid and PF samples from natural cycles were used as controls. Results There was an augmentation in the permeability rate of both FF and PF from patients undergoing controlled ovarian hyperstimulation (COH) who responded with an increasing number of eggs compared with controls (51% and 39%, respectively). When analyzing samples from patients who responded with a low number of oocytes, no significant increase was observed. Conclusions It is known that in OHSS, the increase in capillary permeability is related to the administration of gonadotropins, and is believed to be mediated by a vasoactive substance of ovarian origin. In this study, FF and PF from patients undergoing COH showed a significant increase in the permeability rate through endothelial cells in vitro. Based on these findings, it could be hypothesized that if the same events took place in vivo, the isolation of this factor from ovarian source could be of significant importance to elucidate the pathogenesis of OHSS.
[Analysis of safety and effects on the oral whole cell/recombinant B subunit cholera vaccine in university students and workers].

Objective To evaluate the safety, immunogenicity and protective efficiency of the oral whole cell/recombinant B subunit cholera vaccine in Beijing Olympic volunteers and workers. Method Analyzing the incidence rate of adverse reaction and Protective Rate (PR) after taking the vaccine in Olympic volunteers in 6 universities in Beijing; comparing the anti-cholera toxin(CT) detected with ELISA prior and after taking the vaccine in Olympic workers. Results The total rate of adverse reaction of Olympic volunteers was 0. 38% ; the main side effects were gastrointestinal symptoms ,such as bellyache and diarrhea which were mild and temple; the acute diarrhea incidence rate of Olympic volunteers after taking the vaccine was significantly lower than those not taking it ,the PR was 76. 27% ;the positive rate of anti-CT of Olympic workers after taking the vaccine was significantly higher than those before taking it, the levels of anti-CT titers declined after 6 months since they had taken the vaccine. Conclusion The results from above two observed population indicate that the oral rBS-WC cholera vaccine is efficient and safe. Key words: Cholera vaccines; Diarrhea; Immunogenicity
Teaching Quality Measurement and Improvement, Cost-effectiveness, and Patient Satisfaction in Undergraduate Medical Education: The UME-21 Experience

Background The health care system in the United States is changing at an ever-increasing rate. Recent reports by the Institute of Medicine raising concerns regarding rates of medical errors and suggesting the need for reengineering of the health care delivery system have focused attention on the need for quality measurement and improvement. Methods We abstracted data from final written reports submitted by 18 Undergraduate Medical Education for the 21st Century (UME-21) schools, as well as other materials available from participating UME-21 schools. Specific curricular innovations developed and implemented were identified. Additionally, senior medical students' responses to the annual Graduation Questionnaire administered by the Association of American Medical Colleges (AAMC) were available for analysis. The change from 1999 to 2001 in the proportion of seniors rating instruction in quality assurance as adequate was compared among four groups of UME-21 schools and the other 107 US medical schools. Results Eleven of the 18 schools specifically addressed the content areas of quality measurement and improvement, including utilization management (27% of schools), cost-effectiveness (45% of schools), use of clinical practice guidelines (73% of schools), and patient satisfaction assessment (45% of schools). Each school developed unique approaches and educational materials pertinent to the content area. Overall, the percentage of seniors rating the relative amount of instructional time devoted to quality assurance in medicine by their school's curriculum as adequate or better rose from 49% to 66% between 1999 and 2001 at the 11 UME-21 schools that introduced initiatives in quality improvement into their curricula. This change was significantly higher than the pattern at other US medical schools between 1999 and 2001, at which seniors' ratings rose only from 43% to 56%. Conclusions Curriculum development and implementation addressing quality improvement in medical practice accelerate improvement of students' perception that their education has adequately addressed this subject area. This article summarizes some of the experiences, curricular approaches, successes, failures, and lessons learned in quality improvement by schools participating in the UME-21 project.
A New Family of Multivariate Distributions for Survival Data

We introduce a family of multivariate distributions in discrete time which may be regarded as a multiple logistic distribution for discrete conditional hazards. In the independent case, the marginal laws are identical to those of the univariate logistic model for survival data discussed by Efron (1988). We present the analysis of a data set previously analyzed using frailty models.
Complications in children with a severe allergy to cow milk.

A case-comparison study compared the allergic and health complications of children who had severe IgE-mediated allergy To cow milk in infancy (study group) with those of other atopic children (control group). Severity of clinical atopy, IgE sensitization to other allergens, and recurrent episodes of anaphylaxis, as well as growth and development were compared in 16 health plan member children aged 2 to 18 years with histories of IgE-mediated anaphylisis and 16 age- and gender-matched allergy patients. Data were analyzed using the sign test or the signed-rank test of the difference scores of the matched study-control pairs. The results showed the study group differed from the control group throughout childhood by having more specific allergen sensitizations, atopic dermatitis, episodes of sudden severe anaphylaxis, and hospitalizations
A Comparison of Request Process and Outcomes in Donation After Cardiac Death and Donation After Brain Death: Results From a National Study.

Available literature points to healthcare providers’ discomfort with donation after cardiac death (DCD) and their perception of the public's reluctance toward the procedure. Using a national sample, we report on the communication content of actual DCD and donation after brain death (DBD) approaches by organ procurement organization (OPO) requesters and compare family decision makers’ (FDMs’) experiences of both modalities. We recruited 1,601 FDMs using a validated protocol; 347 (21.7%) were of potential DCD donors. Semi-structured telephone interviews yielded FDMs’ sociodemographic data, predisposition toward donation, assessment of approach, final outcomes, and substantiating reasons. Initial analysis consisted of bivariate analyses. Multilevel mixture models compared groups representing authorization outcome and DCD/DBD status. No significant differences in family authorization were found between DCD and DBD cases. Statistically significant associations were found between sociodemographic characteristics and authorization, with White FDMs more likely to authorize DCD or DBD than Black FDMs. FDMs of both modalities had similar evaluations of requester skills, topics discussed, satisfaction, and reasons for refusal. The findings suggest that the DCD/DBD distinction may not be notable to families. We recommend the use of similar communication skills and strategies during approaches and the development of education campaigns about the public's acceptance of DCD. This article is protected by copyright. All rights reserved.
New CP-odd observable in H → tt

We study a $CP$-violating triple product correlation that occurs in the decay of a neutral Higgs boson into $t\overline{t}$ pairs when the Higgs boson does not have a definite $CP$ nature. We consider the $H\ensuremath{\rightarrow}t\overline{t}$ decay channel as well as the gluon fusion process $gg\ensuremath{\rightarrow}H\ensuremath{\rightarrow}t\overline{t}$. The asymmetry in Higgs decay, normalized to the $H\ensuremath{\rightarrow}t\overline{t}$ width, can reach the 6% percent level. In the gluon fusion process the corresponding normalized asymmetry is smaller by an order of magnitude. We present a crude estimate of this observable at the LHC.
Facilitation strategies and problem space coverage: comparing face-to-face and online case-based discussions

In this exploratory, descriptive study we examined how discussion goals were accomplished during face-to-face and online case-based discussions facilitated by the same co-instructors. An analysis of discussion transcripts suggests that despite different instructor and student participation patterns across contexts, the instructors’ goals of creating social cohesion and supporting students’ case understanding were equally met. However, coverage of the targeted problem space indicated greater attention to “problem finding” (i.e., identifying relevant issues) by face-to-face students and greater attention to “problem solving” (i.e., identifying workable solutions) by online students, as indicated by the frequencies with which these different aspects were discussed. We interpret results by considering how the affordances of each context shaped both teacher–student interactions and students’ coverage of the problem-finding and problem-solving space.
Case 15: Life-Threatening Arrhythmia in a 5-Month-Old

A 5-month-old child was scheduled for elective correction of transposition of the great arteries (Senning procedure). She was diagnosed with the transposition immediately after birth, and a balloon septostomy was performed with good result. Prior to this proposed operation, the child was in good physical condition and weighed 5.9Kg. She tolerated the operation well and came off cardiopulmonary bypass uneventfully. She was paralyzed, ventilated, and sedated postoperatively. Her cardiovascular system was supported with small continuous doses of dopamine, phentolamine, and epinephrine with good effect. However, a persistent tachycardia ranging from 140 to 230 beats per minute led to a decrease in mean arterial pressure and contributed to renal insufficiency with a rising creatinine. Peritoneal dialysis was initiated successfully. However, the tachyarrhythmia did not improve (Fig. 1). Digoxin (Lanoxin) 0.16, 0.08, and 0.08 mg was given according to recommendation for children aged 2 weeks to 2 years. (0.04–0.06 mg/kg was given IV during the next hours). Unfortunately, no improvement was seen, and episodes of tachycardia up to 360 beats/min were observed even after the child was fully digitalized. Verapamil, propranolol, lidocaine, and phenytoin were given with no effect on this life-threatening arrhythmia. The patient was now completely anuric. An arterial blood gas showed the pH 7.33, pCO2 33 mmHg, BE – 7.7 mmol/l, and pO2 is 92 mmHg on FiO2 0.4. The child had been in the ICU for over 24 h, and of great concern now was the fact that the serum potassium had risen to 5.9 mmol/l. The standard recommended treatment of high potassium, including normalizing the pH and giving glucose-insulin infusion, was started. The peritoneal dialysis fluid with potassium-free solutions was now used. Despite all this, a repeat potassium showed a further increase to 7.8 mmol/l (Fig. 2). Serum calcium and magnesium were within normal limits. The child was now critical; as besides the increased serum potassium and anuria, her cardiovascular system showed a heart rate of 300 beats per min and a mean arterial pressure of 48 mm Hg.
Cell Cycle and Cell Proliferation Markers

Current concepts in cell biology suggest that there are checkpoints in the various phases of the cell cycle at which cells are monitored for damage to their DNA. Studies in our laboratory on the effect of radiation on cells in culture have shown delay of progression in both the G1 and G2 phases of the cell cycle of normal, non-transformed cells. It has been proposed that the delay period in these phases allows time for cells to repair DNA damage before proceeding to the next phase of the cell cycle. Thus cells in G1 would be required to repair potential DNA damage prior to entering S phase in order to alleviate the possibility of replicating an abnormal and potentially malignant genome. Studies on the regulations at the proposed checkpoints are important for elucidating cell cycle control mechanisms. Such investigations require techniques that can continuously monitor the distribution of cell throughout the cell cycle and access the proliferation potential of cells in different phases of the cell cycle.
A FETI-DP Formulation for Compressible Elasticity with Mortar Constraints

A FETI-DP formulation for three dimensional elasticity problems on non-matching grids is considered. To resolve the nonconformity of the finite elements, a mortar matching condition is imposed on subdomain interfaces. The mortar matching condition are considered as weak continuity constraints in the FETIDP formulation. A relatively large set of primal constraints, which include average and moment constraints over interfaces (faces) as well as vertex constraints, is further introduced to achieve a scalable FETI-DP method. A condition number bound, C(1+log(H/h)), for the FETI-DP formulation with a Neumann-Dirichlet preconditioner is then proved for elasticity problems with discontinuous material parameters when the primal constraints are enforced on only some of the faces instead of all of them. These faces are called primal faces. An algorithm for selecting a quite small number of primal faces is described in [5].
The Matrix Approach to Log-Linear Models

Analysis of variance and regression analysis are both branches of linear model theory. Regression analysis and linear model theory are almost always taught using matrices. It is less common to teach analysis of variance with matrices. Although log-linear model theory is analogous to analysis of variance, the basic results are more easily stated in matrix notation. It is assumed that the reader is familiar with the basics of using matrices.
Etiology of Pituitary Adenomas

Although pituitary adenomas have been found by routine autopsy study to be surprisingly common, their emergence as clinical problems is far less frequent. The factors that determine the incidence of adenoma and their growth are the subject of this chapter.
Expressiveness of Data State Model

Visualization transforms data into graphical forms to be represented on the computer display. Hence, visualization deals with both transformations and representations. Transformation is the process that converts data into graphical primitives. Representation is the data structures that are used to handle and store the various outputs of these processes.
Pharmacokinetic determinants of cisplatin-induced subclinical kidney injury in oncology patients

The ability to predict and detect clinical and subclinical nephrotoxicity early in the course of therapy has the potential to improve long-term outcomes in cancer patients receiving cisplatin chemotherapy. Pharmacokinetic parameters could serve as predictors of cisplatin-induced nephrotoxicity. Participants [n = 13] were treated with a 1-h cisplatin infusion [30–75 mg/m2]. Blood was collected pre-dose and up to 6 h post-dose. Urinary biomarkers [KIM-1, calbindin, clusterin, GST-pi, β2M, albumin, NGAL, osteopontin, clusterin, MCP-1, cystatin C, and TFF3] were measured at baseline, days 3 and 10. Total and unbound platinum concentrations were measured using ICP/MS. Noncompartmental analysis was performed, and correlation and regression analyses evaluated the relationships between platinum pharmacokinetics and nephrotoxicity. Peak platinum urinary concentrations correlated with urinary levels of KIM-1, calbindin, clusterin, GST-pi, β2M, albumin, NGAL, osteopontin, clusterin, cystatin C, and TFF3 at day 10. Unbound platinum plasma concentrations at 2 h also correlated with urinary clusterin, β2M, cystatin C, NGAL, osteopontin, and TFF3 at day 3. Regression analyses suggested 2-h total plasma platinum concentrations greater than 2000 ng/ml, and peak urinary platinum concentrations above 24,000 ng/ml may serve as potential approximations for elevated risk of nephrotoxicity. Platinum area under the plasma concentration time curve was associated with serum creatinine and estimated glomerular filtration rate. Peak plasma and urinary platinum concentrations and pharmacokinetic parameters were associated with risk of subclinical cisplatin-induced kidney injury as assessed using novel urinary biomarkers. Future studies will examine these relationships in larger clinical populations of cisplatin-induced acute kidney injury.
The influence of 15-week exercise training on dietary patterns among young adults

Little is currently known about how exercise may influence dietary patterns and/or food preferences. The present study aimed to examine the effect of a 15-week exercise training program on overall dietary patterns among young adults. This study consisted of 2680 young adults drawn from the Training Intervention and Genetics of Exercise Response (TIGER) study. Subjects underwent 15 weeks of aerobic exercise training, and exercise duration, intensity, and dose were recorded for each session using computerized heart rate monitors. In total, 4355 dietary observations with 102 food items were collected using a self-administered food frequency questionnaire before and after exercise training (n = 2476 at baseline; n = 1859 at 15 weeks). Dietary patterns were identified using a Bayesian sparse latent factor model. Changes in dietary pattern preferences were evaluated based on the pre/post-training differences in dietary pattern scores, accounting for the effects of gender, race/ethnicity, and BMI. Within each of the seven dietary patterns identified, most dietary pattern scores were decreased following exercise training, consistent with increased voluntary regulation of food intake. A longer duration of exercise was associated with decreased preferences for the western (β: −0.0793; 95% credible interval: −0.1568, −0.0017) and snacking (β: −0.1280; 95% credible interval: −0.1877, −0.0637) patterns, while a higher intensity of exercise was linked to an increased preference for the prudent pattern (β: 0.0623; 95% credible interval: 0.0159, 0.1111). Consequently, a higher dose of exercise was related to a decreased preference for the snacking pattern (β: −0.0023; 95% credible interval: −0.0042, −0.0004) and an increased preference for the prudent pattern (β: 0.0029; 95% credible interval: 0.0009, 0.0048). The 15-week exercise training appeared to motivate young adults to pursue healthier dietary preferences and to regulate their food intake.
850 nm VCSELs for 50 Gb/s NRZ Error-Free Transmission over 100-Meter OM4 and up to 115 °C Operation

850-nm multi-mode oxide-VCSELs with record performance of 50-Gb/s (RT) and 44-Gb/s (85°C) NRZ error-free transmission over 100-meter OM4 are demonstrated. The L-I-V, optical bandwidth and BER of 30 GHz VCSEL are characterized up to 115°C.