cssi/SciSciGPT-SciSciNet huggingface dataset:
Mechanisms of alcohol abuse and alcoholism in adolescents: A case for developing animal models

This paper reviews the ontogeny of neurotransmitter systems and neuropharmacological challenge within transmitter systems and discusses the actions of alcohol on such systems during the juvenile through adolescent periods. To place the animal research within the context of human development, an attempt is made to first examine some fundamental principles of developmental research as they relate to the adolescent period. Evidence presented from animal studies indicates that unique neurochemical and behavioral changes are occurring during postnatal development, including adolescence, that could mediate the response to alcohol. The limited number of studies on the neurochemical and behavioral response to alcohol during adolescence has employed rats and has been restricted by the relatively brief adolescent period in that species. While one alternative is to use primates, it is suggested that innovative behavioral paradigms be developed for adolescent animals in other species to study behaviors such as alcohol self-administration or alcohol stimulus discrimination. It is also suggested that existing behavioral models that are more easily adapted to younger age ranges (e.g., conditioned place preference, conditioned taste aversion, thermal response to ethanol) be extended to make ontogenetic comparisons through adolescence and adulthood. This may further our understanding of alcohol's immediate consequences during each maturational stage and, more important, the contribution of early alcohol exposure to excessive drinking and abnormal cognitive and social functioning during subsequent stages of development.
Duodenal carcinoid tumor: report of a case diagnosed by endoscopic ultrasound-guided fine-needle aspiration biopsy with immunocytochemical correlation.

Fine-needle aspiration biopsy is a reliable and accurate method for the endoscopic diagnosis of gastrointestinal malignancies and it is particularly well suited for evaluation of submucosal lesions. We report the cytopathologic findings of a case of malignant carcinoid tumor of a 44-year-old male who presented with melena and a nonhealing duodenal ulcer. Endoscopic ultrasound examination revealed a submucosal lesion in the pyloric region. Fine-needle aspiration revealed abundant cellularity with tumor cells arranged in sheets and loose groups and dispersed single cells in a clean background. Papillary fragments, capillaries cuffed by tumor cells, and rosette formation were also noted. The cells were moderate in size, round to oval, with a small subpopulation of spindle-shaped cells. The nuclei were uniform, round to oval, with smooth nuclear borders. The chromatin pattern was finely granular with a salt-and-pepper appearance. The cytoplasm of the cells was small to moderate in amount, pale, and showed fine granularity. The differential diagnosis included a neuroendocrine neoplasm vs. an epithelioid gastrointestinal stromal tumor. The tumor cells were focally positive for chromogranin and negative for CD34, supporting the diagnosis of a neuroendocrine neoplasm. The differential diagnosis of primary gastrointestinal carcinoid tumors from gastrointestinal stromal tumors can be very difficult in cytologic material. In cases when diagnostic material is scant, or only present on one smear, the use of smear division and cell transfer in order to perform immunocytochemical stains may be of considerable value to confirm the neuroendocrine nature of the neoplasms.
Fair On-Line Scheduling of a Dynamic Set of Tasks on a Single Resource

In many real-time applications, a set of "tasks" compete for the use of a single "resource", where: (i) only one task is allowed to use the resource at a time, (ii) the resource is scheduled in unit-time intervals, (iii) each task requires a specific fraction of the resource capacity over an extended period, and (iv) tasks arrive and depart at any time. We refer to such a task system as an instance of the single-resource scheduling problem. The problem of designing a "fair" scheduling algorithm for such task systems has recently received a great deal of attention in the literature. This paper makes two main contributions. First, we point out that a 1980 paper of Tijdeman concerning the so-called "chairman assignment problem" provides a simple and efficient on-line algorithm for the static version of the single-resource scheduling problem (i.e., where the set of tasks competing to use the resource does not change over time). We then extend Tijdeman''s algorithm to obtain a simple and efficient on-line algorithm for the dynamic single-resource scheduling problem.
Traveling-wave photon-phonon coupling as the basis for new signal processing technologies

We present progress towards the development of novel hybrid photonic-phononic oscillator technologies in both nanoscale silicon photonics and in fiber optic systems. These systems utilize traveling-wave photon-phonon couplings involving both stimulated Brillouin scattering processes (SBS). We explore numerous geometries that have enabled large forward-SBS processes in nanoscale silicon waveguides for the first time, and examine new approaches to achieving integrated Brillouin based signal processing.
Phosphorylation-induced Conformational Changes in a Mitogen-activated Protein Kinase Substrate IMPLICATIONS FOR TYROSINE HYDROXYLASE ACTIVATION

Mitogen-activated protein (MAP) kinase-mediated phosphorylation of specific residues in tyrosine hydroxylase leads to an increase in enzyme activity. However, the mechanism whereby phosphorylation affects enzyme turnover is not well understood. We used a combination of fluorescence resonance energy transfer (FRET) measurements and molecular dynamics simulations to explore the conformational free energy landscape of a 10-residue MAP kinase substrate found near the N terminus of the enzyme. This region is believed to be part of an autoregulatory sequence that overlies the active site of the enzyme. FRET was used to measure the effect of phosphorylation on the ensemble of peptide conformations, and molecular dynamics simulations generated free energy profiles for both the unphosphorylated and phosphorylated peptides. We demonstrate how FRET transfer efficiencies can be calculated from molecular dynamics simulations. For both the unphosphorylated and phosphorylated peptides, the calculated FRET efficiencies are in excellent agreement with the experimentally determined values. Moreover, the FRET measurements and molecular simulations suggest that phosphorylation causes the peptide backbone to change direction and fold into a compact structure relative to the unphosphorylated state. These results are consistent with a model of enzyme activation where phosphorylation of the MAP kinase substrate causes the N-terminal region to adopt a compact structure away from the active site. The methods we employ provide a general framework for analyzing the accessible conformational states of peptides and small molecules. Therefore, they are expected to be applicable to a variety of different systems.
The ‘borrowed language’ of German unification: State, society and party identity

The political debate over German unification among the Federal Republic's party elites occurred in a highly compressed and potentially volatile political environment. As ‘fortune’, in Chancellor Kohl's words, assembled an agenda for German unification, party elites scrambled for conceptual frames to make sense of a rapidly shifting political terrain. In the nineteenth century dichotomisa‐tion of state and society, a powerful conceptual pairing in German political ideology predating both the FRG and the GDR, western party elites found a complex, versatile, and normatively meaningful set of categories with which to frame party identities and policy alternatives.
Extending the graphics pipeline with adaptive, multi-rate shading

Due to complex shaders and high-resolution displays (particularly on mobile graphics platforms), fragment shading often dominates the cost of rendering in games. To improve the efficiency of shading on GPUs, we extend the graphics pipeline to natively support techniques that adaptively sample components of the shading function more sparsely than per-pixel rates. We perform an extensive study of the challenges of integrating adaptive, multi-rate shading into the graphics pipeline, and evaluate two- and three-rate implementations that we believe are practical evolutions of modern GPU designs. We design new shading language abstractions that simplify development of shaders for this system, and design adaptive techniques that use these mechanisms to reduce the number of instructions performed during shading by more than a factor of three while maintaining high image quality.
The immunochemical effects of metal substitution in the prosthetic group of hemoglobin.

Abstract We have used immunodiffusion, quantitative precipitin analyses and radioimmunoassay measurements to investigate the immunochemistry of various metallo- and non-metallohemoglobin A0 derivatives. Hemoglobin A0 reconstituted with iron(III), manganese(III), cobalt(II), copper(II), nickel(II), zinc(II) and protoporphyrin IX along with apohemoglobin were studied to determine the effects of these substitutions on the antigenic properties of the protein. Immunodiffusion studies showed that reconstituted iron(III), manganese(III), cobalt(II), copper(II) and apohemoglobin reacted with complete identity to hemoglobin A0 with antibodies raised against hemoglobin A0, while nickel(II), zinc(II) and protoporphyrin IX reacted with partial identity. Quantitative precipitin analyses showed that reconstituted iron(III), cobalt(II) and copper(II) hemoglobins are identical to the native protein, whereas manganese(III) and protoporphyrin IX differed only slightly. However, large differences were seen with the nickel(II), zinc(II) and apohemoglobin derivatives. Radioimmunoassay of the various hemoglobin derivatives showed that the reconstituted iron(III), manganese(III) and cobalt(II) derivatives completely displaced all of the labelled hemoglobin A0 from its antibody. Protoporphyrin IX and apohemoglobin were found to have displacement curves similar to each other but different from hemoglobin A0. Copper(II), nickel(II) and zinc(II) hemoglobins showed significant differences in their displacement curves, indicating some structural reorganization which affects antigenic binding sites. These results indicate that electronic changes in the center of the porphyrin ring can be detected by quantitative immunochemical procedures as structural changes on the surface of the hemoglobin molecule.
Test of the thermal-noise hypothesis in m.o.s.f.e.t.s

Evidence is given that, for m.o.s.f.e.t.s, another source o noise besides thermal noise must be operating in the conducting channel.
Ti:Al2O3 laser with phase conjugate feedback of the residual pump

Abstract A Ti:Al2O3 laser is demonstrated in which that portion of the all lines argon laser pump not absorbed in the first pass through the gain medium is fed back for a second pass through the gain medium by a photorefractive self pumped phase conjugate mirror using barium titanate. As an additional pump, this phase conjugate feedback is compensated for beam distortion due to astigmatism and thermal nonlinearities in the laser crystal. The phase conjugate pump has optimum overlap with the first pump. The feedback lowers the laser's threshold and increases its output power.
Electrosleep Enhanced by Intravenous Lidocaine

Many drugs have been used to enhance the action of electro — sleep and electro — anesthesia currents. They include chlorpromazine and phenobarbital (Andolfi, Boaro, de Renzo and Artemagni,1967) trifluoperazine (Kulifkova, 1967) anesthetic agents and muscle relaxants (Marinov, 1968;Wulfsohn, 1966) and progesterone (Snyder and Glazier, 1967).
Student Teaching Experience in Diverse Settings, White Racial Identity Development and Teacher Efficacy

This study examined how diversity of field placement affected White student teachers’ White racial identity (WRI) development, and the relationship between WRI and teacher efficacy. There was no change in WRI development regardless of placement; however, as the percentage of students of color in the placement increased, two subscales (instructional strategies, classroom management) of the Teacher Sense of Efficacy Scale (TSES) decreased. A negative correlation existed between WRI (Pseudo-Independence and Contact subscales of the White Racial Consciousness Development Scale-Revised) and subscales of the TSES. Results indicate that teacher preparation programs critically examine Whiteness and WRI as a construct.
Religion and Psychological Distress in Japan

This study introduces data from a new random sample of Japanese adults. Findings show that reporting of distress symptoms are: (1. positively associated with a religious coping index (i.e., beliefs that religion or supernatural beings provide comfort, support or protection), (2. associated in different directions with ownership of different household altars (positively for Shintō altars and negatively for ancestor altars), (3. negatively associated with frequency of ancestral grave visitations, (4. positively associated with certain beliefs (e.g., in supernatural beings), and (5. generally do not differ per religious identification (e.g., religious vs. not religious). Also, physical health and "balance in life" (i.e., balance between work/household obligations and leisure) are strongly and negatively associated with depression symptoms. Results indicate important distinctions between Japan and the United States concerning the relationship between religion and psychological distress.
A low-power network search engine based on statistical partitioning

Network search engines based on ternary CAMs (content addressable memories) are widely used in routers. However, due to the parallel search nature of TCAMs, power consumption becomes a critical issue. We propose an architecture that partitions the lookup table into multiple TCAM chips, based on the individual TCAM cell status, and achieves lower power figures.
Role of clinical pharmacology in the development of antiplatelet drugs.

Abstract Purpose This review discusses the role of clinical pharmacology in the development of low-dose aspirin and other antiplatelet agents during the past 30 years, emphasizing the main determinants of several success stories as well as of complete failures in the field. Methods The author employs personal appraisal of the literature, with emphasis on personal contributions to the field. Findings Low-dose aspirin provides an interesting paradigm of the independent development of a “new” antiplatelet agent by the medical/scientific community. Aspirin “resistance,” improved dosing regimens for personalized therapy, and chemoprevention of colorectal cancer are thoroughly discussed. The industry-driven development paradigm includes 12 mechanism-based antiplatelet agents. Of those completing Phase 3, only 6 have been approved for the acute treatment or secondary prevention of atherothrombosis. Inadequate Phase 2 studies were largely involved in Phase 3 failures. Implications The design of mechanism-based pharmacodynamic biomarkers and sophisticated Phase 2 investigations appear as an important key to successful drug development in this field. Clinical pharmacology has an excellent track record in this endeavor, and its role needs to be expanded, as suggested by the case studies discussed in this review. Finally, the choice of appropriate platelet-dependent end points and homogeneous clinical settings for Phase 3 trials not only represent desirable objectives for an integrated scientific and regulatory discussion but also deserve proper ethical consideration by all stakeholders to avoid an unacceptable burden of drug toxicity and an unsustainable waste of financial resources.
Moving Forward or Sliding Backward: The Evolution of Charter School Policies in Michigan and the District of Columbia

What is the fate of charter school policy in the American states? The authors argue that dramatic new policies brought about by a radical reconfiguration of interests and politics are frequently short lived, though new policies are rarely erased; instead, they reach a compromise between competing sets of interests. The authors test this notion in a study of the evolution of charter school policy in Michigan and the District of Columbia. They find in Michigan that the original law, dramatic in the breadth of its change to public education, has slowly reverted to reflect a balance of power between the ideal positions preferred by pro- and anti-charter school interests. But in the District of Columbia, the innovativeness of the new law has largely been sustained, mainly because organized opposing interests largely failed to emerge.
Decision making and strategic considerations in the processes of managing medical technology in US hospitals: findings from a comprehensive empirical study

This paper reports findings from a comprehensive study of over 121 hospitals and medical centers in the United States. The study examined the decision making process involving the acquisition, allocation, and replacement of medical technology (including information technology, diagnostic/therapeutic equipment and devices, and disposable). In addition, the study explored the role that medical technology plays in the hospital's strategic considerations. The paper also discusses the role of these findings in the field of MMT (management of medical technology) and their implications for further research and for practice.
Comparison of outcomes from sepsis between patients with and without pre-existing left ventricular dysfunction: a case-control analysis

The aim of this study was to determine if there are differences between patients with pre-existing left ventricular dysfunction and those with normal antecedent left ventricular function during a sepsis episode in terms of in-hospital mortality and mortality risk factors when treated in accordance with a sepsis treatment algorithm. We performed a retrospective case-control analysis of patients selected from a quality improvement database of 1,717 patients hospitalized with sepsis between 1 January 2005 and 30 June 2010. In this study, 197 patients with pre-existing left ventricular systolic dysfunction and sepsis were compared to 197 case-matched patients with normal prior cardiac function and sepsis. In-hospital mortality rates (P = 0.117) and intubation rates at 24 hours (P = 0.687) were not significantly different between cases and controls. There was no correlation between the amount of intravenous fluid administered over the first 24 hours and the PaO2/FiO2 ratio at 24 hours in either cases or controls (r2 = 0.019 and r2 = 0.001, respectively). Mortality risk factors for cases included intubation status (P = 0.016, OR = 0.356 for no intubation), compliance with a sepsis bundle (P = 0.008, OR = 3.516 for failed compliance), a source of infection other than the lung (P = 0.019, OR = 2.782), and the initial mixed venous oxygen saturation (P = 0.004, OR = 0.997). Risk factors for controls were the initial platelet count (P = 0.028, OR = 0.997) and the serum lactate level (P = 0.048, OR = 1.104). Patients with pre-existing left ventricular dysfunction who died had a lower initial mean mixed venous oxygen saturation than those who survived (61 ± 18% versus 70 ± 16%, P = 0.002). Clinical outcomes were not different between septic patients with pre-existing left ventricular dysfunction and those with no cardiac disease. There was no correlation between fluid administration and oxygenation at 24 hours in either cohort. The mortality risk factor profile of patients with pre-existing left ventricular dysfunction was different when compared with control patients, and may be related to oxygen delivery determinants.
Robust Tracking of Small-Scale Mobile Primary User in Cognitive Radio Networks

In cognitive radio networks (CRNs), secondary users must be able to accurately and reliably track the location of small-scale mobile primary users/devices (e.g., wireless microphones) in order to efficiently utilize spatial spectrum opportunities, while protecting primary communications. However, accurate tracking of the location of mobile primary users is difficult due mainly to the CR-unique constraint, i.e., localization must rely solely on reported sensing results (i.e., measured primary signal strengths), which can easily be compromised by malicious sensors (or attackers). To cope with this challenge, we propose a new framework, called Sequential mOnte carLo combIned with shadow-faDing estimation (SOLID), for accurate, attack/fault-tolerant tracking of small-scale mobile primary users. The key idea underlying SOLID is to exploit the temporal shadow fading correlation in sensing results induced by the primary user's mobility. Specifically, SOLID augments conventional Sequential Monte Carlo (SMC)-based target tracking with shadow-fading estimation. By examining the shadow-fading gain between the primary transmitter and CRs/sensors, SOLID 1) significantly improves the accuracy of primary tracking regardless of the presence/absence of attack, and 2) successfully masks the abnormal sensing reports due to sensor faults or attacks, preserving localization accuracy and improving spatial spectrum efficiency. Our extensive evaluation in realistic wireless fading environments shows that SOLID lowers localization error by up to 88 percent in the absence of attacks, and 89 percent in the presence of the challenging "slow-poisoning” attack, compared to the conventional SMC-based tracking.
Listening Is for Acting

Interpersonal communication researchers have not only tended to ignore the role that listening plays in face-to-face interaction, they have also viewed message production and message processing as distinct processes. The message production-message processing bipolarity is belied by recent research suggesting that mirror neurons subserving speech production are activated as people listen to speech and that the same brain areas that process gestural communication are activated in both senders and receivers of gestural communication. The prevalence of interaction routines and the unconscious activation of interaction goals also suggest that production and processing mechanisms are integrated.
Disability, Limitations, and Function for People with Arthritis

There is no single definition for “disability,” and many different definitions are used for specific purposes or based on available data. Over the past half century, thinking about disability has evolved considerably to reflect more inclusive attitudes and to facilitate examination of impact at the levels of body, person, and society. The World Health Organization’s International Classification of Functioning, Disability, and Health (ICF) is an international standard for describing and measuring health and disability that explicitly includes personal and environmental context to describe the experience of disability as a conflict of person–environment interaction.
Abnormal cerebral activation associated with a motor task in Tourette syndrome.

BACKGROUND AND PURPOSE In Gilles de la Tourette syndrome, PET scanning and EEG suggest an abnormal organization of the sensorimotor cortex and basal ganglia. The purpose of this study was to use functional MR imaging to study activation in the sensorimotor cortex in patients with Tourette syndrome. METHODS From echo-planar images acquired during intermittent performance of a finger-tapping task, the location of activated pixels was determined by means of conventional signal processing methods. In five patients with Tourette syndrome and five healthy volunteers, the number of activated pixels in the sensorimotor cortices and supplementary motor areas were counted. The area over which the activation was distributed was calculated. RESULTS In the five patients, the average number of pixels activated during the finger-tapping task in the sensorimoter cortices and supplementary motor area (69.4 pixels) exceeded that in the volunteers (49.2 pixels). The difference was significant. The area over which the pixels was distributed was significantly larger (25.4 vs 13.8 cm2). CONCLUSION Motor function is organized differently in patients with Tourette syndrome than in healthy subjects.
DJAO: a communication-constrained DCOP algorithm that combines features of ADOPT and action-GDL

In this paper we propose a novel DCOP algorithm, called DJAO, that is able to efficiently find a solution with low communication overhead; this algorithm can be used for optimal and bounded approximate solutions by appropriately setting the error bounds. Our approach builds on distributed junction trees used in Action-GDL to represent independence relations among variables. We construct an AND/OR search space based on these junction trees. This new type of search space results in higher degrees for each OR node, consequently yielding a more efficient search graph in the distributed settings. DJAO uses a branch-and-bound search algorithm to distributedly find solutions within this search graph. We introduce heuristics to compute the upper and lower bound estimates that the search starts with, which is integral to our approach for reducing communication overhead. We empirically evaluate our approach in various settings
Examining booktalks to shed light on authentic classroom discussion

In this qualitative case study, we examine the texture of talk in the booktalks of a fifth-grade classroom where authentic classroom discussions were common. The discourse analysis of classroom transcripts yielded 13 overlapping move categories describing the talk of the teacher, and nine the talk of the students. A comparison between authentic discussion and ‘other’ episodes indicated that move categories and their usage differed substantially for both the teacher and the students. In authentic discussions, the teacher decreased her attempts to provide information and to set themes. At the same time the students increased their moves used to provide information, connect with written text, reflect and express opinion.
IT and Educational Policy in North Africa and Middle East Region

North African countries include Egypt, Libya, Sudan, Algeria, Tunisia, and Morocco. Gulf countries are Kuwait, Qatar, Bahrain, United Arab Emirates, and Oman. Other countries in the region include Lebanon, Iraq, Syria, Palestine, Saudi Arabia, Yemen, Jordan, and Israel. Although the use of communication facilities using IT is growing very substantially in the region, the expenditures in the educational sector are probably insufficient to educate the users about how to use IT facilities for learning. Middle East and North-African countries are starting to embrace IT integration in education and training. The Gulf countries and Israel at the infusing level of policy, while the other countries in the region are at the applying-policy level. Infrastructure investments need to be balanced with investments in digital content development and staff training.
Long and Short Range Dispersal of the Pink Bollworm Pectinophora gossypiella over Southern California

A study was conducted in 1975 to learn more of short and long range dispersal of the pink bollworm, Pectinophora gossypiella (Saunders). About 170 Sharma traps baited with the sex pheromone, gossyplure, were placed in the desert over southern California encompassing an area of ca. 75,000 km2. High numbers of moths were captured from short range dispersal in all trap lines in the triangular area between Coachella, Imperial, and Palo Verde Valleys throughout the summer and into the winter. The largest number of moths captured from long range dispersal occurred in the Mojave Desert following 2 wind and rain storms of tropical origin moving northwestward over southern California and into central California. The data show moths are continually flying between cotton fields and over the lower Colorado Desert. This may partially explain why the pink bollworm sex pheromone, when used to confuse mating, often gives poor results in controlling populations in cotton fields.
Analysis on the main causes of death in Zhoukou City from 2010-2012

[Objective]To understand on the mortality level and main death causes among inhabitants in Zhoukou City,provide evidence for comprehensive control.[Methods]The classification and code of the causes of death were conducted by means of ICD-10, to analyze the crude mortality rate standardized mortality rate and constitution of causes of death.[Results]The average annual mortality rate was 733. 43 / lakh in Zhoukou City from 2010-2012,and the all-cause mortality in males was higher than that in females( χ2= 44. 81,P 0. 01). The top five leading causes of death were cardiovascular disease,malignant tumors,respiratory diseases, injuries and poisoning,and other diseases. The death cases of the five leading causes accounted for 94. 60% of all death causes. Traffic-accidents,accidental fall,accidental poisoning and suicide were the main reasons for death induced by injury and poisoning,and they were the most common causes of early death among young adults.[Conclusion]The proportion of non-communicable disease is the highest in total death cases,and it is the main death causes that harm the health of residents in Zhoukou City. Injury and poisoning are the main risk factors that endanger the health of young adults. So it is urgent to strengthen the prevention and control of non-communicable disease,and the government should establish the control and prevention planning aiming at injuries as soon as possible.
Impact of myeloablative therapy with bone marrow transplantation in advanced neuroblastoma

Current results suggest that purged autologous bone marrow transplant may improve outcome for some subsets of high risk neuroblastoma, but the risk of relapse is still high.
A modified higher order power filter for grid-connected renewable energy systems

In order to reduce the influence of the grid harmonic currents and voltages, harmonic compensation is regularly implemented for a grid-tied inverter. In this paper a new topology of higher order power filter for single-phase grid-tied voltage-source inverters (VSI), named L(LCL)2, is introduced. The subscript is added to the name to avoid confusion with LLCL filter. In the proposed design the inverter side inductance is divided into three parts, and the grid side inductor is removed. Also an additional resonant branch at the double of switching frequency is added to the traditional LLCL filter to attenuate high frequency harmonics. The total inductance of this filter is less than LLCL filter with the amount of the grid side inductor. A comparative study and discussions on the subject of the traditional LLCL filter and the proposed L(LCL)2 filter have been conducted and assessed through both experimental hardware implementation and Matlab/Simulink-based simulation on a 700 W, 120V / 60 Hz single-phase grid-tied inverter. Also, a straightforward engineering design benchmark is suggested to discover parameters of the proposed L(LCL)2 filter. It is concluded that, compared with the LLCL filter, the L(LCL)2 filter not only has less voltage drop and total inductor size, but also has better performance on reducing high order current harmonics.
Postoperative respiratory failure necessitating transfer to the intensive care unit in orthopedic surgery patients: risk factors, costs, and outcomes

Postoperative pulmonary complications in orthopedic surgery patients have been associated with worse clinical outcomes. Identifying patients with respiratory risk factors requiring enhanced monitoring and management modifications is an important part of postoperative care. Patients with unanticipated respiratory decompensation requiring transfer to the intensive care unit (ICU) have not been studied in sufficient detail. A retrospective case-control study of elective orthopedic surgery patients (knee, hip, shoulder, or spine, n = 51) who developed unanticipated respiratory failure (RF) necessitating transfer to the ICU over a 3-year period was conducted. Controls (n = 153) were frequency matched to cases by gender, age, and surgical procedure. Patient and perioperative care factors, clinical outcomes, and cost of care were examined. Transfer to the ICU occurred within 48 h of surgery in 73 % of the cases, 31 % required non-invasive ventilation, and 18 % required mechanical ventilation. Cases had a higher prevalence of chronic obstructive pulmonary disease (COPD), obstructive sleep apnea (OSA), and regular psychotropic medication use than controls. Cases received more intravenous opioids during the first 24 postoperative hours, were hospitalized 4 days longer, had higher in-hospital mortality, and had excess hospitalization costs of US$26,571. COPD, OSA, preoperative psychotropic medications, and anesthesia time were associated with risk of RF in a multivariate analysis. Unanticipated RF after orthopedic surgery is associated with extended hospitalization, increased mortality, and higher cost of care. Hospital protocols that include risk factor assessment, enhanced monitoring, and a cautious approach to opioid use in high-risk patients may reduce the frequency of this complication.
Introspection as a Metaphor

So, if introspection is not a kind of perception, what is it? What are we doing when we introspect? The primary goal of the remainder of this book is to develop a satisfying answer to this question, providing a viable understanding of introspection and its epistemic properties. Before turning to the details, however, I want to emphasize here in this transitional chapter the fact that introspection is a diverse phenomenon, held together not by a single kind of cognitive process or epistemic status, but rather by a metaphorical unity applied to the subjective first-person orientation we have towards our own minds. Key to understanding the diversity of introspection is the realization that the concept of introspection itself, as a looking within, is a metaphor. If we want an accurate characterization of introspection, we cannot take the concept itself literally. It is, rather, a unifying perceptual metaphor projected onto a diverse set of epistemic relationships we hold to ourselves. Once this is understood, the concept of introspection is opened up for revision, to be reconsidered and reconceived. Regarded as a metaphor, introspection need not be confined to a singular mechanism or process. Instead, it can be treated as a unifying concept for multiple states and processes at work in our first-person epistemic grasp of our own minds. The articulation of this point here will provide a framework for understanding how the various aspects of introspection discussed in subsequent chapters fall together under this one umbrella concept of ‘introspection’.
Expressive Aphasia as an Initial Manifestation of the Syndrome of Transient Headache and Neurologic Deficits with Cerebrospinal Fluid Lymphocytosis (P6.096)

Objective: To describe a case of expressive aphasia due to the syndrome of transient headache and neurologic deficits with cerebrospinal fluid lymphocytosis (HaNDL). Background: HaNDL is a condition of unknown etiology, with only approximately 100 cases reported to date. Unfamiliarity with the condition and variability in neurological deficits may contribute to under-diagnosis. Prompt recognition is essential for reducing morbidity from misdiagnosis. Methods: Case report. Results: A 24-year-old male presented with two hours of expressive aphasia. He also had a severe left-temporal headache, vomiting, and right hemibody paresthesias that rose sequentially from the lower extremity to the upper extremity and face over 10 minutes. Exam was notable for initial mutism that improved to short sentences with paraphasic errors and difficulty following simple verbal commands. Symptoms resolved with no residual language deficits, and thus tissue plasma antigen was not administered. Non-contrast head CT, MRI brain with and without contrast, and MRA head and neck were normal. Electroencephalogram showed slowing over the left temporal lobe without epileptiform activity. Opening pressure on lumbar puncture was normal, and cerebral spinal fluid analysis revealed elevated protein (116) and total nucleated cell count (54) with 90[percnt] lymphocytes. Further infectious workup was unrevealing. Similar self-resolving episodes recurred approximately five times over three months. Given recurrent stereotyped episodes of transient neurologic deficits and severe headache, hemiparesthesias, and CSF lymphocytic pleocytosis in temporal relation to neurologic deficits, the patient fit ICHD-3 criteria for HaNDL. The patient demonstrated a remission in symptom recurrence three months after onset. Repeat asymptomatic testing demonstrated resolution of CSF pleocytosis and normal encephalogram findings. Conclusions: HaNDL is a rare condition with varied neurological deficits. This case, which illustrates expressive aphasia as a potential initial neurological manifestation of HaNDL, expands known characteristics of this uncommon syndrome. Disclosure: Dr. Kabaria has nothing to disclose.
Neurocognitive Function Is Associated With Serum Iron Status in Early Adolescents.

Objective:The association between iron and neurocognition remains underexplored in adolescents, and the neurocognitive effects of low and high iron levels have yet to be established. The aim of thi...
Increasing Wnt3a Signaling in Myeloma Cells Inhibits the Osteolytic Phenotype and Tumor Growth In Vivo through Regulation of the RANKL/OPG Axis in Osteoblasts and Indirectly Regulates Osteoclastogenesis.

We have demonstrated that canonical and non-canonical Wnt signaling occurs in myeloma cells (Qiang et al., 2005) and overexpression of Wnt3a in myeloma cells inhibits the osteolytic phenotype and also tumor growth in vivo (Qiang et al Blood, Abstract #3420, 2006). To further investigate the mechanisms that contribute to this process we have expanded our in vivo data by showing that while H929 cells stably expressing Wnt3a (H929/W3a) leads to reduced tumor growth in the in-vivo SCID-hu bone graft model compared with H929 vector alone transfected control cells (H929/EV), there was no significant difference in the subcutaneous growth of the two cell lines in SCID mice. Taken together these data suggests that alteration of the human bone marrow microenvironment is central to Wnt-mediated reduction in tumor growth in bone. We next employed an in-vitro co-culture model in which the mouse osteoprogenitor cell line, C2C12, and human osteoblast cell line, Saos-2 were co-cultured with either H929/Wnt3 or H929/EV cells. QPCR analysis demonstrated that osteoprotegerin ( OPG ) mRNA expression (relative OPG mRNA to GAPDH ) in C2C12 cells co-cultured with H929/W3a was significantly elevated compared with H929/EV (mean±SD: 14.34±0.97 vs 8.43±0.16; P OPG mRNA and protein levels were observed in Saos-2 cells co-cultured with H929/W3a relative to H929/EV. Furthermore, treatment of C2C12 cells with recombinant Wnt3a protein induced both OPG mRNA (48.1 ±1.2 vs 1.0±0.5; P OPG transcription in osteoblast progenitors in-vivo . To further confirm the role of Wnt signaling in regulation of OPG and RANKL transcription, we produced C2C12 cells that stably express Dkk1. These clones showed a significant inhibition of Wnt3a induced OPG mRNA (22.2± 2.3 vs 1.7±0.35; p RANKL mRNA (5.1±0.9 vs 1.0± 0.5, p P P in-vitro . Taken together, these data suggest that Wnt ligand-mediated inhibition of myeloma cell growth, and inhibition of osteolytic lesions, in-vivo may result from upregulation of OPG and loss of RANKL in osteoblast progenitors, which subsequently diminishes osteoclast formation. Results of these studies provide new insights into mechanism by which Wnts may serve as an important indirect regulator of myeloma growth and osteoclast formation, and as such, targeting Wnt signaling may be an new therapeutic strategy for controlling myeloma growth and associated bone disease.
It’s a process: reactions to HIV diagnosis and engagement in HIV care among high-risk heterosexuals

After HIV diagnosis, heterosexuals in high-poverty urban areas evidence delays in linkage to care and antiretroviral therapy (ART) initiation compared to other groups. Yet barriers to/facilitators of HIV care among these high-risk heterosexuals are under-studied. Under the theory of triadic influence, putative barriers to HIV care engagement include individual/attitudinal-level (e.g., fear, medical distrust), social-level (e.g., stigma), and structural-level influences (e.g. poor access). Participants were African American/Black and Hispanic adults found newly diagnosed with HIV (N=25) as part of a community-based HIV testing study with heterosexuals in a high-poverty, high-HIV-incidence urban area. A sequential explanatory mixed-methods design was used. We described linkage to HIV care and clinical outcomes (CD4 counts, viral load levels) over one year, and then addressed qualitative research questions about the experience of receiving a new HIV diagnosis, its effects on timely engagement in HIV care, and other barriers and facilitators. Participants were assessed five times, receiving a structured interview battery, laboratory tests, data extraction from the medical record, a post-test counseling session, and in-person/phone contacts to foster linkage to care. Participants were randomly selected for qualitative interviews (N=15/25) that were recorded and transcribed, then analyzed using systematic content analysis. Participants were 50 years old, on average (SD=7.2 years), mostly male (80%), primarily African American/Black (88%), and low socioeconomic status. At the first follow-up, rates of engagement in care were high (78%), but viral suppression was modest (39%). Rates improved by the final follow-up (96% engaged, 62% virally suppressed). Two-thirds (69%) were adequately retained in care over one year. Qualitative results revealed multi-faceted responses to receiving an HIV diagnosis. Problems accepting and internalizing one’s HIV status were common. Reaching acceptance of one’s HIV-infected status was frequently a protracted and circuitous process, but acceptance is vital for engagement in HIV care. Fear of stigma and loss of important relationships were potent barriers to acceptance. Thus, partially as a result of difficulties accepting HIV status, delays in achieving an undetectable viral load are common in this population, with serious potential negative consequences for individual and public health. Interventions to foster acceptance of HIV status are needed.
Multi-agent based distributed power agreement for enhanced frequency response of transmission systems

In this paper, we propose a distributed open loop control algorithm for large-scale transmission systems having multiple control areas exchanging power through tie-lines. Inspired from graph theoretic methods in multi-agent systems, it ensures a high degree of coordination among control areas to improve the frequency response with minimal inter-area oscillations in case of sudden loss of generation. Local nodes associated with generation units coordinate with regional nodes monitoring tie-line flows to ensure load-generation balance is maintained at all times with sparse information exchange. We develop a Cyber-Physical abstraction which allows for a scalable architecture that is independent of the internal dynamics of the control areas. Consequently, these areas can quantitatively predefine their contribution in frequency restoration during primary control. We perform simulations on a test system resulting in improved frequency response and reduced deviation from the nominal frequency, demonstrating the efficacy of our proposed protocol.
Connecting Antarctic sea ice to deep‐ocean circulation in modern and glacial climate simulations

Antarctic sea-ice formation plays a key role in shaping the abyssal overturning circulation and stratification in all ocean basins, by driving surface buoyancy loss through the associated brine rejection. Changes in Antarctic sea ice have therefore been suggested as drivers of major glacial-interglacial ocean circulation rearrangements. Here, the relationship between Antarctic sea ice, buoyancy loss, deep-ocean stratification, and overturning circulation is investigated in Last Glacial Maximum and preindustrial simulations from the Paleoclimate Modelling Intercomparison Project (PMIP). The simulations show substantial inter-model differences in their representation of the glacial deep-ocean state and circulation, which is often at odds with the geological evidence. We argue that these apparent inconsistencies can largely be attributed to differing (and likely insufficient) Antarctic sea-ice formation. Discrepancies can be further amplified by short integration times. Deep-ocean equilibration and sea-ice representation should, therefore, be carefully evaluated in the forthcoming PMIP4 simulations.
New Economy Narrative?: A Comparative Analysis of Technology and Economic Recovery in the Business Press

Recently, terms such as the “fourth industrial revolution”, or the “second machine age”, have been used both in the business press and by academics to describe the current era of technological deve...
Meta-Analysis Comparing Catheter-Guided Ablation Versus Conventional Medical Therapy for Patients With Atrial Fibrillation and Heart Failure With Reduced Ejection Fraction.

The prognostic benefit of catheter ablation (CA) for atrial fibrillation in the setting of heart failure (HF) with reduced ejection fraction (EF) is unclear. A systematic search of medical literature was limited to randomized controlled trials. The primary outcome was all-cause mortality, and secondary outcomes were HF hospitalizations, stroke, left ventricular EF improvement, change in 6-minute walk test, and change in Minnesota living with HF questionnaire (Δ MLHFQ). Random effects risk ratios (RR) were calculated for categorical outcomes and standardized mean differences (SMD) for continuous ones, using Der-Simonian and Liard model. A total of 775 ambulatory patients from 6 trials were included. The mean EF was 31% with a mean New York Heart Association classification class 2.5. At a mean follow-up of 26 months, CA was associated with lower incidences of all-cause mortality (RR 0.50, 95% confidence intervals [CI] 0.34 to 0.74, I2 = 0%, p