cssi/SciSciGPT-SciSciNet huggingface dataset:
Preventing suicide in Montana: a community-based theatre intervention

Purpose This study aims to examine whether a community-based suicide prevention project could increase willingness to seek professional help for suicidal ideation among young people. Design/methodology/approach Online surveys were administered at baseline (n = 224) and six months post-test (n = 217), consisting of the Risk Behavior Diagnosis scale; self-report questions on suicidality; willingness to engage with suicide prevention resources; and willingness to communicate with peers, family members, teachers or counselors about suicide. Findings A comparison of means within groups from pre- to post-test showed increases in self-efficacy for communicating about suicidal concerns with a teacher, school counselor or social worker; increases in self-efficacy for helping others; and increases in response-efficacy of interpersonal communication about suicide with a teacher, school counselor or social worker. Practical implications Young adults need to be willing and able to intervene in life-threatening situations affecting their peers. In step with narrative empowerment education, personal experiences can be used to communicatively reduce peer resistance to behavior change. Originality/value Health communicators tend to rely on overly didactic education and awareness-raising when addressing suicide prevention. This research shows the importance of direct and personal forms of influence advocated by social marketing professionals.
(3) Uses and Misuses of Anti-inflammatory Drugs in Racehorses - II

SUMMARY The author indicates that the use of drugs to restore normal function can constitute doping and this imposes serious problems for the veterinary surgeon and trainer. The rates of excretion in relation to the route of administration of certain drugs and the influence of the pH of the urine on their detection is discussed. RESUME L'auteur indique que l'emploi de medicaments pour retablir des fonctions normales peut etre considere comme un doping; il en resulte des difficultes pour le veterinaire et pour l'entraineur. Les vitesses et taux d'excretion de certains medicaments en relation avec leur voie d'administration et l'influence du PH urinaire sur leur detection sont discutes. ZUSAMMENFASSUNG Der Autor zeigt, dass der Gebrauch von Medikamenten zur Wiederherstellung normaler Funktionen als Doping betrachtet werden kann, was zum ernsthalten Problem fur den Tierarzt und den Trainer werden kann. Die Ausscheidungsgeschwindigkeit gewisser Medikamente wird in Beziehung gesetzt zur Art der Applikation und der Einfluss des Harn-pH auf den Nachweis der Substanzen wird diskutiert.
A complexity analysis of the JPEG image compression algorithm

Digital Image Processing (DIP) is one of the fastest evolving fields in Computer Science with growing numbers of applications. As the demand for multimedia increases, more advanced sensors are being developed, producing a more demanding volume of data. As a result, the theory of data compression has become extremely significant in reducing data redundancy to save hardware storage space and transmission bandwidth in the context of digital imagery. In this paper, we will analyze the complexities of the various algorithms implemented in JPEG Image Compression Algorithm both theoretically and experimentally. These algorithms include Discrete Cosine Transform, Quantization, and Symbol Encoding techniques such as Huffman and Arithmetic Coding. Finally, we will explore different optimization schemes in terms of computational performance.
Hispanic Populations, Veterans, and Symptom Assessment

The current issue of Journal of Dual Diagnosis covers a wide range of topics. Two of the papers focus on veterans. Moore and Skinner examined the longitudinal impact of emotional regulation and rel...
Da cordialidade à brega: o veneno-remédio das culturas periféricas em Sérgio Buarque de Holanda, José Miguel Wisnik e Arcadio Díaz-Quiñones

O espaco periferico engendra fantasias poderosas, capazes de converter a periferia num centro produtor de alternativas para os descaminhos do mundo moderno. Reagindo ao otimismo dessa visao, procuro flagrar tres momentos da producao critica moderna e contemporânea, no Brasil e no Caribe, em que os espacos perifericos parecem ter criado praticas sociais e culturais que resistem ao poder da norma. Para alem de um elogio simplista das sociedades “hibridas” ou “mesticas”, pretendo perguntar, com Sergio Buarque de Holanda, Jose Miguel Wisnik e Arcadio Diaz-Quinones, pela nocao de sujeito que emerge das experiencias marginais. Palavras-chave: Sergio Buarque de Holanda. Jose Miguel Wisnik. Arcadio Diaz-Quinones. Culturas perifericas.
In vitro growth and differentiation of rabbit bulbar, fornix, and palpebral conjunctival epithelia. Implications on conjunctival epithelial transdifferentiation and stem cells.

Purpose The anterior surface of the eye is covered by several physically contiguous but histologically distinguishable epithelial overlying the cornea, limbus, bulbar conjunctiva, fornix conjunctiva, and palpebral conjunctiva. It is important to determine whether the different phenotypes of these epithelia are the result of intrinsic divergence, extrinsic modulation, or a combination of both. Based on keratin expression and cell kinetic criteria, the authors previously suggested that corneal epithelial stem cells may actually reside in the limbal basal layer. Methods In this article, the relationship between the corneal-limbal epithelial cells and conjunctival epithelial cells was analyzed by comparing their growth and differentiation properties in an identical cell culture environment. Results Using Dispase instead of trypsin to dissociate the cells, the authors were able to grow all five rabbit ocular surface epithelia in the presence of 3T3 feeder cells. They found that corneal and limbal cells synthesize identical keratins, including large amounts of the K3 and K12 markers of corneal-type differentiation. By contrast, all three conjunctival epithelia shared another keratin pattern, with large amounts of simple epithelial keratins but only minute amounts of K3/K12 keratins. Conclusions This observation, coupled with previous findings that the "transdifferentiation" of conjunctival epithelial cells to corneal epithelium appears to be both incomplete and reversible, provides strong evidence that (1) the limbal-corneal epithelial cells form a lineage distinct from the conjunctival lineage and (2) conjunctival transdifferentiation actually represents a process of environmental modulation. In addition, of the three types of conjunctival epithelial cells, fornix cells were found to have a much greater proliferative potential than bulbar and palpebral cells. This observation, coupled with recent finding that fornix is enriched in slow-cycling (label-retaining) cells, raises the possibility that conjunctival epithelial stem cells may preferentially reside in the fornix.
Aorto-Innominate Artery Bypass

Symptomatic innominate artery stenosis >50%. Asymptomatic stenosis >70% or deep ulcerated plaque lesion associated with >50% stenosis. Debranching procedure prior to TEVAR.
Circulation to Bone

Circulation of blood through bone has a dual function: to supply nutrition to this structure and to contribute to the maintenance of homeostasis by acting as a depot for many ions and cations of body fluid. Although bone is a highly vascular tissue, experimental and clinical data regarding the architecture of its arterial and venous systems and the physiologic and pathologic responses of the local vessels are in many instances contradictory and fragmentary.
Abstract A129: A second-site mutation in BRAF confers resistance to RAF inhibition in a BRAF V600E-mutant brain tumor

BRAF V600E drives tumors by hyperactivating ERK signaling, is activated in a RAS-independent manner, and signals as a monomer. Selective inhibitors of RAF potently inhibit BRAF V600E and downstream ERK signaling, and have been associated with impressive clinical responses in patients whose tumors harbor V600E mutations in BRAF. Almost all patients, however, ultimately develop resistance. To date, acquired resistance mechanisms validated in patient samples have included splice forms of BRAF, mutations in NRAS, and BRAF amplification, all of which promote formation of RAF dimers, and mutations in MEK. Second-site point mutations in BRAF that promote dimer formation and are associated with acquired resistance have not previously been identified in RAF inhibitor-resistant tumors. Here, we report a complete response followed by clinical progression of a BRAF V600E-mutant pediatric brain tumor treated with the RAF inhibitor dabrafenib. We identified a second-site mutation in BRAF at the time of progression that was not present in the pretreatment tumor. Further study indicated the acquired mutation is in cis with V600E. We demonstrate that the acquired resistance mutation induces RAF dimer formation, and is sufficient to confer resistance to dabrafenib. Moreover, we showed that ERK signaling activated by the double mutation is sensitive to MEK inhibition or to the RAF plus and MEK inhibitor combination. We also find that two novel RAF dimer inhibitors may overcome resistance mediated by the novel mutation in BRAF. This is the first study, to our knowledge, that demonstrates the emergence of a confirmed second-site mutation in BRAF V600E and validates that this mutation is responsible for acquired resistance in an initially responding patient treated with dabrafenib. The mechanism of acquired resistance can be abrogated by the novel RAF dimer inhibitors. Our data confirm that a novel class of RAF dimer inhibitors are active against an acquired resistance mutation, suggesting an improved personalized treatment option for patients who harbor similar second-site mutations in BRAF. Citation Format: Jiawan Wang, Zhan Yao, Philip Jonsson, Amy Allen, Alice Can Ran Qin, David Pisapia, Neal Rosen, Barry S. Taylor, Christine A. Pratilas. A second-site mutation in BRAF confers resistance to RAF inhibition in a BRAF V600E-mutant brain tumor [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference: Molecular Targets and Cancer Therapeutics; 2017 Oct 26-30; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2018;17(1 Suppl):Abstract nr A129.
Management of pancreatitis and pancreatic: fluid collections

Acute pancreatitis is a constant management challenge, especially with peripancreatic collection that are one of the most common complications; after the first surgical attempts that had high mortality, there had to be a new approach based in decades of acquired knowledge in physiopathology added to the development of endoscopic intervention techniques and the evolution of endoscopic devices help to establish less invasive and conservative management. This review allows us to know the last advances in the management of acute pancreatitis, pancreatic pseudocyst and walled off necrosis, determined the right time for the management to become more invasive, even considering surgery at a final stage. It also reviews the different types of drainage of peripancreatic collections and the accessories currently in use.
The effectiveness of peer assessment and a proposal for its analysis using game theory

A close look at the educational literature reveals both negative perceptions among peer assessment participants and evidence that peer assessment may not as effective as generally thought. An analy...
Processes influencing heat transfer in the near-surface ice of Greenland's ablation zone

Abstract. To assess the influence of various heat transfer processes on the thermal structure of near-surface ice in Greenland's ablation zone, we compare in situ measurements with thermal modeling experiments. A total of seven temperature strings were installed at three different field sites, each with between 17 and 32 sensors and extending up to 21 m below the ice surface. In one string, temperatures were measured every 30 min, and the record is continuous for more than 3 years. We use these measured ice temperatures to constrain our modeling experiments, focusing on four isolated processes and assessing the relative importance of each for the near-surface ice temperature: (1) the moving boundary of an ablating surface, (2) thermal insulation by snow, (3) radiative energy input, and (4) subsurface ice temperature gradients below the seasonally active near-surface layer. In addition to these four processes, transient heating events were observed in two of the temperature strings. Despite no observations of meltwater pathways to the subsurface, these heating events are likely the refreezing of liquid water below 5–10 m of cold ice. Together with subsurface refreezing, the five heat transfer mechanisms presented here account for measured differences of up to 3 ∘ C between the mean annual air temperature and the ice temperature at the depth where annual temperature variability is dissipated. Thus, in Greenland's ablation zone, the mean annual air temperature is not a reliable predictor of the near-surface ice temperature, as is commonly assumed.
Discrete Lattice Material Vacuum Airship

Vacuum airships fueled by renewable energy would reduce reliance on fossil fuel-based modes of transport, lessen the need for limited and non-renewable lifting gases, and can be achieved using novel manufacturing techniques for ultra-light, discrete lattice material systems.The Discrete Lattice Material Vacuum Airships (DLMVA) system combines novel material science and manufacturing technologies for new modes of mass transportation, resulting in a disruptive approach to reduce national resource consumption and emissions. Through the use of high performance building block elements, modular, scalable and extensible aircraft can be rapidly assembled into positive net-buoyancy systems utilizing a vacuum instead of a lifting gas. By using architected lattice material principles, show that lattice materials can overcome stability limitations of previous vacuum balloon designs. Additionally, we show that lattice vacuum balloons are strength limited, rather than stability limited. As a result,airborne infrastructure can be developed to support the proliferation of modern systems such as e-commerce and distributed communications, while simultaneously reducing dependence on finite, non-renewable, emission-heavy resources.
Interactive worst-case execution time analysis of hard real-time systems

Hard real-time systems are already common in aerospace, automobiles, and industrial robotics, and they will become even more prevalent with the emergence of new domains such as computer-assisted surgery. Perpetual concerns over safety and overall mission success require a guarantee that these increasingly complex systems perform as designed. One technique involves a static analysis to place an upper bound on the worst-case execution time (WCET) of hard real-time software. Without knowledge of WCET, the timing behavior of a program cannot be guaranteed. Although substantial research has been applied to the problem of WCET analysis, virtually all prior work has focused on increasing accuracy without regard to speed. The resulting implementations are often too slow to be integrated into the development cycle, requiring WCET analysis to be postponed until a final validation phase. Fixing timing errors after the code has been written is expensive, time-consuming, and may necessitate a redesign of the system. A new approach, interactive WCET analysis, would prevent such problems. Its novelty lies in making timeliness a fundamental concern of system design from the moment the first line of code is written. Rather than waiting until an implementation is complete before starting the analysis, it incorporates knowledge of worst-case time into the development cycle continuously and dynamically, allowing early detection and removal of timing errors. This dissertation proposes a variety of methods for making WCET analysis interactive. It begins with a simplification of the problem by relying on Java-based microprocessors to eliminate many sources of unpredictability. It then presents contributions in a bottom-up fashion, starting with a technique for annotating control flow graphs with decompiled source code. These graphs are used to map the results of WCET analysis to source code as it is written, a process known as interactive back-annotation. Additional contributions include compiler support for type-safe WCET annotations, statically analyzable collection classes, and a fast tree-based analysis algorithm with method cache support. Each contribution is implemented within a suite of extensible, modular, open-source tools that demonstrate how interactive WCET analysis can be integrated into a traditional software development environment.
Underwriter Certification: Evidence from Seasoned Equity Issues

This proposal examines the relationship between certification and the reputation of underwriters. Based on seasoned equity offers between 1976 and 2005, in the first part of this proposal I document a positive abnormal announcement return associated with the selection of an underwriter that is more reputable than expected given publicly available firm and issue characteristics. Having an issue underwritten by a surprisingly more reputable underwriter is associated with a durable decrease in bid-ask spreads lasting about three quarters. This effect and the aforementioned one on announcement returns are both stronger with firms that have higher levels of asymmetric information ahead of the offering. These results are consistent with the quality of the underwriter being directly related to the often mentioned certification effect, consisting of a reduction in information asymmetry. In the second part of this proposal, I analyze the firm's use of a commercial vs. an investment bank in equity underwriting, while considering the underwriter's reputation and the endogeneity of the fees. Firms with higher levels of asymmetric information are more prone to have their equity issues underwritten by a commercial bank. The firms react to the fees that would be charged by the different bank types and reputations. After controlling for the underwriter's reputation, the effect on announcement returns of a surprise announcement of being underwritten by a commercial bank is directly related to the firm's level of information asymmetry. This is consistent with the commercial banks' competitive advantage in certification residing in economies of scope/ information transfers, and the investment banks' relative strength consisting of an outsider certification capability that is less variable across the spectrum of firms transparency.
Risk assessment of dietary deoxynivalenol exposure in wheat products worldwide: Are new codex DON guidelines adequately protective?

Abstract Background Deoxynivalenol (DON) is a mycotoxin produced primarily by the fungi Fusarium graminearum and F. culmorum in cereal grains. It causes vomiting, anorexia, reduced weight gain, and impaired immune function in multiple animal species. Several outbreaks of human gastroenteritis in different populations worldwide suggest a possible link to dietary DON exposure. Because of these acute and chronic health risks, the United Nations (UN) Codex Alimentarius Commission has recently set guidelines on maximum tolerable DON levels in wheat, barley, and maize. Scope and approach This review describes DON occurrence in wheat worldwide, and current regulations regarding DON in foods set by Codex Alimentarius Commission and some individual countries. We review toxicological evaluations of DON and extend global human health risk assessments for different age-subgroups. Whether the recent Codex DON guidelines are adequately protective is addressed on the basis of risk assessments with and without these guidelines in place, in different nations of the world. Key findings and conclusions Using updated wheat consumption data from the FAO/WHO Chronic individual food consumption database (CIFOCO), we found adult populations in Brazil, China and Belgium and child populations in Australia, China, and Belgium have DON exposures that could pose chronic health risks. The new Codex guidelines for DON in wheat are stricter than most nations’ current regulatory standards. Some populations worldwide may not be well protected even if Codex standards are applied, because of high wheat consumption. In those populations, pre- and postharvest interventions to reduce DON in wheat should be implemented to protect health.
Impact of invasive regional lymph node examination (IRLNE) and time to radiation on overall survival for patients with stage I NSCLC treated with SBRT- a NCDB analysis.

e20041Background: SBRT is the standard of care for patients (pts) with early stage NSCLC who are not surgical candidates due to co-morbidities. Current NCCN guidelines state that IRLNE prior to def...
Integrating a Geneticist in a Multidisciplinary Clinic for Down Syndrome Increases Commitment to Genetic Counseling.

Background Although most physicians and genetic professionals are familiar with Down syndrome, many families do not have experience with Down syndrome before having a child diagnosed. The American Academy of Pediatrics has specific recommendations for genetic counseling and chromosome analysis for Down syndrome. Local Problem The literature indicates that adherence to completion of appropriately timed genetic counseling is low at 31%. This study was initiated to determine our adherence rates and to improve if needed. Methods In the Down syndrome clinic at Nationwide Children's Hospital, a subspecialty clinic in the Division of Developmental and Behavioral Pediatrics, a genetic counselor was on-call but did not routinely attend. The intervention consisted of multidisciplinary care with the presence of a clinical geneticist. Statistical Process Control Charts and Fisher's exact test were used to determine the impact of the intervention. Results Our baseline rate of adherence to genetic counseling was similar to previous publications. Direct genetics involvement in the Down syndrome clinic in place of an on-call genetic counselor led to significant improvement in adherence to genetic counseling recommendations over a 6-month period from 35% to 62%, P < 0.001 and sustained for 6 months. Postclinic adherence rates and subanalyses by age showed similar results. The final postvisit adherence rate of 89% in February 2017 demonstrates continued improvement. Geneticist involvement allowed chromosome reports uploading and karyotype listing in electronic medical records. Implications and Lessons Learned Genetic counseling in newborns with Down syndrome is important, yet was often not received at Nationwide Children's Hospital before this study. Integrating a geneticist resulted in improvement. Implementing similar models at other institutions can ensure that the correct genetic testing is completed, results documented and families counseled appropriately.
The Most Integrated Hour in America: Reframing the Organizational Discourses of Church Purpose

Religious organizations have increasingly drawn the attention of communication scholars. This interest is due in part to the significant role these organizations have in building social capital – p...
Using Simple Interactions to Improve Pedagogy in a Cross-Aged Leadership Program.

Cross-aged teaching programs provide leadership experiences to youth who aim to influence children to be responsible, caring, and compassionate. Purpose: The purpose of this study was to examine the impact of a leadership development protocol on relationship development in an established cross-aged teaching program. Method: Guided by the developmental relationships framework, “Simple Interactions” was implemented with a group of nine youth leaders. The intent was to help them improve their relationships with children in four categories (a) connection, (b) reciprocity, (c) participation, and (d) progression. Data were collected through reflection documents and focus group interviews. Results: Qualitative results explain how Simple Interactions impacted reflection and revealed strategies youth leaders used to build relationships with children. Discussion: The findings suggest that the Simple Interactions protocol may provide an innovative strategy to promote reflective practice and develop positive relationships in a cross-aged teaching program.
Immunotherapy for food allergy

Food allergy is an important cause of life-threatening hypersensitivity reactions. Avoidance of allergenic foods is the only method of prevention that currently is available for sensitized patients. This method of prevention is difficult and often impossible. With better characterization of allergens and better understanding of the immunologic mechanism, investigators have developed several therapeutic modalities that potentially are applicable to the treatment and prevention of food allergy. Therapeutic options currently under investigation include peptide immunotherapy, DNA immunization, immunization with immunostimulatory sequences, anti-IgE therapy, and genetic modification of foods. These exciting developments hold promise for the safe and effective treatment and prevention of food allergy in the next several years.
Cortical pattern generation during dexterous movement is input-driven

The motor cortex controls skilled arm movement by sending temporal patterns of activity to lower motor centres1. Local cortical dynamics are thought to shape these patterns throughout movement execution2-4. External inputs have been implicated in setting the initial state of the motor cortex5,6, but they may also have a pattern-generating role. Here we dissect the contribution of local dynamics and inputs to cortical pattern generation during a prehension task in mice. Perturbing cortex to an aberrant state prevented movement initiation, but after the perturbation was released, cortex either bypassed the normal initial state and immediately generated the pattern that controls reaching or failed to generate this pattern. The difference in these two outcomes was probably a result of external inputs. We directly investigated the role of inputs by inactivating the thalamus; this perturbed cortical activity and disrupted limb kinematics at any stage of the movement. Activation of thalamocortical axon terminals at different frequencies disrupted cortical activity and arm movement in a graded manner. Simultaneous recordings revealed that both thalamic activity and the current state of cortex predicted changes in cortical activity. Thus, the pattern generator for dexterous arm movement is distributed across multiple, strongly interacting brain regions.
Exploring the Aggregative Growth of Nanoporous Zeolitic Imidazolate Framework ZIF-8

Nucleation and crystallization have been proven to be the key steps for early stage formation of metal–organic framework nanoparticles. However, the growth mechanisms attributed to size and topolog...
Chapter 16 – The student

Publisher Summary This chapter focuses on the variants of expertise as possessed by a student involved in learning. These variants are described as knowledge states. This chapter discusses further dimensions of variability in knowledge states: scope, incorrect knowledge, and a more subtle notion of viewpoints. In this chapter, the term “theory of bugs” is used in a general way to refer to any study of epistemic deviations of any type for a given domain and student population. When learning is viewed as successive transitions between knowledge states, the purpose of teaching is accordingly to facilitate the student's traversal of the space of knowledge states by means of a variety of instructional actions. This definition of teaching involves two basic types of activity: (1) attempts at perceiving the student's current knowledge state and (2) attempts at causing or supporting a transition to a new state.
Attention Meets Normalization and Beyond

To make Convolutional Neural Networks (CNNs) more efficient and accurate, various lightweight self-attention modules have been proposed. In this paper, we systematically study state-of-the-art attention modules in CNNs and discover that self-attention mechanism can be closely related to normalization. Based on this observation, we propose a novel attention module, named Normalization-Attention module (NA module in short), which is almost parameter-free. The NA module calculates the mean and standard deviation of intermediate feature maps and processes the feature context with normalization, which makes a CNN model easier to be trained and more responsive to informative features. Our proposed Normalization-Attention module can be integrated into various base CNN architectures, and used for many computer vision tasks, including image recognition, object detection, and more. Experimental results on ImageNet and MS COCO benchmarks show that our method outperforms state-of-the-art works using fewer parameters. Codes are made publicly available 1.1 https://github.com/13952522076/NANet
Reduction in Osteoarthritis Risk After Treatment With Ticagrelor Compared to Clopidogrel: A Propensity Score–Matching Analysis

OBJECTIVE Osteoarthritis (OA) is a common cause of joint pain and disability, and effective treatments are lacking. Extracellular adenosine has antiinflammatory effects and can prevent and treat OA in animal models. Ticagrelor and clopidogrel are both used in patients with coronary artery disease, but only ticagrelor increases extracellular adenosine levels. This study was undertaken to determine whether treatment with ticagrelor was associated with a lower risk of OA. METHODS We conducted a 1:2 propensity score-matching analysis using data from 2011-2017 in the Optum Clinformatics Data Mart. Patients who had received either ticagrelor or clopidogrel for ≥90 days were included in our study, and patients with a prior diagnosis of OA or inflammatory arthritis were excluded. OA was identified using International Classification of Diseases codes. The primary outcome was the time to diagnosis of OA after treatment with ticagrelor versus clopidogrel. RESULTS Our propensity score-matched cohort consisted of 7,007 ticagrelor-treated patients and 14,014 clopidogrel-treated patients, with a median number of days receiving treatment of 287 and 284, respectively. For both groups, the mean age was 64 years, and 73% of the patients were male. Multivariate Cox regression analysis estimated a hazard ratio for developing OA of 0.71 (95% confidence interval 0.64-0.79) (P < 0.001) after treatment with ticagrelor compared to clopidogrel. CONCLUSION Treatment with ticagrelor was associated with a 29% lower risk of developing OA compared to treatment with clopidogrel over 5 years of follow-up. We hypothesize that the reduction in OA seen in patients who received ticagrelor may in part be due to increased extracellular adenosine levels.
Expanding OSCE-related Learning Opportunities For Pre-Clerkship Students: Insights From an Assessment for Learning Curriculum:

Pre-clerkship clinical skills courses at many medical schools use objective structured clinical examinations (OSCEs) to assess students’ development as it relates to the foundational clinical skill...
Heart Failure due to Left Ventricular Systolic Dysfunction

Heart failure is a clinical syndrome in which abnormal cardiac function causes either a failure of the heart to pump blood at a rate matching the requirement of metabolizing tissues, or a situation in which filling pressures are elevated, or frequently both conditions simultaneously. Patients with impaired cardiac pumping function experience symptoms related to abnormal perfusion and retention of vascular fluid volume. The cardinal symptoms of heart failure include fatigue or exercise intolerance, dyspnea, and edema, although other related symptoms may also occur. Heart failure may be caused by disorders of the pericardium, myocardium, heart valves, or great vessels, but most patients manifest the syndrome through abnormalities in systolic function. Reduction in myocardial contractility is more commonly referred to as systolic dysfunction and may also coexist with chamber filling abnormalities, also referred to as diastolic dysfunction. This chapter focuses on patients with heart failure due to systolic dysfunction.
A Plutonium Mass Uncertainty Assessment Using a Cherenkov-Based Neutron Multiplicity Water Detector

We present a new analysis of the sensitivity of a water Cherenkov-based neutron multiplicity counter for nondestructive assay of trace quantities of 240Pu. The multiplicity counter [water-based neutron detector (WaND)] contains 1.0 m3 of water doped with 0.2% gadolinium in the form of a gadolinium salt (0.4% GdCl3). It can be used for testing the presence of trace quantities of 240Pu within a sample of unknown material by observing the correlated timing behavior of neutron capture candidates in the detector. The new analysis takes advantage of the fact that the detector is comprised almost entirely of a homogeneous medium, which permits the use of a simple model to reproduce the observed neutron capture timing behavior. The results of this analysis indicate that the detector has an absolute neutron detection efficiency of 23.4 ± 1.1% and is sensitive to a 240Pu mass as small as 2.3 mg (at $1\sigma $ ) after a 1-h data acquisition.
An updated paradigm for evaluating measurement invariance incorporating common method variance and its assessment

Measurement invariance is necessary before any substantive cross-national comparisons can be made. The statistical workhorse for conducting measurement invariance analyses is the multigroup confirmatory factor analysis model. This model works well if a few items exhibit clearly differential item functioning, but it is not able to capture, model, and control for measurement bias that affects all items, i.e., this model cannot account for common method variance. The presence of common method variance in cross-national data leads to poorly fitting models which in turn often results in biased, if not incorrect, results. We introduce a procedure to analyze and control for common method variance in one’s data, based on a series of factor analysis models with a random intercept. The modeling framework yields constructs and factor scores free of method effects. We use marker variables to support the validity of the interpretation of the random intercept as method factor. An empirical application dealing with material values in Spain, the UK, and Brazil is provided. We compare results with those obtained for the standard multigroup confirmatory factor analysis model.
Thinking Beyond the West: Seeing Religions with Unaccustomed Eyes

Social science was invented in the West and was shaped by Western culture. This includes its approach to religion. Scholars saw that Christians cared about people’s beliefs and about who ran their churches, so they focused on these parts of religious life. They ignored much of the rest. As a result, they had trouble understanding religions for which beliefs and church organization were less important. Had social science arisen in other parts of the world, it would have emphasized different things. This chapter explores two of these. From ancient China we get the Confucian idea of a relational self. Lǐ, or the ritual regard for the people who shape us, creates de, or virtue. A Confucian social scientist would ask, ‘Who sustains the sacred relationships on which our religious communities depend?’ From the traditional Navajo, we learn how rituals shape people’s inner experiences to restore their sense of the world’s beauty. A Navajo social scientist would ask, ‘Do rituals in other religions guide people to a sense of wholeness? If so, how?’ These non-Western ideas also have their blind spots. Even so, they let us see religion through unaccustomed eyes.
Abstract 15055: Quantitative Echocardiography of the Left Atrium: Traditional Measurement by Manual Planimetry Can be Replaced by Automated Four-dimensional Imaging That is More Efficient and Provides Additional Information

Background: Manual volume measurement of the left atrium (LA) using two-dimensional (2D) imaging is time consuming and mainly produces volumetric information. Hypothesis: LA chamber quantification ...
Graphene Manipulation on 4H-SiC(0001) Using Scanning Tunneling Microscopy

Atomic-scale topography of epitaxial multilayer graphene grown on 4H-SiC(0001) was investigated using scanning tunneling microscopy (STM). Bunched nano-ridges ten times smaller than previously recorded were observed throughout the surface, the morphology of which was systematically altered using a relatively new technique called electrostatic-manipulation scanning tunneling microscopy. Transformed graphene formations sometimes spontaneously returned to their original morphology, while others permanently changed. Using an electrostatic model, we calculate that a force up to ~5 nN was exerted by the STM tip, and an energy of around 10 eV was required to alter the geometry of a ~100×200 nm2 area.
Negative school experiences in early adolescence on depressive affect in middle adulthood

Abstract This study takes a life course perspective to examine the long-term effect of negative school experiences during early adolescence on depressive affect in middle adulthood. The study uses a prospective longitudinal panel dataset that spanned nearly three decades with three waves: when respondents were at 7th grade (Time 1, mostly 12–13 years of age), young adulthood (Time 2, in their 20 s), and middle adulthood (Time 3, in their mid-30 s to early 40 s). The OLS regression models yielded results demonstrating that early negative school experiences were contemporaneously associated with depressive affect at Time 1, which endured through Time 2 and Time 3. Furthermore, independently of Time 1 control variables and the stability effects of depressive affect at Time 1 and Time 2, early negative school experiences still exerted a direct effect on depressive affect in middle adulthood. Ad hoc analysis demonstrated that this significant direct effect was mediated by the economic attainment of the respondents in middle adulthood net of the stability effects of depressive affect. Apparently, part of the influences of early negative school experiences on depressive affect in middle adulthood may be explained by its impeding economic attainment in adulthood, which in turn was associated with depressive affect.
Surgical Techniques: Operative Decompression Using Thoracoscopic Approach for Neurogenic Thoracic Outlet Syndrome

First rib resection is commonly performed for patients with neurogenic thoracic outlet syndrome. A variety of approaches to this operation have been described including supraclavicular, infraclavicular, paraclavicular, and transaxillary approaches. In recent years, thoracoscopic approaches including thoracoscopic assisted transaxillary, thoracoscopic transthoracic, and robot-assisted transthoracic approaches to first rib resection have been described. In this chapter the rationale, advantages and disadvantages, and short-term outcomes of thoracoscopic first rib resections for neurogenic thoracic outlet syndrome are presented.
Opioid Prescribing Among Outpatients with Rheumatoid Arthritis.

STUDY OBJECTIVES To examine the outpatient opioid prescribing practices and the factors associated with opioid prescriptions in patient visits with rheumatoid arthritis (RA). DESIGN This cross-sectional study used the 2011-2016 National Ambulatory Medical Care Survey. Descriptive weighted analyses were used to examine the trends in opioid prescribing practices for RA. Multivariable logistic regression was used to examine the factors associated with opioid prescriptions among RA visits. SUBJECTS Adult patients (>18 years of age) with a primary diagnosis of RA based on the International Classification of Diseases. RESULTS According to the national surveys, an average of 4.45 (95% confidence interval [CI], 2.30-6.60) million office visits were made annually for RA. Approximately 24.28% of these visits involved opioid prescriptions. The RA visits involving opioid prescriptions increased from 1.43 million in 2011-2012 to 3.69 million in 2015-2016 (P < .0001). Being in the age group of 50-64 years (odds ratio [OR] = 3.40; 95% CI, 1.29-9.00), being Hispanic or Latino (OR = 2.92, 95% CI, 1.10-7.74), visiting primary physician (OR = 4.67; 95% CI, 1.86-11.75), prescribing of muscle relaxants (OR = 64.32; 95% CI, 9.71-426.09), acetaminophen (OR = 93.40; 95% CI, 26.19-333.04), antidepressants (OR = 6.10; 95% CI, 2.63-14.14), and glucocorticoids (OR = 3.20; 95% CI, 1.61-6.38), were associated with an increased likelihood of receiving opioid prescriptions in RA. CONCLUSIONS One in four adult RA visits resulted in opioid prescriptions, and the opioid visits more than doubled during the study period. Several patient and provider factors were associated with the opioid prescribing among RA visits. Understanding these prescribing practices can help to devise strategies for safe opioid prescribing practices in RA.
Aggressively recurring cervical intramedullary anaplastic astrocytoma in a pregnant patient.

Background Many patients with spinal juvenile pilocytic astrocytoma can experience prolonged remission after resection. However, some reports suggest that pregnancy may be associated with progression. Case description The authors provide an image report highlighting a case of rapid and aggressive transformation of an intramedullary astrocytoma of the cervical spine in a pregnant patient. Over the course of 1 year, the lesion progressed from a juvenile pilocytic astrocytoma to an anaplastic astrocytoma. Genetic testing revealed mutations associated with aggressive behavior. Conclusion The case and associated imaging demonstrate the importance of close neurologic monitoring and counseling regarding risk of progression in pregnant patients with spinal gliomas.
Negotiating professional identity formation in medicine as an ‘outsider’: The experience of professionalization for minoritized medical students

Abstract Introduction While the U.S. general population is increasingly diverse, less than 15% of medical school matriculants are from minoritized backgrounds. Unfortunately, early evidence suggests that the process of professional identity formation (PIF) for minoritized medical students is more difficult than that of their counterparts. We conducted serial, semi-structured interviews to learn about the experiences of minoritized medical students. We asked: How do participants understand their personal identity, and how it fits in—or does not—with the medical culture? Methods Participants were nine third-year medical students at a historically White and rural institution who self-identified as being members of at least one group that is historically underrepresented in medicine. Participants were interviewed one-on-one, twice, using a semi-structured guide with open-ended questions. Data were collected and analyzed simultaneously, using the principles of grounded theory. Results Two themes speak to the process of PIF for minoritized students within the dominant cultures of medicine and medical education. First, participants experienced a complex push-pull of their personal identities: they pulled their personal identities into their professional development in positive ways, but also sometimes found it necessary to push their personal identities away and make them less salient in order to be successful. Second, this push-pull contributed to feelings of self-doubt and isolation. Conclusion The results suggest that existing PIF frameworks are too simplistic with regard to the individual person. We therefore suggest that the social psychology concept of identity theory might appropriately complicate how we think about what the individual person brings to the PIF process.
Russian Nationalism and the National Reassertion of Russia

List of Tables and Figures. Preface - John B. Dunlop 1. Introduction - Marlene Laruelle Part I: Historical And Conceptual Issues In The Study Of Russian Nationalism 2. Rethinking Russian Nationalism: Historical Continuity, Political Diversity, and Doctrinal Fragmentation - Marlene Laruelle 3. Stalinism And Russian Nationalism: A Reconceptualization - Veljko Vujacic 4. Concepts of Fascism in Contemporary Russia and The West - Andreas Umland Part II. The "Far Right" And "New Right": ideological recompositions 5. Future Prospects of Contemporary Russian Nationalism - Alexander Verkhovsky 6. Dugin and the Eurasian Controversy: is Eurasianism "Patriotic?" - Wayne Allensworth Part III. Intellectual and Sociological Niches Of Contemporary Russian Nationalism 7. New Racism, 'Clash of Civilizations', and Russia - Victor Shnirelman 8. Electoral Choice, Cultural Capital, and Xenophobic Attitudes in Russia (1994-2006) - Anastassia Leonova 9. Fear has Wide Eyes: why do Russians see some migrant minorities as more numerous than others? - Mikhail A. Alexseev Part IV. Construction of an Official Patriotism: in search of a new ideology? 10. From Belgrade to Kiev: The hard-line nationalism and Russia's foreign policy - Andrei P. Tsygankov 11. A Religion for the Nation or a Nation for the Religion? Putin's Third Way for Russia - Beth Admiraal 12. Making the Public Patriotic: militarism and anti-militarism in Russia - Valerie Sperling The authors Index
Exponentially Weighted Moving Average (EWMA) Control Chart

An exponentially weighted moving average (EWMA) is a filter of sequential process data, giving the most recent observation the most weight and older observations exponentially less weight. EWMA control charts are especially useful in detecting small shifts in the mean or variance of a process. For processes that tend to wander over time, EWMAs are also a basic technique for predicting future observations, for making automatic adjustments to a process and for monitoring a sequence of forecast or regulation errors. Keywords: process monitoring; mean; variance; time series; feedback control
IBIS--a tool for automated sequential assignment of protein spectra from triple resonance experiments

We have developed a tool for computer-assisted assignments of protein NMR spectra from triple resonance data. The program is designed to resemble established manual assignment procedures as closely as possible. IBIS exports its results in XEASY format. Thus, using IBIS the operator has continuous visual and accounting control over the progress of the assignment procedure. IBIS achieves complete assignments for those residues that exhibit sequential triple resonance connectivities within a few hours or days.
Comparing Gay Identity Development Theory to Cognitive Development: An Empirical Study

The relationship between gay identity development and cognitive development, as outlined by Ivey's Developmental Counseling Therapy Model, was explored. The Gay Identity Questionnaire and the Standard Developmental Counseling Interview were administered to 78 gay men. Results suggested that there is a relationship between gay identity development and cognitive development. In addition, the findings provide evidence that gay identity development can be categorized by concrete and abstract frames of reference.
SOME IMPROVED METHODS IN P22 TRANSDUCTION

Recent refinements simplify methods for P22 transduction in Salmonella and allow improved recovery of phage-free transductional clones. The methods include use of: integration- and lysis-defective phage mutants, heat-killed bacteria to eliminate free phage, direct plating of phage and bacteria, replica-plating for detection of phage content of individual clones, improved broth for phage growth, and procurement of high titer phage from P22 lysogens.