cssi/SciSciGPT-SciSciNet huggingface dataset:
Hernandez V. Commissioner of Internal Revenue, 490 U.S. 680 (1989)

This piece is an encyclopedia entry on Hernandez v. Commissioner of Internal Revenue. Hernandez is best known as a leading United States Supreme Court decision on taxation and nonprofit organizations. It is also important, however, for the questions it raises about both the law's treatment of unconventional religious movements and its broader conceptualization of religion itself. In Hernandez, the Supreme Court upheld the Internal Revenue Service's rejection of charitable deductions claimed by members of the Church of Scientology for payments they made for practices of the church known as "auditing" and "training." The Scientologists contented that the fees, although fixed in amount and required to obtain those services, were similar to other sorts of religious payments whose deductibility the IRS had long allowed, including pew rents, tithes, and mass stipends. The Court's statutory analysis held that, to qualify as contributions or gifts, payments cannot be made as part of a quid pro quo in expectation of a good or service. Moreover, the Court rejected the Scientologist's statutory and constitutional arguments that this analysis is inappropriate to payments made for purely religious benefits. As noted, Hernandez acutely exposed some of the complexities in the law's understanding of religion. Nonprofits law has always classed churches as "charities." In some respects, though, they more closely resemble "mutual benefit" organizations such as social clubs, and payments by believers to their churches - whether part of a formal quid pro quo or not - often look more like club dues than gifts. Nevertheless, the law's assignment of charitable status to all churches rests less on an empirical claim than on an intricate set of considerations, including both a respect for religious autonomy and a healthy reluctance to ascribe undue legal significance to the considerable differences among churches in their practices and modes of organization.
Investment-Based Social Security

According to Senator Gramm, the impending bankruptcy of the current social security system won't be just a financial crisis, it will be a human tragedy, not unlike the turmoil of the Great Depression. The funding crisis of social security under the status quo, he argues, boils down to two bad choices: Americans will have to choose between lost opportunity for our children due to higher taxes that choke off economic growth, or abandoned security for our parents due to benefit cuts. There is a better way, Senator Gramm believes. It requires doing what social security promised but never delivered. It requires that we save and invest now rather than tax and borrow later. But it is not just money at stake here, according to the author. Tax tomorrow and we diminish our children's future, cut benefits tomorrow and we harden our parents' retirement. Save today and we save our children's dreams tomorrow. Invest today and we invest in our parents' security.
Research Ethics Case Study: Behavior, Leadership and Economic Success

This case study is used to explore ethical issues related to empirical research on human research ethics.
Using the olfactory system as an in vivo model to study traumatic brain injury and repair.

Abstract Loss of olfactory function is an early indicator of traumatic brain injury (TBI). The regenerative capacity and well-defined neural maps of the mammalian olfactory system enable investigations into the degeneration and recovery of neural circuits after injury. Here, we introduce a unique olfactory-based model of TBI that reproduces many hallmarks associated with human brain trauma. We performed a unilateral penetrating impact to the mouse olfactory bulb and observed a significant loss of olfactory sensory neurons (OSNs) in the olfactory epithelium (OE) ipsilateral to the injury, but not contralateral. By comparison, we detected the injury markers p75NTR, β-APP, and activated caspase-3 in both the ipsi- and contralateral OE. In the olfactory bulb (OB), we observed a graded cell loss, with ipsilateral showing a greater reduction than contralateral and both significantly less than sham. Similar to OE, injury markers in the OB were primarily detected on the ipsilateral side, but also observed contral...
Cumulative amount of intravenous lipid intake and parenteral nutrition-associated cholestasis in neonates with gastrointestinal surgical disorders.

Objective To evaluate if cumulative amount of intravenous lipid (IL) intake is associated with severity of parenteral nutrition (PN)-associated cholestasis (PNAC) in neonates with gastrointestinal surgical disorders (GISD). Study Design The authors performed a retrospective study including 36 neonates > 34 weeks gestational age with GISD. Neonates with metabolic liver disorders, chromosomal disorders, TORCH infections, which includes toxoplasmosis, other (syphilis, varicella-zoster, parvovirus B19), rubella, cytomegalovirus (CMV), and herpes, biliary tract anomalies, or direct hyperbilirubinemia (DHB) within first postnatal week were excluded. Results There was no significant difference in clinical factors between three groups of neonates: (1) without PNAC ( n = 13), (2) with mild-to-moderate PNAC (DHB 1–5 mg/dL, n = 12), and (3) with severe PNAC (DHB > 5 mg/dL or PNAC with elevated amino-transaminases, n = 11) except for duration of enteral starvation and PN. Using ordered logistic regression, cumulative amount of IL, glucose, and protein intake were independently associated with severity of PNAC ( p p = 0.008) compared with intravenous protein (0.257) and glucose (0.431) intake. Conclusions IL intake is associated with and is a better predictor of severity of PNAC in neonates with GISD.
Chronological age when healthcare transition skills are mastered in adolescents/young adults with inflammatory bowel disease.

Chronological age when healthcare transition skills are mastered in adolescents/young adults with inflammatory bowel disease
Approach to Acute Pharyngitis

The evaluation of the patient with a "sore throat" is deceptively complex. The clinician must first assess the potential for airway compromise. Specific risk factors, reviewed in this article, should be considered, including the presence of a pharyngeal membrane, immunocompromise, potential gonococcal exposure, and prior rheumatic fever.
Abruptio placentae in the setting of an atypical presentation of acute appendicitis: a case report.

Background Causes of placental abruption include traumatic events, cocaine use, hypertension, cigarette smoking and advanced maternal age. Recent studies also implicate inflammatory precursors, such as preterm premature rupture of membranes and chorioamnionitis. Clear precipitating events are often not identified, and precise etiologic determinants are still being determined. Case A 25-year-old woman, grayida 4, para 2012, presented with acute onset of severe abdominal pain; frequent, low-amplitude contractions; and a nonreassuring fetal heart tracing. While performing an urgent cesarean section for acute placental abruption, a ruptured appendicitis was identified. Conclusion This case suggests that appendicitis in the third trimester may be a risk factor for placental abruption.
Percutaneous radiologic gastrostomy catheter placement without gastropexy: a co-axial balloon technique and evaluation of safety and efficacy.

Purpose The purpose of this study is to evaluate the short-term safety and efficacy of a co-axial angioplasty balloon technique for percutaneous radiologic gastrostomy catheter placement (PRG).
Geospatial Evaluation for Urban Agriculture Land Inventory: Roanoke, Virginia USA

Urban agriculture is recently being recognized as a distinctive urban land use contributing to greenspaces and food security. The land inventory forms the critical first step in identifying sites for urban agriculture. The authors' analysis greatly expands on prior land inventory strategies, first analyzing land cover to identify all open areas available for siting urban agriculture. Then in GIS, the authors completed a land use suitability analysis, and finally a demographic analysis to assess potential sites for contribution to food security of lower income populations. Results show that Roanoke includes 2,312 hectares suitable for schoolyard gardens, urban farms, community gardens, orchards, and home gardens, of which 189.4 hectares are found in neighborhoods with extremely high rates of poverty. The authors' inventory strategy can be implemented elsewhere without special data or software. A detailed inventory offers opportunities for long-range planning, and broadening participation of stakeholders.
Mitigate overestimation of voltage stability margin by coupled single-port circuit models

Wide-area measurement-based voltage stability assessment (VSA) by coupled single-port circuit models has been widely discussed recently. This method models the coupling effects of load buses within a meshed network into extra impedance of a single-port model for each load bus. In simulation studies, overestimations of voltage stability margin using this approach have been observed when critical load bus or buses are decoupled from other load buses. In this paper, the overestimations are reported for the first time through examples and are further analyzed in details. Moreover, to mitigate such overestimations, two methods are proposed: one method uses a mitigation factor based on actual system reactive power response; the other method changes the types of certain weak generation buses when forming the coupled impedance. Both approaches are applied to a sample 4-bus system as well as the IEEE 118-bus system and successfully mitigate the overestimations.
Design, properties, and weldability of advanced oxidation-resistant FeCrAl alloys

Abstract Iron-chromium-aluminum (FeCrAl) alloys are promising as corrosion- and oxidation-resistant materials for high-temperature applications. However, further design and improvement of FeCrAl-based materials require a delicate balance between workability, weldability, and a propensity for α′-phase formation. Here, a series of advanced oxidation-resistant FeCrAl alloys were produced and investigated. FeCrAl variants with aluminum (+ 2%), niobium (+ 1%), and titanium carbide (+ 0.1%, + 0.3%, and + 1%) additions were characterized in detail before and after controlled laser-beam welding; tensile tests with digital image correlation, scanning electron microscopy-electron back scattered diffraction analysis, and fractography analysis were conducted. All investigated alloys demonstrated a yield stress of over 500 MPa in the weldment; no welding-induced cracking was observed. However, it was shown that increasing the aluminum content to over 5% was detrimental to the material's integrity, leading to a brittle fracture mechanism and decreased ductility in the weldment. At the same time, the niobium and titanium carbide additions helped prevent grain growth and reduce local softening (yield stress reduction) in the heat-affected zone. The 1% titanium carbide addition also effectively refined grain size in the weldment.
Case of a Girl with Primary Amenorrhea, Delayed Puberty, and High Gonadotropin Levels

Primary ovarian insufficiency (POI) is the depletion or dysfunction of ovarian follicles with cessation of menses before age 40. The condition was formerly known as premature menopause or premature ovarian failure. However, ovarian function is often intermittent and unpredictable in affected adolescents and women, and ovarian reserve is decreased rather than depleted. The diagnosis of POI is often delayed in teenagers. These patients may present with primary or secondary amenorrhea. Most cases of POI will not have an identified cause even after a complete evaluation. POI represents an example of primary hypogonadism with estrogen deficiency. One of the major medical complications can be skeletal losses and lack of bone accrual. Hormone replacement therapy is the central component of treatment. However, the optimal dose and delivery system are still under investigation. The diagnosis of POI often has effects on physical, mental, and emotional health. An interdisciplinary approach to management is recommended.
Unaffected first-degree relatives of essential tremor cases have more imbalance than age-matched control subjects.

Abstract Background Endophenotypes are measurable clinical characteristics that may be present in individuals with increased risk for disease (e.g., unaffected family members). Endophenotypes are useful; they may clarify diagnosis in genetic studies and foster the development of animal models. In recent years, problems with balance and mild gait ataxia have been associated with essential tremor (ET). We compared gait and balance of first-degree relatives of ET cases (FD-ET) to that of age-matched controls (Co). Methods One-hundred-ninety FD-ET and 68 Co, none of whom reported tremor or were diagnosed with ET, underwent a standardized assessment of gait and balance. Results FD-ET reported more near-falls in the past year (p = 0.015) and lower balance confidence according to the Activities of Balance Confidence (ABC-6) Scale (p = 0.03). The specific ABC-6 items for which FD-ET reported lower balance confidence than Co were being bumped into by people while walking (p = 0.006) and walking outside on icy sidewalks (p = 0.007). On videotaped neurological examination, FD-ET were able to stand in the tandem position for fewer seconds than were Co (p = 0.048). The differences between FD-ET and Co, although statistically significant, were clinically mild. Conclusion FD-ET reported more near-falls in the past year and a reduction in balance confidence; additionally, ability to maintain tandem stance was impaired compared to Co. These data suggest a more pervasive abnormality of cerebellar dysfunction than previously conceived, extending beyond ET cases themselves and manifesting in mild form in their unaffected family members.
Reading The American Political Tradition in the 21st Century

Brilliantly written, powerfully argued, The American Political Tradition by Richard Hofstadter, published in 1948, is flawed for readers today because of serious gaps and omissions, in particular its lack of reference to African American figures and sources. Late in his career, Hofstadter began to broaden his range of reference, calling attention in vivid prose to the horrors of slavery during the long period of American settlement and colonization. This later emphasis exposes all the more the shortcomings of The American Tradition, yet, at the same time, it does not diminish the rhetorical power and insight of this important book. It remains a significant work of American history but, even more, we should read and respond to it now as a major achievement, a distinguished act of writing, in the field of American literature.
ATP synthesis driven by inorganic pyrophosphate in Rhodospirillum rubrum chromatophores.

Inorganic pyrophosphate was demonstrated to drive the synthesis of ATP from ADP and Pi in Rhodospirillum rubrum chromatophores. The reaction was inhibited by uncouplers and inhibitors of phosphorylation such as Cl-CCP, S-13, and oligomycin, thus illustrating the energy-linked characteristics of the reaction. Exchange reactions involving the direct transfer of phosphate from PPi to ADP or ATP were very low in chromatophores and did not appear to contribute to the ATP synthesis. Fluoride inhibited the inorganic pyrophosphatase and PPi⇋Pi exchange of chromatophores but had no effect on ATP-linked reactions. The PPi driven synthesis of ATP was inhibited by fluoride also, indicatting that the membrane bound inorganic pyrophosphatase may be involved in the energy metabolism in the cell.
Robust deep learning for improved classification of AD/MCI patients

Accurate classification of Alzheimer’s Disease (AD) and its prodromal stage, Mild Cognitive Impairment (MCI), plays a critical role in preventing progression of memory impairment and improving quality of life for AD patients. Among many research tasks, it is of particular interest to identify noninvasive imaging biomarkers for AD diagnosis. In this paper, we present a robust deep learning system to identify different progression stages of AD patients based on MRI and PET scans. We utilized the dropout technique to improve classical deep learning by preventing its weight co-adaptation, which is a typical cause of over-fitting in deep learning. In addition, we incorporated stability selection, an adaptive learning factor and a multi-task learning strategy into the deep learning framework. We applied the proposed method to the ADNI data set and conducted experiments for AD and MCI conversion diagnosis. Experimental results showed that the dropout technique is very effective in AD diagnosis, improving the classification accuracies by 6.2% on average as compared to classical deep learning methods.
The Relationship Between Pharmacists' Tenure in the Community Setting and Moral Reasoning

Objective: To explore the relationship between pharmacists' tenure in the community setting and their moral reasoning abilities. Design: Systematic random sample design. Setting: A large southeastern city in the United States. Participants:450 independent and chain community pharmacists identified from the state board of pharmacy list of licenced community pharmacists. Interventions: A mailed questionnaire that included a well-known moral reasoning instrument and collected demographic information. Main Outcome Measures: Moral Reasoning abilities and tenure of community pharmacists. Results: As a group, community pharmacists with greater years of tenure in community practice scored significantly lower on moral reasoning than those pharmacists with fewer years of tenure (p = 0.016). Conclusion: Four plausible explanations for the results are given including: a) a selection of lower ethical reasoners and/or an exodus of higher ethical reasoners from the community setting; b) a retrogression in the moral reasoning skills as community pharmacists obtain tenure in this setting; c) differences between the low and high moral reasoning groups may be due to a cohort effect; and d) the obtained practitioner sample may not have been representative of the population of community pharmacists.
Efficient Velodyne SLAM with point and plane features

This paper develops and tests a plane based simultaneous localization and mapping algorithm capable of processing the uneven sampling density of Velodyne-style scanning LiDAR sensors in real-time. The algorithm uses an efficient plane detector to rapidly provide stable features, both for localization and as landmarks in a graph-based SLAM. When planes cannot be detected or when they provide insufficient support for localization, a novel constraint tracking algorithm selects a minimal set of supplemental point features to be provided to the localization solver. Several difficult indoor and outdoor datasets, totaling 6981 scans, each with $$\sim $$ 70,000 points, are used to analyze the performance of the algorithm without the aid of any additional sensors. The results are compared to two competing state-of-the-art algorithms, GICP and LOAM, showing up to an order of magnitude faster runtime and superior accuracy on all datasets, with loop closure errors of 0.14–0.95 m, compared to 0.44–66.11 m.
Experimental and numerical investigations of permeability in heterogeneous fractured tight porous media

Abstract Analyzing gas flow behavior is important for production prediction in heterogeneous fractured shale reservoirs, which is complex due to the presences of nanopores and high-degree heterogeneity in these complex flow network. First, we applied the discrete fracture model to simulate gas pulse-decay experiments in core plugs with different configurations. The effective permeability ratio was proposed to evaluate the effects of heterogeneity, fracture, and vug on the flow behavior. Second, we performed pulse-decay experiments on one intact fractured shale core to examine the effects of pore pressure and effective stress on permeability variations. The measured pressure profiles were history matched by numerical methods to obtain the porosity and permeability of matrix and fracture. The matching degree is evaluated by the Global Matching Error (GME). Our results highlight the positive impact of dense fracture network to improve flow capacities in the tight reservoir: effective permeability of the fractured core with 8 pairs of 1.3-cm connected fractures increases 4.07 times that of the un-fractured core. Vugs might be important as well if they connect adjacent fracture networks, but their own contribution to flow capacity is negligible: effective permeability increases only 1.00 to 1.02 times when the number of vugs increase from 3 to 35. The GME ranges from 0.04% to 0.2% for history matching of the fractured core. Core heterogeneity is exhibited more obviously when gas flows through under low pressure than under high pressure, which can be used to guide the design of pulse-decay experiment properly depending on the purpose. The main contributions of this study are that we constructed the finite-element based numerical model to simulate the pulse-decay experiment, proposed a methodology to upscale core permeability when fractures and vugs are present, and measured porosity and permeability for the matrix and fracture simultaneously in one fractured core over a wide range of pressure and effective stress.
Recombinant human proteoglycan-4 reduces phagocytosis of urate crystals and downstream nuclear factor kappa B and inflammasome activation and production of cytokines and chemokines in human and murine macrophages.

Gout is an inflammatory arthritis caused by monosodium urate monohydrate (MSU) crystals’ joint deposition. MSU phagocytosis by resident macrophages is a key step in gout pathogenesis. MSU phagocytosis triggers nuclear factor kappa B (NFκB) activation and production of cytokines and chemokines. Proteoglycan-4 (PRG4) is a glycoprotein produced by synovial fibroblasts and exerts an anti-inflammatory effect in the joint mediated by its interaction with cell surface receptor CD44. PRG4 also binds and antagonizes TLR2 and TLR4. The objective of this study is to evaluate the efficacy of recombinant human PRG4 (rhPRG4) in suppressing MSU-induced inflammation and mechanical allodynia in vitro and in vivo. THP-1 macrophages were incubated with MSU crystals ± rhPRG4 or bovine submaxillary mucin (BSM), and crystal phagocytosis, cytokines and chemokines expression and production were determined. NFκB p65 subunit nuclear translocation, NLRP3 induction, caspase-1 activation and conversion of proIL-1β to mature IL-1β were studied. MSU phagocytosis by Prg4+/+ and Prg4−/− peritoneal macrophages was determined in the absence or presence of rhPRG4, BSM, anti-CD44, anti-TLR2, anti-TLR4 and isotype control antibodies. Rhodamine-labeled rhPRG4 was incubated with murine macrophages and receptor colocalization studies were performed. Lewis rats underwent intra-articular injection of MSU crystals followed by intra-articular treatment with PBS or rhPRG4. Weight bearing and SF myeloperoxidase activities were determined. rhPRG4 reduced MSU crystal phagocytosis at 4 h (p < 0.01) and IL-1β, TNF-α, IL-8 and MCP-1 expression and production at 6 h (p < 0.05). BSM did not alter MSU phagocytosis or IL-1β production in human and murine macrophages. rhPRG4 treatment reduced NFκB nuclear translocation, NLRP3 expression, caspase-1 activation and generation of mature IL-1β (p < 0.05). MSU-stimulated IL-1β production was higher in Prg4−/− macrophages compared to Prg4+/+ macrophages (p < 0.001). rhPRG4, anti-CD44, anti-TLR2 and anti-TLR4 antibody treatments reduced MSU phagocytosis and IL-1β production in murine macrophages (p < 0.05). rhPRG4 preferentially colocalized with CD44 on Prg4−/− peritoneal macrophages compared to TLR2 or TLR4 (p < 0.01). rhPRG4 normalized weight bearing and reduced SF myeloperoxidase activity compared to PBS in vivo. rhPRG4 inhibits MSU crystal phagocytosis and exhibits an anti-inflammatory and anti-nociceptive activity in vitro and in vivo. rhPRG4’s anti-inflammatory mechanism may be due to targeting CD44 on macrophages.
Determination of traces of polyoxyethylene non-ionic surfactants in water by solvent extraction-spectrophotometry

The determination of traces of polyoxyethylene non-ionic surfactants (APE) in water is based on the formation of a complex between APE and sodium picrate. The complex is extracted into 1,2-dichloroethane and the absorbance of the solvent phase is measured at 378 nm. Quarternary ammonium surfactants and iron(III) caused positive errors, but the interference due to iron(III) was effectively masked with CyDTA. Humic acids, anionic surfactants, common cations and anions did not interfere. For general type APE (n=8–13) the apparent molar absorptivities of the picrate complexes were 5–7 times larger than those of cobalt thiocyanate complexes. Various polyethoxylated compounds in the range ofn from 9 to 85 in the same quantity were almost the same in absorbance; recoveries of APE were about 93–107%. Therefore this method is quite usable. As little as 0.04 ppm can be determined. In a river water sample 0.04–0.05 ppm and in another case 0.34 ppm of APE were found.
Financial hardship associated health care utilization among cancer survivors in the United States.

133Background: A cancer diagnosis is associated with medical financial hardship in the U.S. However, little is known about health consequences associated with financial hardship. This study examine...
Trauma in Competency to Stand Trial Evaluations

The competency to stand trial evaluation has long been identified as the most important inquiry in the area of criminal mental health (American Bar Association, Judicial Administration Division, in Standards Relating to Appellate Courts, Vol. 3, 1994; Perlin, Behav Sci Law 21:297–310, 2003; Stone, 1975) as it is part of the bedrock of the commitment to the right to a fair trial. Certainly, it is the most frequently ordered and performed criminal evaluation with an estimated 90,000 (Fuller et al., Emptying the ‘new asylums’: A beds capacity model to reduce mental illness behind bars. Arlington, VA: Treatment Advocacy Center, 2017. http://www.treatmentadvocacycenter.org/storage/documents/emptying-new-asylums.pdf) up from the oft-cited 60,000 per year in the United States in 2000 (Bonnie and Grisso, Adjudicative competence and youthful offenders. In T. Grisso and R. Schwartz (Eds.), Youth on trial: A developmental perspective on juvenile justice (pp. 73–103). Chicago, IL: University of Chicago Press, 2000). This chapter provides an overview of competency to proceed to trial evaluations (CST) and examines how assessing trauma during these evaluations is an important, if often overlooked, area, which could impact competency decisions and thus fair resolutions (typically not at trial) of criminal cases. While psychotic symptoms are the most often-cited issues related to impairments in CST, trauma symptoms have also been found to play a role. Case examples are included to illustrate some ways that the presence of trauma symptoms informed competency to stand trial evaluations and their outcomes. Trauma symptoms are only now coming to be recognized as possibly important factors in competency to proceed evaluations, as they include alterations in attention, concentration, interpersonal relationships, and, at times, reality testing. All too often, competency evaluators focus solely on the presence or absence of psychotic symptoms. Trauma symptoms can be quite similar to those seen in psychosis, specifically dissociation, disruptive thought and emotional processes, and hallucination-like flashbacks but may not be queried if prominent psychotic symptoms are not present. While it is true that psychotic symptoms are the primary reason defendants are found not competent, to overlook the role trauma may play on an individual’s functioning is a disservice to the defendant, the forensic evaluator, the courts, and ultimately, the criminal justice system.
Modified Aminoglycosides Bind Nucleic Acids in High-Molecular-Weight Complexes.

Aminoglycosides represent a large group of antibiotics well known for their ability to target the bacterial ribosome. In studying 6”-substituted variants of the aminoglycoside tobramycin, we serendipitously found that compounds with C12 or C14 linear alkyl substituents potently inhibit reverse transcription in vitro. Initial observations suggested specific inhibition of reverse transcriptase. However, further analysis showed that these and related compounds bind nucleic acids with high affinity, forming high-molecular weight complexes. Stable complex formation is observed with DNA or RNA in single- or double-stranded form. Given the amphiphilic nature of these aminoglycoside derivatives, they likely form micelles and/or vesicles with surface-bound nucleic acids. Hence, these compounds may be useful tools to localize nucleic acids to surfaces or deliver nucleic acids to cells or organelles.
Validation of the problematic social casino gaming scale

Few investigations have focused on problematic social casino gaming. Social casino games are a type of video game that feature gambling elements. Unlike gambling machines, social casino games prese...
Stepping-Stone Intrusion Detection and its Integration into Cybersecurity Curriculum

This chapter introduces stepping-stone intrusion and its detection techniques and integrates eight stepping-stone intrusion detection techniques into cybersecurity curriculum. Eight hands-on labs are designed to enhance students’ learning experience on stepping-stone intrusion detection techniques.
Review and Updates on Pediatric Fever

The aim of this review is to discuss the management of febrile children and evaluate current and potential markers to screen for serious bacterial infection (SBI). Procalcitionin (PCT) and C-reactive protein (CRP) seem to be the most useful; however, newer markers such as presepsin, neutrophil CD64, and secretory phospholipase A2 (sPLA2) have shown to be promising. A confirmed viral infection lowers the risk of a concomitant SBI and may reduce the need for further invasive studies. The approach and workup of a febrile infant still remain challenging. Biomarkers and viral testing serve as useful adjuncts in guiding clinical decision making but should not be used as definitive tools to rule out a SBI in children.
Peyronie Disease as a Marker of Inflammation-Is There Hope on the Horizon?

Abstract Although the description of Peyronie disease, a connective tissue disorder involving the growth of fibrous plaques in the soft tissue of the penis, is attributed to Francois de la Peyronie, surgeon to Louis XV of France, there are reports previous to that time. Over the intervening 450 years, a variety of empiric treatments, varying in barbarity, have been proposed. The frequency of this condition and the etiology of the fibrosis are unknown. Quality of life for affected men and their partners is adversely impacted. In this review, the authors summarize the history of the discovery of this condition, review contemporary management approaches, and address the pathophysiology leading to the underlying disordered fibrosis. The potential immunomodulatory role of testosterone as well as inflammatory conditions and environmental stimuli that may provoke fibrosis are also considered. Peyronie disease may be part of a spectrum of fibrotic conditions, including Dupuytren contracture. Treatment strategies to date have focused on reversing fibrosis; work is needed to prevent fibrosis and to accurately document disease prevalence.
A Custom Low-Noise Silicon Photodiode Detector Designed for Use With X-Ray Capillary Optics

We present the first results of a custom low-noise silicon photodiode detector designed for use with X-ray capillary optics. This system is intended to perform as a smaller, lighter, and low-powered alternative to currently existing X-ray telescope technologies. The detector has an active area with a diameter of 100 $\mu \text{m}$ , and its small size leads to a low capacitance of well under 1 pF and a leakage current of 1 pA or less at the depletion voltage. We tested the detector with both a discrete preamp and an ultralow-noise front-end application-specific integrated circuit (ASIC). The front-end ASIC, developed at Brookhaven National Laboratory, was designed for low-capacitance detectors but had not been previously tested with a detector. Here, we discuss the detector design, the experimental setup, and the resulting detector performance. Using radioactive laboratory sources, we measure a full-width at half-maximum (FWHM) of 211 ± 8 eV at 5.9 keV with the ASIC and are able to set the threshold as low as 0.6 keV.
Using SMS and parental outreach to improve early reading skills in Zambia

We evaluate an intervention using SMS messaging to send short stories to 2nd and 3rd graders in Zambia’s Eastern province, aimed at improving reading skills. For nine months households received thr...
Length of stay has minimal impact on the cost of hospital admission.

Abstract Background: Hospital cost containment, cost reduction, and alternative care delivery systems continue to preoccupy health care providers, payers, employers, and policy makers throughout the United States. The universal metric for gauging the success of these efforts is hospital length of stay (LOS). Reducing the LOS purportedly yields large cost savings. The purpose of this study is to assess precisely how much hospitals save by shortening LOS. Study Design: We reviewed the cost-accounting records of all surviving patients (n = 12,365) discharged from our academic medical center during fiscal year 1998 with LOS of 4 days or more. Actual costs were identified through the University of Michigan cost-accounting system. Individual patient costs were broken out on a daily basis and then decomposed further into variable direct, fixed direct, and indirect categories. The population was analyzed by determining the incremental resource cost of the last full day of stay versus the total cost for the entire stay. The data were also stratified by LOS and by surgical costs. An analysis of all trauma patients was then performed on all patients discharged from the hospital's adult level I trauma center (n = 665). Costs were determined on specific days, including admission day, each ICU day, day of discharge from the ICU, and each of the last 2 days before the discharge day. Results: The incremental costs incurred by patients on their last full day of hospital stay were $420 per day on average, or just 2.4% of the $17,734 mean total cost of stay for all 12,365 patients. Mean end-of-stay costs represented only a slightly higher percentage of total costs when LOS was short (eg, 6.8% for patients with LOS of 4 days). Even when the data were stratified to focus on patients without major operations, the $432 average last-day variable direct cost was only 3.4% of the $12,631 average total cost of care. A focus on the trauma center helps to explain this phenomenon. For our trauma center, variable direct costs accounted for 42% of the mean total cost per patient of $22,067. The remaining 58% was hospital overhead (fixed and indirect costs). The median variable direct cost on the first day of admission is $1,246, and the median variable direct cost on discharge is $304. Approximately 40% of the variable costs are incurred during the first 3 days of admission. Conclusions: For most patients, the costs directly attributable to the last day of a hospital stay are an economically insignificant component of total costs. Reducing LOS by as much as 1 full day reduces the total cost of care on average by 3% or less. Going forward, physicians and administrators must deemphasize LOS and focus instead on process changes that better use capacity and alter care delivery during the early stages of admission, when resource consumption is most intense.
Skip-Splay: Toward Achieving the Unified Bound in the BST Model

We present skip-splay, the first binary search tree algorithm known to have a running time that nearly achieves the unified bound. Skip-splay trees require only O (m lg lg n + UB (*** )) time to execute a query sequence *** = *** 1 ... *** m . The skip-splay algorithm is simple and similar to the splay algorithm.
Communications and Radar, Detection in

Signals arriving at a communication or a radar receiver are stochastic in nature and therefore many optimum processing techniques have been developed on the basis of statistical models for these signals. Here, we describe various signal detection procedures that are employed in communications and radar systems. Fundamentals of discrete-time and continuous-time matched filtering are introduced. Applications to demodulation of digital modulation signals, single and multiple-pulse radar target detection, constant false alarm rate processing for radar, and netted radar systems are presented. Keywords: matched filter; correlated noise; Gaussian noise; whitening filter; Karhunen–Loeve series; digital modulation; multiuser detection; Rayleigh density; single-pulse detection; multiple-pulse detection; distributed detection; Swerling models; constant false alarm rate detector; netted radar; decision fusion
Quality of the Business Environment Versus Quality of Life in a Dynamic Model of Urban Composition and Growth Do Firms and Households Like the Same Cities

Appropriately constructed measures of the quality of life and the quality of the business environment should be important determinants of the growth and composition of population across urban areas. This paper examines that question by extending theoretical measures of household quality of life to construct the first ever measure of the quality of the business environment ? the value that firms place on the basket of amenities in a metropolitan area. An annual panel of quality of life and quality of business environment values for 37 cities in the United States is then constructed for the 1977 to 1995 period. A key finding is that many cities attractive to firms are unattractive to households, and vice versa. In addition, estimates from an error correction model (ECM) indicate that improvements in the quality of the business environment and quality of life have strong positive effects on equilibrium city shares of workers, but negative effects on equilibrium city shares of retirees. The former result reflects outward shifts of labor supply and demand in response to improved amenities. The latter is because retirees avoid high land rents that arise from the in-migration of firms and workers. Moreover, following a shock that creates migratory pressures in the system of cities, worker-population shares converge back to long run equilibrium in 8-1/2 years, while retiree-population shares converge back in 6 years. The longer response time of the worker population likely reflects the cost of adjusting the spatial distribution of industry-specific human and physical capital in a coordinated manner.
Electrostatic actuation without electrolysis in microfluidic MEMS

Electrostatic actuators exhibit fast response times and are easily integrated into microsystems because they can be fabricated with standard IC micromachining processes and materials. Although electrostatic actuators have been used extensively in "dry" MEMS, they have received little attention in microfluidic systems because of challenges such as electrolysis, anodization, and electrode polarization. Here we demonstrate that ac drive signals can be used to prevent electrode polarization, and thus enable electrostatic actuation in many liquids, at potentials low enough to avoid electrochemistry. We measure the frequency response of an interdigitated comb drive actuator in liquids spanning a decade of dielectric permittivities and four decades of conductivity. The results show that actuation is initiated at frequencies less than 1 MHz, in electrolytes of ionic strength up to 10 mmol/L.
The successful use of problem-based learning in an online nurse practitioner course.

Abstract The development of technology and online education has opened the door to creative use of new and existing teaching methodologies. The authors describe how they used problem-based learning in an online course as a method for teaching clinical decision making to nurse practitioner students. The close match between problem-based learning and the characteristics of adult learners and successful distance learners is outlined as support for use of this methodology. In addition, the authors describe the challenges, rewards, and lessons learned in this innovative approach to online education.
Pathways to Injury in Chronic Pancreatitis: Decoding the Role of the High-Risk SPINK1 N34S Haplotype Using Meta-Analysis

Background: The complex interactions between recurrent trypsin-mediated pancreatic injury, alcohol-associated pancreatic injury and SPINK1 polymorphisms in chronic pancreatitis (CP) are undefined. We hypothesize that CP occurs as a result of multiple pathological mechanisms (pathways) that are initiated by different metabolic or environmental factors (etiologies) and may be influenced differentially by downstream genetic risk factors. We tested this hypothesis by evaluating the differences in effect size of the high risk SPINK1 N34S haplotype on CP from multiple etiologies after combining clinical reports of SPINK1 N34S frequency using meta-analysis. Methods and Findings: The Pubmed and the Embase databases were reviewed. We studied 24 reports of SPINK1 N34S in CP (2,421 cases, 4,857 controls) using reported etiological factors as surrogates for pathways and multiple meta-analyses to determine the differential effects of SPINK1 N34S between alcoholic and non-alcoholic etiologies. Using estimates of between-study heterogeneity, we sub-classified our 24 studies into four specific clusters. We found that SPINK1 N34S is strongly associated with CP overall (OR 11.00; 95% CI: 7.59-15.93), but the effect of SPINK1 N34S in alcoholic CP (OR 4.98, 95% CI: 3.16-7.85) was significantly smaller than in idiopathic CP (OR 14.97, 95% C.I. = 9.09-24.67) or tropical CP (OR 19.15, 95% C.I. = 8.83-41.56). Studies analyzing familial CP showed very high heterogeneity suggestive of a complex etiology with an I2 = 80.95%. Conclusion: The small effect of SPINK1 N34S in alcoholic subjects suggests that CP is driven through a different pathway that is largely trypsin-independent. The results also suggest that large effect sizes of SPINK1 N34S in small candidate gene studies in CP may be related to a mixture of multiple etiologic pathways leading to the same clinical endpoint. © 2008 Aoun MD et al.
Nrf2 is a critical modulator of the innate immune response in a model of uveitis

Uveitis is an inflammatory condition that can lead to blindness. It is therefore important to understand the pathophysiology against which to develop targeted therapy. Herein, we tested whether the oxidant-responsive transcription factor Nrf2 is involved in regulating the innate immune response and oxidative damage in the LPS uveitis model. As shown by dihydroethidium staining, intraperitoneally injected LPS increased reactive oxygen species in the retina and iris-ciliary body of Nrf2+/+ and Nrf2-/- mice. After LPS injection, ICAM-1, IL-6, TNF-alpha, COX-2, iNOS, and MCP-1 mRNAs were increased more in the retina and iris-ciliary body of Nrf2-/- than in those of Nrf2+/+ mice. NQO-1 and GCLM, two Nrf2-responsive antioxidant enzymes, had reduced expression in Nrf2+/+ retinas after LPS injection, but no change in expression in Nrf2-/- mice. The number of FITC-Con A-labeled leukocytes adherent to the retinal vascular endothelium increased after LPS treatment in both Nrf2+/+ and Nrf2-/- mice compared to control injections, with more adherent leukocytes in Nrf2-/- than in Nrf2+/+ mice. Pretreatment with the Nrf2 activator 1-(2-cyano-3,12-dioxooleana-1,9(11)-dien-28-oyl)imidazole increased antioxidant gene expression in the retina, reduced inflammatory mediator expression, and reduced leukocyte adherence to retinal vasculature after LPS treatment in Nrf2+/+ mice, but had no effect on Nrf2-/- mice. Treatment targeting the Nrf2 pathway may be a new therapy for uveitis.
Reliability of screening methods for the diagnosis of primary aldosteronism.

Abstract An attempt has been made in studies on 1,036 consecutive, referred, hypertensive patients to determine the reliability of four measurements, as screening tests for primary aldosteronism: serum sodium, serum potassium, stimulated plasma renin activity (PRA) (after furosemide administration, 40 mg intravenously, and ambulation for 2 hours) and the plasma aldosterone concentration after a 2 liter infusion of 0.9 per cent saline solution, all performed during an 8 hour outpatient study. Based on the results of subsequent tests in selected patients, which showed failure of deoxycorticosterone (DOC) and fludrocortisone to produce normal suppression of plasma levels and excretion of aldosterone, 22 of the 1,036 patients were considered to have primary aldosteronism. Adrenal scans and adrenal vein aldosterone measurements revealed that primary aldosteronism was caused by a unilateral adrenal adenoma in five patients, probably by an adrenal adenoma in three other patients and by excessive aldosterone release from both adrenals in 14 patients. Serum sodium and serum potassium measurements were inadequate screening procedures because of unacceptably high rates of false-positive and false-negative results. A low PRA alone failed to differentiate patients with primary aldosteronism from 14 times the number of patients with "low-renin hypertension." The saline suppression test yielded an encouragingly high sensitivity (0.77) when a plasma aldosterone concentration of 8.5 ng/dl after the saline infusion was used as the criterion of hyperaldosteronism. This diagnostic yield was improved to give a sensitivity of 0.95 by combining this saline suppression criterion with the alternative requirement that the patients have a low stimulated PRA, a fasting serum potassium concentration below 3.5 meq/liter and no depressor response to the administration of saralasin. It is concluded that this combination of laboratory procedures provides a safe, efficient and highly reliable means of discovering patients with primary aldosteronism among unselected hypertensive patients.
The Index of Harm : A Measure for Comparing Occupational Risk Across Industries

Abstract This paper presents an index of harm methodology that compares occupational risk among workers exposed to radiological and nonradiological harms. It extends the work of the International Commission on Radiological Protection (ICRP) by considering American rather than European and Japanese industry groups, by treating the relative importance of various occupational harms as a parameter rather than an arbitrary constant, and by identifying several ways in which both the methodology and the database could be improved. In the analysis, we examine the risk affects of six occupational harms — three nonradiological (death, accidental injury, and disease or illness) and three radiological (somatic effects, genetic effects, and somatic effects to the fetuses or embryos of pregnant women). We performed our analysis under five different assumptions about the relative importance of averting of the six harms in question. The results of this analysis show that radiological workers exposed to the current industry average of 0.35 rem/year are among the safest of all industry groupings, and the riskiest industries appear to be mining; agriculture, fishing, and farming; construction; transportation; and manufacturing, roughly in that order.