cssi/SciSciGPT-SciSciNet huggingface dataset:
Psychometric evaluation of the Epworth sleepiness scale in an obstetric population.

Abstract Background The Epworth Sleepiness Scale (ESS) was initially developed to measure daytime sleep propensity in patients affected by a variety of sleep disorders. Obstetrical research has measured sleepiness in pregnant women with the ESS, although psychometric analyses and dimensionality evaluations have never been conducted with this population. Objective The objective was to perform a psychometric evaluation of the ESS in an obstetric population. The design was a secondary data analysis of the subjects enrolled in the Prenatal Exposures and Preeclampsia Prevention III (PEPP) study. The setting for the subjects who received prenatal care was at Magee-Women's Hospital UPMC in Pittsburgh, Pennsylvania and included 337 pregnant women in their first trimester that completed the ESS. Methods Principal components analysis and confirmatory factor analysis were performed using SPSS and M-Plus. Additionally, reliability was assessed and construct validity was measured using the Life Orientation Test (LOT). Lastly, a relationship between daytime sleepiness and snoring was investigated using item 5e from the Pittsburgh Sleep Quality Index (PSQI). Results PCA with varimax rotation yielded two factors that explained approximately 50% of the variance and CFA results verified this two-factor solution. An overall Cronbach's alpha (0.751) revealed moderate reliability (Factor 1 α =.754; Factor 2 α =.524). Both convergent and discriminant validity were established. Conclusion The ESS is appropriate for use in an obstetric population to measure daytime sleepiness. Future work should include additional evaluations of the ESS in a diverse group of pregnant women.
Employee Change Agents: The Foundation for Effective Organizational Change

This paper specifically looks at the process of organizational change and how employees can influence the outcomes. Organizations tend to underutilize their employees during times of change. An organization is basically a collection of people with the same objectives. Ultimately, I seek to understand how an employee change agent framework can function as an essential tool for controlling and analyzing organizational change. As a manager and an instructor of management, I believe that is the employee that essentially controls the success of any change in an organization. Employees should be charged with the ability to foster positive change by management, but more so, by themselves. It is the employees responsibility to make the change work in the organization, along with making changes in themselves to help improve not only the organization, but to improve their own working behaviors. All employers should be creating a learning organization by asking their employees to become responsible members of the organization. Allow your staff to be present at the table. Also empower your staff to become more aligned with the core mission of the organization. The more your staff believes they are making a difference for the organization, the more vested, accountable, and responsible they will become.
Tai Chi, Qi Gong and Reiki.

Before discussing Qi Gong and Tai Chi, one needs to understand clearly the concept of Qi in Chinese culture. Qi in Chinese means ‘‘air,’’ ‘‘puff,’’ or ‘‘power.’’ Qi is the universal life force that exists in all living things. No comparable word in English exists to describe Qi. In Japanese, it is called Ki, as in Reiki. In Sanskrit, it is called Prana. Qi can be compared with the electrical charge in a battery. A new battery has a full electrical charge, which can be used to operate a radio, boom box, or electric toy. When the battery is old, exhausted of all electrical charge, it no longer can be used for any battery-powered item. When a person is full of Qi, he or she can work or be active without fatigue. When the body is low in Qi, it becomes tired easily. A person with chronic fatigue syndrome can be said to be chronically low in Qi. When a person’s body is exhausted of Qi, the person is dead. At the time of birth, an infant inherits Qi from his or her parents. This Qi is called preheaven Qi, or original Qi (Yuan Qi). When the infant grows up, it requires foods to produce energy. The Qi that comes from foods is called food Qi (Gu Qi). The Gu Qi ascends up to the lung and is associated with air to become gathering Qi (Zhong Qi). The Zhong Qi is transformed to true Qi (Zhen Qi), which spreads out over the body to nourish each organ and channel. True Qi or Zhen Qi assumes two different forms: nutritive Qi (Ying Qi) and defense Qi (Wei Qi) [1]. Qi Gong and Tai Chi are special exercises designed to increase Qi in the body.
Improved duochromator for measurement of small spectral line shifts.

Doppler effect induced small spectral line shifts measured by modified duochromator in MPD arc jet
Destruction or Potentiation of Different Prions Catalyzed by Similar Hsp104 Remodeling Activities

Yeast prions are protein-based genetic elements that self-perpetuate changes in protein conformation and function. A protein-remodeling factor, Hsp104, controls the inheritance of several yeast prions, including those formed by Sup35 and Ure2. Perplexingly, deletion of Hsp104 eliminates Sup35 and Ure2 prions, whereas overexpression of Hsp104 purges cells of Sup35 prions, but not Ure2 prions. Here, we used pure components to dissect how Hsp104 regulates prion formation, growth, and division. For both Sup35 and Ure2, Hsp104 catalyzes de novo prion nucleation from soluble, native protein. Using a distinct mechanism, Hsp104 fragments both prions to generate new prion assembly surfaces. For Sup35, the fragmentation endpoint is an ensemble of noninfectious, amyloid-like aggregates and soluble protein that cannot replicate conformation. In vivid distinction, the endpoint of Ure2 fragmentation is short prion fibers with enhanced infectivity and self-replicating ability. These advances explain the distinct effects of Hsp104 on the inheritance of the two prions.
MODELING ASCENT CONFIGURATIONS OF STRAINED HIGH ALTITUDE BALLOONS

We consider the problem of estimating stresses in the ascent shape of an elastic high-altitude scientie c balloon. The balloon envelope consists of a number of long, e at, tapered sheets of polyethylene called gores that are sealed edge-to-edge to form a complete shape. Because the e lm is so thin, it has zero bending stiffness and cannot support compressions. In particular, the balloon e lm forms internal folds of excess material when the volume is not sufe ciently large. Because of these factors, a standard e nite element approach will have dife culty computing partially ine ated balloon shapes. In our approach, we develop a variational principle for computing strained balloon shapes that incorporates regions of folded material as a part of the geometric model. We can apply our modeltofullyine atedorpartially ine ated cone gurations.Theequilibriumshapeisthesolutionofminimum energy satisfying a given volume constraint. Weapply our model to a design shape representativeofthoseused in scientie c ballooning and compute a family of ascent cone gurations with regions of external contact for a volume as low as 22% of its e oat value.
Performance modeling of optical-burst switching with fiber delay lines

We develop analytical models to evaluate the performance of optical-burst switch (OBS) architectures employing fiber delay lines (FDLs) as optical buffers to reduce burst-loss probability. The performance of such architectures cannot be captured accurately using traditional queueing models, since FDLs behave fundamentally differently from conventional electronic buffers. We formulate a Markovian model to evaluate the system performance when the burst-arrival process is Poisson and the burst lengths are exponentially distributed under an idealized model of FDL behavior. The model accurately captures both the balking and deterministic delay properties of FDLs, but the complexity of the model makes it infeasible for solving problems of practical interest. By considering approximations of the model in the regimes of short and long FDLs, we develop relatively simple closed-form expressions that can be used for dimensioning OBS architectures. We also extend the approximate model to include the impact of FDL delay granularity. We present numerical results that validate our modeling approach and demonstrate that significant performance gains in optical-burst switching are achievable when FDLs are employed as optical buffers.
Stratified volume holographic optical elements.

A computational algorithm for analyzing diffraction properties of optical devices, the optical beam propagation method, has suggested a new class of devices by which Bragg regime (thick grating) response can be obtained from a spaced sequence of thin grating layers. Such stratified volume holographic optical elements (SVHQE’s) can emulate distributed volume gratings in terms of diffraction efficiency and angular selectivity and in addition possess periodic diffraction properties that might serve, for example, as interconnections for optical cellular logic arrays. SVHOE’s also offer a unique capability for altering the device diffraction response on a layer-by-layer basis, allowing for control of both the diffraction peak width and the angular separation of adjacent peaks.
Arbutamine stress thallium-201 single-photon emission computed tomography using a computerized closed-loop delivery system. Multicenter trial for evaluation of safety and diagnostic accuracy

Objectives. This study sought to evaluate the efficacy and safety of arbutamine when used in conjunction with thallium-201 single-photon emission computed tomography (SPECT) in a multicenter trial and to compare arbutamine stress and treadmill exercise thallium-201 SPECT for diagnostic sensitivity and myocardial perfusion pattern. Background. Arbutamine is a potent beta-agonist developed specifically for pharmacologic stress testing. Methods. Arbutamine was administered by a novel computerized closed-loop device that measures heart rate and adjusts arbutamine infusion to achieve a selected rate of heart rate increase toward a predetermined limit. The cohort included 184 patients who underwent arbutamine stress testing, of whom 122 (catheterization group) had angiographically defined coronary artery disease (≥50% diameter stenosis of a major coronary artery), and 62 had a low pretest likelihood of coronary artery disease (low likelihood group). A subset of 69 patients from the catheterization group underwent both arbutamine and exercise stress testing. Results. Hemodynamic responses during arbutamine and exercise stress testing demonstrated no significant difference in percent increase in heart rate (81% vs. 76%) or systolic blood pressure (26% vs. 30%). The sensitivity for detecting coronary artery disease (≥50% stenosis) using arbutamine thallium-201 SPECT was 87% (95% for detecting ≥70% stenoses), and the normalcy rate in the low likelihood group was 90%. In patients completing both arbutamine and exercise stress testing, thallium-201 SPECT sensitivity for detecting coronary artery disease (≥50% stenosis) was 94% and 97% (p = NS), respectively. Furthermore, SPECT segmental visual score agreement (defect vs. no defect) showed a concordance of 92% between arbutamine and exercise results (kappa 0.80, p Conclusions. Arbutamine, administered by a closed-loop feedback system was shown to be a safe and effective pharmacologic stress agent. Arbutamine stress thallium-201 SPECT appears to be accurate for the diagnosis of coronary artery disease with a diagnostic efficacy similar to that of treadmill exercise thallium-201 studies.
SiC device edge termination using finite area argon implantation

In this paper, the results obtained with limited area amorphization by argon ion-implantation at the periphery of 6H-SiC Schottky barrier diodes are reported. It is demonstrated that only 50 /spl mu/m of implant region is required at the periphery to obtain ideal plane parallel breakdown voltages. The leakage current at small reverse bias voltages was found to be directly proportional to the implant area.
An Arabidopsis F-box protein acts as a transcriptional co-factor to regulate floral development

Plants flower in response to both environmental and endogenous signals. The Arabidopsis LEAFY (LFY) transcription factor is crucial in integrating these signals, and acts in part by activating the expression of multiple floral homeotic genes. LFY-dependent activation of the homeotic APETALA3 (AP3) gene requires the activity of UNUSUAL FLORAL ORGANS (UFO), an F-box component of an SCF ubiquitin ligase, yet how this regulation is effected has remained unclear. Here, we show that UFO physically interacts with LFY both in vitro and in vivo, and this interaction is necessary to recruit UFO to the AP3 promoter. Furthermore, a transcriptional repressor domain fused to UFO reduces endogenous LFY activity in plants, supporting the idea that UFO acts as part of a transcriptional complex at the AP3 promoter. Moreover, chemical or genetic disruption of proteasome activity compromises LFY-dependent AP3 activation, indicating that protein degradation is required to promote LFY activity. These results define an unexpected role for an F-box protein in functioning as a DNA-associated transcriptional co-factor in regulating floral homeotic gene expression. These results suggest a novel mechanism for promoting flower development via protein degradation and concomitant activation of the LFY transcription factor. This mechanism may be widely conserved, as homologs of UFO and LFY have been identified in a wide array of plant species.
Reactive Oxygen Species in the Vasculature. Molecular and Cellular Mechanisms

Accumulating evidence indicates that reactive oxygen species (ROS) play major roles in the initiation and progression of cardiovascular dysfunction associated with diseases such as hyperlipidemia, diabetes mellitus, hypertension, ischemic heart disease, and chronic heart failure. ROS produced by migrating inflammatory cells as well as vascular cells (endothelial cells, vascular smooth muscle cells, and adventitial fibroblasts) have distinct functional effects on each cell type. These include cell growth, apoptosis, migration, inflammatory gene expression, and matrix regulation. ROS, by regulating vascular cell function, can play a central role in normal vascular physiology, and can contribute substantially to the development of vascular disease.
The Structure, Energetics and Evolution of the Dominant Frequency-Dependent Three-Dimensional Atmospheric Modes

The three-dimensional structure of the dominant modes of wintertime variability are examined, and the mode structures are determined by an EOF analysis of the coupled vertical mean and shear streamfunction fields for a wide range of time-scale classes. The time mean energy conversions are determined from a two-layer quasigeostrophic model. Lag-cross correlations between the dominant low-frequency modes tend to be small and/or symmetric about zero, the high frequency modes are found to show highly asymmetric sinusoidal cross correlation functions similar to traveling waves, and some intermediate and short-time scale modes exhibit correlations indicating an association with the decaying phases of blocking in the Pacific. It is suggested that the mean flow barotropic (baroclinic) instabilities are an important source of variance for some of the lowest (highest) fluctuations considered.
Design fixation and cooperative learning in elementary engineering design project: A case study

This paper presents a case study examining 3rd, 4th and 5th graders’ design fixation and cooperative learning in an engineering design project. A mixed methods instrument, the Cooperative Learning Observation Protocol (CLOP), was adapted to record frequency and class observation on cooperative learning engagement through detailed field notes. Students’ design journals and reflections were also analyzed for an inductive qualitative analysis. The findings indicate three major themes of design fixation: 1) fixation on common features of things; 2) fixation on popular teenage culture; 3) fixation on the first design idea. In the cooperative learning process of elementary engineering design project, although pupils had demonstrated some abilities to solve concrete problems in a logical fashion, the participants encountered a number of obstacles in the group. Dominance, social loafing, and other problems occurring in the group process might have offset certain benefits of cooperative learning. Implications of the findings are also discussed.
The Basic Economics of Pease and PEP

The Pease provision does not limit the benefits of making charitable contributions or other expenditures that give rise to itemized deductions. Instead, it raises effective marginal tax rates on adjusted gross income, as does the personal exemption phaseout. The Pease and PEP provisions are similar to, but less transparent than, increases in statutory tax rates.
Structural Design Considerations for a 50 kW-Class Solar Array for NASA's Asteroid Redirect Mission

NASA is planning an Asteroid Redirect Mission (ARM) to take place in the 2020s. To enable this multi-year mission, a 40 kW class solar electric propulsion (SEP) system powered by an advanced 50 kW class solar array will be required. Powered by the SEP module (SEPM), the ARM vehicle will travel to a large near-Earth asteroid, descend to its surface, capture a multi-metric ton (t) asteroid boulder, ascend from the surface and return to the Earth-moon system to ultimately place the ARM vehicle and its captured asteroid boulder into a stable distant orbit. During the years that follow, astronauts flying in the Orion multipurpose crew vehicle (MPCV) will dock with the ARM vehicle and conduct extra-vehicular activity (EVA) operations to explore and sample the asteroid boulder. This paper will review the top structural design considerations to successfully implement this 50 kW class solar array that must meet unprecedented performance levels. These considerations include beyond state-of-the-art metrics for specific mass, specific volume, deployed area, deployed solar array wing (SAW) keep in zone (KIZ), deployed strength and deployed frequency. Analytical and design results are presented that support definition of stowed KIZ and launch restraint interface definition. An offset boom is defined to meet the deployed SAW KIZ. The resulting parametric impact of the offset boom length on spacecraft moment of inertias and deployed SAW quasistatic and dynamic load cases are also presented. Load cases include ARM spacecraft thruster plume impingement, asteroid surface operations and Orion docking operations which drive the required SAW deployed strength and damping. The authors conclude that to support NASA's ARM power needs, an advanced SAW is required with mass performance better than 125 W/kg, stowed volume better than 40 kW/cu m, a deployed area of 200 sq m (100 sq m for each of two SAWs), a deployed SAW offset distance of nominally 3-4 m, a deployed SAW quasistatic strength of nominally 0.1 g in any direction, a deployed loading displacement under 2 m, a deployed fundamental frequency above 0.1 Hz and deployed damping of at least 1%. These parameters must be met on top of challenging mission environments and ground testing requirements unique to the ARM project.
Structure and ultimate properties of epoxy resins

Common epoxy thermosets are glassy at ambient temperatures and are characterized by a densely crosslinked microstructure. Under normal use conditions they generally fail by brittle fracture mechanisms. The influence of network microstructure on glassy fracture is largely undetermined in spite of a sizeable literature. This can be attributed to a lack of studies on structurally characterized networks and the often complicated microstructure of typical epoxy systems. To address these problems we examine structure-fracture relationships in simple epoxy systems whose structural variables are systematically controlled. Densely crosslinked networks may be characterized by equilibrium modulus measurements above Tg. Application of rubber elasticity theory yields very reasonable average network chain molecular weights (Mc); surprising in view of the expected non-Gaussian character of short epoxy network chains. Rubbery fracture energy increases with Mc when compared at equivalent temperatures above Tg. In fact, the dependence approximates a M c 1/2 ordering, suggesting that the influence of a threshold fracture energy persists well into nonthreshold testing conditions. Often, glassy fracture is characterized by brittle, unstable crack propagation leading to initiation and arrest fracture energies. The initiation values increase with temperature and generally increase with Mc. In comparison, the arrest values are independent of temperature and display a strong proportionality to M c 1/2 . A theory presuming material devitrification at a sharp crack tip is consistent with this observation.
The anterior interosseous nerve syndrome.

Two cases of paresis of the anterior interosseous nerve in the forearm have been added to the twelve cases previously reported in the English literature.
Analysis of trace elements in animal tissues : III. Determination of managanese by graphite furnace atomic absorption spectrophotometry.

Graphite furnace atomic absorption spectrophotometry is a method used for the measurement of low concentrations of manganese (ppb range). Despite the widespread use of this technique, there is considerable inconsistency concerning sample preparation and choice of instrumental parameters. In this paper, we determined manganese concentrations of National Bureau of Standards (NBS) bovine liver by both graphite furnace (Instrumentation Laboratory IL 555B) and flame atomic absorption following wet digestion of the sample with nitric acid. The following instrumental parameters for the graphite furnace were found optimal for the measurement of manganese in digested NBS bovine liver: inert gas flow=14 SCFH, drying temperature 100°C/15 s (step 1), 125°C/15 s (step 2), pyrolysis temperature 500°C/15 s (step 3), and 1000°C/15 s (step 4); atomization temperature 2250°C/10 s (step 5). For optimal results, the nitric acid concentration of the sample should be between 2 and 4M. There were no significant differences found for manganese concentrations determined by either peak height or peak area measurement. Additionally, no significant differences were found in manganese concentrations determined by flame or furnace methods. Assuming proper sample preparation and choice of instrumental parameters, values obtained for manganese concentration by graphite furnace and flame atomic absorption spectrophotometry are similar. Therefore, data obtained by these two methods can be compared directly.
Terahertz Radiation: A Non-contact Tool for the Selective Stimulation of Biological Responses in Human Cells

Abstract : Collective motions of water and of many biological macromolecules have characteristic time scales on the order of a picosecond. As a result, these biomolecules can strongly absorb terahertz (THz) radiation. Due to this absorption, THz radiation can exert a diverse range of effects on biological structures. For example, THz radiation has been shown to impact the structure, functional activity, and dynamics of macromolecules such as deoxyribonucleic acid (DNA) and proteins. THz-molecular interactions can affect several gene expression pathways and, consequently, can alter various biochemical and physiological processes in cells. Indeed, THz radiation has been shown to influence the expression of several genes within different cell types. However, a complete view of the global transcriptional responses and the intracellular canonical pathways specifically triggered by THz radiation has not been elucidated. In this study, we performed a global profiling of transcripts in human cells exposed to 2.52 THz radiation and compared the exposure responses to a thermally-matched bulk-heating (BH) protocol. Our results show that both THz radiation and BH induce a significant change in the expression of numerous messenger ribonucleic acid (mRNA) and microRNAs (miRNAs). The data also show that THz radiation triggers specific intracellular canonical pathways that are not affected in the BH-exposed cells. This study implies that THz radiation may be a useful, non-contact tool for the selective control of specific genes and cellular processes.
The Design of Roller Kiln Control System Based on Intelligent Instrumen

An intelligence instrument was adopted in the design of the roller kiln control system for a better control of the temperature and pressure in the roller kiln.With high adaptability,controlling precision,and user-friendliness,it is a desirable kiln control system at present.
Pumped Hydroelectric Storage

Abstract Pumped hydroelectric storage (PHES) is the most established technology for utility-scale electricity storage and has been commercially deployed since the 1890s. Since the 2000s, there has been revived interest in developing PHES facilities worldwide. Because most low-carbon electricity resources (e.g., wind, solar, and nuclear) cannot flexibly adjust their output to match fluctuating power demands, there is an increasing need for bulk electricity storage due to the increasing adoption of renewable energy. PHES has been the traditional way of storing energy. This chapter introduces PHES technology, its pros and cons, its historical developments, and its prospects.
Phytoremediation: Uptake and Role of Metal Transporters in Some Members of Brassicaceae

Plants absorb water and minerals for their growth and survival from the matrix they grow upon. For every resource absorbed, there is a specific pathway for its translocation. While water finds its way through semipermeable plasma membrane and also through aquaporins to some extent, minerals get their entry along with it due to their soluble nature. With these, heavy metals also enter the plants through specific metal transporters. These metal transporters have remained conserved to some extent throughout evolution. Phytoremediation reports claim that most of the efficient phytoremediators belong to the family Brassicaceae. Heavy metal transporters namely Zinc-regulated transporter (ZRT), Iron regulated transporter (IRT), ZRT-, IRT-like proteins (ZIP), Natural resistance-associated macrophage proteins (NRAMP), Cation diffusion facilitator (CDF)/Metal tolerance protein (MTP), Heavy metal ATPase (HMA), Endomembrane-type CA-ATPase (ECA), Detoxification (DTX), Magnesium/Proton Exchanger (MHX), and Copper transporter (COPT) have been identified in Arabidopsis thaliana. Many researches showed that some of these genes are upregulated in Arabidopsis halleri, a hyperaccumulator. The difference in regulation of these genes is responsible for the potential in A. halleri. The aim of present study is to identify heavy metal transporters in Brassica rapa and Brassica oleracea, so that they can be engineered upon by molecular techniques in future, making them highly efficient for the treatment of contaminated sites.
CONCORDANCE CLASSES OF FREE ACTIONS OF COMPACT LIE GROUPS ON INFINITE DIMENSIONIAL MANIFOLDS

Publisher Summary This chapter presents the concordance classes of free actions of compact lie groups on infinite dimensional manifolds. Every free action of a compact Lie group G on a Q(l 2 )-manifold is G -concordant to a tame free action. Moreover, if the free action is tame on a Q(l 2 )-manifold, invariant Z -set N , then the concordance can be chosen to be relative to N. Consequently, every free n-toral action on T n ×Q is T n -concordant to the trivial one. The chapter presents a theorem that states that given a compact Lie group G , every free G -action on a Q(l 2 )-manifold is G -concordant to a tame free action.
Splat! er, shmup? A postmortem on a capstone production experience

Developing large-scale software applications in teams has long been a popular feature of capstone courses in computing degree programs, particularly in the fields of computer science and software engineering. Instructors utilize real world problems as well as external clients to motivate the students and to provide authentic experiences. Within the field of game design and development, students have strong desires to make and ship a game or series of games during their collegiate experience. To address this need, we created a production studio course offering that addressed the desires of students to create a game as a culminating experience while focusing upon the production process and challenges that are particular to the game industry. In this paper we describe the process undertaken by students, faculty and staff to ship a game. We discuss the successes and failures of the team and in achieving their goals. We show the similarities and differences between the process of developing and shipping a game and other types of large-scale software design and development projects undertaken in similar courses
Tensor fascia lata musculocutaneous flap for trochanteric pressure ulcer coverage

The tensor fascia lata (TFL) flap has been successfully used for decades for coverage of hip defects, particularly trochanteric pressure sores. Flap can also be employed to reconstruct defects within the groin, gluteal, ischial, and lower abdominal regions. Flap may be designed as a pedicled or free flap, depending on the region requiring coverage. Flap has a predictable, consistent vascular pedicle based on the transverse branch of the lateral femoral circumflex artery. Several design modifications have been described to avoid dog-ear creation during rotation. These include V-Y advancement and hatchet-shaped flap. In this section, we will describe the tensor fascia lata V-Y musculocutaneous flap for coverage of trochanteric pressure ulcer. Flap is elevated, advanced, and rotated posterior-superior into the defect. Donor site can often be closed primarily. Otherwise, a split thickness graft is used. Favorable outcomes can be achieved with appropriate technique and post-operative care with special attention to wound care, pressure off-loading, and optimization of nutrition and physical rehabilitation.
Antigens of Normal and Malignant Human Exocrine Pancreatic Cells

Pancreatic cancer is currently the fourth leading cause of cancer-related death in the United States (Cohn, 1976). The diagnosis of pancreatic adenocarcinoma is usually a late event in the disease, which has a 5-yr survival rate of less than 2% (Hirayama et al., 1980). Early signs and symptoms of this disease are often vague or lacking, except for occasional obstructive jaundice or major vascular involvement. Ascites, liver involvement, and other signs of advanced disease are often the presenting physical findings. It is not yet clear whether the low survival rate is due to a late stage of disease presentation, the early development of metastases, or other factors. The few survivors, however, are almost exclusively patients in whom a tumor was detected fortuitously and surgically excised at an early, premetastatic stage. This fact suggests that early diagnosis could substantially improve the prognosis for the disease and has stimulated many attempts at defining systems for early diagnosis including: exploratory surgery and biopsy (Mikal, 1964; Wave, 1975); ultrasonic scanning (Filly and Fiemanis, 1970); selective arteriography with hypotonic duodenography (Suzuki et al., 1974); computerized transaxial tomography (Sorabella et al., 1974); endoscopic retrograde cholangiopancreatography (Fukumoto et al., 1974); and pancreatic functional tests (Cohn, 1976). Unfortunately, to date such attempts have not been useful as cancer-screening tests.
Isotretinoin as a Possible Environmental Trigger to Autoimmunity in Genetically Susceptible Patients

Introduction. Isotretinoin is commonly used to treat cystic acne. Definitive mechanisms of action for isotretinoin are not known though despite many side effects having been documented. Various case reports have noted autoimmune diseases succeeding isotretinoin treatment. Case Report. A 16-year-old female presents with symptoms of tremors, lack of focus, sleeplessness, emotional liability, bulging eyes, loose stools, heat intolerance, and missed menstrual periods. Symptoms manifested shortly after the patient finished a course of oral isotretinoin treatment for acne. Physical exam showed resting tremors, bilateral proptosis, hyperactivity, and rapid speech. A diagnosis of Graves' Disease was made by correlating symptoms, physical exam findings, ultrasound, and positive family history of autoimmune thyroid disease. Conclusion. Emergence of autoimmune thyroid diseases depends upon genetic predisposition and environmental triggers. Mechanism of action for isotretinoin is not known but the drug may play a role in triggering autoimmunity in genetically susceptible individuals.
Evaluation of readmissions due to surgical site infections: A potential target for quality improvement.

Abstract Introduction Readmissions have become a focus of pay-for-performance programs. Surgical site infections (SSI) are the reason for most readmissions. Readmissions for SSI could be a unique target for quality improvement. Methods Readmission risk for SSI were evaluated for patients undergoing colectomies from 2013 to 2014. Hazard models were developed to examine factors associated with and hospital-level variation in risk-adjusted rates of readmission for SSI. Results Among 59,088 patients at 525 hospitals, the rate of readmissions for SSI ranged from 1.45% to 6.34%. Characteristics associated with a greater likelihood of SSI readmissions include male gender, smoking, open surgery and hospitals with increased socioeconomically-disadvantaged patients. After risk adjustment, there was little correlation between hospital performance with SSI readmission rate and performance with overall SSI or total readmission rate (r 2 = 0.29, r 2 = 0.14). Conclusions Readmission for SSI represents a unique aspect of quality beyond that offered by measuring only SSI or readmission rates alone, and may provide actionable quality improvement.
Implications of Liebig’s Law of the Minimum for Tree-Ring Reconstructions of Climate

A basic principle of ecology, known as Liebig's Law of the Minimum, is that plant growth reflects the strongest limiting environmental factor. This principle implies that a limiting environmental factor can be inferred from historical growth and, in dendrochronology, such reconstruction is generally achieved by averaging collections of standardized tree-ring records. Averaging is optimal if growth reflects a single limiting factor and noise but not if growth also reflects locally variable stresses that intermittently limit growth. In this study a collection of Arctic tree ring records is shown to follow scaling relationships that are inconsistent with the signal-plus-noise model of tree growth but consistent with Liebig's Law acting at the local level. Also consistent with law-of-the-minimum behavior is that reconstructions based on the least-stressed trees in a given year better-follow variations in temperature than typical approaches where all tree-ring records are averaged. Improvements in reconstruction skill occur across all frequencies, with the greatest increase at the lowest frequencies. More comprehensive statistical-ecological models of tree growth may offer further improvement in reconstruction skill.
Naturalism, Estrangement, and Resistance: On the Lived Senses of Nature

The tension within environmental theory between the view that humans are “part of” nature and the view that humans are alienated from nature cannot be resolved by endorsing either position, since both perspectives are motivated by structures of human experience: “unrestricted” nature, which incorporates everything that exists, including humans and their technology, and “pure” nature, which contrasts with the artifactual. This distinction resolves quandaries that emerge in environmental debates over, for example, restoration and wilderness preservation. Yet this resolution of our paradoxical relationship with nature raises the deeper problem of whether the correlation of experience with nature is fundamentally anthropocentric and consequently eliminates any descriptive access to nature “as such.” Phenomenology is uniquely poised to address this concern, since our experience of nature also reveals to us, albeit indirectly, the manner in which nature withdraws from that very experience. As descriptions from Heidegger and Merleau-Ponty suggest, and as developed more recently by Amanda Boetzkes, certain works of art prove especially valuable for revealing a fundamental duplicity of nature by which it retains an uncompromised autonomy.
Reading m6A in the Transcriptome: m6A-Binding Proteins

N6-Methyladenosine (m6A) is the most prevalent post-transcriptional modification of eukaryotic mRNA and long noncoding RNA. m6A mediates its effects primarily by recruiting proteins, including the multiprotein eukaryotic initiation factor 3 complex and a set of proteins that contain the YTH domain. Here we describe the mechanisms by which YTH domain-containing proteins bind m6A and influence the fate of m6A-containing RNA in mammalian cells. We discuss the diverse, and occasionally contradictory, functions ascribed to these proteins and the emerging concepts that are influencing our understanding of these proteins and their effects on the epitranscriptome.
Two-Dimensional NMR Spectroscopy: A Graphical, “Top-Down” Description

Publisher Summary In this chapter, an introduction to the principles and uses of homonuclear and heteronuclear two-dimensional nuclear magnetic resonance (NMR) spectroscopy is presented. The pulse sequences and phase cycling procedures for a few of the most common experiments are analyzed in detail. The experiments are described by using a visual description of spin system evolution and coherence transfer processes. This method of description allows for the discussion of any multidimensional, multinuclear pulse sequence by a top–down approach. Two-dimensional NMR spectroscopy has become a mainstay experiment in many disciplines. The use of two- and higher- dimensional NMR has greatly advanced the applications of NMR to biochemical systems. Two-dimensional methods revolutionized the study of macromolecules by NMR spectroscopy. At the beginning of macromolecular NMR, the only options available to the scientist were one-dimensional spectra of well-resolved resonances. Any analysis of NMR experiments still requires well-resolved resonances; however, the resolution toolkit from which the spectroscopist can draw is much larger now. The current trend in the study of larger molecules is to obtain 3D, 4D, and even higher dimensional spectra of isotopically labeled molecules. The logic since higher resolution is required, however, does not leave two-dimensional NMR in the dust. It is always a good idea to obtain data from the simplest possible experiment. If the data can be unambiguously obtained from one-dimensional NMR spectrum, then there is no real need to use two-dimensional spectroscopy. Likewise, many problems associated with large molecular systems can be solved by simple two-dimensional methods.
The Effect of Team Configuration on the Incidence of Adverse Events in Pediatric Critical Care Transport.

Abstract Objective Specialty pediatric transport teams are widely used for pediatric interfacility transport in the United States, with little industry consensus on optimal team configuration. The aim of this study is to assess the quality of the nurse/paramedic specialty team configuration as indirectly measured by the rate of adverse events in these transports. Methods Retrospective analysis of pediatric transport data from a hospital-based dedicated pediatric/neonatal transport team was conducted for patients transported in 2016. Data were categorized by general characteristics of transport and analyzed for the occurrence of adverse events. Results Five hundred sixty-four cases were analyzed. Cases were described by team configuration and then by transport mode, duration, time, patient age and acuity, and disposition. The overall rate of adverse event incidence was 8.3%, chiefly centered in device and process domains. There was no significant difference in the rate of adverse events between team configurations. Conclusion There was no significant difference in the rate of adverse event occurrence in nurse/paramedic team configurations versus nurse/nurse configuration. Using critical care paramedics on pediatric transport teams enables a larger volume of patients to be transported to definitive care without concerns for decrease in quality or safety.
Behavior and dynamics of bubble breakup in gas pipeline leaks and accidental subsea oil well blowouts.

Abstract Subsea oil well blowouts and pipeline leaks release oil and gas to the environment through vigorous jets. Predicting the breakup of the released fluids in oil droplets and gas bubbles is critical to predict the fate of petroleum compounds in the marine water column. To predict the gas bubble size in oil well blowouts and pipeline leaks, we observed and quantified the flow behavior and breakup process of gas for a wide range of orifice diameters and flow rates. Flow behavior at the orifice transitions from pulsing flow to continuous discharge as the jet crosses the sonic point. Breakup dynamics transition from laminar to turbulent at a critical value of the Weber number. Very strong pure gas jets and most gas/liquid co-flowing jets exhibit atomization breakup. Bubble sizes in the atomization regime scale with the jet-to-plume transition length scale and follow −3/5 power-law scaling for a mixture Weber number.
A Version of Guided Notetaking for Use in Music History Courses: Fostering Engagement and Achievement through Critical Thinking and Writing

Many studies show that guided notetaking, in which the instructor provides prompts for information to be included in students’ notes, is associated not only with more complete notes and better academic achievement, but also with greater participation than unassisted notetaking. Yet guided notetaking has traditionally involved having students write relatively little, focusing primarily on recording factual information and examples presented by the instructor. The expanded version of guided notetaking I have developed, which includes prompts for use in class as well as short writing assignments to be completed outside of class, emphasizes writing and critical thinking to a greater degree than does traditional guided notetaking. I contend that the version of guided notetaking I use is successful in improving student engagement and achievement in music history courses by fostering skills that are central to our discipline.
Racial and Ethnic Postoperative Outcomes After Surgery: The Hispanic Paradox.

Abstract Background The Hispanic population in the United States have previously been shown to have, in some cases, better health outcomes than non-Hispanic whites (NHWs) despite having lower socioeconomic status and higher frequency of comorbidities. This epidemiologic finding is coined as the Hispanic Paradox (HP). Few studies have evaluated if the HP exists in surgical patients. Our study aimed to examine postoperative complications between Hispanic and NHW patients undergoing low- to high-risk procedures. Materials and methods We conducted a retrospective cohort study analyzing adult patients who underwent high-, intermediate-, and low-risk procedures. The Healthcare Cost and Utilization Project California State Inpatient Database between 2006 and 2011 was used to identify the patient cohort. Candidate variables for the adjusted model were determined a priori and included patient demographics with the ethnic group as the exposure of interest. Results The median age for Hispanics was 52 (SD 19.3) y, and 38.8% were male (n = 87,837). A higher proportion of Hispanics had Medicaid insurance (23.9% versus 3.8%) or were self-pay (14.2% versus 4.5%) compared with NHWs. In adjusted analysis, Hispanics had a higher odds risk for postoperative complications across all risk categories combined (OR 1.06, 95% CI 1.04-1.09). They also had an increased in-hospital (OR 1.38, 95% CI 1.14-1.30) and 30-d mortality in high-risk procedures (OR 1.34, 95% CI 1.19-1.51). Conclusions Hispanics undergoing low- to high-risk surgery have worse outcomes compared with NHWs. These results do not support the hypothesis of an HP in surgical outcomes.
Correction of intrinsic penile chordee with a ventral penile graft of fascia lata.

Abstract Chordee is an abnormal curvature of the penis detected on erection. Congenital or primary curvature of the penis without hypospadias is, however, rare. There are two kinds of primary curvatures; those associated with a normal corpus spongiosum and those with a hypoplastic spongiosum. Secondary curvatures associated with Peyronie’s disease or periurethral fibrosis associated with urethral stricture are more common in adults. Four nonhuman primates had successful correction of artificially induced chordee with a graft of fascia lata.
Student Perspectives of Self-Directed Language Learning: Implications for Teaching and Research

This article presents findings from a qualitative study examining students’ perspectives of engaging in an autonomous learning project at a community college. Through the conceptual prism of self-directed learning, this study describes how students view the benefits of SDL as well as the roles of teachers. It also touches on factors contributing to the variances in students’ SDL competencies. With data collected from focus group interviews, the findings confirmed the utility of SDL as a potent learning strategy for students of foreign languages because this format could lead to improvements in knowledge domain, meta-cognitive skills, and motivation. In addition, the findings call for the need to consider individual differences in the design of SDL programs. Implications of the study findings for further teaching and research are also discussed.
Data-driven resource flexing for network functions visualization

Resource flexing is the notion of allocating resources on-demand as workload changes. This is a key advantage of Virtualized Network Functions (VNFs) over their non-virtualized counterparts. However, it is difficult to balance the timeliness and resource efficiency when making resource flexing decisions due to unpredictable workloads and complex VNF processing logic. In this work, we propose an Elastic resource flexing system for Network functions VIrtualization (ENVI) that leverages a combination of VNF-level features and infrastructure-level features to construct a neural-network-based scaling decision engine for generating timely scaling decisions. To adapt to dynamic workloads, we design a window-based rewinding mechanism to update the neural network with emerging workload patterns and make accurate decisions in real time. Our experimental results for real VNFs (IDS Suricata and caching proxy Squid) using workloads generated based on real-world traces, show that ENVI provisions significantly fewer (up to 26%) resources without violating service level objectives, compared to commonly used rule-based scaling policies.
Programming of Systems with Hysteresis Using Pulsed Inputs

The hysteresis nonlinearity is widely exhibited in a variety of materials and systems. As a popular model, the Preisach operator has been adopted to capture both monotonic and non-monotonic hysteresis. Existing studies on the control of hysterestic systems predominantly rely on feedforward or feedback approaches that require a constantly applied input. As an energy-efficient alternative, in this paper we consider the programming of a hysteretic system, represented by a Preisach operator, to achieve the transition of different output values with pulsed inputs. Given a desired output value, the required input pulse is calculated with an iterative algorithm. In particular, the monotonicity and convergence conditions of the proposed algorithm are analyzed. Simulation results are provided to support the convergence analysis and the effectiveness of the proposed scheme.