cssi/SciSciGPT-SciSciNet huggingface dataset:
Analysis of the technical efficiency and the influencing factors of provincial Maternal and Child Health Centers by DEA-Tobit two-step method

Objective This study aimed to evaluate the technical efficiency(TE) of 20 provincial Maternal and Children Health Centers in 2012, and explore the influencing factors of TE, so as to provide references for improving the TE of provincial MCH. Methods Data Envelopment Analysis was used to calculate TE. The influencing factors of TE were explored by Tobit regression. Results The average of total TE, pure TE and scale efficiency were 0.919, 0.995, 0.923, respectively. The average efficiency of provincial MCH in Westh China was the highest. The proportion of medical graduates in work force, bed utilization rate, and diagnostic accuracy are positively related to TE, but negatively related to the total liability of provincial MCH. Conclusion The proportion of medical graduates in total work force, bed utilization and diagnosis accuarcy should be increased to improve the TE of provincial MCH.
Frequency Conversion Reform Project of Central Air Conditioning

This paper introduces the necessity of improving frequency converter of central air conditioning with frequency converter and analyzes the general situation and shortcomings of original central air conditioning system.It also introduces the content of inverter reform and energy-saving effect after reform.The power consumption is greatly reduced,its mechanical wear is dropped by using variable frequency control central air conditioning.It has high efficiency and low operating cost.
Physicochemical Considerations in Gallstone Pathogenesis

Explicit consideration of the rate processes involved in cholelithiasis is necessary if the goal of accelerating gallstone dissolution as an alternative to surgical therapy is eventually to be achieved. The rate processes described here as important in this context are those affecting stone origin (nucleation), stone growth (precipitation and aggregation), and gallbladder function (layering and emptying).
Epidemiological impact of achieving UNAIDS 90-90-90 targets for HIV care in India: a modelling study

Objective Recent UNAIDS ‘90-90-90’ targets propose that to end the HIV epidemic by 2030, 90% of persons living with HIV (PLWH) worldwide should know their diagnosis, 90% of diagnosed PLWH should be on antiretroviral therapy (ART) and 90% of PLWH on ART should be virally suppressed by 2020. We sought to quantify the epidemiological impact of achieving these targets in India. Methods We constructed a dynamic-transmission model of the Indian HIV epidemic to project HIV infections and AIDS-related deaths that would occur in India over 15 years. We considered several scenarios: continuation of current care engagement (with early ART initiation), achieving 90-90-90 targets on time and delaying achievement by 5 or 10 years. Results In the base case, assuming continuation of current care engagement, we project 794 000 (95% uncertainty range (UR) 571 000–1 104 000) HIV infections and 689 000 (95% UR 468 000–976 000) AIDS-related deaths in India over 15 years. In this scenario, nearly half of PLWH diagnosed would fail to achieve viral suppression by 2030. With achievement of 90-90-90 targets, India could avert 392 000 (95% UR 248 000–559 000) transmissions (48% reduction) and 414 000 (95% UR 260 000–598 000) AIDS-related deaths (59% reduction) compared to the base-case scenario. Furthermore, fewer than 20 000 (95% UR 12 000–30 000) HIV infections would occur in 2030. Delaying achievement of targets resulted in a similar reduction in HIV incidence by 2030 but at the cost of excess overall infections and mortality. Conclusions India can halve the epidemiological burden of HIV over 15 years with achievement of the UNAIDS 90-90-90 targets. Reaching the targets on time will require comprehensive healthcare strengthening, especially in early diagnosis and treatment, expanded access to second-line and third-line ART and long-term retention in care.
Technology assessment. How effective is medical care

Physicians need to understand technology assessment in order to learn the facts that underlie ethical decisions as to which course of action will most benefit the patient. As technology is scrutinized, many procedures are abandoned, while others are found to be more useful than originally thought. By studying patient outcome in both therapeutic and diagnostic technology assessment, physicians may avoid the rationing of useful technology by abandoning useless technology.
Iterative learning control for non-repetitive trajectory tracking of robot manipulators with joint position constraints and actuator faults

In this work, we present a novel iterative learning control ILC scheme for a class of joint position constrained robot manipulator systems with both multiplicative and additive actuator faults. Unlike most ILC literature that requires identical reference trajectory from trail to trail, in this work the reference trajectory can be non-repetitive over the iteration domain without assuming the identical initial condition. A tan-type Barrier Lyapunov Function is proposed to deal with the constraint requirements which can be both time and iteration varying, with ILC update laws adopted to learn the iteration-invariant system uncertainties, and robust methods used to compensate the iteration and time varying actuator faults and disturbances. We show that under the proposed ILC scheme, uniform convergence of the full state tracking error beyond a small time interval in each iteration can be guaranteed over the iteration domain, while the constraint requirements on the joint position vector will not be violated during operation. An illustrative example on a two degree-of-freedom robotic manipulator is presented to demonstrate the effectiveness of the proposed control scheme. Copyright © 2016 John Wiley & Sons, Ltd.
Series connection front-to-front and back-to-back of silicon heterojunction solar cells

Alternating cells with p- and n-type emitters enables direct series connection of equivalent sides, i.e. front-to-front and back-to-back connection of adjacent cells. The challenge is to match the current of cells with p- and n-type emitters. The electrical properties of silicon heterojunction solar cells with front and rear junctions are remarkably similar. The short-circuit current density mismatch between front and rear junction cells is as low as 0.1 mAcm−2. The cells are connected using thin indium coated wires. One-cell and two-cells modules were manufactured, and efficiencies up to 21.2% were reached for one-cell modules. Electroluminescence of the two-cells module is a good indication about the quality of the direct series connection between front and rear junction cells.
Predicting Adjustment to Divorce from Social Support and Relational Quality in Multiple Relationships

ABSTRACTThe purpose of the study was to investigate adjustment to divorce as predicted by social support in multiple relationships to delineate how these interactions, in conjunction with individual characteristics, influence relational quality and adjustment to divorce. Participants (229 divorced individuals) recalled interactions with ex-spouses, family, and friends reporting risk of support, effectiveness of support, closeness and satisfaction, and adjustment to divorce. Risk of support is predictive of less effective social support in the family and friend relationships. More effective support is predictive of increased relational qualities in all 3 relationships but is not predictive of adjustment. The current relational qualities with the ex-spouse, in addition to individual divorcee characteristics, emerged as predictive of adjustment.
Advancement in the Diagnosis and Treatment of Granulomatous/Lymphocytic Interstitial Lung Disease

Common variable immunodeficiency (CVID) comprises the most clinically important primary immunodeficiency due to its prevalence, serious complications and long-term costs of therapy. A form of inter...
Accuracy of a novel photoacoustic-based approach to surgical guidance performed with and without a da Vinci robot

Minimally invasive surgery carries the deadly risk of rupturing major blood vessels, such as the internal carotid arteries hidden by bone in endonasal transsphenoidal surgery. We propose a novel approach to surgical guidance that relies on photoacoustic-based vessel separation measurements to assess the extent of safety zones during these type of surgical procedures. This approach can be implemented with or without a robot or navigation system. To determine the accuracy of this approach, a custom phantom was designed and manufactured for modular placement of two 3.18-mm diameter vessel-mimicking targets separated by 10-20 mm. Photoacoustic images were acquired as the optical fiber was swept across the vessels in the absence and presence of teleoperation with a research da Vinci Surgical System. When the da Vinci was used, vessel positions were recorded based on the fiber position (calculated from the robot kinematics) that corresponded to an observed photoacoustic signal. In all cases, compounded photoacoustic data from a single sweep displayed the four vessel boundaries in one image. Amplitude- and coherence-based photoacoustic images were used to estimate vessel separations, resulting in 0.52-0.56 mm mean absolute errors, 0.66-0.71 mm root mean square errors, and 65-68% more accuracy compared to fiber position measurements obtained through the da Vinci robot kinematics. Results indicate that with further development, photoacoustic image-based measurements of anatomical landmarks could be a viable method for real-time path planning in multiple interventional photoacoustic applications.
Surgeon leadership in the coding, billing, and contractual negotiations for fenestrated endovascular aortic aneurysm repair increases medical center contribution margin and physician reimbursement

Abstract Background Fenestrated endovascular aneurysm repair (FEVAR) allows endovascular treatment of thoracoabdominal and juxtarenal aneurysms previously outside the indications of use for standard devices. However, because of considerable device costs and increased procedure time, FEVAR is thought to result in financial losses for medical centers and physicians. We hypothesized that surgeon leadership in the coding, billing, and contractual negotiations for FEVAR procedures will increase medical center contribution margin (CM) and physician reimbursement. Methods At the UMass Memorial Center for Complex Aortic Disease, a vascular surgeon with experience in medical finances is supported to manage the billing and coding of FEVAR procedures for medical center and physician reimbursement. A comprehensive financial analysis was performed for all FEVAR procedures (2011-2015), independent of insurance status, patient presentation, or type of device used. Medical center CM (actual reimbursement minus direct costs) was determined for each index FEVAR procedure and for all related subsequent procedures, inpatient or outpatient, 3 months before and 1 year subsequent to the index FEVAR procedure. Medical center CM for outpatient clinic visits, radiology examinations, vascular laboratory studies, and cardiology and pulmonary evaluations related to FEVAR were also determined. Surgeon reimbursement for index FEVAR procedure, related adjunct procedures, and assistant surgeon reimbursement were also calculated. All financial analyses were performed and adjudicated by the UMass Department of Finance. Results The index hospitalization for 63 FEVAR procedures incurred $2,776,726 of direct costs and generated $3,027,887 in reimbursement, resulting in a positive CM of $251,160. Subsequent related hospital procedures (n = 26) generated a CM of $144,473. Outpatient clinic visits, radiologic examinations, and vascular laboratory studies generated an additional CM of $96,888. Direct cost analysis revealed that grafts accounted for the largest proportion of costs (55%), followed by supplies (12%), bed (12%), and operating room (10%). Total medical center CM for all FEVAR services was $492,521. Average surgeon reimbursements per FEVAR from 2011 to 2015 increased from $1601 to $2480 while the surgeon payment denial rate declined from 50% to 0%. Surgeon-led negotiations with the Centers for Medicare & Medicaid Services during 2015 resulted in a 27% increase in physician reimbursement for the remainder of 2015 ($2480 vs $3068/case) and a 91% increase in reimbursement from 2011 ($1601 vs $3068). Assistant surgeon reimbursement also increased ($266 vs $764). Concomitant FEVAR-related procedures generated an additional $27,347 in surgeon reimbursement. Conclusions Physician leadership in the coding, billing, and contractual negotiations for FEVAR results in a positive medical center CM and increased physician reimbursement.
P01.13 The role of non-coding RNAs in GBM stem-like cells subtype identity maintenance and transition

AbstractDecades of research on protein coding genes (2% of the genome) led to only incremental improvements of outcomes in glioblastoma multiforme (GBM) patients. Meanwhile, research on non-protein-coding genes, which constitute the vast majority of the human transcriptome, have received comparatively little attention to date. Large scale transcriptomic profiling of GBM into four subtypes has provided remarkable insight about the pathobiology and heterogeneous nature of this disease, including the mechanisms of subtype maintenance and adaptation to tumor anatomic niche and microenvironmental challenges. The co-existence of several molecular subtypes of differentiated tumor cells and GBM stem-like cells (GSCs) within individual tumors is further complicated by their complex speciation, inter-subtype transitions and hybrid stages. The role of non-coding RNAs (such as microRNAs and long, non-coding RNAs) in these processes is poorly understood. Through their unique capability of targeting multiple mRNA targets, microRNAs, whose expression is often de-regulated in cancers, play pivotal role in pathophysiology of tumor. Subtype-specific expression of microRNA-128 (miR-128) affects complex subpopulation dynamics within the heterogeneous GBM tumors. Alterations in miR-128 levels, acting through de-regulation of multiple mRNA targets that control epigenetic landscape, are a potent mechanism of bi-directional transitions between proneural and mesenchymal GSC subpopulations resulting in intermediate hybrid stages and emphasizing highly intricate intra-tumoral networking. Long non-coding RNAs (lncRNAs) have an undefined role in the pathobiology of GBM. Hypoxia Inducible Factor 1 Alpha-Anti Sense RNA 2 (HIF1A-AS2) was identified as a subtype-specific hypoxia-inducible lncRNA, upregulated in mesenchymal GSCs. Knockdown of HIF1A-AS2 affected GSC growth, self-renewal, and hypoxia-dependent molecular reprogramming, leading to delayed growth of mesenchymal GSC tumors, survival benefits, and impaired expression of downstream genes. Our data demonstrate that HIF1A-AS2 contributes to GSCs’ speciation and adaptation to hypoxia within the tumor microenvironment, acting directly through its interactome and targets and indirectly by modulating responses to hypoxic stress depending on the subtype-specific genetic context. These examples highlight immense, yet not fully appreciated, role of non-coding RNAs in pathophysiology of GBM.
Quality Outcomes and Credentialing: Implication for Informatics and Big Data Science

This chapter explores the links among methods to measure expert nursing practice, patient outcomes, and data systems that enable an examination of factors that lead to patient outcomes. Certification and the nursing credential are discussed as examples of methods to designate expertise in practice. However, the literature shows that the ability to link the credential to patient outcomes is yet to be refined. The Institute of Medicine’s Standing Committee on Credentialing Research in Nursing provides the background for research on credentialing and outcomes along with a discussion on the work of the National Quality Forum in developing measures for performance. Measurement sets for quality performance are experiencing considerable precision but fall short as a way to measure the work of nursing and its direct influence on quality. Recommendations are suggested for continued work on pathways to evidence and refining measures to capture the influence on credentialing in quality.
Going with the Flow: Water Flux and Cell Shape during Cytokinesis

Cell shape changes during cytokinesis in eukaryotic cells have been attributed to contractile forces from the actomyosin ring and the actomyosin cortex. Here we propose an additional mechanism where active pumping of ions and water at the cell poles and the division furrow can also achieve the same type of shape change during cytokinesis without myosin contraction. We develop a general mathematical model to examine shape changes in a permeable object subject to boundary fluxes. We find that hydrodynamic flows in the cytoplasm and the relative drag between the cytoskeleton network phase and the water phase also play a role in determining the cell shape during cytokinesis. Forces from the actomyosin contractile ring and cortex do contribute to the cell shape, and can work together with water permeation to facilitate cytokinesis. To influence water flow, we osmotically shock the cell during cell division, and find that the cell can actively adapt to osmotic changes and complete division. Depolymerizing the actin cytoskeleton during cytokinesis also does not affect the contraction speed. We also explore the role of membrane ion channels and pumps in setting up the spatially varying water flux.
Abstract 16353: Triglyceride Reduction With Omega-3 Fatty Acids is Associated With Regression of Coronary Plaque Volume in Subjects With Coronary Artery Disease on Maximal Statin Therapy

Introduction: High-dose statin treatment resulted in coronary plaque regression measured by intravascular ultrasound. The benefit of triglyceride (TG) reduction on plaque regression with maximal st...
The Valuable Contribution of Diagnostic Ultrasound in the Preoperative Diagnosis of Splenic Cysts

Two illustrative cases are presented wherein the modality of diagnostic ultrasound provided decisive data in the preoperative diagnosis of perplexing left upper quadrant masses. In both cases the ultrasound examination was obtained early in the course of the diagnostic workup and actually determined the direction of subsequent diagnostic examinations.
CHI '02 Extended Abstracts on Human Factors in Computing Systems

Interactive technologies have changed - and continue to change - our world. We are living in an era of transformation driven by the Internet, hand-held computing, digital photography, interactive entertainment, and wireless communication technologies. But such transformations are nothing new. Adoption of many technologies has transformed our work, play, communication, and thought. It has also transformed our research and practice in the HCI community.CHI 2002 explores transforming technologies, looking back to the past and forward to the future. First, by reflecting on past (and current) technologies, we seek a better understanding of questions like: Why do some technologies succeed where others fail? How have economic and work conditions and leisure been changed? What roles have technologists, entrepreneurs, legislators, lawyers, and citizens played? We examine these issues especially as they relate to HCI, a young field that will celebrate its 20th anniversary at CHI 2002.Second, we look forward, examining emerging technologies and involving us all in shaping their progress. Profound HCI issues are raised as computer and communications technologies progress from portable to wearable to implantable, as the power and speed of technology increases and the cost decreases, and as the standard desktop graphical interface is augmented by mobile devices, tangible and mixed reality interfaces. In response, we ask: What role should HCI professionals play in the development and deployment of such profoundly transformative devices and the socio-technical systems surrounding them? How can we ensure usability and a regard for personal privacy? What is the role of the legal and political system can they "keep up" with technology, or do sufficiently compelling technologies simply push them aside.Third, in addition to looking outward, CHI 2002 has looked inward to the practices of our community. We used some new technologies to nudge the CHI conference in the direction of greater interactivity, turning attendees into participants. CHIplace.org, our interactive online forum, enables people to exchange ideas, offer suggestions, and preview conference content. As part of CHIs increasing emphasis on issues of interest to designers and usability practitioners, CHI 2002 features the Practitioners Special Track. Professional and student designers present portfolios of their work, and usability professionals reflect on the experiences they have gained with usability methods in practice. CHI 2002 also is proud to feature a two-day forum, the CHI 2002|AIGA Experience Design Forum. Held in collaboration with the Experience Design Group of AIGA, the American Institute of Graphic Arts, this forum serves as an in-depth, interdisciplinary exploration of issues in design and human-computer interaction.
Diabetes and Associated Cardiovascular Complications in American Indians/Alaskan Natives: A Review of Risks and Prevention Strategies

Diabetes mellitus (DM) is the seventh leading cause of death in the United States and the leading cause of death in the U.S. American Indian/Alaskan Natives (AI/ANs), who comprise only 2% of the total population. The AI/AN population has a high prevalence of DM in adults aged 20 years or older and is developing DM at a younger age than the general U.S. population. DM is a major risk factor for cardiovascular disease (CVD), and mortality from CVD is higher in AI/ANs than the general population, as is the prevalence of stroke and 1-year poststroke mortality for both genders when compared to non-Hispanic whites. A genome-wide scan found a number of chromosome linkages in the AI/AN population that suggest that genetic factors may contribute to their high risk of DM and CVD. Importantly, studies also suggest that in addition to race/ethnicity, cultural norms and historic conditions play important roles in the prevalence of DM and CVD in this population. Therefore, multiple factors should be taken into consideration when establishing prevention programs to decrease the prevalence of obesity, diabetes, and CVD incidence among adults and children in the AI/AN population. Prevention programs should focus on behavioral risk factors and lifestyle changes like encouraging smoking cessation, healthy diet, and increased physical activity while taking into consideration cultural, economic, and geographic factors.
Rapidly separable microneedle patch for the sustained release of a contraceptive

Women often have limited access to contraception, and barrier methods have low acceptance and a high failure rate, mostly due to incorrect use, which can result in unplanned pregnancies. Sustained-release formulations of contraceptive hormones are available, yet typically require their administration by trained personnel. Here, we report the design of a microneedle patch with rapidly separable biodegradable polylactic acid and polylactic-co-glycolic acid needles, and its application for the continuous release of levonorgestrel—a contraceptive hormone. Bubble structures between each microneedle and the patch backing allow the microneedles to efficiently penetrate skin under compression, and to snap off under shear within five seconds after patch administration. In rats, the microneedle patch was well tolerated, leaving little visible evidence of use, and maintained plasma concentrations of the hormone above the human therapeutic level for one month. Further development of the rapidly separable microneedle patch for self-administered, long-acting contraception could enable women to better control their fertility. A microneedle skin patch with rapidly separable, biodegradable polymer needles continuously releases the contraceptive levonorgestrel for over one month in rats.
Reducing the hospital burden associated with the treatment of pulmonary embolism

Pulmonary embolism (PE) is the most feared clinical presentation of venous thromboembolism (VTE). Patients with PE have traditionally been treated in hospital; however, many are at low risk of adverse outcomes and current guidelines suggest outpatient treatment as an option. Outpatient treatment of PE offers several advantages, including reduced risk of hospital-acquired conditions and potential cost savings. Despite this, patients with low-risk PE are still frequently hospitalized for treatment. This narrative review summarizes current guideline recommendations for the identification of patients with low-risk PE who are potentially suitable for outpatient treatment, using prognostic assessment tools (e.g. the Pulmonary Embolism Severity Index [PESI] and simplified PESI) and clinical exclusion criteria (e.g. Hestia criteria) alone or in combination with additional cardiac assessments. Treatment options are discussed along with recommendations for the follow-up of patients managed in the non-hospital environment. The available data on outpatient treatment of PE are summarized, including details on patient selection, anticoagulant choice, and short-term outcomes in each study. Accumulating evidence suggests that outcomes in patients with low-risk PE treated as outpatients are at least as good as, if not better than, those of patients treated in the hospital. With mounting pressures on health care systems worldwide, increasing the proportion of patients with PE treated as outpatients has the potential to reduce health care burdens associated with VTE.
The Barber Queue.

EVERYBODY gets involved in waiting lines?lines in cafeterias, supermarkets, banks, toll booths, service stations, the doc tor's office, restrooms, and many other places. If you are waiting for a service, you probably don't want to wait very long, and if you are the one providing the service, you probably don't want to make the people being served wait very long because they will become disgruntled and go somewhere else with their business. Since waiting lines are a common occurrence, it is important that people providing services understand more about them, in order to assure their customers satisfaction with service delivery. The purpose of this article is to explore the theory of waiting lines by considering a simple example and by simulating the wait ing line with a computer. The theory of waiting lines is called queuing theory, and a waiting line is called a queue. The literature on queuing theory is extensive and is growing rapidly. In col leges, queuing theory is generally taught in courses in operations research or mathe matical modeling. The elementary aspects of the theory can be understood by second ary school mathematics students, and proj ects involving the collection and analysis of data involving queuing are easily in troduced and enjoyed by students. In order to study a queue, one needs to know three things about it. First, the arrival scheme?how or at what time do persons or objects arrive at the service port(s)? Do Have you ever waited in line for something? Mathematics can help students analyze this problem.
Association of hypomagnesemia with cardiovascular diseases and hypertension.

Abstract Objective The objective of this study was to review the current evidence on the effects of Mg2+ deficiency on cardiovascular disease (CVD) and hypertension, since Mg2+ is a potent vasodilator and modulates vasomotor tone, blood pressure and peripheral blood flow. Several factors could contribute to its deficiency and when it occurs, is associated with an increased incidence of cardiovascular disease (CVD), hypertension, heart failure (HF), and cardiac arrhythmias. Methods In order to get a better to get an updated perspective of the current status of Mg2+ deficiency and its implications in CVD, hypertension, and cardiac arrhythmias, a focused Medline search of the English language literature was conducted between 2014 and 2018 and 30 pertinent papers were retrieved. Results The analysis of data showed that Mg2+ deficiency is difficult to occur, under normal circumstances, because it is plentiful in green leafy vegetables, cereals, nuts, and the drinking water. However, Mg2+ deficiency can occur under special circumstances such as hypertension and HF treated with large doses of diuretics, patients with chronic kidney disease (CKD) treated with hemodialysis, and patients with gastroesophageal reflux disease treated with proton pump inhibitors. When hypomagnesemia occurs, it is associated with serious cardiac arrhythmias and aggravation of hypertension. Conclusion The analysis of data suggests that Mg2+ deficiency does occur and it is associated with an increased incidence of CVD, HF, serious cardiac arrhythmias, and hypertension. Retaining normal Mg2+ levels will prevent the onset of these diseases.
Influence of high-resolution data on the assessment of forest fragmentation

Remote sensing has been a foundation of landscape ecology. The spatial resolution (pixel size) of remotely sensed land cover products has improved since the introduction of landscape ecology in the United States. Because patterns depend on spatial resolution, emerging improvements in the spatial resolution of land cover may lead to new insights about the scaling of landscape patterns. We compared forest fragmentation measures derived from very high resolution (1 m2) data with the same measures derived from the commonly used (30 m × −30 m; 900 m2) Landsat-based data. We applied area-density scaling to binary (forest; non-forest) maps for both sources to derive source-specific estimates of dominant (density ≥ 60%), interior (≥ 90%), and intact (100%) forest. Switching from low- to high-resolution data produced statistical and geographic shifts in forest spatial patterns. Forest and non-forest features that were “invisible” at low resolution but identifiable at high resolution resulted in higher estimates of dominant and interior forest but lower estimates of intact forest from the high-resolution source. Overall, the high-resolution data detected more forest that was more contagiously distributed even at larger spatial scales. We anticipate that improvements in the spatial resolution of remotely sensed land cover products will advance landscape ecology through re-interpretations of patterns and scaling, by fostering new landscape pattern measurements, and by testing new spatial pattern-ecological process hypotheses.
(12) Establishing a Ventilator Weaning and Extubation Readiness Protocol in the Pediatric Intensive Care Unit Utilizing Pressure Regulated Volume Control and Volume Support: A Quality Improvement Initiative

Specific Aim: To establish and implement a respiratory therapist (RT) ventilator weaning and extubation readiness protocol utilizing pressure regulated volume control (PRVC) and volume support (VS) to reduce length of mechanical ventilation (MV). Background: Many patients admitted to the PICU require MV as part of management of their critical illness. Pediatric patients who require MV are at increased risk for infection, lung injury, delirium, and habituation to sedation. This Ventilator Weaning and Extubation Readiness (VEER)Protocol was designed to reduce the number of days a patient remained on the ventilator, averaged per one hundred patient days, …
TIMING OF CEREBRAL PROCESSES RELATIVE TO CONCOMITANT CONSCIOUS EXPERIENCES IN MAN

Publisher Summary This chapter focuses on the timing of cerebral processes relative to concomitant conscious experiences in man. For conscious sensory experience, the neuronal activations at the cortical level appear to require a substantial minimum time, up to about 0.5 sec. This requirement is certainly true for stimuli applied directly either to the sensory cortex or to the specific projection system in the thalamus or medial lemniscus (LM). When the intensity (I) of stimulus pulses is adjusted for each train duration (TD), so that the same just barely threshold conscious sensory experience is produced by each I-TD combination, there is a minimum intensity below which no sensation can be elicited no matter how long the TD. At this liminal intensity, the minimum or utilization train duration averages around 0.5 sec; this is true regardless of the pulse frequency or of other stimulus variables. However, a single pulse is completely ineffective for eliciting conscious sensation.
Adverse Childhood Experiences, Smoking and Alcohol Use, and Allostatic Load Among People Living with HIV

Allostatic load is an indicator of multisystem physiologic dysregulation that may arise from prolonged or accumulated exposure to stress, including adverse childhood experiences (ACEs) and chronic stressors persisting into adulthood. People living with HIV (PLWH) may be particularly vulnerable given their high burdens of adversity across the life course. Using data from a cohort of middle aged PLWH, we examined associations between ACEs and two measures of allostatic load. In order to determine whether the negative impact of ACEs on allostatic load operates through increasing the adoption of adverse coping behaviors, we tested for mediation by smoking and alcohol use. PLWH who had experienced 4 or more ACEs had on average higher allostatic load in adulthood compared to those who experienced fewer. Neither smoking nor alcohol use mediated this relationship, however, suggesting alternative mechanisms may be at play.
Imaging Approaches for Aortic Disease

Aortic disease is an important cause of morbidity and mortality if diagnosis is delayed or missed. Noninvasive imaging is a dynamic field that has undergone major advances in recent years, replacing invasive techniques in diagnosing aortic diseases. This chapter will discuss certain disease processes affecting the thoracic and abdominal aorta, with a focus on different imaging modalities used to diagnose, follow up, and monitor these respective conditions.
Online monitoring and diagnosis of high voltage circuit breaker faults: feature extraction analysis of vibration signals

The development of power grid system not only increases voltage and capacity, but also increases power risk. This paper briefly introduces the feature extraction method of the vibration signal of high voltage circuit breaker and support vector machine (SVM) algorithm and then analyzed the high voltage circuit breaker in three states: normal operation, fixed screw loosening and falling of opening spring, using the SVM based on the above feature extraction method. The results showed that the accuracy and precision rates of fault identification of circuit breaker were the highest by using the wavelet packet energy entropy extraction features, the false alarm rate was the lowest, and the detection time was the shortest.
Clinical observation of telbivudine and lamivudine in treament of patients with chronic hepatitis B

Objective To investigate the efficacy and side effects of telbivudine and lamivudine for treatment of chronic hepatitis B for 1 year. Methods In this random and control study,the efficacy of telbivudine and lamivudine treatments were compared in 120 patients who consisted of 60 cases with HBeAg-negative and 60 cases with HBeAg-positive chronic hepatitis B.The patients were randomly assigned to a daily 600mug telhivudine treatment group or daily 100mg lamivudine group for 52 weeks.The clinical efficacy and adverse reactions of the two groups were observed in control after 52 weeks of therapy,and dynamics of serum HBsAg,HBeAg levels were monitored and compared. Results At week 52,mean reductions of serum HBV DNA from baseline and undetectable serum HBV DNA rates among patients with HBeAg-negative and HBeAg-positive chronic hepatitis B were significantly greater in the telbivudine-treated patients than in the lamivudine-treated group(all P＜0.05).Viral resistance and viral breakthrough was significant common in lamivudine compared with telbivudine(all P＜0.05).Among patients with HBeAg-positive chronic hepatitis B,telbivudine was significant superior to lamivudine with respect to loss of HBeAg(P＜0.05).There was no significant difference in side effects between patients treated with tebivudine and Iamivudine. Conclusion Telbivudine was more effective than lamivudine in treatment of patients with chronic hepatitis B,and the drug was well tolerated. Key words: Chronic hepatitis B; Lamivudine; Telbivudine
Break on Through: Golgi-Derived Vesicles Aid in Mitochondrial Fission.

Mitochondrial fission is sustained through contact with several organelles, including the endoplasmic reticulum, lysosomes, and the actin cytoskeleton. Nagashima et al. (2020) now demonstrate that PI(4)P-containing Golgi-derived vesicles also modulate mitochondrial fission, driven by Arf1 and PI(4)KIIIβ activity, identifying a new organelle contact involved in maintaining mitochondrial homeostasis.
Research on Accounting Intelligence System Modeling of Financial Performance Evaluation

In the current competitive market environment, both enterprises and academia attach great importance to the research of financial performance evaluation. The quality of financial performance directly affects the sustainable development of enterprises. With the deepening of enterprise management concept, enterprises pay more attention to the use of financial performance evaluation analysis to promote the sound development of the whole enterprise. In order to understand the development status and development trend of enterprises and improve the efficiency of enterprise management, it is of great significance to establish a scientific and professional financial performance evaluation model for the sustainable development of enterprises. In this paper, based on FCM clustering algorithm, a fuzzy decision model is established. Combined with the factors affecting the financial performance of enterprises, the corresponding indicators are selected from the four aspects of profitability, operation ability, debt paying ability, and development ability to construct the financial performance evaluation system, and the comprehensive fuzzy evaluation model is constructed according to the financial evaluation system. This paper selects listed companies as the research object to evaluate and analyze the performance of enterprises. The results show that the overall performance of listed companies is not ideal and solvency, operation ability, and development ability need to be enhanced. Finally, in view of the problems existing in the listed enterprises, this paper puts forward the following countermeasures: implement cost assessment and pay attention to cost analysis to strengthen cost control; strengthen the cooperation between industrial chain enterprises and RD and pay attention to the use of talents and improve the ability of independent innovation.
An Uncommon Cause of Dysphagia: Postpneumonectomy Syndrome.

Objective Dysphagia after pneumonectomy is uncommon but concerning. The purpose of this paper is to present a case of dysphonia secondary to postpneumonectomy syndrome. Case Report. A 66-year-old female with stage IIIa adenocarcinoma of the lung was treated with a left pneumonectomy. Three years later, she presented with severe dysphagia, dyspnea, and dysphonia. Esophagram demonstrated severely deviated esophagus to the left of midline, attributed to prior left-sided pneumonectomy, without clear evidence of any external compression. Chest CT scan showed associated leftward mediastinal shift. This patient was treated with voice therapy and an exclusion diet, as the patient elected not to have surgery. Conclusion This is the first reported case of dysphonia accompanying severe dysphagia following left pneumonectomy. While postpneumonectomy syndrome is rare, a high degree of clinical suspicion is recommended when treating patients with history of pneumonectomy.
Analytic functions of several complex variables

The theory of analytic functions of several complex variables enjoyed a period of remarkable development in the middle part of the twentieth century. After initial successes by Poincare and others in the late 19th and early 20th centuries, the theory encountered obstacles that prevented it from growing quickly into an analogue of the theory for functions of one complex variable. Beginning in the 1930s, initially through the work of Oka, then H. Cartan, and continuing with the work of Grauert, Remmert, and others, new tools were introduced into the theory of several complex variables that resolved many of the open problems and fundamentally changed the landscape of the subject. These tools included a central role for sheaf theory and increased uses of topology and algebra. The book by Gunning and Rossi was the first of the modern era of the theory of several complex variables, which is distinguished by the use of these methods. The intention of Gunning and Rossi's book is to provide an extensive introduction to the Oka-Cartan theory and some of its applications, and to the general theory of analytic spaces. Fundamental concepts and techniques are discussed as early as possible. The first chapter covers material suitable for a one-semester graduate course, presenting many of the central problems and techniques, often in special cases. The later chapters give more detailed expositions of sheaf theory for analytic functions and the theory of complex analytic spaces. Since its original publication, this book has become a classic resource for the modern approach to functions of several complex variables and the theory of analytic spaces.
Botulinum toxin in the masseter muscle: Lingering effects of denervation.

Botulinum neurotoxins (BoNTs) are paralytic agents used to treat a variety of conditions in jaw muscles. Although their effect is considered temporary, there are reports of persistent functional changes. Using rabbits that received BoNT injection in one masseter muscle, the recovery of neuromuscular connection was investigated using nerve stimulation to evoke an electromyographic (EMG) response, and the recovery of muscle fibers was investigated using histological morphometry and bromodeoxyuridine (BrdU) immunohistochemistry. One month after treatment, evoked EMG was greatly reduced in both amplitude and duration, indicating that little reinnervation had taken place. Muscle fibers were atrophied and collagenous tissue was increased. Three months after treatment, evoked EMG duration was normal, indicating that at least some neuromuscular junctions were functional. Histologically, some muscle fibers were hypertrophied, some were still atrophied, and some appeared to have died. Fibrosis was still apparent amid slight increases in dividing cells and regenerating fibers. The histological effects of BoNT were evident although attenuated at a distance of about 1 cm from the injection level, but no regional differences could be discerned for the evoked EMGs. In conclusion, there were persistent muscular deficits seen 3 months after BoNT treatment that may have been caused by the failure of some affected muscle fibers to become reinnervated.
A framework for prototyping collaborative virtual environments

Unicron is a platform for rapidly developing virtual environments that combine two popular forms of collaboration: a 3D collaborative virtual environment fostering meetings, appointments, whiteboard sessions and lectures, along with a 2D development environment including collaborative software design, text editing, and debugging tools. This paper presents novel aspects of the Unicron design and implementation.
Mechanism of phosphorylation in the lumen of the Golgi apparatus. Translocation of adenosine 5'-triphosphate into Golgi vesicles from rat liver and mammary gland.

Abstract The occurrence of phosphorylated secretory proteins such as caseins and vitellogenin and the recent characterization of phosphorylated proteoglycans, in the xylose and protein core, has raised the question of where in the cell and how this phosphorylation occurs. Previous studies have described a casein kinase activity in the lumen of the Golgi apparatus and this organelle as the site of xylose addition to the protein core of proteoglycans. We now report the translocation in vitro of ATP into the lumen of rat liver and mammary gland Golgi vesicles which are sealed and have the same membrane topographical orientation as in vivo. The entire ATP molecule was translocated into the lumen of the Golgi vesicles; this was established by using ATP radiolabeled with tritium in the adenine and gamma-32P. Translocation was temperature dependent and saturable, with an apparent Km of 0.9 microM and Vmax of 58 pmol/mg protein/min. Preliminary evidence suggests that translocation of ATP into the vesicles' lumen is coupled to exit of AMP from the lumen. Following translocation of ATP into the lumen of the vesicles, proteins were phosphorylated.
Overview of Investment Banking

Investment banking changed dramatically during the 20-year period preceding the global financial crisis that started in mid-2007 as market forces pushed banks from their traditional low-risk role of advising and intermediating to a position of taking considerable risk for their own account and on behalf of clients. This high level of risk-taking, combined with high leverage, transformed the industry during 2008, when several major firms failed, huge trading losses were recorded, and many firms were forced to reorganize their business. Although each investment bank takes a somewhat different approach, the principal businesses of most large investment banks include: an investment banking business managed by the Investment Banking Division, which focuses on capital raising and MA sales and trading business managed by the Trading Division, which provides investing, intermediating, and risk-management services to institutional investor clients, performs research, and also participates in nonclient-related investing activities; and asset management business managed by the Asset Management Division, which is responsible for managing money for individual and institutional investing clients.
A 6-Year-Old Boy With Fever, Emesis, Rash, and an Acute Abdomen.

Apreviously healthy 6-year-old boy presentedwith 6 days of fever (maximum temperatureof40°C), intermittentnonbiliousemesis, and4daysof crampy,diffuseabdominalpain. Physical examination findingsweresignificant for ill appearance,bilateralnonexudativeconjunctivitis, shotty bilateral anterior cervical lymphadenopathy, diffuse abdominal tenderness (greatest in the right upper quadrant), and associated rebound and guarding. There was also a blanching, erythematous, macular rash on his cheeks (Figure, A) and an intermittent, erythematous, reticular rash on his chest, abdomen,arms,and legs (Figure,B) that sparedhispalmsandsolesand flaredwith fever.Theremainderofhisexaminationfindingswereunremarkable.Laboratorystudieswere significant for an elevated aspartate transaminase level of 264 U/L (reference range, 12-47 U/L; toconvert tomicrokatalsper liter,multiplyby0.0167)andanalanine transaminase level of251U/L (reference range, 17-63U/L; toconvert tomicrokatalsper liter,multiplyby0.0167). Acompletebloodcell count revealed leukopeniawithawhitebloodcell countof28300/μL (to convert to ×109/L, multiply by 0.001) (neutrophils, 64%; lymphocytes, 18%; monocytes, 4%; eosinophils, 2%; basophils, 1%; and bands, 11%), a low-normal hemoglobin level of 11.4g/dL (toconvert togramsper liter,multiplyby 10), andthrombocytopeniawithaplatelet countof610× 103/μL (to convert to×109/L,multiplyby 1). Computed tomographyof the abdomen revealed a dilated appendix (7 mm) with mucosal hyperemia and an internal appendicolith; acute appendicitis could not be excluded radiographically, so the patient was admitted for further workup because of a concern for acute abdomen. The patient lives in the southeasternUnited States and had no reported history of unusual exposures or insect or tick bites. Quiz at jamapediatrics.com Macular rash on bilateral cheeks A Reticular rash on left arm B