cssi/SciSciGPT-SciSciNet huggingface dataset:
Multiple Response Optimization for Higher Dimensions in Factors and Responses

When optimizing a product or process with multiple responses, a two-stage Pareto front approach is a useful strategy to evaluate and balance trade-offs between different estimated responses to seek optimum input locations for achieving the best outcomes. After objectively eliminating non-contenders in the first stage by looking for a Pareto front of superior solutions, graphical tools can be used to identify a final solution in the second subjective stage to compare options and match with user priorities. Until now, there have been limitations on the number of response variables and input factors that could effectively be visualized with existing graphical summaries. We present novel graphical tools that can be more easily scaled to higher dimensions, in both the input and response spaces, to facilitate informed decision making when simultaneously optimizing multiple responses. A key aspect of these graphics is that the potential solutions can be flexibly sorted to investigate specific queries, and that multiple aspects of the solutions can be simultaneously considered. Recommendations are made about how to evaluate the impact of the uncertainty associated with the estimated response surfaces on decision making with higher dimensions. Copyright © 2016 John Wiley & Sons, Ltd.
Prevalence of Major Methicillin-Resistant Staphylococcus aureus Clones in Korea Between 2001 and 2008

BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) are important pathogens causing nosocomial infections in Korean hospitals. This study aimed to investigate the epidemiological and genetic diversity of clinical S. aureus isolates in healthcare settings from 2001 to 2008. METHODS Samples and data were obtained from 986 individuals as part of the National Antimicrobial Surveillance Project, involving 10 regions nationwide. Molecular typing studies, including multilocus sequence typing (MLST) and staphylococcal cassette chromosome mec (SCCmec) typing were performed, and a representative clone of Korean MRSA was classified by combinational grouping using a DiversiLab (DL; bioMerieux, France) repetitive element polymerase chain reaction (rep-PCR) system. RESULTS Nine Korean MRSA clones (KMRSA-1 to -9) were identified by analysis of genetic backgrounds and molecular characteristics. KMRSA-1 to -3, expressing clonal complex (CC) 5 (carrying SCCmec II), CC8 (carrying SCCmec III), and CC72 (carrying SCCmec IV) were spread nationwide. In contrast, KMRSA-6 was highly prevalent in Gyeongsangnam-do, and KMRSA-4 was highly prevalent in Jeollanam-do and Jeollabuk-do. CONCLUSIONS Epidemic KMRSA clones were genetically similar to major clones identified from the USA, with the exception of KMRSA-2, which had the SCCmec III type. Our results provide important insights into the distribution and molecular genetics of MRSA strains in Korea and may aid in the monitoring of MRSA spread throughout the country.
On the convergence of the forward–backward splitting method with linesearches

In this paper we focus on the convergence analysis of the forward–backward splitting method for solving nonsmooth optimization problems in Hilbert spaces when the objective function is the sum of two convex functions. Assuming that one of the functions is Frechet differentiable and using two new linesearches, the weak convergence is established without any Lipschitz continuity assumption on the gradient. Furthermore, we obtain many complexity results of cost values at the iterates when the stepsizes are bounded below by a positive constant.
Therapeutic hypothermia for perinatal asphyxia in an Urban Tertiary Referral Center in South India: Our experience

Objective: To study the outcomes after starting therapeutic hypothermia in our unit. Primary Outcomes: Mortality in Neonatal Intensive Care Unit, neurological examination at discharge, seizures, encephalopathy duration, and mortality up to 18 months were the primary outcomes. Secondary Outcomes: Number of anti-epileptic drugs (AED) at discharge, duration of mechanical ventilation, hospital cost, feeding patterns, duration of hospital stay, and neurodevelopmental outcome at 18 months were the secondary outcomes. Setting: The study was conducted at the NICU, Dr. Mehta's Children Hospital, Chennai. Study Period: October 2013 to December 2015. Conclusion: Therapeutic hypothermia resulted in better survival and neurodevelopmental outcomes though there was no significant reduction in MRI and EEG abnormalities.
Theoretical underpinnings of version spaces

Mitchell's version-space approach to inductive concept learning has been highly influential in machine learning, as it formalizes inductive concept learning as a search problem-to identify some concept definition out of a space of possible definitions. This paper lays out some theoretical underpinnings of version spaces. It presents the conditions under which an arbitrary set of concept definitions in a concept description language can be represented by boundary sets, which is a necessary condition for a set of concept definitions to be a version space. Furthermore, although version spaces can be intersected and unioned (version spaces are simply sets, albeit with special structure), the result need not be a version space; this paper also presents the conditions under which such intersection and union of two version spaces yields a version space (i.e., representable by boundary sets). Finally, the paper shows how the resulting boundary sets after intersections and unions can be computed from the initial boundary sets, and proves the algorithms correct.
Dilated Cardiomyopathy and Cardioskeletal Involvement

Dilated cardiomyopathy encompasses a large heterogeneous group of genetically triggered and acquired etiologies. Cardioskeletal involvement in this population is increasingly identified. Recognition of multifactorial causes such as genetics, proteomics, and inflammation offer a more overarching and unifying explanation for cardioskeletal disease. The neuromuscular patient with Duchene muscular dystrophy provides a vivid example of cardioskeletal disease. In such patients the heritable defect in dystrophin leads to abnormal protein formation, inflammation in both cardiac and skeletal myocytes, and ultimately cardioskeletal disease. Similarly, acquired autoimmune inflammatory processes such as dermatomyositis are associated with inflammation and injury of myocytes and can result in cardioskeletal disease. In this chapter we discuss both heritable and acquired etiologies of dilated cardiomyopathy and explain some of the links to cardioskeletal disease. We discuss the evaluation and diagnosis of dilated cardiomyopathy and the subsequent management. Finally, we explore future directions that may further clarify the relationship between dilated cardiomyopathy and cardioskeletal disease.
The Birl: Adventures in the Development of an Electronic Wind Instrument

This article reflects on the markedly distinct development stages of an electronic wind instrument called the Birl. Stemming from an early idea for an electro-mechanical oscillator inspired by the sounds of pen plotters, the Birl was formed through the connection of that oscillator prototype to a rough wind instrument body. Originally intended to fulfill the role of the wind section in an ensemble of instruments built for the author’s doctoral dissertation composition, the instrument took on a new life after the completion of the piece. The development of a “cello-like” resonator body and refinements to the electro-mechanical aspects had brought the instrument to a performable state, but several limitations suggested further development. A desire to make the instrument more conducive to exploratory improvisation pushed the Birl in new directions, toward open-holed fingering systems and embouchure sensors with neural net mapping structures and physical models of dynamically configurable toneholes, resulting in an instrument that bore little resemblance to the original electro-mechanical concept. The author discusses the design challenges that arose as the instrument evolved, the solutions that were found along the way, and the ways in which user feedback informed the design as the needs of the instrument changed.
Bit-parallel all-to-all and flexible AWGR-based optical interconnects

This paper demonstrates bit-parallel, all-to-all communication with AWGR for on-board optical interconnects. A flexible bandwidth allocation is also presented. Trade-off studies optimize the bit-parallelism and achieve up to 3.5× higher energy efficiency compared to the single-bit case.
Variation in the Echocardiographic Surveillance of Primary Mitral Regurgitation.

Background— Clinical outcomes after surgical treatment of mitral regurgitation are worse if intervention occurs after deterioration of left ventricular size and function. Transthoracic echocardiographic (TTE) surveillance of patients with mitral regurgitation is indicated to avoid adverse ventricular remodeling. Overly frequent TTEs can impair patient access and reduce value in care delivery. This balance between timely surveillance and overutilization of TTE in valvular disease provides a model to study variation in the delivery of healthcare services. We investigated patient and provider factors contributing to variation in TTE utilization and hypothesized that variation was attributable to provider practice even after adjustment for patient characteristics. Methods and Results— We obtained records of all TTEs from 2001 to 2016 completed at a large echocardiography laboratory. The outcome variable was time interval between TTEs. We constructed a mixed-effects linear regression model with the individual physician as the random effect in the model and used intraclass correlation coefficient to assess the proportion of outcome variation because of provider practice. Our study cohort was 55 773 TTEs corresponding to 37 843 intervals ordered by 635 providers. The mean interval between TTEs was 12.4 months, 17.0 months, 18.3 months, and 17.4 months for severe, moderate, mild, and trace mitral regurgitation, respectively, with 20% of providers deemed overutilizers of TTEs and 25% underutilizers. Conclusions— We conclude that there is substantial variation in follow-up intervals for TTE assessment of mitral regurgitation, despite risk-adjustment for patient variables, likely because of provider factors.
Generalities on Homotopy Classes of Mappings

The set [X, Y] of homotopy classes of maps between two compactly generated spacesX, Y has no particular algebraic structure. This Chapter is devoted to the study of conditions on one or both spaces in order that [X, Y] support additional structure of interest. Guided by the fact that π1 (X, 0 ) = [S 1 , y 0 ; X, x 0 ] is a group, while[S 1 , X] is in one-to-one correspondence with the set of all conjugacy classes inπ 1 (X, x0), and the latter set has no algebraic structure of interest, we discuss in §1 the way in which [X, x 0 ; Y,y 0 ] depends on the base points. It turns out that under reasonable conditions the sets [X, x 0 ; Y 0 , y 0 ] andX, x 0 ; Y, y 1 ] are isomorphic. However, there is an isomorphism between them for every homotopy class of paths inY fromy 1 toy 0 . In particular, the group π1(Y, y 0 ) operates on[X, x 0 ;Y,y 0 ], and [X, Y] can be identified with the quotient of the latter set under the action of the group. This action for the caseX = Sn was first studied by Eilenberg [1] in 1939; it, and an analogous action ofπ 1 (B, y 0 ) on the set [X, A, x0;B, y 0 ], are discussed in §1.
The hominin fossil record and the emergence of the modern human central nervous system

We describe and evaluate the methods used to reconstruct the central nervous system (CNS) of extinct hominin taxa. Overviews of each hominin taxon are provided, focusing on evidence related to the evolution of the CNS. Trends in the evolution of the hominin CNS are investigated using these data. Encephalization in the hominin clade may have begun as early as Australopithecus afarensis and Au. africanus, but it is only with the appearance of Homo rudolfensis and H. habilis that both absolute and relative brain size have departed from a Pan-like condition. Brain size increase and the appearance of some aspects of modern humanlike brain morphology occur in at least two hominin lineages, Paranthropus and Homo, which have absolutely and relatively larger brains than Australopithecus. However, only fossil Homo taxa show a substantial increase in brain size and a shift to a modern humanlike brain morphology.
Reproduction of Rhabdoviruses

The rhabdoviruses are ubiquitous, highly infectious agents of animal and plant disease and are generally transmitted by arthropods. Assignment of viruses to the taxon rhabdoviruses (rod-shaped viruses) was originally based entirely on morphology. This classification has turned out to be fortuitously fortunate because later biochemical studies have revealed remarkable uniformity among these structurally similar viruses isolated from extremely diverse hosts. It is perhaps not farfetched to postulate a common ancestor for all the rhabdoviruses of plants, arthropods, and vertebrates. Classification of a virus as a rhabdovirus should be based on the following most important characteristics: 1. Rhabdoviruses are rod-shaped particles, varying considerably in length (60–400 nm) but of a reasonably consistent width (60–85 nm). 2. Animal rhabdoviruses tend to be bullet-shaped in appearance, flat at one end and a tapered sphere at the other. Plant rhabdoviruses are usually bacilliform in shape, quite elongated and with two round ends. 3. All rhabdoviruses appear to be surrounded by a membranous envelope with protruding spikes. All these viruses probably contain lipids and are, therefore, susceptible to disruption by ether and detergents.
Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck.

Importance Cutaneous squamous cell carcinoma (CSCC) is one of the most common malignant tumors worldwide. There is conflicting evidence regarding the indications for and benefits of adjuvant radiation therapy for advanced CSCC tumors of the head and neck. Objective To assess indications for adjuvant radiation therapy in patients with CSCC. Design, Setting, and Participants Retrospective analysis of 349 patients with head and neck CSCC treated with primary resection with or without adjuvant radiation therapy at 2 tertiary referral centers from January 1, 2008, to June 30, 2016. Main Outcomes and Measures Data were compared between treatment groups with a χ2analysis. Disease-free survival (DFS) and overall survival (OS) were analyzed using a Kaplan-Meier survival analysis with log-rank test and a Cox proportional hazards multivariate regression. Results A total of 349 patients had tumors that met the inclusion criteria (mean [SD] age, 70 [12] years; age range, 32-94 years; 302 [86.5%] male), and 191 (54.7%) received adjuvant radiation therapy. The 5-year Kaplan-Meier estimates were 59.4% for DFS and 47.4% for OS. Patients with larger, regionally metastatic, poorly differentiated tumors with perineural invasion (PNI) and younger immunosuppressed patients were more likely to receive adjuvant radiation therapy. On Cox proportional hazards multivariate regression, patients with periorbital tumors (hazard ratio [HR], 2.48; 95% CI, 1.00-6.16), PNI (HR, 1.90; 95% CI, 1.12-3.19), or N2 or greater nodal disease (HR, 2.16; 95% CI, 1.13-4.16) had lower DFS. Immunosuppressed patients (HR, 2.17; 95% CI, 1.12-4.17) and those with N2 or greater nodal disease (HR, 2.43; 95% CI, 1.42-4.17) had lower OS. Adjuvant radiation therapy was associated with improved OS for the entire cohort (HR, 0.59; 95% CI, 0.38-0.90). In a subset analysis of tumors with PNI, adjuvant radiation therapy was associated with improved DFS (HR, 0.47; 95% CI, 0.23-0.93) and OS (HR, 0.44; 95% CI, 0.24-0.86). Adjuvant radiation therapy was also associated with improved DFS (HR, 0.36; 95% CI, 0.15-0.84) and OS (HR, 0.30; 95% CI, 0.15-0.61) in patients with regional disease. Conclusions and Relevance Among patients with advanced CSCC, receipt of adjuvant radiation therapy was associated with improved survival in those with PNI and regional disease.
Magnetostatic Spring Softening and Stiffening in Magneto-Mechanical Resonator Systems

Integrating magnets into resonant mechanical systems allows for intriguing capabilities, such as the ability to tune the mechanical resonance frequency or induce coupling between resonators without any physical contact. Here, we present analytical models as well as the experimental study of an integrated magneto-mechanical system. Using a point dipole approximation, we explore the magneto-static spring effect, which can either soften or stiffen a spring depending on dipole orientation and spatial position of the magnets. We use translational and rotational resonance as commonly encountered demonstrative cases and, experimentally, demonstrate both the spring softening and stiffening effects.
Malignant Hyperthermia–Susceptible Adult Patient and Ambulatory Surgery Center: Society for Ambulatory Anesthesia and Ambulatory Surgical Care Committee of the American Society of Anesthesiologists Position Statement

This document represents a joint effort of the Society for Ambulatory Anesthesia (SAMBA) and the Ambulatory Surgical Care Committee of the American Society of Anesthesiologists (ASA) concerning the safe anesthetic care of adult malignant hyperthermia (MH)-susceptible patients in a free-standing ambulatory surgery center (ASC). Adult MH-susceptible patients can safely undergo a procedure in a free-standing ASC assuming that proper precautions for preventing, identifying, and managing MH are taken. The administration of preoperative prophylaxis with dantrolene is not indicated in MH-susceptible patients scheduled for elective surgery. There is no evidence to recommend an extended stay in the ASC, and the patient may be discharged when the usual discharge criteria for outpatient surgery are met. Survival from an MH crisis in an ASC setting requires early recognition, prompt treatment, and timely transfer to a center with critical care capabilities.
Individual differences in social network size linked to nucleus accumbens and hippocampal volumes in functional neurological disorder: A pilot study

Abstract Background In the biopsychosocial formulation of functional neurological (conversion) disorder (FND), little is known about relationships between social behavior and brain anatomy. We hypothesized that social behavior would relate to brain areas implicated in affiliative behaviors and that social network size would correlate with symptom severity and predisposing vulnerabilities in FND. Methods This neuroimaging pilot probed how social network size, as measured by the Social Network Index, related to structural brain profiles in 23 patients with motor FND (15 woman and 8 men). FreeSurfer cortical thickness and subcortical volumetric analyses were performed correcting for multiple comparisons. Stratified analyses compared FND patients with a low social network size to matched healthy controls. Secondary exploratory analyses in an expanded sample of 38 FND patients investigated relationships between social network size, risk factors and patient-reported symptom severity. Results Adjusting for age and gender, neuroimaging analyses showed that social network size positively correlated with left nucleus accumbens and hippocampal volumes in patients with FND; stratified analyses did not show any group-level differences. In individuals with FND, social network size correlated with health-related quality of life, graduating college, working full-time and a non-epileptic seizure diagnosis; social network size inversely related to lifetime trauma burden, post-traumatic stress disorder severity and age. Limitations Only patient-reported scales were used and social network size information was not collected for healthy subjects. Conclusions This neuroimaging pilot adds to the literature linking affiliation network brain areas to pro-social behaviors and enhances the biopsychosocial conceptualization of FND.
Noxious Chemical Exposure Trends as Measures of Green Victimization: Public Health, National Health and Nutrition Examination Survey Trends, and Green Criminology

AbstractGreen criminologists have argued that exposure to environmental pollution constitutes a serious form of green victimization of the general public and public health. This claim has not been ...
Predicting lung mass density of patients with interstitial lung disease and healthy subjects using deep neural network and lung ultrasound surface wave elastography

Abstract The Hounsfield unit (HU) obtained from high resolution computed tomography (HRCT) has been used to assess lung pathology. However, lung mass density has not been quantified in vivo noninvasively. The objective of this study was to develop a method for analyzing lung mass density of superficial lung tissue of patients with interstitial lung disease (ILD) and healthy subjects using a deep neural network (DNN) and lung ultrasound surface wave elastography (LUSWE). Surface wave speeds at three vibration frequencies (100, 150 and 200 Hz) from LUSWE and a pulmonary function test (PFT) including predicted forced expiratory volume (FEV1% pre) and ratio of forced expiratory volume to forced vital capacity (FEV1%/FVC%) were used. Predefined lung mass densities based on the HU for ILD patients and healthy subjects (77 in total) were also used to train the DNN model. The DNN was composed of four hidden layers of 1024 neurons for each layer and trained for 80 epochs with a batch size of 20. The learning rate was 0.001. Performances of two types of activation functions in the DNN, rectified linear activation unit (ReLU) and exponential linear unit (ELU), as well as, machine learning models (support vector regression, random forest, Adaboost) were evaluated. The test dataset of wave speeds, FEV1% pre and FEV%/FVC%, was used to predict lung mass density. The results showed that predictions using a DNN with ELU obtained a comparatively better performance in the testing dataset (accuracy = 0.89) than those of DNN with ReLU or machine learning models. This method may be useful to noninvasively analyze lung mass density by using the DNN model together with the measurements from LUSWE and PFT.
EMERGENCY ROOM EVALUATION OF PATIENTS WITH CARDIAC COMPLAINTS AND NEW LEFT BUNDLE BRANCH BLOCK: THE UTILITY OF THE SGARBOSSA AND MODIFIED SGARBOSSA CRITERIA

Background: Accurate recognition of ST elevation myocardial infarction (STEMI) in the presence of left bundle branch block (LBBB) remains a challenge. Sgarbossa criteria has a sensitivity of 52% and a specificity of 98%, while modified Sgarbossa criteria has a sensitivity of 91% and specificity of
Optic nerve damage in glaucoma: II. Insufficiency of blood flow☆

Abstract Ladies and gentlemen, our case rests. I do not contend that ischemia is the sole mechanism by which the optic nerve becomes damaged in glaucoma. But can one seriously doubt that it plays an important role?
Association Between Dual Trajectories of Opioid and Gabapentinoid Use and Healthcare Expenditures Among US Medicare Beneficiaries.

Abstract Objectives Little is known about relationships between opioid- and gabapentinoid-use patterns and healthcare expenditures that may be affected by pain management and risk of adverse outcomes. This study examined the association between patients’ opioid and gabapentinoid prescription filling/refilling trajectories and direct medical expenditures in US Medicare. Methods This cross-sectional study included a 5% national sample (2011-2016) of fee-for-service beneficiaries with fibromyalgia, low back pain, neuropathy, or osteoarthritis newly initiating opioids or gabapentinoids. Using group-based multitrajectory modeling, this study identified patients’ distinct opioid and gabapentinoid (OPI-GABA) dose and duration patterns, based on standardized daily doses, within a year of initiating opioids and/or gabapentinoids. Concurrent direct medical expenditures within the same year were estimated using inverse probability of treatment weighted multivariable generalized linear regression, adjusting for sociodemographic and health status factors. Results Among 67 827 eligible beneficiaries (mean age ± SD = 63.6 ± 14.8 years, female = 65.8%, white = 77.1%), 11 distinct trajectories were identified (3 opioid-only, 4 gabapentinoid-only, and 4 concurrent OPI-GABA trajectories). Compared with opioid-only early discontinuers ($13 830, 95% confidence interval = $13 643-14 019), gabapentinoid-only early discontinuers and consistent low-dose and moderate-dose gabapentinoid-only users were associated with 11% to 23% lower health expenditures (adjusted mean expenditure = $10 607-$11 713). Consistent low-dose opioid-only users, consistent high-dose opioid-only users, consistent low-dose OPI-GABA users, consistent low-dose opioid and high-dose gabapentinoid users, and consistent high-dose opioid and moderate-dose gabapentinoid users were associated with 14% to 106% higher healthcare expenditures (adjusted mean expenditure = $15 721-$28 464). Conclusions Dose and duration patterns of concurrent OPI-GABA varied substantially among fee-for-service Medicare beneficiaries. Consistent opioid-only users and all concurrent OPI-GABA users were associated with higher healthcare expenditures compared to opioid-only discontinuers.
Destruction of DNA-binding proteins by programmable O’PROTAC: Oligonucleotide-based PROTAC

Abstract DNA-binding proteins including transcription factors (TFs) play essential roles in gene transcription and DNA replication and repair during normal organ development and pathogenesis of diseases such as cancer, cardiovascular disease and obesity, deeming to be a large repertoire of attractive therapeutic targets. However, this group of proteins are generally considered undruggable as they lack an enzymatic catalytic site or a ligand binding pocket. PROteolysis-TArgeting Chimera (PROTAC) technology has been developed by engineering a bifunctional small molecule chimera to bring a protein of interest (POI) to the proximity of an E3 ubiquitin ligase, thus inducing the ubiquitination of POI and further degradation through proteasome pathway. Here we report the development of Oligonucleotide-based PROTAC (O’PROTACs), a class of noncanonical PROTACs in which a TF-recognizing double-stranded oligonucleotide is incorporated as a binding moiety of POI. We demonstrate that O’PROTACs of ERG and LEF1, two highly cancer-related transcription factors selectively promote degradation of these proteins and inhibit their transcriptional activity in cancer cells. The programmable nature of O’PROTACs indicates that this approach is applicable to destruct other TFs. O’PROTACs not only can serve as a research tool, but also can be harnessed as a therapeutic arsenal to target DNA binding proteins for effective treatment of diseases such as cancer.
Evaluating the psychometric properties of the e-cigarette barriers to cessation scale

Evidence suggests that electronic cigarette (e-cigarette) users have difficulty quitting e-cigarettes. The Electronic Cigarette Barriers to Cessation Scale (E-BCS) was developed to assess barriers ...
SARS-CoV-2 Seroprevalence Among Firefighters in Los Angeles, California

Objective We estimate the seroprevalence of SARS-CoV-2 antibodies among firefighters in the Los Angeles, California fire department in October 2020 and compare demographic and contextual factors for seropositivity. Methods We conducted a serologic survey of firefighters in Los Angeles, California, USA, in October 2020. Individuals were classified as seropositive for SARS-CoV-2 if they tested positive for immunoglobulin G, immunoglobulin M, or both. We compared demographic and contextual factors for seropositivity. Results Of 713 participants, 8.9% tested positive for SARS-CoV-2 antibodies. Seropositivity was not associated with gender, age, or race/ethnicity. Furthermore, firefighters who worked in zip codes with lower income or higher share of minority population did not have higher rates of SARS-CoV-2 infection. Seropositivity was highest among firefighters who reported working in the vicinity of Los Angeles International Airport, which had a known outbreak in July 2020. Conclusions Seroprevalence among firefighters was no higher than seroprevalence in the general population, suggesting that workplace safety protocols, such as access to PPE and testing, can mitigate increased risk of infection at work. Workplace safety protocols for firefighters also eliminated differences in disease burden by geography and race/ethnicity observed in the general population.
Starvation Ketoacidosis Induced by Ketogenic Diet and Consumption of Ketone Supplement

The ever-changing landscape of dieting and its correlation with health outcomes have continued to evolve with time. New diets appear and disappear just as quickly as they gain notoriety. This is a rare case of a 67-year-old female with a history of type II diabetes who presented with generalized weakness, nausea, and vomiting, and was found to have severe anion gap metabolic acidosis. In an effort to lose weight, she was combining a ketogenic diet with prolonged fasting and exogenous ketone supplement use that she purchased online. The patient reported drinking an exogenous ketone ester supplement that contained 30 g of D-beta hydroxybutyrate (BHB) per serving, three times per day. This case is unique in that the patient was initially thought to be in diabetic ketoacidosis upon arrival, but after further investigation into her initial labs, medication, and social history, the underlying factor for hospitalization became evident; that is, a combination of a ketogenic diet with prolonged fasting and exogenous BHB-induced ketoacidosis in the setting of type II diabetes. Thus, this case highlights the importance of thorough history taking, the dangers of over-the-counter supplement consumption, and the risks consumers inherit with trend dieting.
Pride amid Prejudice: The Influence of LGBT+ Rights Activism in a Socially Conservative Society

How do mass publics react to lesbian, gay, bisexual, and transgender (LGBT+) advocacy efforts in socially conservative societies? We consider how the first-ever LGBT+ Pride in Sarajevo, Bosnia and Herzegovina influences ordinary citizens’ attitudes and behavior regarding LGBT+ support. Using nationwide and local panel surveys, we find that support for LGBT+ activism increased locally after the Pride but did not diffuse nationwide, signaling how proximity mechanisms reinforce Pride effects. In survey experiments, we show that subjects are responsive to both mobilization and counter-mobilization appeals by local activists. We also find evidence from a behavioral experiment that the Pride had a positive effect on shifting the allocation of financial resources toward local pro-LGBT+ activists and away from opposition groups. Finally, in-depth interviews with local LGBT+ activists underscore the challenges facing LGBT+ activism in socially conservative societies but also point to the substantial possibilities of collective action on behalf of minorities at risk.
Gambling demand: a meta-analysis of the price elasticity.

Many studies have examined the demand for gambling, providing roughly 200 estimates of the price elasticity associated with horse racing, casino gaming, and the lottery. Treating these price elasticities as observations of the dependent variable in a meta-regression model, several features of the literature are found to influence the price responsiveness of gambling. For instance, the price elasticity of casino gambling is lowest in absolute value, while the price elasticities of horse racing and the lottery are of similar value. Also, not only are there regional differences in the price elasticity of gambling, but other model features, such as the functional form of gambling demand, are found to influence the price elasticities.
SU-C-BRA-02: Gradient Based Method of Target Delineation On PET/MR Image of Head and Neck Cancer Patients

Purpose: Validate the consistency of a gradient-based segmentation tool to facilitate accurate delineation of PET/CT-based GTVs in head and neck cancers by comparing against hybrid PET/MR-derived GTV contours. Materials and Methods: A total of 18 head and neck target volumes (10 primary and 8 nodal) were retrospectively contoured using a gradient-based segmentation tool by two observers. Each observer independently contoured each target five times. Inter-observer variability was evaluated via absolute percent differences. Intra-observer variability was examined by percentage uncertainty. All target volumes were also contoured using the SUV percent threshold method. The thresholds were explored case by case so its derived volume matched with the gradient-based volume. Dice similarity coefficients (DSC) were calculated to determine overlap of PET/CT GTVs and PET/MR GTVs. Results: The Levene’s test showed there was no statistically significant difference of the variances between the observer’s gradient-derived contours. However, the absolute difference between the observer’s volumes was 10.83%, with a range from 0.39% up to 42.89%. PET-avid regions with qualitatively non-uniform shapes and intensity levels had a higher absolute percent difference near 25%, while regions with uniform shapes and intensity levels had an absolute percent difference of 2% between observers. The average percentage uncertainty between observers wasmore » 4.83% and 7%. As the volume of the gradient-derived contours increased, the SUV threshold percent needed to match the volume decreased. Dice coefficients showed good agreement of the PET/CT and PET/MR GTVs with an average DSC value across all volumes at 0.69. Conclusion: Gradient-based segmentation of PET volume showed good consistency in general but can vary considerably for non-uniform target shapes and intensity levels. PET/CT-derived GTV contours stemming from the gradient-based tool show good agreement with the anatomically and metabolically more accurate PET/MR-derived GTV contours, but tumor delineation accuracy can be further improved with the use PET/MR.« less
A Neuro-Fuzzy Classifier Based on Rough Sets

In this paper, we use the concept of rough sets to define equivalence classes encoding input data, and to eliminate redundant or insignificant attributes in data sets which leads to reduction of the complexity of designed systems. In order to deal with ill-defined or real experimental data, we represent input object as fuzzy variables by fuzzy membership function. Furthermore we incorporate the significance factor of the input feature, corresponding to output pattern classification, in order to constitute a fuzzy inference which enhances classification considered as a nonlinear mapping. A new kind of rough fuzzy neural classifier and a learning algorithm with LSE are proposed in this paper. The neuro-fuzzy classifier proposed here can realize a nonlinear mapping from the input feature vector space (that may have the overlapping characteristic) into the output classification vector space.
KEY DEVELOPMENTS IN THE FOOD DISTRIBUTION SYSTEM

Many changes are occurring in food retailing. Forces driving these changes include the sales gains by supercenter, membership club, and convenience stores, the growing popularity of foodservice, the expansion of private label products (and the response by branded food manufacturers), and the identification of new consumer interests and concerns. These forces encouraged food processors, distributors, and retailers to improve the efficiency of the food distribution system. The Efficient Consumer Response and Efficient Foodservice Response initiatives are designed to lower the costs to move products through the system. These developments in the food distribution system have several important implications for other food and agricultural businesses.
To Write a Book, To Plant a Tree...

Losing My Mind An Intimate Look at Life with Alzheimer9s. Thomas DeBaggio. Free Press, New York, 2002. 219 pp. $24, C$36.50. ISBN 0-7432-0565-0. Paper, 222 pp. $13, C$21. ISBN 0-7432-0566-9. Large print, Thorndike, Waterville, ME. 352 pp. $27.95. ISBN 0-7862-4376-7. DeBaggio provides a harrowing first-hand account of the progress of Alzheimer9s disease.
INTERGRANULAR BRITTLENESS STUDIES IN TUNGSTEN USING AUGER SPECTROSCOPY.

The present investigation was aimed at understanding the problem of brittleness in powder metallurgy tungsten by utilizing Auger Electron Emission Spectroscopy as a tool for direct chemical analysis of fracture surfaces. Substantial segregation of phosphorus to the grain boundaries was observed in tungsten and the concentration of phosphorus can be related to the ductile-brittle transition temperatures. The amount of segregation was dependent upon the grain size—the larger the grain size, the greater the concentration of phosphorus at the grain boundary and the associated embrittlement.
RAPID SLIDE TEST FOR PREGNANCY.

Abstract A rapid test for the detection of pregnancy has been evaluated. The test has been found to be simple to perform and gives a result within 3 minutes. The reliability and sensitivity of the test correlated well with the Friedman test. During the late stage of pregnancy when clinical signs are usually unmistakable, the sensitivity of the test decreases with the lower level of chorionic gonadotropin.
Hepatic function in Weil's disease.

Summary 1.A case of Weil's disease is described with detailed serial studies of hepatic function and electrophoretic analysis of the serum proteins. 2.The findings are interpreted as indicative of severe hepatic parenchymal damage.
Missing the Forest for the Trees?: Drug-Eluting Balloon Treatment for Infrapopliteal Disease.

The treatment of patients with infrapopliteal disease has become common in our clinical practice as the number of patients with symptomatic peripheral arterial disease skyrockets, affecting 12% to 29% of the elderly and as many as 8 to 10 million Americans [(1,2)][1]. Contemporary data suggest that
A combined 2-D ultrasound and NIR imaging system

A combined ultrasound and near infrared (NIR) diffusive light imager capable of simultaneous three-dimensional (3-D) volumetric imaging and co-registration is constructed. The ultrasound imaging system consists of a 64-element 2-D array and 64 parallel transmission and reception channels. The NIR imaging system consists of an array of 12 dual-wavelength (780nm and 830nm) laser diode sources and 8 photomultiplier (PMT) detectors as well as associated electronics. The combined imager can provide near real-time ultrasound and optical images suitable for clinical experiments.
An adaptive risk management and access control framework to mitigate insider threats

Insider Attacks are one of the most dangerous threats organizations face today. An insider attack occurs when a person authorized to perform certain actions in an organization decides to abuse the trust, and harm the organization. These attacks may negatively impact the reputation of the organization, its productivity, and may produce losses in revenue and clients. Avoiding insider attacks is a daunting task. While it is necessary to provide privileges to employees so they can perform their jobs efficiently, providing too many privileges may backfire when users accidentally or intentionally abuse their privileges. Hence, finding a middle ground, where the necessary privileges are provided and malicious usage are avoided, is necessary. In this paper, we propose a framework that extends the role-based access control (RBAC) model by incorporating a risk assessment process, and the trust the system has on its users. Our framework adapts to suspicious changes in users' behavior by removing privileges when users' trust falls below a certain threshold. This threshold is computed based on a risk assessment process that includes the risk due to inference of unauthorized information. We use a Coloured-Petri net to detect inferences. We also redefine the existing role activation problem, and propose an algorithm that reduces the risk exposure. We propose a methodology to help administrators managing inference threats. We present experimental evaluation to validate our work.
Alterations in Nitrogen Monoxide-Synthesizing Cortical Neurons in Amyotrophic Lateral Sclerosis with Dementia

Cognitive impairment in the absence of lesions indicative of Alzheimer's disease and other dementing conditions has long been recognized in a subgroup of patients with motor neuron disease (MND), including amyotrophic lateral sclerosis. However, the mechanisms underlying this cognitive deterioration and its relationship with the relatively selective involvement of motor neurons remains elusive. We used histo- and immunocytochemical labeling methods to study the nitrogen monoxide (NO ; a.k.a. nitric oxide) synthase (NOS)-/NADPH diaphorase-containing neurons (NOSN) in three patients with MND and dementia (MND + D), two patients with MND without dementia, and 19 controls that included patients with Alzheimer and non-Alzheimer dementias. Patients with MND + D, but not those with MND without dementia, exhibit numerous dystrophic perikarya and neurites throughout all sensory, motor, association, and limbic neocortices examined. Interestingly, affected NOSN appear to correspond to some subtypes (smooth stellate and spiny neurons), while other neurons containing the same molecular phenotype (such as layer I local circuit neurons and layer II granule cells) are either spared or significantly less affected. These observations indicate that cognitive impairment and dementia in MND may be due, at least in part, to a pancortical involvement of certain types of NOSN. Consequently, the elucidation of the factors that make NOSN vulnerable in MND, and the prevention or pharmacological palliation of their loss, may eventually help to prevent or ameliorate cognitive impairment in MND and may also shed some light on the nature of the insult that targets motor neurons.
Outcomes of genetic evaluation for hereditary cancer syndromes in unaffected individuals

Genetic testing (GT) for inherited cancer predisposition is most informative when initiated in individuals with cancer, thus standard practice recommends GT start in an affected individual. This strategy can be frustrating for unaffected consultands and providers. Retrospective review of cases was performed to compare outcomes of testing the unaffected consultand and recommending that testing start in an affected relative. Records from cancer-free consultands (N = 101), presenting to the University of Michigan Cancer Genetics Clinic between 6/1/2011 and 12/30/2011 were reviewed. All genetics records for these consultands were reviewed through 3/31/2013 for GT recommendations (117 total). The unaffected consultand was offered testing in 14.5 % of cases, testing was completed in 64.7 % of these with one mutation identified. Of consultands tested initially, 70.5 % received cancer-screening recommendations based on family history and test results. Testing was recommended to start in an affected family member in 30.7 % of cases. Fifty percent returned to clinic with information on an affected family member; 83.3 % documented that their family member underwent GT with one mutation identified. Consultands reported the affected family member refused testing in 22.2 % and two of these consultands subsequently pursued GT, identifying one mutation. Fifty percent of cases where testing the family member first was recommended were lost to follow-up with 66.6 % of these never given cancer-screening recommendations. Cancer genetic risk evaluation of healthy consultands should consider the option of pursuing GT in the unaffected consultand and should implement a plan for tailored risk management in the absence of informative genetic evaluation within the family.
Drug rash with eosinophilia and systemic symptoms syndrome and renal toxicity with a nevirapine-containing regimen in a pregnant patient with human immunodeficiency virus.

Abstract Background Antiretroviral therapy is associated with serious adverse events. We report the case of a pregnant human immunodeficiency virus type 1–infected woman who developed drug rash with eosinophilia and systemic symptoms syndrome and renal failure shortly after initiation of a nevirapine-containing antiretroviral regimen at 27 weeks’ gestation. Case A 26-year-old primigravida presented with a fever of 40.2C, urticarial rash, and icteric sclera 6 weeks after starting a nevirapine-containing antiretroviral regimen. Eosinophils, serum creatinine, bilirubin, and liver enzymes were markedly elevated, and abnormal coagulation studies were noted on admission. Serology testing was negative for viral hepatitis and microbiologic cultures were negative for growth. Abnormal laboratory findings at discharge resolved within 4 months after discontinuation of antiretroviral agents and systemic corticosteroid therapy. Conclusion Our case suggests the need for close monitoring of liver and renal function after initiation of nevirapine-containing antiretroviral regimens.
Parallels in intercellular communication in oomycete and fungal pathogens of plants and humans.

Sexual reproduction is one of the most fascinating evolutionary outcomes in nature. Sexual development is paradoxical, conferring both benefits and costs, which makes sex an attractive subject in evolutionary biology. In pathogenic microbes, sexual development generates progeny with diverse genetic repertoires and can contribute to create more virulent genotypes. Sexual reproduction is ubiquitous in eukaryotic organisms, from single-celled yeasts to humans. Mating systems are highly adapted in each group and vary from species to species, which results in extremely diverse sexual modes throughout nature. However, in some cases, quite divergent groups share similar mechanisms. This review describes a similarity in pheromone synthesis routes in two group of microbial pathogens of historic importance that are evolutionarily quite distinct: zygomycete pathogenic fungi that belong to the kingdom Fungi in the opisthokonts clade, and Phytophthora oomycete species that belong to the stramenopile supergroup [1] (Figure 1). Figure 1 Eukaryotic tree of life (adapted from Baldauf, Science, 2003 [1], with her permission). Historical Aspects of the Two Evolutionarily Distinct Pathogenic Molds: Mucoralean Fungi and Phytophthora Mucorales of the fungal Zygomycota and Phytophthora in the oomycetes have historical significance. One of the Mucor species belonging to the Mucoralean order was the first microbe ever observed in detail by the human eye via Robert Hooke's microscope. Hooke described the microscopic structures of this mold in his book Micrographia [2]. In addition, the first description of sexual development in fungi was of a Mucoralean species nearly two hundred years ago [3]. Several fungal species in the Mucoralean order are the causal agents of mucormycosis, a deadly fungal infection. These species include Rhizopus spp., Mucor spp., Rhizomucor spp., Absidia spp., Cunninghemella spp., and others [4]. Mucormycosis is an emerging, serious fungal infection with high mortality rates. A recent mucormycosis outbreak occurred in victims of the tornadoes in Joplin, Missouri, United States. Oomycetes such as Phytophthora spp. were previously considered members of the fungal kingdom. However, more recent molecular analyses revealed oomycetes are not true fungi but instead divergent stramenopiles that are more closely related to the diatoms and brown alga, with only one known human pathogen in the group: Blastocystis hominis [5]. Phytophthora spp are known as notorious plant destroyers. Phytophthora infestans exemplifies this threat; it was the first species described in the genus and left a path of devastation in its wake on potato crops in the US, Ireland, and Europe in the 19th century [6]. Movement of infected potato tubers led to the potato famine epidemics of the 19th century, which resulted in widespread human hunger, disease, and ultimately the death of 2 million people in Ireland. The pathogen is still a threat to food security in the developing world.