cssi/SciSciGPT-SciSciNet huggingface dataset:
Using high-fidelity medical simulation to assess critical thinking in medical students

USING HIGH-FIDELITY MEDICAL SIMULATION TO ASSESS CRITICAL THINKING IN MEDICAL STUDENTS by Lynda Daniel-Underwood Chair: Robson Marinho ABSTRACT OF GRADUATE STUDENT RESEARCH DissertationOF GRADUATE STUDENT RESEARCH Dissertation Andrews University School of Education Title: USING HIGH-FIDELITY MEDICAL SIMULATION TO ASSESS CRITICAL THINKING IN MEDICAL STUDENTS Name of researcher: Lynda Daniel-Underwood Name and degree of faculty chair: Robson Marinho, Ph.D. Date completed: February 2016 Problem Graduating competent physicians is an imperative societal need. The development of critical thinking skills during medical school is important to meet this societal need and for the care of ill patients. Research shows this skill is key in decreasing medical errors, which in turn decreases cost. (Norman and Eva, 2010) Missing from the literature is a method to assess critical thinking in the setting of caring for the critically ill patient. This instrumental case study tests medical simulation as a method of assessing critical thinking, which incorporates all six competency domains, by looking at the assessment environment, summative patient experience, and participant’s reflection on the case and environment. Method A qualitative instrumental case study design was used to evaluate twelve senior medical students’ critical thinking skills in the setting of identified competency domains. A single simulation patient encounter was administered to each student and data collected from the videotape of the encounter, their written documentation, and oral presentation of the case, mimicking the real-life scenario. The participants were also asked five questions regarding this case. These data were analyzed and presented in narrative format. Results The analysis revealed six major themes: assessment environment, coalescence of knowledge and skills, decision-making and deep thinking/reasoning, integrative experience, lack of depth in thought process, and safe environment. This research identified gaps in the students’ knowledge, skill, and behaviors of competency domains as they apply to critical thinking. Despite all students successfully completing medical school, errors were made in their individual care of the simulated patient. Four cases ended in “death” of the patient. The documentation of their patient encounter also lacked sufficient detail to allow other medical professionals to understand the issues during the case. The students’ opinion of the patient encounter was positive. Several students noted they had not had similar encounters as the sole provider of patient care. The experience gave them the opportunity to apply what they had learned and reflect on their
Thoracic splenosis mimicking pleural mass: The importance of clinical history

A 45-year old man with obesity, type 2 diabetes, hypertension and 30-pack-year smoking history presented with intermittent, severe, sharp, left sided chest pain, associated with dizziness for 5 days. A computed-tomography angiography of the chest ruled out pulmonary embolism, but showed multiple pleural-based nodules along the left diaphragmatic pleura (Figure 1A, arrow). Given his smoking history, malignancy was considered a high probability, and …
Atomoxetine treatment for children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD): a comprehensive meta-analysis of outcomes on parent-rated core symptomatology

Attention-Deficit/Hyperactivity Disorder (ADHD) impacts a significant number of children and adolescents and often leads to deleterious functional impairment. Psychostimulant medication has historically been the first line of pharmacological intervention, though recent years have seen greater attention paid to non-stimulant alternatives. The objective of the present study was to conduct the most comprehensive meta-analysis to date evaluating the efficacy of atomoxetine in reducing core symptomatology of ADHD according to parent report. Selection criteria were applied, and studies were located by searching electronic databases, review of reference sections, and contact with expert researchers; article searching began on 10/01/2013, and the final search was conducted on 09/01/2014. A total of 42 studies met inclusion criteria—33 with control groups and 9 without—for a total sample of 8398 individuals. For those receiving atomoxetine, the summary pre–post (e.g., standardized mean gain) effect size estimate was 1.37 (95% CI [1.24, 1.51], p < .001); atomoxetine was found to statistically significantly outperform control conditions overall (Z = 4.07, p < .001), though results differed by the type of control group; for instance, when comparing atomoxetine to alternative medications as controls, significant differences were no longer present. The non-stimulant atomoxetine led to significant improvement in core ADHD symptomatology and should be considered as a viable pharmacological treatment option for ADHD.
Generation of Tp*2U(N3) from a family of new uranium(III) alkyl complexes

Abstract A new family of uranium(III) benzyl species supported by bulky hydrotris(3,5-dimethylpyrazolyl)borate (Tp*) ligands has been synthesized and characterized. These derivatives were synthesized by treating Tp* 2 UI ( 1-I ) with various benzylpotassium salts to afford Tp* 2 U(CH 2 - para - iso propylphenyl) ( 1- p - i Pr ), Tp* 2 U(CH 2 - para - tert -butylphenyl) ( 1- p - t Bu ), Tp* 2 U(CH 2 - meta -methoxyphenyl) ( 1- m -OMe ), and Tp* 2 U(CH 2 - ortho -picolyl) ( 1- o -Picolyl ). Along with previously reported Tp* 2 U(CH 2 Ph) ( 1-CH 2 Ph ), these uranium alkyl complexes can be treated with an equivalent of Me 3 SiN 3 to yield Tp* 2 UN 3 ( 2-N 3 ), releasing an equivalent of the corresponding benzyltrimethylsilane. All compounds were characterized by multinuclear NMR, IR, and electronic absorption spectroscopies as well as X-ray crystallography.
Weights, hematology, and serum chemistry of free-ranging brown boobies (Sula leucogaster) in Johnston Atoll, Central Pacific.

H?matologie and serum chemistry values are reported for 105 brown boobies (Sula leucogaster) from Johnston Atoll, Central Pacific. Hematocrit, estimated total plasma solids, total and differential white cell counts, serum glucose, calcium, phosphorus, uric acid, total protein, albumin, globulin, aspartate aminotransferase, and creatinine phosphokinase were analyzed. H?matologie and serum chemistry values varied with age and sex. Values were compared with those of red-footed boobies and other tropical and temperate marine pelecaniforms.
Mismatch repair participates in an error-free repair of psoralen crosslinks in human cells.

2278 Psoralen is a bifunctional crosslinking agent that can form DNA interstrand crosslinks (ICLs) following exposure to UVA irradiation. ICLs present a formidable block to DNA metabolism and must be repaired for cell survival. Crosslinking agents are both beneficial and detrimental to human health, as they are used in the treatment of human disease, yet they are also known to induce mutagenesis, which may lead to tumorigenesis. In bacteria, the repair of ICLs is performed primarily by nucleotide excision repair (NER) and homologous recombination (HR). However little is known about the repair of ICLs in mammalian cells. We and others have demonstrated previously that NER is involved in an error-prone repair of triplex-directed psoralen ICLs. Recently it has been reported that mismatch repair (MMR) proteins are involved in the removal of psoralen ICLs in human cell extracts. Here we show for the first time, that MMR is involved in an error-free repair of triplex-directed ICLs in human cells. Because NER is involved in an error-prone repair of triplex-directed ICLs, we hypothesized that MMR may be involved in an error-free repair of these lesions. To test this hypothesis, we used psoralen-conjugated triplex-forming oligonucleotides to target ICLs to a specific site in a mutation reporter plasmid. Binding assays demonstrated that human MSH2-3 specifically bound the psoralen ICLs with high affinity. We performed DNA repair assays to compare the processing of the lesion in MMR-deficient and -proficient human cell extracts. The DNA repair synthesis level was greatly reduced in the MMR-deficient extracts, suggesting that MMR plays a critical role in the processing of ICLs. To determine the nature of the MMR repair, we subjected ICL-damaged plasmids to a mutagenesis assay in MMR-deficient and -proficient human cell lines. The mutation frequencies were similarly high in both MMR-deficient and -proficient human cells. These results indicate that the MMR proteins do not participate in the error-prone repair of ICLs. Taken together, our findings suggest that human MMR proteins can recognize triplex-directed psoralen ICLs and participate in an error-free repair of this complex lesion in human cells. Thus it may be possible to sensitize a cell to repair a triplex-directed psoralen ICL in an error-free fashion by regulating the function of these proteins.
Brown adipose tissue derived ANGPTL4 controls glucose and lipid metabolism and regulates thermogenesis.

Abstract Objectives Brown adipose tissue (BAT) controls triglyceride-rich lipoprotein (TRL) catabolism. This process is mediated by the lipoprotein lipase (LPL), an enzyme that catalyzed the hydrolysis of triglyceride (TAG) in glycerol and fatty acids (FA), which are burned to generate heat. LPL activity is regulated by angiopoietin-like 4 (ANGPTL4), a secretory protein produced in adipose tissues (AT), liver, kidney, and muscle. While the role of ANGPTL4 in regulating lipoprotein metabolism is well established, the specific contribution of BAT derived ANGPTL4 in controlling lipid and glucose homeostasis is not well understood. Methods and results We generated a novel mouse model lacking ANGPTL4 specifically in brown adipose tissue (BAT-KO). Here, we report that specific deletion of ANGPTL4 in BAT results in enhanced LPL activity, circulating TAG clearance and thermogenesis. Absence of ANGPTL4 in BAT increased FA oxidation and reduced FA synthesis. Importantly, we observed that absence of ANGPTL4 in BAT leads to a remarkable improvement in glucose tolerance in short-term HFD feeding. Conclusion Our findings demonstrate an important role of BAT derived ANGPTL4 in regulating lipoprotein metabolism, whole-body lipid and glucose metabolism, and thermogenesis during acute cold exposure.
The Skull and Meninges

Injuries to the skull and meninges frequently occur concomitantly with head trauma. Controversies over the operative versus nonoperative management of depressed skull fractures, frontal sinus fractures, cerebrospinal fluid leaks, and cranial nerve injuries are discussed in this article.
Signal Recovery From 1-Bit Quantized Noisy Samples via Adaptive Thresholding

In this paper, we consider the problem of signal recovery from 1-bit noisy measurements. We present an efficient method to obtain an estimation of the signal of interest when the measurements are corrupted by white or colored noise. To the best of our knowledge, the proposed framework is the pioneer effort in the area of 1-bit sampling and signal recovery in providing a unified framework to deal with the presence of noise with an arbitrary covariance matrix including that of the colored noise. The proposed method is based on a constrained quadratic program (CQP) formulation utilizing an adaptive quantization thresholding approach, that further enables us to accurately recover the signal of interest from its 1-bit noisy measurements. In addition, due to the adaptive nature of the proposed method, it can recover both fixed and time-varying parameters from their quantized 1-bit samples.
A comprehensive cost-benefit analysis of the penetration of Smart Grid technologies in the Saudi Arabian electricity infrastructure

Abstract The study proposes an economic framework based on detailed cost-benefit analysis of the insertion of Smart Grid technologies for electricity infrastructure modernization. The framework maps Smart Grid assets to their functions and benefits to estimate the feasibility of each Smart Grid technology and infrastructure. Net present value and discounted cash flow models, benefit/cost ratio, and minimum total cost are included in the analysis. The framework is applied to the Saudi electricity infrastructure as a case study. The framework is a comprehensive approach for economic analysis adapted from the EPRI Smart Grid model, the NETL modern grid initiative, and a study conducted by CESI and A.T. Kearney to estimate the impact of smart meters and smart equipment on the Saudi electric grid. Our findings show that advanced asset management infrastructure technologies are the most profitable technologies for the Saudi electricity infrastructure, followed by advanced distribution operations technologies, advanced transmission operations technologies, and advanced metering infrastructure technologies.
Transcendental meditation and hypothalamic-pituitary-adrenal axis functioning: a pilot, randomized controlled trial with young adults.

Transcendental meditation (TM) is effective in alleviating stress and anxiety and promoting well-being. While the underlying biological mechanisms of TM are not yet fully explored, the hypothalamic...
Alcohol Drinking Alters Stress Coping via Extended Amygdala Kappa Opioid Receptor Signaling

Abstract BACKGROUND Maladaptive responses to stress are a hallmark of alcohol use disorder, but the mechanisms that underlie this are not well characterized. OBJECTIVES Here we show that kappa opioid receptor (KOR) signaling in the bed nucleus of the stria terminalis (BNST) is a critical molecular substrate disrupting stress-coping behavior following heavy alcohol drinking. RESULTS Altered responses to an innate stressor were associated with enhanced PFC-driven excitation of prodynorphin-containing neurons in the BNST during protracted withdrawal from intermittent alcohol drinking. CONCLUSIONS These findings suggest that increased corticolimbic connectivity may underlie impaired stress-coping during protracted withdrawal from heavy drinking and represents a target of potential therapeutic mediation as well as a potential biomarker of negative outcomes.
Developing a surveillance system of sub-county data: Finding suitable population thresholds for geographic aggregations

Abstract The Centers for Disease Control and Prevention's National Environmental Public Health Tracking Program created standardized sub-county geographies that are comparable over time, place, and outcomes. Expected census tract-level counts were calculated for asthma emergency department visits and lung cancer. Census tracts were aggregated for various total population and sub-population thresholds, then suppression and stability were examined. A total of 5,000 persons was recommended for the more common outcome scheme and a total of 20,000 persons was recommended for the rare outcome scheme. Health outcomes with a median case count of 17.0 cases or higher should produce stable estimates at the census tract level. This project generated recommendations for three sub-county geographies that will be useful for surveillance purposes: census tract, a more common outcome aggregation scheme, and a rare outcome aggregation scheme. This methodology can be applied anywhere to aggregate geographic units and produce stable rates at a finer resolution.
On the reaction between rhodium(III) bromide dihydrate and diphenylphosphine: Crystal and molecular structures of Trans-Bromotetrakis(diphenylphosphine)hydridorhodium(III) bromide, Trans-Dibromotetrakis(diphenylphosphine)rhodium(III) Trans-Tetrabromobis(diphenylphosphine)rhodate(III), and Mer-Tribromotris(diphenylphosphine)rhodium(III)

Abstract The aim of this work is to identify the products obtained from the chemical reaction between rhodium(III) bromide dihydrate and diphenylphosphine. If three to four equivalents of diphenylphosphine are used, a mixture of colorless trans-[Rh(H) (Br){PH(C6H5)2}4]Br (product A) and orange trans-[RhBr2{PH(C6H5)2}4]+ trans-[RhBr4{PH(C6H5)2}2]- (product B) is formed, and these products are easily separated by filtration. Both A and B have been structurally characterized by single-crystal X-ray diffraction. If B is treated with excess diphenylphosphine, or if RhBr3 · 2H2O is treated with five or six equivalents of diphenylphosphine, then only A is formed. In CD3OD solution, H/D exchange occurs in A, leading to the penta-substituted isotopomer trans-[Rh(D) (Br){PD(C6H5)2}4]Br. Finally, a suspension of B in acetone-d6 at room temperature led to the formation of red crystals of mer-[RhBr3{PH(C6H5)2}3] (product C) after several days. C was also structurally characterized by single-crystal X-ray diffraction.
Small World: Ireland, 1798–2018

Seamus Deane was one of the most vital and versatile authors of our time. Small World presents an unmatched survey of Irish writing, and of writing about Irish issues, from 1798 to the present day. Elegant, polemical, and incisive, it addresses the political, aesthetic, and cultural dimensions of several notable literary and historical moments, and monuments, from the island's past and present. The style of Swift; the continuing influence of Edmund Burke's political thought in the USA; the echoing debates about national character; aspects of Joyce's and of Elizabeth Bowen's relation to modernism; memories of Seamus Heaney; analysis of the representation of Northern Ireland in Anna Burns's fiction – these topics constitute only a partial list of the themes addressed by a volume that should be mandatory reading for all those who care about Ireland and its history. The writings included here, from one of Irish literature's most renowned critics, have individually had a piercing impact, but they are now collectively amplified by being gathered together here for the first time between one set of covers. Small World: Ireland, 1798–2018 is an indispensable collection from one of the most important voices in Irish literature and culture.
Investigation of recycled asphalt mixtures in Missouri: laboratory, field, and ILLI-TC modelling

This study investigates the lab and field performance of four asphalt mixtures placed in Missouri, USA, containing reclaimed asphalt pavement (RAP) and recycled asphalt shingles (RAS). Laboratory t...
Better Buses, Better Cities: How to Plan, Run, and Win the Fight for Effective Transit: Steven Higashide (2019). Washington, DC: Island Press. 184 pages. $25 (paperback)

Reinvestment in bus transit is a contentious but necessary topic of discussion in transportation planning. Public transit systems provide access and mobility across urban regions with many differen...
Persistence of aerially-sprayed naled in coastal sediments.

Abstract Aerial sprays of the organophosphate pesticide, naled, were intensified over beach areas during the summer of 2016 to control the locally-acquired Zika outbreak in the continental U.S. Concerns were raised in beach frequented areas about contaminated sediments. The aim of this study was to evaluate the persistence and levels of naled and its byproduct, dichlorvos, in sediments obtained from the affected areas. Laboratory experiments were designed to simulate the effect of various natural conditions on the decomposition of naled in three sediment types (beach sand, marl, and calcinated beach sand). The three sediment samples were also exposed to field aerial sprays. After 30 min of exposure, more dichlorvos was detected in the sediments than naled, with 33 to 43% of the molar concentration initially applied as either naled or dichlorvos. Under dark conditions, trace levels of naled were observed after 24 h on sediments. Higher temperature accelerated the natural decomposition of both naled and dichlorvos in sediments. The half-life of naled ranged from 3 to 5 h at 22.5 °C and ranged from 1 to 3 h at 30 °C. Expedited decomposition of naled was observed under sunlight conditions with a half-life of naled of 20 min. In the field, only dichlorvos was detected in the sediment samples at concentrations between 0.0011 and 0.0028 μmol/g 1 h after aerial sprays. This data can be used towards a risk assessment that evaluates exposures to naled and dichlorvos through beach sands impacted by aerial spray activities.
Prioritized Optimization of Total Toxicity Burden for Head and Neck Cancer Patients.

Purpose/Objective(s) Head and neck cancer (HNC) RT typically results in high doses to organs-at-risk (OARs), contributing to decreased quality-of-life (QOL) seen in patient reported outcomes (PRO). Current RT planning methods are driven by singular dosimetric trade-offs that may be inconsistent with improving a patient's overall predicted total toxicity burden (TTB). We developed an aggregate toxicity assessment over time including PROs that represents a paradigm shift over informal summary of individual toxicity. Here we introduce a treatment planning approach to directly optimize and reduce the predicted TTB-PRO of a patient's RT plan. Materials/Methods We implemented a prioritized approach to TTB optimization using an in-house optimization plugin linked to a commercial treatment planning system. Prioritized TTB (P-TTB) plans were optimized using a two-stage hierarchal method for inverse IMRT planning. In the first stage, TTB, defined as the weighted-sum of NTCPs, is minimized subject to high-priority OAR dose limits, target prescription, and target coverage requirements. Weights for the toxicities directly represent the relative undesirability of toxicities. In the second stage, a weighted-sum dose-metric objective is minimized, similar to current clinical practice. This stage is subject to the same constraints as the first stage, but an additional constraint for TTB is incorporated based on the optimal solution of the first stage. Using this approach, we retrospectively generated plans for 5 HNC patients and compared the resulting plans to IMRT plans generated without the added TTB constraint. Both plans consisted of 9 equally spaced beams with the same OAR dose limits and dose-metric objective. Target dose requirements were based on simultaneous integrated boost prescriptions of 70 and 56 Gy delivered in 35 fractions. TTB was calculated using previously published NTCP models for dysphagia and xerostomia. Dysphagia was based on increase in aspiration or HNQOL score > 81 as a function of pharyngeal constrictor (PC) mean dose. Xerostomia was based on parotid flow ratio 73 as a function of parotid gland (PG) mean dose. Results Our optimization engine successfully generated P-TTB plans for all five patients while maintaining similar target coverage to the standard dosimetrically optimized plans. P-TTB plans resulted in average absolute NTCP reductions of 15.5% (range: 0.2 - 53.4) for dysphagia and 20.5% (1.9 - 68.5) for xerostomia. These changes correlate to average mean dose decreases of 6.9 Gy (0.2 - 22.7) for PC and 10.2 Gy (1.2 - 33.5) for PGs. P-TTB planning resulted in greater fluence modulation and higher doses to OARs not included in the calculation of TTB. Conclusion The P-TTB planning method offers an intuitive optimization approach to balancing trade-offs between various treatment outcomes and has the ability to directly reduce and redistribute predicted toxicity which may aid in improving QOL for HNC patients receiving RT.
Redesigning Digital Peer-to-Peer Payments for Social Connections

My dissertation research explores how digital peer-to-peer (P2P) payments (performing one to one online financial transactions via a digital or mobile device) as an emerging financial technology affect people’s everyday economic and social lives and seeks to redesign such technology for supporting both secure financial transactions and nuanced social interactions/connections through a sociotechnical approach. Specifically, my goal is to i) reveal and elaborate the multidimensional influences of digital P2P payments on interpersonal relationships in terms of both experiences of financial exchanges and everyday social interactions, ii) redesign and develop prototypes for future digital P2P payments platforms that highlight the importance of the interplay of financial transactions and social engagement. My research will not only contribute to better understanding new and more complicated social phenomena and dynamics emerging in today’s digital economy but also benefit the HCI community by informing future research on computer-mediated communication through financial technologies.
Advanced Renal Cell Carcinoma: Natural History and Response to Chemotherapy

To place the chemotherapy of metastatic disease in perspective, certain features of the disease must be discussed.
Tissue microarray analysis of connexin-26 and Drg-1 in urinary bladder cancer

Proc Amer Assoc Cancer Res, Volume 47, 2006 920 Tissue microarray analysis of Connexin-26 and Drg-1 in Bladder Cancer. Tissue microarrays (TMAs) are an excellent method to examine protein expression and to perform rapid profiling of molecular tumor markers. We have evaluated the expression of Cx-26 and Drg-1 on a TMA of bladder cancer specimens to determine the significance of these proteins in bladder cancer. Cx-26 is a component of the gap junction intercellular communication (GJIC) network. GJIC provides intercellular communication which is necessary for cell growth, proliferation and differentiation. The loss of expression of connexins and gap junction assembly has been found in a variety of cancers. Recent data suggests Cx-26 plays a role specifically in bladder carcinogenesis. Several human bladder cancer cell lines either lack or have low Cx-26 expression. Drg-1 is also implicated in cancer. Its function is relatively unknown, but it was found upregulated in differentiation induced colon cancer cells. Data suggests Drg-1 is regulated by the tumor-suppressor gene PTEN. Recent IHC analysis found that PTEN expression correlated with Drg-1 in prostate and breast cancers. We recently completed TMA analysis with PTEN and wanted to determine if this correlation also existed in bladder cancer. IHC probing of a TMA consisting of 251 human transitional cell carcinomas of the bladder was performed using antibodies to Cx-26 and Drg-1. Four tumor types were examined: nonpapillary invasive grade (G) 3, papillary invasive G3, papillary noninvasive G3, and papillary noninvasive G2. The slides were scanned and analyzed using Applied Images automated system and software. Both Cx-26 and Drg-1 had moderate expression in most of the four tumor types. The staining pattern of Cx-26 and Drg-1 was altered in the bladder cancer specimens. Cx-26 expression in normal urothelium was focused and punctate, whereas in cancer tissues the staining was diffuse throughout the cytoplasm. We found Drg-1 expression among some cancer specimens to be membraneous as well as cytoplasmic where there was only cytoplasmic staining in the normal urothelium. Among the tumor types, Drg-1 exhibited the lowest expression in nonpapillary invasive G3 (p<0.0001). The expression of Cx-26 was lower in papillary invasive G3 than in nonpapillary invasive (p=0.003). Our analysis also identified a moderate negative correlation between Cx-26 and Drg-1 expression (Spearman correlation coefficient = -0.19 (p=0.04)). However, we did not find a significant correlation between Drg-1 and PTEN. Survival analysis was performed and a Cox proportional hazards model including T-stage and Drg-1 as prognostic factors suggested that Drg-1 was a marginally significant predictor to recurrence free survival (HR=1.54, p=0.05). This tissue microarray analysis demonstrated that the expression of Cx-26 and Drg-1 are altered, suggesting that these molecules should be studied further to determine their role in bladder cancer progression.
Power and Discourse

Power and discourse are two perennially contested subjects. Power is often defined as a person's ability to influence the behaviors of other people, whereas discourse generally refers to the use of language as a form of social action. The relation between the two is largely contingent upon the divergent conceptions held by different academic disciplines of what power is and how discourse functions. Language and social interaction (LSI) is concerned about the interplay between language use and social action, and thus power and discourse are dealt with explicitly or implicitly in many LSI studies. Five approaches are reviewed here in terms of their analytical positions on the link between power and discourse. These discourse-analytic approaches are language pragmatics (specifically speech act theory), critical discourse analysis, conversation analysis, ethnography of communication, and interactional sociolinguistics. Keywords: discourse; discourse analysis; power
Multidrug resistance phenotype in high grade soft tissue sarcoma: correlation of P-glycoprotein immunohistochemistry with pathologic response to chemotherapy.

BACKGROUND P-glycoprotein–mediated drug efflux has been implicated as an important mechanism of multidrug resistance (MDR) in cancer. Its role in chemotherapy resistance in soft tissue sarcoma is unclear. METHODS Tumor specimens prior to and following neoadjuvant chemotherapy from 29 cases of high grade soft tissue sarcoma were analyzed with 2 monoclonal antibodies (C494 and JSB-1) that recognize different epitopes of P-glycoprotein. Staining intensity was graded 0 = negative, 1 = equivocal, 2 = moderate, 3 = strong. Only cases with Grade 2 or 3 staining intensity with both antibodies were considered MDR positive. The resection specimens were evaluated for tumor necrosis postchemotherapy. Pathologic response was graded as good for 50% posttreatment tumor viability. RESULTS Of the 29 pretreatment specimens, 10 (34%) were MDR positive and 19 (66%) were MDR negative. Pathologic response to treatment was characterized as good in 6, moderate in 7, and poor in 16 patients. Of the MDR positive biopsies, 9 (90%) had poor response, compared with 7 (36%) in the MDR negative biopsy group (P = 0.0078). None of the cases with MDR positive biopsies had a good response, compared with 6 cases in which biopsies were MDR negative (32%) (P = 0.057). Only one MDR negative case became MDR positive posttreatment. CONCLUSIONS Expression of MDR phenotype is found in approximately one-third of high grade soft tissue sarcomas. These preliminary data show a significant correlation between MDR phenotype and poor pathologic response to chemotherapy, and suggest that MDR induction by chemotherapy in soft tissue sarcoma is an uncommon event. Cancer 1999;86:976–81. © 1999 American Cancer Society.
Pharmacological Management of Labor

Normal spontaneous labor at term without maternal or fetal complications does not always occur. In these situations, pharmacological intervention is often the safest and most suitable method of delivery. The pharmacological management of labor includes the use of multiple agents that alter cervical dilatation and uterine contractions, resulting in delivery of the fetus and treatment of postpartum emergencies. This article provides a description of normal and abnormal labor patterns and possible peripartum complications. The use of oxytocin, ergot derivatives, and prostaglandins for augmentation of dysfunctional labor, induction of labor, and management of peripartum emergencies is discussed to provide information on availability of product, indications for use, clinical efficacy, potential adverse effects, and contraindications to use.
Balancing Sovereign Creditor and Debtor Rights Under New York Law

Allied Bank International v. Banco Credito Agricola De Cartago was decided in the mid-1980s by the Second Circuit and the result was a solidification of the sanctity of sovereign loan contracts. This paradigm meant that New York creditors were no longer able to use balancing considerations such as comity and the act of state doctrine. Statutory, equitable and other defense have been eliminated. This article reviews the affects this change has had on relations between New York creditors and foreign sovereigns. The article shows the reluctance to cooperate and develop transnational solutions but instead the paradigm provides more creditor rights which can have a grave impact on essential government services which ultimately impacts the development of impoverished countries.The article also provides remedies to problem through jurisdictional choice.
Obstructive Sleep Apnea: Electrical Stimulation Treatment

Obstructive sleep apnea (OSA) is an intermittent occlusion of the upper airways resulting in frequent arousals during sleep. It is a prevalent problem among middle-aged overweight males. Neuromuscular and anatomical factors play a major role predisposing the upper-airways for obstructions. The limited success of current therapies and the strong correlation of the obstructions with the upper-airway muscle mechanics has inspired researchers to apply the experience gained in the field of functional electrical stimulation to this common sleep disorder. A number of upper airway muscles have been tested in animal models and human subjects for their potential to remove or prevent the obstructions. Electrical activation of the extrinsic muscles of the tongue through the stimulation of the XIIth cranial (hypoglossal) nerve stands out as the most promising approach today. In this article, we review these recent attempts to treat OSA by electrical activation of the upper-airway muscles. Keywords: neural stimulation; upper airways; obstructive sleep apnea; hypoglossal nerve; neuroprosthetics
Liquidity Shocks and the Business Cycle

This paper studies the properties of an economy subject to random liquidity shocks. As in Kiyotaki and Moore [2008], liquidity shocks affect the ease with which equity can be used as to finance the down-payment for new investment projects. We obtain a liquidity frontier which separates the state-space into two regions (liquidity constrained and unconstrained). In the unconstrained region, the economy behaves according to the dynamics of the standard real business cycle model. Below the frontier, liquidity shocks have the effects of investment shocks. In this region, investment is under-efficient and there is a wedge between the price of equity and the real cost of capital. As with investment shocks, we argue that liquidity shocks are not an important source of business cycle fluctuations in absence of other frictions affecting the labor market.
On the iterative methods for solving linear systems of equations

ABSTRACT The solution of large systems of linear equations is a problem frequently met in numerical calculations, for example, from finite difference or finite element approximations to partial differential equations. The use of direct methods for solving linear systems of equations is limited by both storage requirement and computing time, and in practice, the only alternative is to use iterative algorithms. This paper presents some basic iterative methods, and also a short survey of recent research on this subject, with emphasis on linear systems whose coefficient matrix is non-Hermitian. We briefly discuss the notion of preconditioning, and we give some practical choices for the preconditioning matrix.
Cost‐analysis comparison of robot‐assisted laparoscopic radical cystectomy (RC) vs open RC

What's known on the subject? and What does the study add? The cost performance of RC has been studied in single institution series, each with its own particular clinical pathway and perioperative parameters. Given the relatively new technique, groups have reported different outcomes based on their unique experience. Most groups have demonstrated an increased materials cost associated with RC but a lower LOS. The study systematically examines and summarizes the cost performance data of RC vs. OC. It reviews all relevant studies and presents them in a succinct overview of the current peer-reviewed literature. OBJECTIVE • To systematically review and compare the economic burden of open radical cystectomy (ORC) vs robot-assisted laparoscopic radical cystectomy (RALRC) with pelvic lymph node dissection and urinary diversion. PATIENTS AND METHODS • A Medline search was conducted to identify English language articles regarding RC with urinary diversion. The resulting articles were then further restricted by the terms ‘laparoscopic’, ‘robotic’, or ‘robotic-assisted’.In all, three articles were identified. • Data from each of these articles were then collected on cost performance in addition to relevant clinical variables, such as length of stay (LOS), operative duration, and complication rates. • When possible, data were subdivided by ileal conduit (IC), continent cutaneous diversion (CCD), and orthotopic neobladder (ON) subgroups. • Direct costs resulting from ORC or RALRC with accompanying hospitalization were identified. The indirect costs of complications were considered. RESULTS • Despite an increased materials cost, RALRC was less expensive than ORC when the cost of complications was considered. • RALRC was less expensive than ORC for IC and CCD, but the cost advantage deteriorated for ON. • The largest cost drivers cited in the published data were LOS, operative durations, and daily hospitalizations costs. • RALRC demonstrated shorter LOS compared with ORC, although this effect was insufficient to offset the increased cost of robotic surgery. • Complications materially affected cost performance. CONCLUSIONS • Despite an increased materials cost, RALRC can be more cost efficient than ORC as a treatment for bladder cancer when the impact of complications are considered. • This effect is most pronounced for patients undergoing IC.
Human pitch perception is reflected in the timing of stimulus-related cortical activity

'Pitch' refers to a sound's subjective highness or lowness, as distinct from 'frequency,' which refers to a sound's physical structure. In speech, music and other natural contexts, complex tones are often perceived with a single pitch. Using whole-head magnetoencephalography (MEG) and stimuli that dissociate pitch from frequency, we studied cortical dynamics in normal individuals who extracted different pitches from the same tone complexes. Whereas all subjects showed similar spatial distributions in the magnitude of their brain responses to the stimuli, subjects who heard different pitches exhibited contrasting temporal patterns of brain activity in their right but not their left hemispheres. These data demonstrate a specific relationship between pitch perception and the timing (phase) of dynamic patterns of cortical activity.
Methoxyamine potentiates iododeoxyuridine-induced radiosensitization not through increasing ionizing radiation-induced apoptosis and necrosis but through enhancing senescence

Proc Amer Assoc Cancer Res, Volume 46, 2005 1665 We previously reported that methoxyamine (MX, an inhibitor of base excision repair) potentiates iododeoxyuridine (IUdR)-induced radiosensitization. In this study, we investigated the mechanism of enhanced cell death. Human colorectal carcinoma RKO cells were exposed to IUdR (3 μM) and/or MX (3 mM) for 48 h before ionizing radiation (IR, 5Gy). Necrotic cell death was evidenced within the second 24h post-IR and continually increased up to 96 h, with the control/IR group demonstrating the highest necrosis and the IUdR/MX/IR group the lowest. Apoptotic cell death also occurred during the second 24 h post-IR and up to 96h, with the control/IR and MX/IR groups showing the highest extent of apoptosis and the IUdR/MX/IR group the lowest. The cells of IUdR/MX/IR group were enlarged dramatically but were alive for up to 8 days post-IR with senescence-associated beta-galactosidase activity being detectable from day 5 post-IR. Cell cycle profile showed that the pretreatment of IUdR/MX led to an increased G1 population and a decreased S population before IR and a retarded early cell cycle response after IR, as well as an increased tetraploid G1 population at the later times post-IR. Western blotting analyses demonstrated that compared to other treatment groups, the IUdR/MX/IR group showed an enhanced increase in p53, p21, p27, p16 and hypo-phospho-pRb as well as a decrease in cdc25A, pcdc2(Y15), cyclin B1 and cyclin A before and after IR, indicating a stringent G1-S checkpoint. However, pCHK1 (S317) and pCHK2 (T68) were not detectable with 48 h IUdR/MX treatment, suggesting that these DNA damage signaling pathways were not appreciably activated before IR. pCHK1(S317) and pCHK2(T68) were significantly increased in all groups at 1 h post-IR, with enhanced pCHK2 while reduced pCHK1 found in the IUdR/MX/IR group compared to other treatment groups. Interestingly, anti-apoptosis pAkt(S473) was up-regulated in the IUdR/MX/IR group before and after IR. γH2AX reappeared at 24h post-IR and sustained thereafter in all groups except the IUdR/MX/IR group, although γH2AX was increased in all groups early after IR (1-3 h post-IR). These results suggest that pretreatment of IUdR/MX before IR evoked mechanism(s) that altered DNA damage responses, and rendered cell resistance to early necrotic and apoptotic cell death, but enhanced cell susceptibility to later senescence. It appears that loss of clonogenic ability is more decisive than the extent of early necrosis and apoptosis in the ultimate outcome of the combined treatment of IUdR/MX/IR. Supported by NIH grant CA84578 to TJK.
Understanding the Nature of Marine Aerosols and Their Effects in the Coupled Ocean-Atmosphere System

Abstract : The long-term goal of this work is to understand the nature of marine aerosol particles and how they influence visibility, cloud microphysics and precipitation, the thermodynamic structure of the marine boundary layer, and the transmission of radiation. The objectives of this project extend across three areas: (i) advancing aerosol measurement techniques via the development of a new instrument to quantify aerosol-water interactions, (ii) improving knowledge and model predictions related to the physicochemical nature of aerosol particles and ocean-aerosol-cloud-precipitation-radiation interactions, and (iii) strengthening a research methodology leveraging multiple complementary tools of analysis to guide future studies of this nature in the marine atmosphere. The main technical approach is to use a combination of in-situ aircraft measurements, cloud models, and satellite remote sensors to study the nature and character of aerosols and their effects in the marine atmosphere over a broad range of spatial and temporal scales.
Age Estimates of the Seaward‐Dipping Volcanic Wedge, Earliest Oceanic Crust, and Earliest Drift‐Stage Sediments Along the North American Atlantic Continental Margin

Owing to their depths of burial along and adjacent to the North American continental margin, there is no direct evidence obtained from boreholes for the ages of the seaward-dipping volcanic wedge, earliest drift-stage sediments overlying the wedge, and the earliest Atlantic oceanic crust between the East Coast (ECMA) and Blake Spur (BSMA) magnetic anomalies. Maximum ages of late Sinemurian for drift-stage sediments have been determined from exploration wells in the Scotian Basin. A similar age is postulated for those sediments in the Georges Bank Basin, but palynomorphs from exploration wells may indicate that earliest drift-stage sediments, in places associated with volcanic rocks, are of Bajocian age and occur higher in the section above the postrift unconformity as recognized on seismic lines. In the Southeast Georgia Embayment of the Blake Plateau Basin, the oldest drift-stage sediments overlying the postrift unconformity that were drilled are of Kimmeridgian-Tithonian age. In the Baltimore Canyon Trough, the volcanic wedge overlies the postrift unconformity which truncates buried synrift rocks that may be as young as Sinemurian. In the Carolina Trough and Blake Plateau Basin, a possible offshore flood basalt marking the postrift unconformity and traced as a reflector to the volcanic wedge may correspond to a subsurface flood basalt onshore that may be part of CAMP (Hettangian). Alternatively, its magmatic source may have been that of the possibly younger volcanic wedge. Sea-floor-spreading-rate lines based on the latest Jurassic time scales and extended to the BSMA and ECMA indicate ages of 166 and 171 Ma for the BSMA and 172 and 179 Ma for the ECMA. An alternative model suggests a middle Pliensbachian/early Toarcian age (188 -190 Ma) for the igneous activity that produced the volcanic wedge and earliest oceanic crust.
Rare Earth Patterns in Red Giants and Blue Dwarfs

Lanthanides are intercompared in normal and chemically peculiar red giants and A dwarfs. There is a surprising similarity, much of which may be accounted for in terms of the observational techniques, the properties of the atomic spectra, and the column densities above optical depth unity. There are important differences between the CP lanthanide anomalies and those of the red giants, especially for the elements praseodymium and europium.
Heat transfer during the melting of ice around a horizontal, isothermal cylinder

An experimental investigation of the melting of ice around a horizontal, isothermal cylinder is performed. Emphasis is placed on interpreting the heat transfer mechanisms which control solid-liquid interface position. Flow visualization and interferometric techniques are employed to study the transient flow patterns and corresponding temperature distributions in the melted region. It has been determined that density inversion plays an important role in the melting of water. The location of the maximum density surface in the liquid has a significant effect on natural convection, and hence on the shape and size of the melted region. Local Nusselt numbers at the surface of the cylinder and at the solid-liquid interface are determined and found to be complicated functions of time and imposed thermal conditions. Average Nusselt numbers at the solid-liquid interface and at the surface of the cylinder decrease with time and quasi-steady conditions are not reached.
Computer-aided control systems course instruction

Teaching of classical control can be significantly enhanced by incorporation of weekly computer lab sessions, utilizing the MATLAB/sup /spl reg// Control Systems Toolbox, Symbolic Math Toolbox and SIMULINK/sup /spl reg//. The paper discusses a basic control course curriculum planning, focusing on the tradeoffs that result from allocating lecture time to computer lab hands-on activities. Some of the specific computer lab activities are highlighted.
Functional analysis of a stable transcription arrest site in the first intron of the murine adenosine deaminase gene.

Abstract Transcription arrest plays a role in regulating the expression of a number of genes, including the murine adenosine deaminase (ADA) gene. We have previously identified two prominent arrest sites at the 5' end of the ADA gene: one in the first exon and one in the first intron (J. W. Innis and R. E. Kellems, Mol. Cell. Biol. 11:5398-5409, 1991). Here we report the functional characterization of the intron 1 arrest site, located 137 to 145 nucleotides downstream of the cap site. We have determined, using gel filtration, that the intron 1 arrest site is a stable RNA polymerase II pause site and that the transcription elongation factor SII promotes read-through at this site. Additionally, the sequence determinants for the pause are located within a 37-bp fragment encompassing this site (+123 to +158) and can direct transcription arrest in an orientation-dependent manner in the context of the ADA and adenovirus major late promoters. Specific point mutations in this region increase or decrease the relative pausing efficiency. We also show that the sequence determinants for transcription arrest can function when placed an additional 104 bp downstream of their natural position.