cssi/SciSciGPT-SciSciNet huggingface dataset:
Novel accelerator structure couplers

Recent experience with X-band accelerator structure development has shown the rf input coupler to be the region most prone to rf breakdown and degradation, effectively limiting the operating gradient. A major factor in this appears to be high magnetic fields at the sharp edges of the coupling irises. As a first response to this problem, couplers with rounded and thickened iris horns have been employed, with improved performance. In addition, conceptually new coupler designs have been developed, in which power is coupled through the broadwall of the feed waveguide. A prototype "mode converter" coupler, which launches the TM/sub 01/ mode in circular waveguide before coupling through a matching cell into the main structure, has been tested with great success. With peak surface fields below those in the body of the structure, this coupler represents a break-through in the NLC structure program. The design of this coupler and of variations which use beamline space more efficiently are described here. The latter include a coupler in which power passes directly through an iris in the broad wall of the rectangular waveguide into a matching cell and one which makes the waveguide itself an accelerating cell. We also discuss techniques for matching such couplers.
Progesterone and RU486 regulation of uterine complement C3 after prior induction with estradiol.

Previous results demonstrated that progesterone (P4) given simultaneously with estradiol (F,) prevented stimulation by E, of complement C3 expression in the immature rat uterus. Northern blot analysis revealed that simultaneous administration of P4 was able to prevent the E,-stimulated increase in C3 mRNA concentration in the luminal epitheial cells. The purpose of the present investigation was to determine whether progesterone modulates C3 expression after the gene has been induced by prior administration of E, and also to determine the reversibility of this effect by the concomitant administration of RU38486, 17�hydroxy-t 1�3-[4-dimethylaminophenyljestra-4,9,-dien-3-one (RU486). This regulation was studied by examination of protein synthesis as well as mRNA concentrations. Immature 21-day-old female rats were treated with F, for 2 days (I pg/day), followed 24 h later by P4 (500 pg) or vehicle. Uteri were removed 6, 9, and 18 h after progesterone treatment and the radiolabeled secreted proteins were analyzed by SDS-PAGE and immunoprecipitation using a goat anti-rat C3 antibody. In animals treated with vehicle, E,-stimulated C3 synthesis remained elevated at 6 and 9 h and returned to control values by 18 h. In contrast, the administration of P4 resulted in a decrease in C3 synthesis at 6 and 9 h with the greatest decrease observed at 9 h. Similar results were obtained when C3 mRNA concentrations were examined. E,-stimulated C3 mRNA concentrations were decreased in rats treated with progesterone compared to those treated with vehicle alone. The simultaneous administration of E,, 1�4, and RU486 for 2 days led to a reversal in the progesterone effect at the level of protein synthesis and mRNA concentrations. Furthermore, following C3 stimulation by F,, a 24-h delay in RU486 and P4 administration resulted in a reversal of the P4 inhibition at the mRNA level. These findings suggest that progesterone may be increasing the rate of C3 mRNA turnover.
The nu(2) band of N(2)O as a frequency standard in the 17-microm region of the infrared.

Direct measurements of the absorption spectra of N/sub 2/O were made in order to determine if higher order terms are needed before the ..nu../sub 2/ band can serve as a frequency standard.(AIP)
Seasonal and Spatial Dynamics of Alate Aphid Dispersal in Snap Bean Fields in Proximity to Alfalfa and Implications for Virus Management

Alfalfa is a source for viruses that may be acquired by aphids and transmitted to snap bean, Phaseolus vulgaris L. Snap bean fields in proximity to alfalfa could have an increased risk of virus infection. Knowledge of the abundance and temporal and spatial dispersal patterns of commonly encountered aphids in commercial snap bean fields, varying in distance from alfalfa, could provide insight into this risk. Alate aphids were monitored using water pan traps in snap bean and alfalfa fields that were adjacent to or >1 km away from each other. The pea aphid, Acyrthosiphon pisum (Harris), was the most common aphid species captured in early-planted snap bean fields in 2002 and 2003 (56 and 23% of total, respectively), whereas the corn leaf aphid, Rhopalosiphum maidis (Fitch), also was common in 2003 (15% of total). In contrast, the yellow clover aphid, Therioaphis trifolii (Monell), and soybean aphid, Aphis glycines Matsumura, were the most abundant species trapped in late-planted snap bean fields in 2002 (77% of total) and 2003 (64% of total), respectively. These species were prevalent in traps in alfalfa as well. The abundance and temporal dispersal patterns of these species in snap beans adjacent to and >1 km away from alfalfa were similar, suggesting that the risk for virus infection may not be affected by proximity to alfalfa. A similar number of alate aphids also were captured along snap bean field edges and field centers, regardless of their proximity to alfalfa. This suggests that the aphids dispersed into snap bean randomly rather than directionally from the field edge. The implication of these results is that separating snap bean fields from alfalfa or using crop borders/barriers are not likely to be successful virus management strategies.
The mRNA “game changer” in gene therapy

Gene therapy promises to correct genomic aberrations and treat many human illnesses, especially owing to the advent of CRISPR/Cas9 technology, a gene editing tool. Another gene therapy technology that involves nanoparticle delivery of nucleic acids, such as mRNA and siRNA, which alter gene
Pet Therapy in Correctional Institutions: A Perspective From Relational-Cultural Theory

In this article the authors apply Relational-Cultural Theory to pet therapy in correctional institutions. An important premise is that when pet therapy is used in prisons a symbiotic relationship develops between pets and prison inmates which, at the same time, improve their relationships with people themselves. Relational-Cultural Theory posits that relationships with individuals are not just a means to an end. Rather, good relationships promote growth and healthy development; they also cultivate reciprocal empathy. Hence, a major reason of suffering for most people is their experience of isolation; healing can occur in growth-fostering relationships.
Dynamics of the Water Hydrogen Bond Network at Ionic, Nonionic, and Hydrophobic Interfaces in Nanopores and Reverse Micelles

The effects of water confinement on hydrogen bond dynamics and hydrogen bond exchange have been analyzed by molecular dynamics simulations for a series of different sizes of spherical nanopores of ionic, nonionic, and hydrophobic interfaces. We have calculated translational diffusion residence times, orientational decay time constants, the infrared spectra, correlation functions describing the hydrogen bond network, the hydrogen bond exchange time and rate constant, and ensemble averages of the hydrogen bond exchange reaction coordinate. We focus on the interfacial layer and bulklike interior of these small water containing nanostructures. Our results indicate a universal slowdown in rotational and hydrogen bond dynamics at the interface relative to bulk water. The interiors of nanopores with highly charged interfaces undergo qualitatively different dynamics than those in other nanopores. The rotational jump hydrogen bond exchange mechanism is shown to be robust and universal, even for this variety of interfaces. The implications of these results are discussed in terms of the role of confinement vs interface structure on water dynamics in nanopores.
Viral hepatitis, type B (MS-2 strain). Detection of antibody after primary infection.

Abstract Further observations of the natural history and prevention of viral hepatitis Type B revealed that all 25 unimmunized susceptible children who had a parenteral exposure to MS-2 serum had evidence of hepatitis B infection; 25 had hepatitis B antigen, and 24 had an abnormal SGOT. Of 15 children who received standard immune serum globulin after a parenteral exposure to MS-2 serum, 13 had detectable hepatitis B antigen, and 12 had an abnormal SGOT. Of 10 children who received hepatitis B immune serum globulin after a parenteral exposure to MS-2 serum, four had detectable hepatitis B antigen and abnormal SGOT; of 29 children who received one to three inoculations of heat-inactivated MS-2 serum before a parenteral exposure to unheated MS-2 serum, 12 had detectable hepatitis B antigen and abnormal SGOT. The use of these active and passive immunizing procedures was associated with a protective effect, a more attenuated hepatitis B infection, and a decreased chronic carrier rate of hepatitis B antigen.
Public Librarians' Views on Collection Development and Censorship

ABSTRACTThis study was a survey of public librarians in Ohio who were responsible for collection development. The survey asked about collection development practices and intellectual freedom; the response rate was 43%. The majority of respondents had a master of library science, were female, were older than 45, and worked in a library for over ten years. Respondents were asked about pressure in collection development decisions, agreement with intellectual freedom statements, collection of hypothetical controversial items, and correspondence between personal beliefs and professional intellectual freedom statements. This survey indicates that, in general, librarians' actions reflect their belief in intellectual freedom.
Undersized Rigid Nonplanar Annuloplasty: The Key to Effective and Durable Repair of Functional Tricuspid Regurgitation

Background Previous clinical experiences have demonstrated high early and late recurrence rates after repair of functional tricuspid regurgitation (TR). We investigated the results of functional TR repair with undersized rigid nonplanar annuloplasty rings. Methods From January 2007 to December 2013, 216 consecutive patients with moderate or greater functional TR were treated with undersized (size 26 mm or 28 mm) rigid nonplanar annuloplasty rings. Results The mean age was 69 ± 13 years. There was a previous history of cardiac operation in 25% (54 of 216 patients). Tricuspid regurgitation was graded as severe in 47% (102 of 216) and moderate in 53% (114 of 216). Concomitant operations included mitral valve procedures in 92% (198 of 216), coronary artery bypass grafting in 21% (45 of 216), aortic valve procedures in 9% (20 of 216), and cryomaze procedures in 35% (76 of 216). Size 26 mm rings were used in 38% of patients (81 of 216), and size 28 mm in 62% (135 of 216). The perioperative mortality rate was 6% (14 of 216). On predischarge echocardiography, TR grade was none or mild in 94% (176 of 187 patients), moderate in 4% (7 of 187), and severe in 2% (4 of 187). At a mean follow-up of 33.0 ± 24.0 months, TR grade was none or mild in 81% of patients (130 of 160), moderate in 16% (26 of 160), and severe in 2% (4 of 160). There were no reoperations for recurrent TR, and no patients have had tricuspid stenosis or annuloplasty ring dehiscence. Conclusions Treatment of functional TR with undersized (26 mm or 28 mm) nonplanar rigid annuloplasty rings is safe and highly effective, with a near absence of recurrent severe TR at midterm follow-up.
D.C. Electrothermal Hybrid BJT Model for SPICE

SPICE — built-in models are the isothermal models with the temperature as a parameter. Electrothermal interactions caused that the device (junction) temperature changes due to changes of dissipated power. In the paper the new BJT electrothermal model which includes the thermal effects is proposed. This model is represented by combination of SPICE-built-in isothermal model and any additionaly controlling generators modelling selfheating and some other electrical effects nonmodeled by SPICE.
The Lykins Valley site (5LR263): An early nineteenth century indigenous occupation at the western edge of the Central Plains

The postcontact period on the western edge of the Central Plains was a dynamic period of technological and territorial change for Plains Indian groups that began with the acquisition of European-derived goods and equines often long before actual physical contacts with Europeans or Euroamericans. These highly mobile and adaptable groups often maintained many traditional precontact subsistence and technological practices despite the procurement of these European-derived materials and animals. Understanding the changes wrought by the introduction of European technologies and contact with European groups, along with the persistence of precontact praxis has proven elusive in the area due to an overall lack of evidence, both archaeological and historical. The Lykins Valley site (5LR263) is a buried early nineteenth century, Native occupied campsite that provides a window into this interesting and little-known period of Plains Indian history. The following analysis of the faunal remains, lithic artifacts, and tr...
Case 83: A Potentially Serious Incident

Today you are in the endoscopy suite. On entering the procedure room, you note that the anesthesia machine is an older version of the one you use in the rest of the hospital. You check the anesthesia machine and find everything is in order. There is piped oxygen into the procedure room and the emergency oxygen and nitrous oxide cylinders on the back of the machine are full. A large see-through plastic bag with an Ambu bag is hanging on the side of the anesthesia machine beside the absorber. You now recall that at a departmental morbidity and mortality (M&M) meeting there had been an incident of a sudden anesthesia machine failure in the endoscopy suite. You check the Ambu bag and find it in order. You ask that a separate full cylinder of oxygen be brought into the procedure room. This is to be used with the Ambu bag to provide a higher inspired oxygen concentration, in case the anesthesia machine stops functioning.
Double-Bundle Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) rupture is a common sports injury, and surgical reconstruction is the standard treatment in most active patients. Double-bundle (DB) ACL reconstruction is one application of the anatomic reconstruction concept, which aims to restore the ACL to its native dimensions, collagen orientation, and insertion site. Biomechanical studies have shown that anatomic DB reconstruction restores knee laxity closer to normal than transtibial single-bundle (SB) reconstruction. Several prospective, comparative clinical studies with level I or II evidence have also reported superior outcomes of anatomic DB compared with SB reconstruction. Although the best evidence from the highest-quality meta-analyses suggests that DB reconstruction yields superior postoperative knee laxity restoration when compared with SB reconstruction, the effect on clinical outcomes and risk of graft failure have not been significantly different. However, heterogeneity of studies, including differences in tunnel position and relatively short-term follow-up, is the limitation of this evidence. Future biomechanical and long-term clinical cohort studies with anatomic ACL reconstruction are needed to further examine the improvement in knee laxity and clinical outcomes afforded by DB reconstruction.
The Psychology and Philosophy of Inquiry, Philosophical Psychology, and Psychological Philosophy

This chapter shows how the pioneering ideas of Carl Jung lead to a very different form of systems thinking, one that is especially suited to the analysis of education. It also introduces the concept of Inquiry Systems (ISs), i.e., different systems for producing knowledge. The chapter shows that for the most part the field of education has relied primarily on the wrong forms of inquiry. In short, education is an ill-structured mess, not a well-structured exercise.
Revisiting the Relation between Distress Risk and Stock Returns

Several prior studies use reduced-form models of bankruptcy or default risk to proxy for corporate distress and find evidence of a significant negative relation between distress risk and average returns. This paper introduces a substantially broader measure of firm failure risk, the probability a firm is delisted from a major U.S. stock exchange for performance reasons, and revisits the pricing of distressed stocks. In contrast to the prior literature, I find distressed stocks earn higher average returns than those with a low probability of failure. Moreover, distress risk is significantly priced in the cross section. While the size and value effects remain robust to controlling for failure risk, I find evidence that SMB and HML contain some distress-related information.
Scalability of an Evidence-Based Adolescent Pregnancy Prevention Program: New Evidence From 5 Cluster-Randomized Evaluations of the Teen Outreach Program.

Objectives. To determine if the Teen Outreach Program (TOP), a youth development and service learning program, can reduce sexual risk-taking behaviors compared with a business as usual or benign counterfactual.Methods. We synthesized results of 5 independent studies conducted in 5 geographically and ethnically diverse locations between 2011 and 2015 with 17 194 middle and high school students. Each study cluster-randomized classes, teachers, or schools to treatment or control groups and included the students enrolled in those clusters at baseline in an intent-to-treat analysis. Multilevel models tested impacts on recent sexual activity, recent unprotected sexual activity, and sexual initiation among the sexually inexperienced at baseline at approximately 1 and 2 years after baseline.Results. Precision-weighted average effect sizes showed nonsignificant reductions of 1 percentage point or less in recent sexual activity (5 studies: −0.6; P = .32), recent unprotected sex (5 studies: −0.2; P = .76), and sexua...
Heat transfer and thermodynamic processes in coal-bearing strata under the spontaneous combustion condition

ABSTRACTSimulations and experiments have been carried out to investigate heat transfer and thermodynamic processes in coal-bearing strata in order to quantitatively understand the development of underground coal fires under the spontaneous combustion condition. With the controlled temperature and under lean oxygen conditions, the thermodynamic parameters for coal oxidation at different stages are experimentally determined in combination with the simultaneous thermal analysis. A combined heat transfer model of conduction, convection, and radiation with finite reactions is developed for the porous coal and rocks. The temperature distributions in the coal and roof strata at different times are simulated based on the single- and two-stage kinetic models, respectively, and compared with field geophysical prospecting. Effects of oxidation kinetic properties due to coal metamorphism on propagation of coal fires are examined. It reveals that a significant step change exists during the thermal process of coal fire...
Effect of intermediate wettability nanoparticles on oil-water emulsion stability

Abstract Emulsions are ubiquitous in oil production operations and in general undesirable for various reasons. These include increased pressure losses leading to reduced oil productivity, pipeline and other equipment corrosion, as well as separation difficulties resulting in increased production costs. Surface active agents (also known as surfactants, like asphaltenes, resins, etc.) and solid particles (for example clays) are naturally present in crude oils. These components can act as stabilizers for oil and water emulsions. Therefore in order to mitigate the aforementioned problems related to emulsions, a better understanding of how emulsions are formed and stabilized is essential. This study focuses on nanoparticle stabilized emulsions and aims to contribute to a deeper understanding as it pertains to the effect of solid nanoparticles on the stability of oil and water emulsions. More specifically, the objective of this research is to investigate the separation kinetics of oil-water emulsions stabilized by spherical silica nanoparticles of intermediate wettability and its dependence on solid particle concentration, initial dispersion phase, water-cut, and shearing time. A novel, state-of-the-art, Portable Dispersion Characterization Rig (P-DCR) is used to run the experiments (as compared to the conventional bottle test method) and the relevant software for accurate data acquisition. All tests are conducted at ambient pressure and temperature conditions. Mineral oil and distilled water are used as the test fluids. The initial oil to water ratio in the batch separator is an important parameter. Therefore a broad range of water-cuts is tested. Starting with a 25% water-cut the experimental results indicate that in most cases no emulsion forms and complete phase separation takes place fast. However, when the water-cut increases to 50% and 75% a stable emulsion rag layer phase is always formed and full separation is not achieved within the experimental time frame. For the stirring times examined, faster separation takes place when the nanoparticles are initially dispersed in the oil phase. Using the specific type of nanoparticles, the formation of multiple emulsions (oil in water in oil, O/W/O) is observed. In general, as the nanoparticle concentration increases the rate of the separation process decreases. The size of the solid nanoparticles is also a critical factor and although not studied intentionally, it is inferred from the results that larger particles do not stabilize the formed emulsions as efficiently as smaller particles do.
Reelin Deficiency Delays Mammary Tumor Growth and Metastatic Progression

Reelin is a regulator of cell migration in the nervous system, and has other functions in the development of a number of non-neuronal tissues. In addition, alterations in reelin expression levels have been reported in breast, pancreatic, liver, gastric, and other cancers. Reelin is normally expressed in mammary gland stromal cells, but whether stromal reelin contributes to breast cancer progression is unknown. Herein, we used a syngeneic mouse mammary tumor transplantation model to examine the impact of host-derived reelin on breast cancer progression. We found that transplanted syngeneic tumors grew more slowly in reelin-deficient (rlOrl −/−) mice and had delayed metastatic colonization of the lungs. Immunohistochemistry of primary tumors revealed that tumors grown in rlOrl −/− animals had fewer blood vessels and increased macrophage infiltration. Gene expression studies from tumor tissues indicate that loss of host-derived reelin alters the balance of M1- and M2-associated macrophage markers, suggesting that reelin may influence the polarization of these cells. Consistent with this, rlOrl −/− M1-polarized bone marrow-derived macrophages have heightened levels of the M1-associated cytokines iNOS and IL-6. Based on these observations, we propose a novel function for the reelin protein in breast cancer progression.
The human rights state: theoretical challenges, empirical deployments: reply to my critics

ABSTRACTI respond to a broad range of challenges that the seven articles of this special issue raise for the theory of a human rights state. The first two articles address the theory as a whole. The first reconfigures the human rights state as an analytical tool for measuring implementation. I counter that such measurement is not possible without normative interpretation. The second article insists that any human rights project can only be valid if valid transcendentally. By contrast, I advocate validity as a this-worldly project undertaken by the addressees themselves. The next three articles examine what happens when the model is deployed empirically. One imagines a Mexican human rights state for indigenous peoples that would develop local structures of autonomy and self-governance. While the author proposes communal agency and cultural unity, I discuss the danger that collective rights pose to the rights of individual members. Another article sketches a Brazilian human rights state that would diminish ...
Recuerdos del porvenir: el 37 Festival Internacional del Nuevo Cine Latinoamericano de La Habana

El Festival Internacional del Nuevo Cine Latinoamericano de La Habana, en donde se pueden ver las peliculas mas recientes, es un paraiso para los amantes del cine. Hoy en dia, lo que era antes un festival que abarcaba hasta los barrios marginales de la ciudad, se concentra en las grandes salas, muchas de ellas venidas a menos, a pesar de que algunas hayan sido modernizadas para proyectar peliculas digitales y de que se encuentren situadas a lo largo de la Calle 23. Ivan Giroud, director del festival, explico que este mantiene costos muy bajos (no hay alfombras rojas, ni limosinas ni demas excesos mediaticos) a cambio de la posibilidad de brindarles a los habitantes de la ciudad la posibilidad de asistir a la proyeccion de peliculas de America Latina, imposibles de conseguir el resto del ano, y a precios modicos. En respuesta, el publico forma colas larguisimas, ansioso de ver los estrenos, especialmente los de las peliculas cubanas.
Polybrominated diphenyl ethers and their hydroxylated and methoxylated derivatives in seafood obtained from Puget Sound, WA

Synthetic polybrominated diphenyl ethers (PBDEs) are ubiquitous environmental contaminants and known to occur in most food items. Consumer fish products have been identified as having some of the highest PBDE levels found in USA food sources. Natural formation of hydroxylated (OH-) and methoxylated (MeO-) PBDEs are also known to occur in simple marine organisms, which may be bioaccumulated by seafood. In this study, we report findings of an initial survey of PBDE, OH-PBDE and MeO-PBDE content in common seafood items available to residents living in the Puget Sound region of Washington State. Seafood samples were either purchased from local grocery stores or caught off the coast of SE Alaska and in Puget Sound. The edible portions of the seafood were analyzed, which for finfish was white muscle (skinless fillets) and for shellfish, either the entire soft tissue (bivalves) or processed meat (calamari, shrimp and scallops). Results indicated that finfish typically had higher levels of PBDEs compared to shellfish with BDE-47 and BDE-99 as the most common congeners detected. Among shellfish, bivalves (clams and mussels) were notable for having much higher levels of OH- and MeO-PBDEs compared to other types of seafood with 6'-OH-BDE-47 and 2'-MeO-BDE-68 being the more common OH- and MeO- congeners, respectively. Based on our results and recent updates to daily fish consumption rates, estimated intake rates for Washington State residents will be between 34 and 644ngPBDEs/day, depending on species consumed. For the OH- and MeO- forms, daily exposure is much more variable but typically would range between 15 and 90ng/day for most seafood types. If shellfish are primarily consumed, OH-PBDE intake could be as high as 350ng/day. These daily intake rates for PBDEs are higher than most dietary intake rates calculated for populations in other world regions.
Variability in Microvascular Estimates of Capillary Surface Area for Exchange

A recurring and tantalizing deficiency in many areas of microvascular research is the problem of quantitative reconciliation of measurements made in whole organs (or whole animals) versus those made at the level of individual microvessels. With respect to endothelial cell function, it is recognized that whole organ measurements of capillary filtration coefficient yield values that are 10–20 times lower than single vessel permeability measurements,1 and that observed transport rates of macromolecules in experimental systems at low volume flows exceed calculations based on the two pore model.2 It is clear that at least a partial contribution to these discrepancies lies in the assumptions underlying the models or experimental systems. For example, comparison of data collected by whole organ versus single vessel approaches depends on how ‘typical’ is the single vessel selected for measurement, or on assumptions describing heterogeneity of function in the whole organ approach.
Persistence of Moraxella catarrhalis in Chronic Obstructive Pulmonary Disease and Regulation of the Hag/MID Adhesin.

BACKGROUND Persistence of bacterial pathogens in the airways has profound consequences on the course and pathogenesis of chronic obstructive pulmonary disease (COPD). Patients with COPD continuously acquire and clear strains of Moraxella catarrhalis, a major pathogen in COPD. Some strains are cleared quickly and some persist for months to years. The mechanism of the variability in duration of persistence is unknown. METHODS Guided by genome sequences of selected strains, we studied the expression of Hag/MID, hag/mid gene sequences, adherence to human cells, and autoaggregation in longitudinally collected strains of M. catarrhalis from adults with COPD. RESULTS Twenty-eight of 30 cleared strains of M. catarrhalis expressed Hag/MID whereas 17 of 30 persistent strains expressed Hag/MID upon acquisition by patients. All persistent strains ceased expression of Hag/MID during persistence. Expression of Hag/MID in human airways was regulated by slipped-strand mispairing. Virulence-associated phenotypes (adherence to human respiratory epithelial cells and autoaggregation) paralleled Hag/MID expression in airway isolates. CONCLUSIONS Most strains of M. catarrhalis express Hag/MID upon acquisition by adults with COPD and all persistent strains shut off expression during persistence. These observations suggest that Hag/MID is important for initial colonization by M. catarrhalis and that cessation of expression facilitates persistence in COPD airways.
Risk Factors for Early Disenrollment From Colorado's Affordable Care Act Marketplace.

BACKGROUND Midyear disenrollment from Marketplace coverage may have detrimental effects on continuity of care and risk pool stability of individual health insurance markets. OBJECTIVE The main objective of this study was to assess associations between insurance plan characteristics, individual and area-level demographics, and disenrollment from Marketplace coverage. DATA All payer claims data from individual market enrollees, 2014-2016. STUDY DESIGN We estimated Cox proportional hazards models to assess the relationship between plan actuarial value and Marketplace enrollment. The primary outcome was disenrollment from Marketplace coverage before the end of the year. We also calculated the proportion of enrollees who transitioned to other coverage after leaving the Marketplace, and identified demographic and area-level factors associated with early disenrollment. Finally, we compared monthly utilization rates between those who disenrolled early and those who maintained coverage. RESULTS Nearly 1 in 4 Marketplace beneficiaries disenrolled midyear. The hazard rate of disenrollment was 30% lower for individuals in plans receiving cost-sharing reductions and 21% lower for those enrolled in gold plans, compared with silver plans without cost-sharing subsidies. Young adults had a 70% increased hazard of disenrollment compared with older adults. Those who disenrolled midyear had greater hospital and emergency department utilization before disenrollment compared with those who maintained continuous coverage. CONCLUSIONS Plan generosity is significantly associated with lower disenrollment rates from Marketplace coverage. Reducing churning in Affordable Care Act Marketplaces may improve continuity of care and insurers' ability to accurately forecast the health care costs of their enrollees.
Strategic improvement of oral antineoplastic investigational agents compliance

Background: The use of oral antineoplastic agents has increased in cancer medicine. However, the convenience of oral medication carries the risk of nonadherence and dosing errors, which could jeopardize therapeutic benefits and patient safety. This is a quality improvement project to investigate reasons for nonadherence and medication errors in patients receiving oral investigational treatment at the Phase 1 Department at MD Anderson Cancer Center, Houston, Texas. Early-phase clinical trials have an enormous impact on drug development and patient safety, not much has been done to evaluate adherence in patients receiving investigational oral antineoplastic agents. Materials and Methods: We examined our clinic dynamic including the initial encounter, follow-up phone calls, medication administration, and patient adherence the following visit. Then we explored and classified the main possible reasons for nonadherence and medication error across the workflow. Results: When examining potential deficiencies in the clinic flow, which are actionable and carry high impact, we found the initial encounter had a significant room for improvement and errors happened when instructions provided were unclear, not correct, or contradicted with the prescription or the label. Furthermore, the follow-up calling was also an important step to monitor and improve compliance. However, it was not a consistent practice and lacked a standardized format. Lastly and although the multistep reconciliation process for oral medication is important to monitor compliance, it was complex, had multiple manual aspects, and added substantial burden on the research staff. Conclusion: In this project, our goal was to shed light on the possible causes of oral medication errors and nonadherence in clinical trials. We proposed feasible measures including educational, training, and adherence monitoring tools. We will continue to monitor and evaluate our data to see any positive or negative impact from our interventions.
Effect of acute exercise on postprandial endothelial function in postmenopausal women: a randomized cross-over study.

High-sugar intake may cause endothelial dysfunction. It is unknown if a bout of aerobic exercise improves endothelial dysfunction caused by a high-sugar meal in postmenopausal women. This study evaluated if prior aerobic exercise attenuates postprandial endothelial dysfunction in postmenopausal women. Twenty-two postmenopausal women (age [mean±SD]: 60.4±6.5 years; % body fat: 40.3%±7.5%) underwent an exercise (EX) or no exercise (NE) condition, in a random order, 13–16 hours prior to the high-sugar meal consumption. The EX condition included a 60 min bout of supervised aerobic exercise at 75% of age-predicted maximum heart rate. The high-sugar meal, consumed after a 12-hour fast, contained 33% of the subjects’ daily energy needs, and 75.6% energy from carbohydrates. Flow-mediated dilation (FMD) and blood concentrations of glucose, insulin, endothelin-1 (ET-1), and nitric oxide (NO) were assessed at baseline and 60 min, 120 min, and 180 min postprandially. Repeated measures analysis test showed that there were no condition by time interaction or condition effects for FMD, glucose, insulin, or NO. There was a significant condition by time interaction but no condition effect for ET-1. Area under the curve was also not different by condition for insulin sensitivity or the above variables. In conclusion, prior aerobic exercise compared with NE did not affect FMD, blood glucose, insulin, ET-1 or NO concentrations, or insulin sensitivity following a high-sugar meal in postmenopausal women. Future studies should look at the effect of different EX intensities on meal-induced endothelial dysfunction in this population. Trial Registration: ClinicalTrials.gov Identifier: NCT02919488
Planning for Data Monitoring and Audits

Auditing and monitoring of clinical trials is crucial to ensure the integrity of the research process. An auditing program will evaluate a study for compliance with federal regulatory requirements, accountability of research drugs, and review of submitted patient data. Each of these components is evaluated according to specific federal guidelines for auditing. The most successful audits occur when preparation for the audit starts at the trial design phase and the principal investigator conducts the trial with oversight of the research process and staff. Monitoring is generally completed for pharmaceutical sponsored trials and includes the same components as auditing. For multicenter studies, the study sponsor will establish the quality assurance program to be used. For single institution studies, the need for auditing or monitoring is established by the institutional research policies. Larger research institutions will have a group that performs audits of the institutional protocols that generally functions through the Institutional Review Board (IRB).
Portable Medical Order Sets (POLST®): Ethical and Legal Landscape

Anyone who has observed the dying of a loved one or who has thought about medical care in the final months of life may be concerned about end-of-life care. How can individuals ensure that their care fits their needs and preferences if they cannot express these because of dementia, confusion, or other frailties? Some worry that they will receive care that is painful and aggressive in the last stages of disease even though they would prefer comfort care only. By contrast, others worry that physicians will withhold therapeutic care because they assume that such care is unwanted by patients who are near death. Reassurance can come in the form of POLST. POLST has traditionally been an acronym for “physician orders for life-sustaining treatment,” but the National POLST Paradigm now defines it as “a portable medical order form.” A POLST form is a tool that can help actualize patients’ wishes for end-of-life care because it consists of a set of medical orders that are integrated into the patient’s medical record. The POLST concept, however, raises significant ethical and policy concerns. This article describes and assesses POLST. It analyzes POLST benefits and risks and the laws and regulations that govern this end-of-life decision-making tool.
The Prospective Huntington At-Risk Observational Study (PHAROS): The Emotional Well-Being, Safety and Feasibility of Long-Term Research Participation.

BACKGROUND There is limited understanding of the feasibility of conducting long-term research among undiagnosed (pre-symptomatic) adults at risk to develop Huntington disease (HD), while protecting their emotional well-being and safety. OBJECTIVE To assess pre-specified events pertaining to emotional well-being, safety, and feasibility among healthy consenting adults at risk for developing HD who have chosen not to undergo genetic testing. METHODS PHAROS research participants prospectively reported the occurrence of events pertaining to psychological distress (psychiatric evaluations, depression, suicidality) and feasibility (maintaining confidentiality, study attrition). PHAROS enrolled 1001 participants. RESULTS Events pertaining to psychological distress were reported by 35% of participants. The most common events included heightened suicide risk (26%), new onset depression (12%), and new mental health evaluation (9%); all occurred significantly more frequently among participants with expanded trinucleotide CAG repeats (≥37). Five deaths occurred, none related to suicide. Forty-one percent of participants reported self-disclosure of their HD at-risk status, and 15% reported that someone else (usually a family member) had done so. Confidentiality of CAG test results was maintained by investigators. The withdrawal rate was largely uniform over the study period and did not differ significantly by gender or CAG status. CONCLUSIONS The potentially vulnerable research participants in PHAROS showed good emotional tolerability and safety. Individual CAG data were not disclosed, and confidentiality about disclosure of at-risk HD status was well maintained by others (family, friends, etc.). Long-term research participation of adults at risk for HD who choose not to undergo pre-symptomatic DNA testing is well tolerated, safe and feasible.
Thousands of small, constant rallies: a large-scale analysis of partisan WhatsApp groups

There is growing concern about the use of social platforms to push political narratives during elections. One very recent case is Brazil's, where WhatsApp is now widely perceived as a key enabler of the far-right's rise to power. In this paper, we perform a large-scale analysis of partisan WhatsApp groups to shed light on how both right-wingers and left-wingers used the platform in the 2018 Brazilian presidential election. Across its two rounds, we collected +2.8M messages from +45k users in 232 public groups (175 right-wing vs. 57 left-wing). After describing how we obtained a sample that is many times larger than previous works, we contrast right-wingers and left-wingers on their social network metrics, regional distribution of users, content-sharing habits, and most characteristic news sources.
Impact of Task-Level Worker Specialization, Workload, and Product Personalization on Consumer Returns

Problem definition: Are consumer product returns largely a function of retailers’ return policies, or can manufacturers influence them through production characteristics and product attributes? How...
Stilling the Pendulum: Regulatory, Supervisory, and Structural Approaches

This short reflection considers whether and to what extent changes to the legal regime governing banking and finance made following the financial crisis are durable and likely to last. It further differentiates between three legal strategies for fostering financial stability: (1) regulatory approaches, which rely on agency law-making (i.e. informal guidance and notice and comment rule-writing); (2) supervisory approaches, which allow administrative agencies to exercise discretionary authority; and (3) structural approaches, which define the overall shape of the industry, generally through legislation (i.e. the separation of investment banking from commercial banking).
Electoral Incentives in Congress: Carson, Jamie L., and Joel, Sievert. Ann Arbor, MI: University of Michigan Press, 2018. 199 pages. $70 (hardcover); $29.95 (softcover).

“… I shall conjure up a vision of United States congressmen as single-minded seekers of reelection…” (Mayhew 1974, 5). With those fifteen words, written more than forty years ago, David Mayhew arti...
Effect of ethanol, clofibric acid and temperature on the uptake and elimination of 2-methylisoborneol in channel catfish (Ictalurus punctatus)

Off-flavor, due to organoleptic compounds such as 2-methylisoborneol (MIB), is the single largest detriment to the harvest, production and profit from the channel catfish aquaculture industry of the Southeastern United States. Methods to increase the metabolism and/or elimination of compounds like MIB would provide a means towards improving catfish rearing practices. Previous studies indicated one or more forms of cytochrome P450 monooxygenase (CYP) may be involved in the biotransformation and elimination of specific organoleptic compounds, such as 2-methylisoborneol (MIB). In order to determine the role of CYP in the elimination of MIB, various compounds that have been shown to modulate cytochrome P450 expression in catfish were administered before and after exposure to 14C-MIB. Uptake and elimination was monitored in fish over 24 and 48 h, respectively. Pretreatment with clofibric acid (100 mg kg−1-gavage) which induces a CYP2K-like isoform, and ethanol (1.0% v/v-aqueous) a CYP2 represser, alone and with enhanced temperature (added 10 °C) failed to affect uptake of MIB. Pretreatment with these compounds and conditions also failed to enhance elimination of MIB from channel catfish. However, when fish were treated with 1.0% ethanol after MIB exposure (i.e., during depuration), beta elimination halflives were changed from 144±35 to 71±13 h. in sexually mature animals but unchanged (191±113) in juveniles. The failure of CYP-modulating agents to alter MIB elimination in catfish suggests MIB may not readily undergo Phase I oxidation via CYP. The enhanced elimination of MIB in adults by ethanol warrants further study as to its potential use in aquaculture in purging MIB and related compounds prior to fish processing.
An Older Woman With Transient Cough, Mild Airway Obstruction, and Lung Nodules

Case Presentation A 66-year-old woman with no significant medical history presented initially to her primary care physician’s office with a 2-weeks history of productive cough and associated wheezing after cough paroxysms. Empiric antibiotic was started, with no improvement. Chest radiograph was performed, which showed bilateral nodular opacities ( Fig 1 ). The patient’s cough resolved in 6 weeks after empiric treatment with oral steroids, inhaled steroids, and bronchodilators. A follow-up chest radiograph done at 6 weeks showed persistent abnormalities, and she was referred for a pulmonary evaluation. She denied any fevers, cough, hemoptysis, shortness of breath, wheezing, loss of appetite, or weight loss at that time. She had no significant medical problems and was not on any medications at that time. She was a nonsmoker. She worked in an office setting and denied any occupational or recreational exposures or recent travels. There was no family history of lung diseases or cancer.
UI Screens Identification and Extraction from Mobile Programming Screencasts

Mobile applications demand is on the rise, leading to more programmers learning to develop or having to maintain this kind of programs. Developers often refer to online resources to find inspiration or answers to questions they have about mobile programming topics and screencasts are a popular resource. However, given the multitude of screencasts available, it can be difficult to quickly comprehend which of the many videos is relevant to one's needs. We propose a novel approach, called UIScreens, which detects, extracts, and presents the most representative user interface (UI) screens embedded in mobile development screencasts. This could help developers quickly comprehend what an app displayed in a video is about, therefore saving time searching for useful videos. UIScreens has been evaluated in two empirical studies on iOS and Android programming screencasts. The first study investigates the accuracy of our UI extraction and shows that our approach is able to detect and extract UI screens with an accuracy of 94%. The second is a user study with mobile app developers, who evaluated both the accuracy and the usefulness of UIScreens. They agreed that UIScreens is accurate and extracts representative UI screens from videos. They considered that the extracted UI screens are useful for understanding what a video is about and if it is relevant to a search. Our approach has been implemented as a free online tool.
A Limit on the Polarized Anisotropy of the Cosmic Microwave Background at Subdegree Angular Scales

A ground-based polarimeter, PIQUE, operating at 90 GHz has set a new limit on the magnitude of any polarized anisotropy in the cosmic microwave background. The combination of the scan strategy and full width half maximum beam of 0.235 degrees gives broad window functions with average multipoles, l = 211+294-146 and l = 212+229-135 for the E- and B-mode window functions, respectively. A joint likelihood analysis yields simultaneous 95% confidence level flat band power limits of 14 and 13 microkelvin on the amplitudes of the E- and B-mode angular power spectra, respectively. Assuming no B-modes, a 95% confidence limit of 10 microkelvin is placed on the amplitude of the E-mode angular power spectrum alone.
Starting Antiseizure Medication

The goal of starting antiseizure medication (ASM) is for the patient to have no further seizures and no significant side effects. At the time of presentation, additional clinical and laboratory testing is typically needed to determine the risk of seizure recurrence. Though early versus delayed initiation of an ASM does not necessarily affect the natural history of epilepsy, it may impact the short-term risk of seizure recurrence. Ultimately, the ASM selected needs to be appropriate for the suspected seizure classification: focal versus generalized. The next consideration is to weigh possible adverse effects and to consider those in the context of an individual patient’s comorbidities. Both the risk of seizure recurrence and potential side effects from ASM need to be discussed with the patient at the time of drug initiation.