cssi/SciSciGPT-SciSciNet huggingface dataset:
Update on epilepsy

Increasing knowledge of prognostic factors and of treatment outcomes has led to major changes in the treatment of epileptic seizures. The management of first seizures can now be individualized, based on the probability of seizure recurrence and its expected repercussions. When a decision is made to treat initial or recurrent seizures, monotherapy with nonsedating AEDs is recommended. Therapy should also be optimized to achieve seizure control as early as possible. During AED therapy, clinical monitoring of drug reaction symptoms is preferred over routine laboratory testing. Laboratory monitoring is not cost-effective, and there is no proof that it can forecast drug reactions. The risk of congenital malformations in newborns prenatally exposed to AEDs is around 5%, which is 2 to 2.5 times that of the general population. Valproate and carbamazepine have recently been associated with a 1% risk of spina bifida. There are measures that can be used to reduce the risk of teratogenicity, the most important of which is using the least amount of AEDs necessary to control seizures during pregnancy. Although AEDs to reduce the efficacy of oral contraceptives, oral contraceptives are still reliable with certain precautions. For patients with intractable epilepsy, surgery should be considered to improve seizure control. Proper selection of candidates increases the probability of an excellent outcome in these patients, who otherwise have no hope of leading a normal life. Postsurgical outcome largely depends on the location, the extent, and the pathology of the epileptogenic tissues in the brain.
Measles Epidemic in Guang'an,2008-2010

Objective To analyze the epidemiological characteristics of measles in Guang'an from 2008 to 2010,and provide scientific evidence for measles control and elimination.Methods Measles cases reported in Guang'an during 2008-2010 was analyzed by using descriptive epidemiology method.Results During these 3 years,40 cases of measles were reported,with the annaul average incidence rate was 0.29/105.The male to female ratio was 2.08:1.Cases were mainly distributed in children aged 0 to 14 years,accounting for 85.00% of the total,in which scattered children were most,accounting for 47.50%,followed by preschool children and the students,accounting for 27.5% and 12.5% respectively.Thirty-two cases were immune blank,accounting for 80.0%.Conclusion Children were high-risk population of measles in Guang'an,so that surveillance should be strengthened to improve routine immunization rate of measles vaccine,and reduce the incidence of measles.
Conservative Treatment of Endometriosis: The Effects of Limited Surgery and Hormonal Pseudopregnancy

This study compares the effects of limited surgery or hormonal pseudopregnancy, or a combination of these two, upon fertility and the need for subsequent surgery with respect to the extent of the disease at the time of initial diagnosis in patients with endometriosis externa. Of the 61 patients who desired to enhance or preserve reproductive capacity, 20 patients became pregnant, for a pregnancy rate of 33%. The pregnancy rate in all categories, that is, those patients treated with pseudopregnancy, conservative surgery, and combined pseudopregnancy and surgery, was found to be in direct relationship to the initial extent of disease. In such patients, conservative surgery alone seemed to give the best results in the achievement of pregnancy. There seemed to be little difference between pseudopregnancy alone and conservative surgery in regard to the need for subsequent surgery after initial therapy, although there seemed to be a significantly greater chance for the need for subsequent surgery in patients receiving a combination of the two forms of therapy. The need for subsequent surgery after initial therapy in 80 patients increased in direct relationship to the initial extent of disease present, despite the form of therapy used. Fifty-nine other patients with endometriosis, who did not desire to preserve fertility and presented for relief of other symptoms, underwent initial "radical" therapy. Forty-six patients underwent complete operation, including removal of uterus, tubes and ovaries, and none required subsequent reoperation. Of the 13 remaining patients, who underwent incomplete surgical removal, leaving one or both ovaries in situ, 11 required subsequent reoperation for recurrent pelvic endometriosis.
Reflecting on the Diverging Destinies of American Families: Policy Approaches as We Move Forward

In an era of increasing income inequality and shifting patterns of family demographics, a growing body of research highlights the widespread consequences of these trends for families and children. The chapters in this volume highlight the numerous ways these trends may be impacting families and draw our attention to how these challenges will impact research and policy approaches in the years to come. This conclusion chapter draws out some of the major themes and ideas presented at Penn State’s 21st annual Symposium on Family Issues and in the preceding chapters. Over the past few decades, policies and programs have been implemented, each with different foci and targets of intervention. The programs generally fall into two broad categories: structural and family-based approaches. These approaches are reviewed, with a discussion of how specific policies may be able to address the patterns and consequences of diverging destinies. Future directions and challenges for policy and program implementation and research are also considered, including constraints for funding and the incorporation of a two-gender approach.
Entrenchment, Incrementalism, and Constitutional Collapse

Entrenchment is fundamental to law. Grand documents like the U.S. Constitution, and mundane ones like city and corporate charters, entrench themselves against change through supermajority rules and other mechanisms. Entrenchment frustrates responsiveness, but it promotes stability, a rule of law virtue extolled for centuries. It does so through a straightforward channel: entrenched law is difficult to change. Scholars and legal designers have long understood this idea, which can be called the first status quo bias of entrenchment. I show that a second bias lurks: entrenchment confines changes that do take place to incremental steps. As entrenchment deepens, the scope of potential change to law collapses on the status quo. This has implications for constitutional law, especially the debate about Article V and the separation of powers, both of which shield the Constitution from change more than scholars realize. It also illuminates several questions, especially in comparative constitutional law, such as why constitutions remain unpopular after amendment. Finally, it generates a theory of constitutional failure. When voters’ preferences evolve consistently in one direction, entrenched law eventually becomes as unstable as ordinary law, only less popular. Thus, entrenchment buys neither stability nor responsiveness. Because entrenchment confines legal change to incremental steps, amendment cannot correct the problem. This recasts fundamental questions of legal design in new light, and it may explain why some constitutions endure while others collapse.
Children treated for lawn mower-related injuries in US emergency departments, 1990–2014

Abstract Objective Investigate the epidemiology of lawn mower-related injuries to children in the US. Methods A retrospective analysis was conducted of children younger than 18years of age treated in US emergency departments for a lawn mower-related injury from 1990 through 2014 using data from the National Electronic Injury Surveillance System. Results An estimated 212,258 children Conclusions Lawn mower-related injuries continue to be a cause of serious morbidity among children. Although the annual injury rate decreased significantly over the study period, the number of injuries is still substantial, indicating the need for additional prevention efforts. In addition to educational approaches, opportunities exist for improvements in mower design and lawn mower safety standards.
The Brief Case: Too Beta To Be a “B”

A 29-year-old African-American woman was seen in her third pregnancy. In her first pregnancy, she experienced preterm labor and premature rupture of membranes with delivery of a previable infant at 5 months. Her second pregnancy ended in spontaneous abortion at 7 weeks. Current other medical
Body Properties and Lorentz Coordinate Transformations

We introduce graphic representation of the Lorentz coordinate transformations and show: 1) The time difference between events to be dependent on the observer’s frame of reference; 2) Temporal simultaneity in a reference frame is a unique measurement prescription of two events; 3) A clock not moving in space ticks slower compared to any clock in motion; the effect we already called time dilation. We describe the consistency with the Lorentz coordinate transformation.
Novel Application of Micro-Computerized Tomography for Morphologic Characterization of the Murine Penis

Abstract Background The murine penis model has enriched our understanding of anomalous penile development. The morphologic characterization of the murine penis using conventional serial sectioning methods is labor intensive and prone to errors. Aim To develop a novel application of micro-computerized tomography (micro-CT) with iodine staining for rapid, non-destructive morphologic study of murine penis structure. Methods Penises were dissected from 10 adult wild-type mice and imaged using micro-CT with iodine staining. Images were acquired at 5-μm spatial resolution on a Bruker SkyScan 1272 micro-CT system. After images were acquired, the specimens were washed of any remaining iodine and embedded in paraffin for conventional histologic examination. Histologic and micro-CT measurements for all specimens were made by 2 independent observers. Outcomes Measurements of penile structures were made on virtual micro-CT sections and histologic slides. Results The Lin concordance correlation coefficient demonstrated almost perfect strength of agreement for interobserver variability for histologic section (0.9995, 95% CI = 0.9990–0.9997) and micro-CT section (0.9982, 95% CI = 0.9963–0.9991) measurements. Bland-Altman analysis for agreement between the 2 modalities of measurement demonstrated mean differences of −0.029, 0.022, and −0.068 mm for male urogenital mating protuberance, baculum, and penile glans length, respectively. There did not appear to be a bias for overestimation or underestimation of measured lengths and limits of agreement were narrow. Clinical Translation The enhanced ability offered by micro-CT to phenotype the murine penis has the potential to improve translational studies examining the molecular pathways contributing to anomalous penile development. Strengths and Limitations The present study describes the first reported use of micro-CT with iodine staining for imaging the murine penis. Producing repeated histologic sections of identical orientation was limited by inherent imperfections in mounting and tissue sectioning, but this was compensated for by using micro-CT reconstructions to identify matching virtual sections. Conclusion This study demonstrates the successful use of micro-CT with iodine staining, which has the potential for submicron spatial resolution, as a non-destructive method of characterizing murine penile morphology. O'Neill M, Huang GO, Lamb DJ. Novel Application of Micro-Computerized Tomography for Morphologic Characterization of the Murine Penis. J Sex Med 2017;14:1533–1539.
Use of chemotherapy for patients with stage IV non-small cell lung cancer.

e19010 Background: Most of the information on the use of chemotherapy (CT) for patients with non-small cell lung cancer (NSCLC) has been obtained from SEER-Medicare, which includes only patients ol...
Proteins, air and water: reporter genes for ultrasound and magnetic resonance imaging

A long-standing goal of molecular imaging is to visualize cellular function within the context of living animals, necessitating the development of reporter genes compatible with deeply penetrant imaging modalities such as ultrasound and magnetic resonance imaging (MRI). Until recently, no reporter genes for ultrasound were available, and most genetically encoded reporters for MRI were limited by metal availability or relatively low sensitivity. Here we review how these limitations are being addressed by recently introduced reporter genes based on air-filled and water-transporting biomolecules. We focus on gas-filled protein nanostructures adapted from buoyant microbes, which scatter sound waves, perturb magnetic fields and interact with hyperpolarized nuclei, as well as transmembrane water channels that alter the effective diffusivity of water in tissue.
Opioid use following cervical spine surgery: trends and factors associated with long-term use.

Abstract Background Context Limited or no data exist evaluating risk factors associated with prolonged opioid use following cervical arthrodesis. Purpose The objectives of this study were to assess trends in postoperative narcotic use among preoperative opioid users (OUs) versus non-opioid users (NOUs) and to identify factors associated with postoperative narcotic use at 1 year following cervical arthrodesis. Study Design/Setting This is a retrospective observational study. Patient Sample The patient sample included 17,391 patients (OU: 52.4%) registered in the Humana Inc claims dataset who underwent anterior cervical fusion (ACF) or posterior cervical fusion (PCF) between 2007 and 2015. Outcome Measures Prolonged opioid usage was defined as narcotic prescription filling at 1 year following cervical arthrodesis. Methods Based on preoperative opioid use, patients were identified as an OU (history of narcotic prescription filled within 3 months before surgery) or a NOU (no preoperative prescription). Rates of opioid use were evaluated preoperatively for OU and trended for 1 year postoperatively for both OU and NOU. Multivariable regression techniques investigated factors associated with the use of narcotics at 1 year following ACF and PCF. Based on the model findings, a web-based interactive app was developed to estimate 1-year postoperative risk of using narcotics following cervical arthrodesis ( http://neuro-risk.com/opiod-use/ or https://www.neurosurgerycost.com/opioid/opioid_use ). Results Overall, 87.4% of the patients (n=15,204) underwent ACF, whereas 12.6% (n=2187) underwent PCF. At 1 month following surgery, 47.7% of NOUs and 82% of OUs had a filled opioid prescription. Rates of prescription opioids declined significantly to 7.8% in NOUs versus 50.5% in OUs at 3 months, but plateaued at the 6- to 12-month postoperative period (NOU: 5.7%–6.7%, OU: 44.9%–46.9%). At 1 year, significantly higher narcotic prescription filling rates were observed in OUs compared with NOUs (45.3% vs. 6.3%, p Conclusions Over 50% of the patients used opioids before cervical arthrodesis. Postoperative opioid use fell dramatically during the first 3 months in NOU, but nearly half of the preoperative OUs will remain on narcotics at 1 year postoperatively. Our findings serve as a baseline in identifying patients at risk of chronic use and encourage discontinuation of opioids before cervical spine surgery.
A Qualitative Approach to Health Related Quality-of-Life in Congenital Muscular Dystrophy

Congenital muscular dystrophies (CMD) cause progressive muscle weakness resulting in severe motor disabilities. Previous studies focused on the effects of motor disability. Here, we explore other factors affecting health related quality-of-life (HRQOL) in CMD. Qualitative interviews were conducted with participant-parent dyads to identify symptoms having the greatest impact on HRQOL. Symptoms were classified into themes and domains representing physical, mental, social health, and disease specific issues. Social role limitations and specific activity impairment were frequently mentioned. A greater understanding of symptoms impacting HRQOL will provide a framework for improved clinical care and patient centered outcomes as new therapies are developed.
Mules for Cartels: Survival and Clandestine Migration in the Sonoran Desert

Since the early 1990s, United States border strategies have relied on hazardous natural environments to deter clandestine migration. American lawmakers believed that by securing urban entryways and making clandestine migration difficult, migrants would be discouraged from illegally crossing the United States-Mexico border. Instead, however, these policies inhumanely funneled migration flows toward the forbidding Arizona desert. Consequently, for more than two decades, migrants have been enduring dangerous environments while sharing transitory space with human smugglers and, more recently, drug traffickers, who rely on the same paths into the United States. Using a framework of structural violence, this paper explores how migrants navigate clandestine migration in the Sonoran Desert, particularly as they become beholden to drug cartels, which, in exchange for assistance in crossing the border, insist that migrants transport illicit drugs. Drawing on two summers of ethnographic research at a migrant shelter in Nogales, Mexico, I argue that migrants are not only victims but also agents who employ specific forms of capital to survive highly violent situations during this process. This research reveals the intricacies of today’s clandestine migration across the Arizona-Sonora border and further illustrates the nuances of structural violence.
Structure-activity relationship studies of hemicholinium (HC-3) congeners.

In a continuing investigation of structural requirements for hemicholinium-like activity (inhibition of neuromuscular transmission due to inhibition of uptake of choline into nerve terminals), some additional molecular modifications of hemicholinium (“HC-3”; structure 1) were made. The target compounds were prepared by standard one- or two-step sequences. Noncyclic acetal moieties in general permitted retention of pharmacological activity, as did concomitant replacement of the central bi-phenyl “spacer” by other bulky cyclic groupings and replacement of the oxazinium rings by piperidine or 4-methylpiperidine. However, these modifications generally produced compounds of a lower potency. Replacement of the biphenyl moiety of HC-3 with polyalkylene chains permitted retention of a considerable degree of activity. In these target compounds, the two quaternary nitrogens can exist the same distance apart (approximately 14 A) as in the hemicholinium molecule. The ditertiary amino congener of a pharmacologically active bis-quaternary oxazinium compound was almost completely inactive. To date, only one tertiary amine has been found which displays a significant degree of hemicholinium-like activity.
Ultrafast Hard X-Rays from Electron Accelerators

Modern third-generation synchrotrons are many orders of magnitude brighter than laser-based laboratory sources of x-ray radiation (see figure 1 and reference [8]). Their importance in ultrafast x-ray science has been limited in the past, because the x-ray pulse duration is generally no shorter than the electron bunch lengths in synchrotrons, which are constrained by various technical considerations in electron storage rings to a range of tens of picoseconds or longer [15]. Some important dynamical phenomena can be studied in this sub-nanosecond time range (for example, [11]); however, the fundamental motion of interatomic bonds is in the range of 10’s to 100’s of femtoseconds. Therefore there is a strong research incentive to find new ways to shorten the pulse duration of x-rays from synchrotron radiation. (See, for example, the recent review [1].)
Eco-Physiological Controls on the Productivity of Spartina Alterniflora Loisel

The intertidal salt marshes of the Atlantic and Gulf coasts of the United States are dominated by the perennial grass, Spartina alterniflora Loisel. The ecology of salt marshes in which this species dominates has been extensively investigated because of the documented biogeochemical functions that these ecosystems perform and the resulting societal values they provide. Since many of the salt marsh-derived values originate, either directly or indirectly, from the presence of a vegetated marsh and its primary productivity, it has long been a major goal of salt marsh ecology to elucidate the determinants of the growth of Spartina. This paper reviews the interaction of the abiotic environment with key eco-physiological processes controlling the growth of this important plant species. The productivity of Spartina can vary on both spatial and temporal scales. Spatial differences in productivity on a local scale are primarily determined by abiotic factors, particularly the interaction of soil anoxia, soluble sulfide, and salinity, with plant nitrogen uptake and assimilation. Also, Spartina can induce a positive feedback on productivity by enhancing substrate aeration. The growth enhancing effects of marsh infauna, e.g., fiddler crabs, are mediated through these interacting abiotic variables. Productivity differences on regional scales are largely dependent on geographical differences in climate, tidal amplitude, and soil parent material. Temporal variation results from seasonal and annual variation in climatic and tidal controls that may influence marsh salinity and/or inundation. The concerted research of a large number of scientists has provided one of the most comprehensive and ecologically-relevant analyses of determinants of the primary productivity of any nonagricultural plant species.
Epidemiology of Concussions in High School Boys' Ice Hockey, 2008/09 to 2016/17 School Years.

Objective This study examined the epidemiology of concussions in high school boys' ice hockey during the 2008/09 to 2016/17 school years. Design Prospective cohort study. Athletic trainers from an average 33 high schools annually reported boys' ice hockey concussion and athlete-exposure (AE) data for the High School Reporting Information Online system. Setting Convenience sample of high school boys' ice hockey programs during the 2008/09 to 2016/17 school years. Patients or other participants High school boys' ice hockey players (aged ∼14-18 years). Independent variables Concussion data on event type, injury mechanism, symptom resolution time, and time loss were obtained. Main outcome measures Concussion rates with 95% confidence intervals (CIs) and distributions were calculated. Results Overall, 348 concussions were reported in boys' ice hockey during the 2008/09 to 2016/17 academic years, leading to a concussion rate of 0.68/1000 AEs (95% CI, 0.61-0.75). Most occurred in competitions (85.6%), particularly after the first period (72.1% of all competition concussions). Among practice concussions, most occurred after the first hour of practice (60.0%). Most concussions were due to player contact (47.7%) and boards/glass contact (31.9%). Although 69.0% of concussed athletes had symptoms resolve in less than 7 days, only 14.1% returned to activity within a week. Conclusions Most concussions occurred within the second and third periods. Preventive strategies that counter an increased risk of concussion due to a greater intensity of gameplay coupled with increased fatigue may be warranted. Moreover, athletes may further benefit from prevention efforts that focus on anticipating impacts during gameplay.
A primer on resolving the nanoscale structure of the plasma membrane with light and electron microscopy

The plasma membrane separates a cell from its external environment. All materials and signals that enter or leave the cell must cross this hydrophobic barrier. Understanding the architecture and dynamics of the plasma membrane has been a central focus of general cellular physiology. Both light and electron microscopy have been fundamental in this endeavor and have been used to reveal the dense, complex, and dynamic nanoscale landscape of the plasma membrane. Here, I review classic and recent developments in the methods used to image and study the structure of the plasma membrane, particularly light, electron, and correlative microscopies. I will discuss their history and use for mapping the plasma membrane and focus on how these tools have provided a structural framework for understanding the membrane at the scale of molecules. Finally, I will describe how these studies provide a roadmap for determining the nanoscale architecture of other organelles and entire cells in order to bridge the gap between cellular form and function.
Transitioning to Long-Term Care

Transitioning a patient with dementia from living at home to long-term care is complex and challenging. The decision is based on patient and caregiver factors as well as their psychosocial and cultural backgrounds. Studies have determined some predictors of institutionalization relating to both the patient and caregiver. For instance, studies have shown that caregiver burden, along with a patient’s functional and cognitive status, may determine the likelihood of transition to long-term care. Evidence does not support that the use of medications such as acetylcholinesterase inhibitors delays placement in long-term care. Providers have to transcend gaps in evidence-based medicine in assisting patients and caregivers with decision-making about such transitions. More research is needed in developing tools and guidelines for both providers and families in assisting with these decisions.
Public Versus Private Employees: A Perspective on the Characteristics and Implications:

Abstract'You’re fired!' Infamous words spoken by Donald Trump from prime-time television to the White House. Trump, businessman turned politician, has carried over his characteristics from the priv...
Changes in College Student Endorsement of ADHD Symptoms across DSM Edition

Changes were made in DSM-5 to address the criticism that ADHD symptoms in DSM-IV were not developmentally appropriate for adults. Specifically, parenthetical examples were added to symptoms, and the symptom threshold was lowered. ADHD diagnosis in college students in particular is a growing concern. It was hypothesized that changes to the ADHD symptoms across DSM editions would result in higher symptom endorsement rates in this group. To this end, 3877 college students rated their own ADHD symptoms using DSM-IV and DSM-5 symptom wording. College students with a past diagnosis of ADHD (n = 435) endorsed slightly more symptoms with the updated DSM-5 wording (an additional 0.41 ADHD symptoms). In addition, 5.2% more college students met the new, lowered DSM-5 symptom threshold as compared to the older DSM-IV threshold. Changes to DSM-5 Criterion A for ADHD increase symptom endorsement and the number of college students eligible for a diagnosis.
The Coming Clash Over Migration Policy Between Canada and the United States

Canada and the United States have historically addressed conflicting issues in migration policy reactively rather than proactively. This chapter argues that unless anticipatory action is taken, this trend will likely continue, exacerbated in the current context of a minority government in Canada and a populist government in the United States. Four issue areas are examined here: changes to labour mobility in the United States Mexico Canada Agreement (USMCA), specific labour mobility issues concerning the migration of tech professionals, entry–exit issues, including marijuana legalisation, and the growing challenge posed by refugees, asylum seekers, and the safe third country agreement. Nevertheless, as the chapter shows, each of these challenges can be overcome through forward-thinking policy. To do this, both Canada and the United States will have to eschew their historical preference for short-term compromises in favour of long-term solutions.
Genetic predictors of severe intraventricular hemorrhage in extremely low-birthweight infants.

To test associations between grades 3 or 4 (severe) intraventricular hemorrhage (IVH) and single nucleotide polymorphisms (SNPs) associated with coagulation, inflammation, angiogenesis, and organ development in an exploratory study. Extremely low-birthweight (ELBW) infants enrolled in the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network’s (NRN) Cytokines Study were included if they had cranial ultrasound (CUS) and genotyping data available in the NRN Anonymized DNA Repository and Database. Associations between SNPs and IVH severity were tested with multivariable logistic regression analysis. One hundred thirty-nine infants with severe IVH and 687 infants with grade 1 or 0 IVH were included. One thousand two hundred seventy-nine SNPs were genotyped. Thirteen were preliminarily associated with severe IVH including five related to central nervous system (CNS) neuronal and neurovascular development. Genetic variants for CNS neuronal and neurovascular development may be associated with severe IVH in premature infants.
Predictors of Initial Hydroxychloroquine Receipt among Medicaid Beneficiaries with Incident Systemic Lupus Erythematosus

Objective Although hydroxychloroquine/chloroquine (HCQ/CQ) form the cornerstone of systemic lupus erythematosus (SLE) treatment, not all patients receive this, which may contribute to disparities in outcomes. We investigated factors associated with first dispensing of HCQ/CQ. Methods Using Medicaid insurance claims from 2000-2010, we identified individuals age 18-65 years with incident SLE (≥3 SLE ICD-9 codes separated by ≥30 days without prior SLE codes or HCQ/CQ use for 24 months.) The primary outcome was first dispensing of HCQ/CQ within 24 months of the first SLE code. We used Cox proportional hazards regression models to examine the association between sociodemographic factors, comorbidities, health care utilization and medication use and HCQ/CQ dispensing within 24 months of diagnosis. Results We identified 9560 Medicaid beneficiaries with incident SLE; 41% received HCQ (N=3949) or CQ (N=14) within 24 months of diagnosis. Younger patients were more likely to receive HCQ/CQ. Black, Asian, Hispanic and American Indian/Alaska Native individuals were more likely to receive HCQ/CQ than White individuals. Alcohol, opioid, and nicotine use, diabetes, and end-stage renal disease were associated with lower dispensing. Outpatient appointments and preventive care services were associated with higher rates; more hospitalizations with lower rates. Conclusion Only 41% of Medicaid beneficiaries with SLE received HCQ/CQ within 24 months of diagnosis. Greater outpatient and preventive care increased receipt. All non-White race/ethnicities had higher rates of first dispensing. Time to initial HCQ/CQ dispensing may not explain racial/ethnic disparities in adverse outcomes, highlighting the need to consider other care quality-related issues and medication adherence challenges.
Ultrasonographic technique to differentiate enhanced myometrial vascularity/arteriovenous malformation from retained products of conception

To objective of this study is to discuss the ultrasonographic technique to diagnose uterine enhanced myometrial vascularity/arteriovenous malformation (EMV/AVM) and differentiate it from retained products of conception. The study also reviews the management and outcome of EMV/AVM. We present a series of three women who developed EMV after early pregnancy loss and a control case of incomplete abortion, where colour Doppler ultrasound was used to distinguish retained products of conception from features of EMV. Clinical status and imaging findings, including peak systolic velocity (PSV), were used for the initial risk stratification of the patients. All cases with EMV/AVM were managed expectantly with serial ultrasound imaging and trending human chorionic gonadotropin levels. The patient with retained products of conception was managed by hysteroscopy and curettage. In all cases, presentation was suggestive of incomplete abortion with retained products of conception. However, colour Doppler ultrasound demonstrated hypoechoic areas within the endometrium extending into the myometrium with a high maximum PSV. In the control case, colour Doppler ultrasound noted a heterogeneous area in the left uterine cavity; however, vascular flow in this area was distinct from the endometrium, suggesting retained products of conception. All three women with EMV were managed expectantly with close monitoring and good outcomes. In patients with early pregnancy loss and bleeding or persistently elevated human chorionic gonadotropin levels, clinical status and appropriate use of ultrasound imaging with colour Doppler, including PSV measurement, can assist in recognition of EMV/AVM. Expectant management with serial ultrasound evaluation is a safe treatment option for EMV/AVM with low PSV and can minimise complications such as need for blood transfusion, uterine artery embolization, and hysterectomy.
No Evidence of Creative Benefit Accompanying Dyslexia: A Meta-Analysis.

Research on the question of creative benefit accompanying dyslexia has produced conflicting findings. In this meta-analysis, we determined summary effects of mean and variance differences in creati...
The Esoteric Roots of the Iranian Revolution: The “Wardenship of the Jurist” Through the Metanomian Shi’a of Ayatollah Khomeini (1902–1989)

As the central figure of the Iranian Revolution of 1978–1979, Ayatollah Khomeini established the Islamic Republic through a Shi’a conception of Islamic sovereignty that can be characterized as metanomian. Informed by an esoteric understanding of wilayat-i faqih, the “Wardenship of the Jurist,” he articulated a conception of the state as an extension of the absolute authority of the Imam or his representatives to interpret or abrogate shari’ah. Simultaneously, he disentangled its application from reliance on messianic and/or Mahdist claims, eschewing such identifications himself despite being the recipient and political beneficiary of their projections. Similarly, he avoided reliance on dualistic formulations beyond the apocalyptic eschatology inherent in Islam. His statements and strategies in the early post-Revolutionary period illustrate his mitigation of that underlying dualism through his embrace and intensification of various expressions of conspiracism pervasive in Iran.
Microbial burden on environmental surfaces in patient rooms before daily cleaning-Analysis of multiple confounding variables.

OBJECTIVES Estimated levels of microbial burden on hospital environmental surfaces vary substantially among published studies. Cultures obtained during a cluster-controlled crossover trial of a quaternary ammonium (Quat) disinfectant versus an improved hydrogen peroxide (IHP) disinfectant provided additional data on the amount of microbial burden on selected surfaces. METHODS RODAC plates containing D/E neutralizing agar were used to sample a convenience sample of 5-8 high-touch surfaces in patient rooms on 2 medical wards, an intensive care unit, and a step-down unit at a large hospital. Before routine daily cleaning, samples were obtained in varying rooms over an 11-month period. RODAC plates (1 per surface sampled) were incubated for 72 hours, and aerobic colony counts per plate (ACCs) were determined. Statistical analysis was used to determine the potential impact on ACCs of study period, cleaning compliance rate, disinfectant used, ward, surface sampled, and isolation room status. RESULTS Overall, 590 cultures were obtained on Quat wards and 589 on IHP wards. Multivariable regression analysis revealed that mean ACCs differed significantly by site (P < .001), type of ward (P < .001), isolation room status (P = .039), and study period (P = .036). The highest mean ACCs per RODAC plate were on toilet seats (112.8), bedside rails (92.0), and bathroom grab bars (79.5). CONCLUSIONS The combination of factors analyzed revealed that estimating microbial burden is complex and is affected by multiple factors. Additional studies should evaluate individual sites, ward types, cleaning and disinfection practices, and isolation room status.
Cancers associated with human gammaherpesviruses.

Epstein-Barr virus (EBV; human herpesvirus 4; HHV-4) and Kaposi sarcoma-associated herpesvirus (KSHV; human herpesvirus 8; HHV-8) are human gammaherpesviruses that have oncogenic properties. EBV is a lymphocryptovirus, whereas HHV-8/KSHV is a rhadinovirus. As lymphotropic viruses, EBV and KSHV are associated with several lymphoproliferative diseases or plasmacytic/plasmablastic neoplasms. Interestingly, these viruses can also infect epithelial cells causing carcinomas and, in the case of KSHV, endothelial cells, causing sarcoma. EBV is associated with Burkitt lymphoma, classic Hodgkin lymphoma, nasopharyngeal carcinoma, plasmablastic lymphoma, lymphomatoid granulomatosis, leiomyosarcoma, and subsets of diffuse large B cell lymphoma, post-transplant lymphoproliferative disorder, and gastric carcinoma. KSHV is implicated in Kaposi sarcoma, primary effusion lymphoma, multicentric Castleman disease, and KSHV-positive diffuse large B cell lymphoma. Pathogenesis by these two herpesviruses is intrinsically linked to viral proteins expressed during the lytic and latent lifecycles. This comprehensive review intends to provide an overview of the EBV and KSHV viral cycles, viral proteins that contribute to oncogenesis, and the current understanding of the pathogenesis and clinicopathology of their related neoplastic entities.
Enhancing goals of care communication by oncologists using a pathway-based intervention.

324Background: Delivering goal-concordant care to patients with advanced cancer requires identifying eligible patients who would benefit from goals of care (GOC) conversations; training clinicians ...
Monte Carlo Estimates of Transport Solutions to the Isotropic Slab Problem

The analytic form of the transport solution to the one-speed finite slab problem with isotropic scattering is known. The parameters for this form can be estimated by Monte Carlo methods.
Spark Plugs of Policy Implementation: Intergovernmental Relations and Public Participation in Florida's Acceler8 Initiative to Speed Everglades Restoration

Implementation of environmental policy depends importantly on the cast of characters and the strategies they employ to 'make implementation unfold on their own terms.' Scheberle, Federalism and Environmental Policy 2 (2d. ed. 2004). Supported with funding from U.S. EPA, a research study at St. Thomas University has sought to identify the 'implementation energizers,' those state and federal agency officials and staff who, despite political and bureaucratic forces to the contrary, have served as the spark plugs for implementation of Everglades restoration since congressional adoption of the Comprehensive Everglades Restoration Plan (CERP) in 2000. This paper describes the evolution of federal-state working relationships and concepts of environmental federalism to implement CERP. It focuses especially on Governor Bush’s initiative which began in 2004 to accelerate features of CERP using state funds and construction contracts ahead of planning and construction schedules of the U.S. Army Corps of Engineers and appropriations of the Congress. This program is known as Acceler8.
Dynamics of Inductive ERK Signaling in the Drosophila Embryo

Transient activation of the highly conserved extracellular-signal-regulated kinase (ERK) establishes precise patterns of cell fates in developing tissues. Quantitative parameters of these transients are essentially unknown, but a growing number of studies suggest that changes in these parameters can lead to a broad spectrum of developmental abnormalities. We provide a detailed quantitative picture of an ERK-dependent inductive signaling event in the early Drosophila embryo, an experimental system that offers unique opportunities for high-throughput studies of developmental signaling. Our analysis reveals a spatiotemporal pulse of ERK activation that is consistent with a model in which transient production of a short-ranged ligand feeds into a simple signal interpretation system. The pulse of ERK signaling acts as a switch in controlling the expression of the ERK target gene. The quantitative approach that led to this model, based on the integration of data from fixed embryos and live imaging, can be extended to other developmental systems patterned by transient inductive signals.
Soft-tissue myxoma of the oral cavity: Report of a case

Abstract An extremely rare lesion—an intraoral soft-tissue myxoma of the lip—has been described. Myxomas are benign neoplasms of mesenchyme-like tissue, and they never metastasize. Surgical removal is the treatment of choice. If excision has been incomplete, recurrence is not uncommon.
On the Universality and Contributions of Multiple Criteria Decision Making: A Systems-Based Approach

This paper highlights the omnipresence of the philosophy, theory, methodology and deployment of multiple criteria decision making (MCDM) in essentially every aspect of our lives. It also highlights the specific philosophical, theoretical, methodological, and deployment perspectives that MCDM has influenced, and how MCDM has thus shaped the decision-making process. The following five themes demonstrate the universality of multiple objectives and their impact on the complex decision-making process: (i) the centrality of the states of the system in MCDM; (ii) the centrality of trade-offs in MCDM and the !-constraint method; (iii) the centrality of the time frame in MCDM; (iv) the centrality of risk and uncertainty in MCDM; and (v) the contributions of MCDM to decision analysis. An epilogue concludes the paper. Copyright © 2011 John Wiley & Sons, Ltd.
Abstract 17749: Magnetohydrodynamic Quantification of the Peripheral Perfusion Index in High-field MRI

Background: Peripheral Perfusion Index (PFI) measurements are typically used in the assessment of total body perfusion, commonly serving as indicators of tissue hypoxia and other potential risks [1]. PFI is typically recorded with pulse oximetry (PO), an indirect measurement. Magnetohydrodynamic Voltages (VMHD), caused by interaction of the MRI’s high-magnetic-field with blood-flow [2], are observed on ECG recordings performed inside MRI. Objectives: Develop a method to directly assess patient perfusion levels and PFI using VMHD observed on 12-lead ECGs in MRI. Methods: ECG data was collected in 5 healthy volunteers, using an MRI-conditional 12-lead ECG system. Measurements were performed while incrementally moving the bed into the bore of a 3T MRI. ECG sets were recorded at each positional step, and the real-ECG-signal subtracted from the total trace observed, thus extracting the VMHD contribution in each trace. A Vectorcardiogram (VCG) was then synthesized from the individual MHD signals using an inverse Dower transform [3], and integrated over the cardiac S-T segment, generating a metric proportional to the summed segmental perfusion (SSP) contributions. The SP at each step was solved for by using a linear decomposition matrix, weighting each term based on the magnetic field exposure. VMHD based PFI estimates were calculated as the ratio of aortic to extremity SP [4], and compared to PO- based measurements. Results: VMHD based PFI was calculated for all subjects, providing an error of Conclusions: VMHD-based PFI and perfusion measurements provide characteristic SP patterns and perfusion levels, at comparable accuracy to standard clinical methods. Ref: [1] Lima, Circulation, 2002. [2] Gupta, IEEE, 2008. [3] Dower, Clinical Cardiology, 1980. [4] Ridling, PediatrNurs, 2009. Acknowledgements: NIH U41-RR019703, NIH R03 EB013873-01A1, SBIR-1 R43 HL110427-01
Daily Work Stress and Awakening Cortisol in Mothers of Individuals with Autism Spectrum Disorders or Fragile X Syndrome

The effect of daily work stress on the next morning’s awakening cortisol level was determined in a sample of 124 mothers (M age = 49.89, SD= 6.33) of adolescents and adults with developmental disabilities and compared to 115 mothers (M age = 46.19, SD = 7.08) of individuals without disabilities. Mothers participated in 8 days of diary telephone interviews and provided saliva samples. Multilevel models revealed that mothers of individuals with developmental disabilities had lower awakening cortisol levels than comparison mothers. Work stress interacted with parental status to predict the awakening cortisol level on the following morning. When mothers of individuals with developmental disabilities experienced a work stressor, their awakening cortisol level was significantly higher on the subsequent morning, but for comparison mothers, work stressors were not significantly associated with cortisol level. Findings extend understanding of the differential impacts of specific types of stressors on physiological functioning of mothers of individuals with and without developmental disabilities.
The HOPE programming environment

HOPE (Human-Oriented Programming Environment) is an architecture for a programming environment designed to work in conjunction with Unix. The primary HOPE functions are to collect and organize information about a software project over the life cycle and to promote reuse. HOPE is layered on Unix and does not duplicate any Unix functions. Tools introduced by HOPE implement higher-level operations on the entities defined by HOPE as opposed to the entities defined by Unix. However, the information maintained by HOPE can enhance the use of existing Unix tools. HOPE is object-oriented. The design of the environment focused first on the information models (HOPE objects), then on the operations on these objects (HOPE tools). HOPE objects represent higher-level representations of the software project than those provided by Unix, typically the file. The major HOPE objects are the project and the store. The project is the HOPE representation for the program and the information associated with the program. It provides the workspace in which both HOPE and Unix tools are used. The store is used for the organized storage of both information and program components. The store consists of a set of libraries, each of which holds related components. >
La psyché du bon citoyen : sur la psychologie de la vertu civique

Quelles sont les sources psychologiques de la vertu civique dans la tradition republicaine? Cet article en identifie trois : l’education des passions, la manipulation des interets et la contrainte du devoir. L’auteure explore chacune de ces sources et conclut qu’une meilleure appreciation de ce qui les distingue est porteuse de nouvelles possibilites pour raviver la vertu republicaine dans le monde moderne.
Design and Control of a Haptic Enabled Robotic Manipulator

Robotic surgery offers various advantages over conventional surgery that includes less bleeding, less trauma, and more precise tissue cutting. However, even surgeons who use the best commercially available surgical robotic systems complain about the absence of haptic feedback in such systems. In this paper, we present the findings of our project to overcome this shortcoming of surgical robotic systems, in which a haptic-enabled robotic system based on master and slave topology is designed and developed. To detect real-time intrusion at the slave end, haptic feedback is implemented along with a programmable system on chip, functioning as an embedded system for processing information. In order to obtain real-time haptic feedback, force and motion sensors are mounted on each joint of the master and slave units. At the master end, results are displayed through a graphical user interface, along with the physical feeling of intrusion at the slave part. Apart from the obvious applications of the current system i...