cssi/SciSciGPT-SciSciNet huggingface dataset:
Mitochondrial replacement therapy: Ethical, sociocultural, and public policy considerations

Abstract The National Academies of Science, Engineering and Medicine released a report on whether research efforts to address heritable mitochondrial DNA diseases using mitochondrial replacement techniques (MRT) are ethically justifiable and permissible. Commissioned by the US Food and Drug Administration (FDA), a diverse committee of experts in medicine, ethics, and the law deliberated on issues related to ethics, society, and public policy and arrived at a consensus opinion that endorsed proceeding with research, including clinical trials under the careful scrutiny of the FDA. However, despite this encouraging decision, political opponents of MRT successfully blocked further progress by embedding into an appropriations bill legislation that precludes the FDA from reviewing research applications related to MRT research. This obstacle was gravely disappointing to thousands of patients who hoped to benefit from MRT use and many physicians and research scientists laboring to eradicate these horrific diseases. Scientific progress in MRT research has been impressive, and American investigators have been on the forefront of assisting the international community to move the research bench to human trials. After a similar metric of review and public debate, the United Kingdom passed laws permitting the research efforts that Americans blocked from performing. This unfortunate political move threatens to halt research initiatives in the United States and certainly delays implementing an effective reproductive choice for curing a vast number of mitochondrial mutational diseases. It is our hope that this law will soon be reversed, and we support all efforts to challenge any action that blocks progress with MRT research efforts.
Multigrid preconditioners for optimal control problems with stochastic elliptic PDE constraints

In this work, we construct multigrid preconditioners to be used in the solution process of pathwise optimal control problems constrained by elliptic partial differential equations with random coeff...
Lines of systemic therapy in patients with metastatic melanoma in the United States.

e19043 Background: To describe treatment patterns by lines of systemic (drug) therapy in patients with metastatic melanoma in the U.S. Methods: Using a large U.S. medical claims database, patients ...
Spectral Density Method of Liquid Propellant Gauging

My summer internship experience with NASA Kennedy Space Center’s Advanced Engineering Development Branch focused on collecting and processing data to aid in developing Modal Propellant Gauging (MPG) for use in future Orion/SLS missions. The MPG project is an effort to develop a non-invasive low-cost propellant mass gauging technology for application to existing spacecraft propellant tanks in both low-gravity and earth-loading applications. During my internship I constructed a fuel gauging framework through characterizing the modal signature of a composite-overwrap liquid propellant tank used for testing purposes. I accomplished this through: writing and implementing algorithms that apply broadband white noise signals to piezoelectric actuators adhered to the tank surface, processing acoustic data using Fourier analysis, and producing frequency response functions to experimentally determine resonant modes of the tank structure. A limitation of the current MPG technique is that it does not work in environments with changing pressure; during my internship I also made fundamental contributions to the development of the Spectral Density Propellant Gauging Method, a technique that does not depend on the stiffness of the tank walls.
Method for Economic Evaluation of Bacterial Whole Genome Sequencing Surveillance Compared to Standard of Care in Detecting Hospital Outbreaks.

BACKGROUND Whole genome sequencing (WGS) surveillance and electronic health record data mining have the potential to greatly enhance the identification and control of hospital outbreaks. The objective was to develop methods for examining economic value of a WGS surveillance-based infection prevention (IP) program compared to standard of care (SoC). METHODS The economic value of a WGS surveillance-based IP program was assessed from a hospital's perspective using historical outbreaks from 2011-2016. We used transmission network of outbreaks to estimate incremental cost per transmission averted. The number of transmissions averted depended on the effectiveness of intervening against transmission routes, time from transmission to positive culture results and time taken to obtain WGS results and intervene on the transmission route identified. The total cost of an IP program included cost of staffing, WGS, and treating infections. RESULTS Approximately 41 out of 89 (46%) transmissions could have been averted under the WGS surveillance-based IP program, and it was found to be a less costly and more effective strategy than SoC. The results were most sensitive to the cost of performing WGS and the number of isolates sequenced per year under WGS surveillance. The probability of the WGS surveillance-based IP program being cost-effective was 80% if willingness to pay exceeded $2400 per transmission averted. CONCLUSIONS The proposed economic analysis is a useful tool to examine economic value of a WGS surveillance-based IP program. These methods will be applied to a prospective evaluation of WGS surveillance compared to SoC.
Prevention of COVID-19 among older adults receiving pneumococcal conjugate vaccine suggests interactions between Streptococcus pneumoniae and SARS-CoV-2 in the respiratory tract.

INTRODUCTION: While secondary pneumococcal pneumonia occurs less commonly after COVID-19 than after other viral infections, it remains unclear whether other interactions occur between SARS-CoV-2 and Streptococcus pneumoniae. METHODS: We probed potential interactions between these pathogens among adults aged ≥65y by measuring associations of COVID-19 outcomes with pneumococcal vaccination (13-valent conjugate and 23-valent polysaccharide; PCV13, PPSV23). We estimated adjusted hazard ratios (aHRs) using Cox proportional hazards models with doubly-robust inverse-propensity weighting. We assessed effect modification by antibiotic exposure to further test the biologic plausibility of a causal role for pneumococci. RESULTS: Among 531,033 adults, there were 3,677 COVID-19 diagnoses, leading to 1,075 hospitalizations and 334 fatalities, between 1 March-22 July, 2020. Estimated aHRs for COVID-19 diagnosis, hospitalization, and mortality associated with prior PCV13 receipt were 0.65 (95% confidence interval: 0.59-0.72), 0.68 (0.57-0.83), and 0.68 (0.49-0.95), respectively. Prior PPSV23 receipt was not associated with protection against the three outcomes. COVID-19 diagnosis was not associated with prior PCV13 within 90 days following antibiotic receipt, whereas aHR estimates were 0.65 (0.50-0.84) and 0.62 (0.56-0.70) during risk periods 91-365d and >365d following antibiotic receipt, respectively. DISCUSSION: Reduced risk of COVID-19 among PCV13 recipients, transiently attenuated by antibiotic exposure, suggests pneumococci may interact with SARS-CoV-2.
Violent trauma as an indirect impact of the COVID-19 pandemic: A systematic review of hospital reported trauma

Abstract Introduction The COVID-19 pandemic has exacerbated many social conditions associated with violence. The objective of this systematic review was to examine trends in hospital reported violent trauma associated with the pandemic. Methods Databases were searched in using terms “trauma” or “violence” and “COVID-19,” yielding 4,473 records (2,194 de-duplicated). Exclusion criteria included non-hospital based studies and studies not reporting on violent trauma. 44 studies were included in the final review. Results Most studies reported no change in violent trauma incidence. Studies predominately assessed trends with violent trauma as a proportion of all trauma. All studies demonstrating an increase in violent trauma were located in the United States. Conclusions A disproportionate rise in violence has been reported within the US. However, most studies examined violent trauma as a proportion of all trauma; results may reflect relative changes from lockdowns. Future studies should examine rates of violent trauma to provide additional context.
Predicting wildfire impacts on the prehistoric archaeological record of the Jemez Mountains, New Mexico, USA

Wildfires of uncharacteristic severity, a consequence of climate changes and accumulated fuels, can cause amplified or novel impacts to archaeological resources. The archaeological record includes physical features associated with human activity; these exist within ecological landscapes and provide a unique long-term perspective on human–environment interactions. The potential for fire-caused damage to archaeological materials is of major concern because these resources are irreplaceable and non-renewable, have social or religious significance for living peoples, and are protected by an extensive body of legislation. Although previous studies have modeled ecological burn severity as a function of environmental setting and climate, the fidelity of these variables as predictors of archaeological fire effects has not been evaluated. This study, focused on prehistoric archaeological sites in a fire-prone and archaeologically rich landscape in the Jemez Mountains of New Mexico, USA, identified the environmental and climate variables that best predict observed fire severity and fire effects to archaeological features and artifacts. Machine learning models (Random Forest) indicate that topography and variables related to pre-fire weather and fuel condition are important predictors of fire effects and severity at archaeological sites. Fire effects were more likely to be present when fire-season weather was warmer and drier than average and within sites located in sloped, treed settings. Topographic predictors were highly important for distinguishing unburned, moderate, and high site burn severity as classified in post-fire archaeological assessments. High-severity impacts were more likely at archaeological sites with southern orientation or on warmer, steeper, slopes with less accumulated surface moisture, likely associated with lower fuel moistures and high potential for spreading fire. Models for predicting where and when fires may negatively affect the archaeological record can be used to prioritize fuel treatments, inform fire management plans, and guide post-fire rehabilitation efforts, thus aiding in cultural resource preservation.
Exploring a novel approach to surgery clerkship didactics during the COVID-19 pandemic: A qualitative study.

Abstract Background The COVID-19 pandemic brings unforeseen challenges in medical education. The current study aims to: 1) describe third-year medical students’ experiences with the novel Shelf-Exam-Type Question Didactics (SET QD) before (in-person) and during (virtual) COVID-19. Methods In this qualitative study using grounded theory, we conducted purposive sampling and used 23 in-depth semi-structured interviews. Audio recordings were transcribed verbatim and the Atlas.Ti software was used to manage the thematic analysis. Results There are three themes and eight subthemes that emerged: 1) The SET QD Framework (sub-themes: questions as learning opportunities; interleaving; notable clinical scenarios; team learning; accountability). 2) Experienced Educator (subtheme: transformational teaching). 3) Virtual Accessibility (sub-themes: alleviating time constraints, and mitigating life-stressors). Conclusions Medical students regarded SET QD as impactful for shelf exam preparation, clinical preparation, and long-term retention of the material. This novel virtual didactic method may be used in non-surgical clerkships as well.
Reasonable Royalties in 'Patent Remedies and Complex Products: Toward a Global Consensus'

Reasonable Royalties, a chapter authored by seven esteemed law professors in Patent Remedies and Complex Products: Toward a Global Consensus, provides a wide-ranging analysis of a complicated topic. Directed to patent specialists, this work offers proposals for substantive change aimed toward worldwide adoption. Several of these ideas might require significant judicial oversight, or, alternatively, that legal authorities reformulate existing law. Because of their complexity, many of these proposals are implementable in juris-dictions where damages are set by the court. Where juries are assigned that role, a reexamination of their fact-finding role in that process is necessary.
Bordering on Crisis; Overcoming Multiagency Crisis Coordination Challenges (co-authored) in Crisis Lawyering: Effective Legal Advocacy in Emergency Situations, edited by Ray Brescia and Eric K. Stern

While crisis management isn’t new, the strategic response landscape now includes formal collaborative frameworks. A key element of interagency alignment involves lawyers who are increasingly being called upon to advise in crisis situations. More than a dozen states, multilateral instruments, and United Nations Security Council resolutions formally acknowledge the benefits of collaboration to address threats, yet the elements and competencies, as well as inclusion, of crisis lawyering receives scant attention. This chapter examines the role of an attorney in crisis management and includes 20 rules for crisis lawyering in a multi-agency response environment.
Vaginal Cuff Dehiscence: Tips for Laparoscopic Repair and Prevention

Study Objective To define vaginal cuff dehiscence, identify risk factors for dehiscence, understand steps needed for laparoscopic cuff revision, and review techniques for cuff closure. Design Vaginal cuff dehiscence, defined as a full thickness separation of the vaginal cuff, is a rare but morbid complication after hysterectomy. After a total laparoscopic hysterectomy, the incidence of vaginal cuff dehiscence is 0.7% (range 0.64 – 1.27%). Risk factors include poor vaginal cuff closure technique, smoking, low body mass index, conditions that cause poor wound healing such as infection, hematoma, prior radiation, or immunosuppression, and increased pressure on the vaginal incision line such as trauma, pelvic organ prolapse, or excessive valsalva. In this video we will demonstrate a laparoscopic repair of a vaginal cuff dehiscence. Setting Patients should be positioned in lithotomy position in the operating room. Standard GYN laparoscopic setup should be used. The authors prefer placing the camera via a 5mm trocar in the umbilicus, with 2 accessory 5mm ports laterally and a 5mm suprapubic port. Patients or Participants N/A. Interventions In this video we describe the 5 steps of a laparoscopic repair of a vaginal cuff dehiscence. We also discuss tips and tricks to optimize cuff closure. • Identify and normalize anatomy • Identify the vaginal cuff defect • Mobilize the cuff • Excise cuff edges • Close the cuff Measurements and Main Results N/A. Conclusion Although vaginal cuff dehiscence is rare, knowledge of safe and effective laparoscopic repair technique is crucial for the gynecologic surgeon, both for repair and for prevention of future cuff dehiscence.
The Nonconstitutional Character of Ineffective Assistance of Counsel Claims in Immigration Proceedings: A Brief Comment on Afanwi v. Mukasey

This brief essay deals with the United States Court of Appeals for the Fourth Circuit's recent decision in Afanwi v. Mukasey. In that case, the Fourth Circuit became the first federal appellate court to hold that ineffective assistance of counsel in immigration proceedings cannot constitute a violation of the alien's Fifth Amendment right to due process. This holding is contrary to the holdings of 9 of the remaining 10 courts of appeals that have addressed the issue. Despite the vast weight of jurisprudential opposition to the Fourth Circuit's decision, however, Afanwi was correctly decided. Because there is no constitutional right to counsel in immigration proceedings, and thus no obligation on the part of the state to provide counsel, there can be no constitutional violation when retained counsel performs ineffectively. The instant essay explores the Supreme Court's decisional law regarding when the ineffective assistance of counsel may be imputed to the state for constitutional purposes, and weighs that body of law against the reasoning of those courts of appeals that have found a due process right to effective assistance of counsel in immigration proceedings. Having explored the false underpinnings of these decisions, the Fourth Circuit’s reasoning in Afanwi is presented. Although a trend towards the Fourth Circuit's rationale is not likely, the issue is now squarely primed for Supreme Court review; in the foreseeable future, perhaps, the issue will then be a matter of settled (non) constitutional law.
Fate and efficacy of polyacrylamide applied in furrow irrigation: Full-advance and continuous treatments

Polyacrylamide (PAM) is applied to 400 000 irrigated hectares annually in the USA to control irrigation-induced erosion, yet the fate of dissolved PAM applied in irrigation water is not well documented. We determined the fate of PAM added to furrow streams under two treatments: Initial-10, 10 mg L-1 PAM product applied only during the initial hours of the irrigation, and Cont-1, 1.0 mg L—1 PAM product applied continuously during the entire irrigation. The study measured PAM concentrations in 167-m-long PAM-treated furrow streams and along a 530-m tail ditch that received this runoff. Soil was Portneuf silt loam (coarse-silty, mixed, superactive, mesic Durinodic Xeric Haplocalcid) with 1.5% slope. Samples were taken at three times during the irrigations, both during and after PAM application. Polyacrylamide was adsorbed to soil and removed from solution as the streams traversed the soil-lined channels. The removal rate increased with stream sediment concentration. Stream sediment concentrations were higher when PAM concentrations were <2 mg L-1 a.i., for early irrigations, and when untreated tributary ?ows combined with the stream. In these cases, PAM concentration decreased to undetectable levels over the ?ow lengths used in this study. When in?ows contained >6 mg L-1 PAM a.i., stream sediment concentrations were minimal and PAM concentrations did not change down the furrow, though they decreased to undetectable levels within 0.5 h after application ceased. One percent of applied PAM was lost in tail-ditch runoff. This loss could have been eliminated by treating only the furrow advance or not treating the last two irrigations.
Considering human capital theory in assessment and training: Mapping the gap between current skills and the needs of a knowledge-based economy in northeast Iowa

In light of the current economic downturn, thousands of Iowan’s are unemployed and this is the ideal time to build the skills of the workforce to compete in the knowledge-based economy so businesses and entrepreneurs can compete in a global economy. A tool for assessing the skills and knowledge of dislocated workers and students as well as identifying skills deficits in order to match individuals’ transferrable skills to high-demand jobs is essential in order for dislocated workers and students to increase their human capital. It is essential for individuals to make informed decisions regarding the training they need and for educational institutions to provide appropriate educational programs that are responsive to the needs of the knowledge-based economy. The purposes of this study were to compare the relationships between knowledge levels, transferrable skills, and skill needs of dislocated workers in northeast Iowa to the knowledge and skill needs of area businesses, to outline and develop a model for equipping Iowa’s workforce for a knowledge-based economy, and to provide a paradigm for assessment and training. The research questions guiding this study included: (a) What are the demographic characteristics of northeast Iowa’s dislocated workers? (b) What are the current skills, knowledge, and competencies of dislocated workers in northeast Iowa? (c) Are there differences in the skills, knowledge, and competencies between male and female dislocated workers? (d) What are the aspirations of dislocated workers in northeast Iowa? (e) What are the skills gaps of dislocated worker regarding the knowledge-based economy? (f) What education and training programs are needed to adapt the current skills set clusters to a knowledge-based economy in northeast Iowa?
Commercial Real Estate: Underwriting, Mortgages, and Prices

Commercial real estate (CRE) has undergone enormous changes over the past two decades, even apart from the financial crisis. At the end of 2011, commercial and multifamily mortgage balances totaled over $3 trillion. That was about twice as much at the end of 2000. At its peak in 2008, the ratio of balances to the size of the U.S. economy was one and a half times as large as in 2000. Since 2007, several indicators signaled that commercial mortgage underwriting, after apparently being lax, had tightened rapidly and severely. Historically, more than half of commercial mortgages were held by commercial banks and other depositories. Life insurers historically were the other major holders. Over the past dozen years, however, securitized pools have held increasingly important shares of total commercial mortgages. Thus, the relative size of the commercial mortgage market has fluctuated considerably and the percentages of total commercial mortgages that different groups of investors held have also shifted considerably over time. In addition, (inflation-adjusted) CRE prices dipped by more than 20 percent in the early 1990s, before rising about 50 percent during the 2000s and then dropping by about 40 percent during 2007-2009.We develop an index of commercial mortgage underwriting that combines information for 1990-2011 from the three largest segments of originators of these mortgages: depositories, life insurers, and issuers of commercial mortgage-backed securities (via conduit and other lenders). For depositories, we used surveys about commercial mortgage underwriting conditions from their loan officers and government-employed examiners. For life insurers, we used indicators of key elements in commercial mortgage underwriting: capitalization rates and yield spreads. For CMBS, we used interest spreads for their mortgages and for their AAA securities. We also explain why loan-to-value ratios were unlikely to accurately reflect underwriting during 1990-2011.We then used the index in a vector autoregression to estimate how CRE price growth and commercial mortgage flows responded to changes in underwriting, and, in turn, how price growth and mortgage flows affected underwriting itself. We found that underwriting had important, independent effects on the CRE market.We also found that underwriting loosened when (the growth rates of) CRE prices rose. Our results suggested that, before the crisis, underwriting responded to recent, past prices. That implies that underwriting amplified movements in CRE markets: Faster price growth loosened underwriting, which raised CRE lending and prices, which in turn loosened underwriting further. The crisis apparently changed how commercial mortgages were underwritten. While past prices continue to directly affected it, underwriting also became significantly affected by predictions of future developments in CRE prices.
Catalytic activities of thermal polyanhydro- alpha-amino acids

Catalytic activities of thermal polyanhydro-alpha- amino acids for modeling enzymes and prebiotic protein
Zeroing In on an Elusive Target

Abstract As an Interlibrary Services (ILS) department in an academic library, we originally set out to find what sources from which to borrow government documents. We found instead that our library already has most of the requested publications, although library users believe most of their publications cannot be found here. A survey of Interlibrary Services requests for the summer of 1997 through the summer of 1998 showed that most of the government documents requested through ILS were located in the library, but published before 1976; others were government-funded technical reports that did not appear on the online catalog. A variety of paper indexes were used to locate these publications. Without these indexes, many of these publications would have been difficult, if not impossible, to find.
Effect of Changes in the Pool of Acetate on the Incorporation and Distribution of 13C- and 14C-Labeled Acetate into Showdomycin by Streptomyces showdoensis

Abstract The effect of concentration of 13C- and 14C-labeled acetate in the soluble pool on the distribution of 13C or 14C in the maleimide ring of showdomycin by Streptomyces showdoensis has been studied. 13C incorporation was observed by means of proton-decoupled 13C Fourier transform NMR spectroscopy. 13C NMR spectra confirmed earlier findings that the carboxyl carbon of [1-14C]acetate incorporates exclusively in carbon 5 of the maleimide ring. When the concentration of acetate is 0.2 µm, all four carbons of the maleimide ring are labeled by 14C from [2-14C]acetate. At high concentration of [2-13C]acetate (1800 µm), carbons 2, 3, and 4 are labeled, but carbon 5 is not. These observations can be explained by the combined action of the Krebs cycle and the malic enzyme. The malic enzyme would give rise to [1,2-14C]acetate from [2-14C]acetate. At 1800 µm, the [1,2-13C]acetate formed via the malic enzyme is diluted by the large amounts of [2-13C]acetate in the acid-soluble pool. The result is a negligible 13C incorporation into carbon 5. The 13C NMR findings were confirmed by using high and low concentrations of [2-14C]acetate. The percentage of 14C in carbon 5 decreased from 22% (low acetate) to 4% (high acetate). While it is very difficult to make comparisons of enzyme activities concerned with the biosynthesis of a compound such as showdomycin, it is now possible to study the actual physiological effects of high and low concentrations of acetate in intact cells. This type of study provides an accurate picture of the biochemistry of those compounds as determined by the Krebs cycle and the malic enzyme.
Models of grids

Grid computing has emerged as a significant new model of computing. Computing grids can be constructed in a centrally organized way, or they can be constructed by mobilizing ad hoc networks of autonomous systems. The primary uses to date have involved the collaboration around information processing tasks and file sharing tasks.
The impact of group B Streptococcus prophylaxis on early onset neonatal infections

Objective To determine if changes have occurred in the causative pathogens and/or antibiotic susceptibility profiles in early onset neonatal infections since initiation of group B Streptococcus (GBS) prophylaxis and to determine risk factors for ampicillin/penicillin resistant microorganisms. Study design Data on 220 infants with positive blood, urine, or cerebrospinal fluid cultures for bacteria or fungi at ≤seven days of age from 1990-2007 were examined and divided into three epochs, based on intrapartum antibiotic prophylactic (IAP) practices. Pathogens and antibiotic resistance were compared among epochs. Results A significant decrease in the incidence of GBS infections occurred over time, with no change in the incidence of other pathogens or the emergence of antibiotic resistance, including the very low-birthweight population. In regression analysis, ampicillin resistance was associated with male gender (OR 3.096). Conclusions No emergence of antibiotic resistant pathogens was found following IAP use. Changing microorganisms and increasing antibiotic resistance found in prior studies are likely multifactorial. Further study is needed to continue to reduce the rates of common early onset pathogens.
Liquefaction and Refrigeration Systems

Although the emphasis of this book is on the development of physical understanding of helium as a cryogenic fluid, the discussion would be incomplete without reviewing the various methods of obtaining low-temperature helium. Such methods are based solidly in engineering thermodynamics and rely primarily on a combination of processes which make up a cycle. A cycle consists of a closed circuit where the working fluid, for example helium, is compressed, expanded, and heat exchanged in such a way as to achieve cooling. The simplest and most thermodynamically ideal cycle is the Carnot cycle which consists of a combination of isothermal and isentropic processes. The Carnot cycle is difficult to achieve in a practical system. However, real refrigeration and liquefaction systems are made up of similar processes which are usually compared in their performance to that of the ideal Carnot cycle. In all gas refrigeration systems, the cooling is achieved by an expansion process. There are essentially two types of expansion which are applied. Isentropic expansion is that where the fluid does work and expands keeping its entropy constant (ΔS = 0). This is the best method of expansion because it produces the largest temperature change over a given pressure change. The other expansion process is isenthalpic expansion,where the fluid undergoes a pressure change without heat transfer (ΔQ = 0). This method is in common application in practical refrigeration systems for its ease of use. However, it is of lower thermodynamic efficiency because it is an irreversible process leading to nonidealities.
cDNA cloning of a mouse factor that activates transcription from a metal response element of the mouse metallothionein-I gene in yeast.

ABSTRACT A cDNA that encodes a mouse factor that activates expression from a metal response element of the mouse metallothionein-I gene has been isolated by complementation cloning in yeast cells. The cDNA encodes a peptide with a maximum length of 99 amino acids that includes a single zinc finger sequence. In yeast cells, the cloned factor induces transcription from the metal response element in a sequence-specific but metal-independent fashion. The cDNA hybridizes to a 550-base mRNA that is constitutively expressed in mouse tissue culture cells. The ability of the mouse factor to activate transcription in yeast cells is dependent upon the carbon source.
A review of the economics of treating Clostridium difficile infection.

Clostridium difficile infection (CDI) is a costly result of antibiotic use, responsible for an estimated 14,000 deaths annually in the USA according to the Centers for Disease Control and Prevention. Annual costs attributable to CDI are in excess of $US1 billion. This review summarizes appropriate utilization of prevention and treatment methods for CDI that have the potential to reduce the economic and humanistic costs of the disease. Some cost-effective strategies to prevent CDI include screening and isolation of hospital admissions based on C. difficile carriage to reduce transmission in the inpatient setting, and probiotics, which are potentially efficacious in preventing CDI in the appropriate patient population. The most extensively studied agents for treatment of CDI are metronidazole, vancomycin, and fidaxomicin. Most economic comparisons between metronidazole and vancomycin favor vancomycin, especially with the emergence of metronidazole-resistant C. difficile strains. Metronidazole can only be recommended for mild disease. Moderate to severe CDI should be treated with vancomycin, preferably the compounded oral solution, which provides the most cost-effective therapeutic option. Fidaxomicin offers a clinically effective and potentially cost-effective alternative for treating moderate CDI in patients who do not have the NAP1/BI/027 strain of C. difficile. Probiotics and fecal microbiota transplant have variable efficacy and the US FDA does not currently regulate the content; the potential economic advantages of these treatment modalities are currently unknown.
Considerations in the Surgical Management of Ovarian Cancer in the Elderly

Elderly patients with advanced epithelial ovarian cancer present a complex treatment dilemma. On the one hand, patients can be treated with primary debulking surgery to achieve the ideal oncologic outcomes but at the expense of risk of surgical morbidity and mortality. On the other hand, they can be treated with alternative, less morbid approaches, reducing toxicity, but sacrificing the survival benefits of low residual disease by surgical cytoreduction. Retrospective studies have attempted to identify risk factors for poor surgical outcome. Although there is no consensus to define “elderly” or “frail,” current evidence identifies age, performance status, nutritional status, and surgical complexity as major risk factors for surgical morbidity. Accepting the shortcomings of these retrospective data, candidates for primary debulking surgery can be assessed for risk of surgical morbidity. Age is likely a contributor to morbidity, particularly in the face of comorbid conditions. Clinicians should strive to treat elderly patients with a standard approach of primary debulking surgery and adjuvant chemotherapy when healthy and in the absence of other risk factors. Elderly patients with the following are poor surgical candidates and an alternative treatment approach should be considered: poor nutritional status (characterized by serum albumin <3.0 g/dL), or poor performance status (ASA ≥3), and stage IV disease. Several of these factors are modifiable by treating the underlying cancer. These patients should be treated with two to three cycles of neoadjuvant chemotherapy and reassessed for surgical debulking. Patients with improvement in their nutritional or performance status can undergo interval debulking with the goal to resect all visible disease.
Two-tone masking and auditory critical bandwidths.

Two-tone masking of 1 000-Hz signals was investigated in 5 normally-hearing listeners. The results indicate a consistent increase in critical bandwidth with level of the two masking tones (approximately 3%/dB). Irregularities in the individual two-tone masking functions led to further investigations with a single listener. For subcritical frequency separations between masking tones, -10 dB/decade masking slopes were demonstrated along with large dips or notches in the two-tone masking functions. Both the -10 dB/decade masking slopes and the large notches were replicated in detail when only the lower-frequency tones of the two-tone masking pairs were employed as maskers. Separate masking bands were then introduced that eliminated the -10 dB/decade masking slope and the large notch. It is concluded that the two-tone masking experiment is really a single-tone experiment, and that the detection of beats, roughness, and combination tones determines the form of single-tone and two-tone masking functions. If cri...
Ambivalence and dialysis discontinuation

Although dialysis discontinuation is the second leading "cause" of death among individuals who are maintained with chronic dialysis, little attention is accorded in the literature to patient ambivalence with this crucial decision. Three cases are presented of clinical situations involving termination of dialysis and ambivalence. The ambivalence of the patients is mirrored by the literature's vacillation between viewing cessation of life-support as pathological, and perceiving it as rational. There is considerable variability in the presentation of these cases, and they require exquisite sensitivity and flexibility on the part of medical personnel. As patient-physician communication is encouraged, and staff attempt to honor requests for initiation and/or discontinuation of treatment, we will see increasing numbers of ambivalent patients.
Dental Allometry in Mammals: A Retrospective

Kleiber suggested that mammalian metabolic rate scales with body mass at Mb3/4. Bigger animals use relatively less energy. Gould reasoned that teeth should scale the same way given caloric need. In many cases though, cheek tooth occlusal area increases isometrically, one-to-one with body mass (i.e., Mb2/3). Fortelius reconciled the discrepancy by noting that larger mammals also chew slower, so a given amount of food per bite but few bites per unit time could still mean metabolic scaling of energy consumed in a day. Here I revisit dental allometry, referencing new studies of tooth size, muscle mass, chewing rate, and food fracture scaling. Early predictions have held up reasonably well through the decades, though many more factors involved have emerged. These can be difficult to parse for intepreting deviations from expected tooth size in fossil mammals, including early hominins. Still, relative tooth size variation can help us generate dietary hypotheses.
Development of an instrument to electronically measure, record, and image washover of a towed body

Abstract Washover is the condition of occasional, partial, or complete inundation of the surface of a body floating in water. Washover is typically caused by wave and wind action. A knowledge of the three-dimensional spatial and temporal parameters of seawater washover of low-profile towed bodies, buoys, and other maritime towed, tethered, and free-floating bodies is extremely helpful in the understanding and improving of their hydrostatic and hydrodynamic performance under a wide variety of sea states. Here we discuss the theory, implementation, and initial testing of a newly developed electromagnetic measurement technique and system (patent pending). This system provides real-time three-dimensional spatial and temporal detection, measurement, and visualization of washover. Data can be acquired and displayed in real time, as well as stored for later post-processing and analysis. The system has been successfully tested in a seawater wave tank and shows promise for open-ocean washover testing of low-profile buoyant towed bodies. This washover assessment measuring system is expected to provide an empirically based benchmarking process for computational fluid dynamic assessments of turbulent flow around arbitrarily shaped surface-towed bodies.
Patterns for four-allele population genetics model.

In this paper, we find and classify all existing patterns for a single-locus four-allele population genetics models in continuous time. An existing pattern for a k-allele model means a set of all coexisting asymptotically stable equilibria with respect to the flow defined by the system of equations pi=pi(ri−r),i=1,…,k, where pi and ri are the frequency and marginal fitness of allele Ai, respectively, and r is the mean fitness of the population. It is well known that for the two-allele model there are only three existing patterns, depending on the relative fitness between the homozygotes and the heterozygote. For the three-allele model there are 14 existing patterns, and we shall show in this paper that for the four-allele model there are 117 existing patterns. We also describe the domains of attraction for coexisting asymptotically stable equilibria. The problem of finding existing patterns has been studied in the past, and it is an important problem because the results can be used to predict the long-term genetic makeup of a population. It should be pointed out that this continuous-time model is only an approximation to the corresponding discrete-time model. However, the set of equilibria and their stability properties are the same for the two models.
Reliability in scientific evidence based on multi trace forensic neutron activation analysis

The forensic activation analyst must often evaluate his own results as they relate to certain legal or moral situations, since investigative officers, and courts of law are not usually competent to make judgements of the validity or meaning of scientific data. In providing scientific evidence in court, two criteria for criminal identification must be met: (1) suspect's sample should be similar to sample found at the scene of the crime, (2) samples relared to other people in the same statistical population should not generally match that found at the crime site. When two or more specimens are submitted for comparison by NAA they will usually fall into one of three classes: (a) materials about which we have partial or inconclusive data, (c) materials with an excellent analytical data background. Ideally all cases would fall in category c; in practice, very few. Some examples of cases and/or situations that fall into these three categories in both individual and corporate investigations are given.
Evaluating the Knowledge of Breast Cancer Screening and Prevention among Arab-American Women in Michigan

Arab-American women are more likely to be diagnosed with advanced staged breast cancer. We analyzed data from 100 women utilizing a breast cancer literacy assessment tool aimed at understanding functional literacy levels about breast-self exams (BSE), clinical breast exams (CBE), and mammograms. The educational program improved women's knowledge of BSE (OR = 0.15; 95% CI = 0.04, 0.50) and CBE (OR = 0.15; 95% CI = 0.04, 0.54), more for women with higher education. Consideration of women's educational status is an important factor in planning educational programs to improve knowledge on breast cancer screening and prevention in this minority population.
Enhancing Early Intervention Services to Infants/Toddlers and Their Families

Early interventionists, regardless of primary discipline, are highly interested in enhancing services to children under three years and their families. A significant barrier to improved case-finding may be a lack of familiarity with an important array of issues related to early intervention. This article is designed to familiarize all members of the early intervention team with several significant issues and thereby gain greater access and improve overall efficacy for children under three years of age.
The Effects of Explicit Instruction on the Reading Performance of Adolescent English Language Learners With Intellectual Disabilities

This study sought to determine the effects of explicit phonics instruction and sight word instruction on the letter-sound identification and word reading of 13- to 15-year-old English language learners in the eighth grade who were identified as having intellectual disabilities (ID). Using a randomized single-subject design, four Hispanic students with mild ID who were native Spanish speakers and receiving free or reduced-price lunch were assigned to receive either phonics or sight word instruction. Both treatments were taught explicitly to the pair of students in the condition and included scaffolding and multiple practice opportunities. Sessions took place every other day for 20 minutes over 8 weeks, totaling 400 minutes of intervention. All students demonstrated increased rates of improvement in identifying letter-sounds and untaught words on the Basic Phonics Skills Test III. Although students in the sight word condition were not explicitly taught letter-sound correspondences, they correctly identified the sounds of all 26 letters by posttest. All students progressed in their ability to read untaught words of increasing complexity. Results suggest that adolescents with mild cognitive impairments attending schools taught in a nonnative language can still profit from explicit instruction in foundational reading skills.
The mechanics in New York politics, 1774–1788

(1964). The mechanics in New York politics, 1774–1788. Labor History: Vol. 5, No. 3, pp. 225-246.
Droplets for ultrasmall-volume analysis.

By using methods that permit the generation and manipulation of ultrasmall-volume droplets, researchers are pushing the boundaries of ultrasensitive chemical analyses. (To listen to a podcast about this feature, please go to the Analytical Chemistry Web site at pubs.acs.org/ancham.)
Studies of Turbulent Heating of Hydrogen Plasma by Numerical Simulation

One-dimensional numerical simulation of the development of the ion-acoustic instability in a plasma with mass ratio 1836 shows considerable electron heating but only small high-temperature tails or large-amplitude, undamped ion-acoustic waves in the ion distribution.
Submicron X-Ray Lithography

We present results of our evaluation of the X-ray lithographic technique for replication of submicron patterns generated by electron beam. Mylar membranes have largely been employed as substrates for X-ray masks, although silicon substrates have also been used. Absorber patterns with high aspect ratio have been obtained by electroplating and by ion milling. Circuit patterns have been replicated with 0.25μm features in both positive and negative X-ray resists.© (1976) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.
Brazilian technocrats and economic development policy

Are there factors of continuity that help in predicting economic development policy in Third World countries? What groups will influence policy as regime types change? In Latin America today several military regimes are shifting to civilian leadership. Technocrats could provide continuity as new decision makers face difficult economic choices. The Brazilian case provides a dramatic example, given the prominent role played by technocrats during the military regimes since 1964 and the increased electoral activity begun in 1982. This study evaluates the role and potential future impact of Brazilian technocrats. It uses the example of Brazilians trained or otherwise influenced by the U.N. Economic Commission for Latin America (ECLA). Given that ECLA has been a major force in promoting development policy involving planning and import substitution, the Brazilians in question could affect major policy change during the current economic crisis.
A STUDY OF A CHARACTERISTIC TPYE OF UPPER-LEVEL FRONTOGENESIS

Abstract The potential vorticity on isentropic surfaces is used to study a characteristic type of upper-level frontogenesis — the development of a sloping stable layer marked by strong vertical wind shear and rapid upward decrease in humidity. In the case studied it was found that the intense portion of the frontal zone consisted of a thin wedge of stratospheric air which had descended to very low levels (700 to 800 millibars), the frontal boundaries being a folded portion of the original tropopause. The circulation within the frontal zone was indirect solenoidal, and surface cyclogenesis accompanied or slightly preceded the strengthening of the upper-level front. Although the frontal zone formed entirely within a polar air-mass, the strong adiabatic heating at and near the warm boundary could give the false impression that tropical air was present there at the end stage.
DO SONS OR DAUGHTERS GIVE MORE MONEY TO PARENTS IN URBAN CHINA

The patriarchal structure of the traditional Chinese family suggests that sons, more than daughters, provide financial support to elderly parents. The norm of receiving support in old age primarily from sons, however, may have been undermined by dramatic demographic, economic, and cultural changes occurring over the last several decades in China, especially in urban areas. We examine gender differences in adult children's financial support to parents using a recent dataset ("Study of Family Life in Urban China") collected in 1999 (N = 1,801). The results show that married daughters, especially those living with parents, provide more financial support to parents than married sons do. This significant gender difference can be primarily explained by daughters' resources, such as education and income.
The Immune System and AMD.

Age-related macular degeneration is a complex, multifactorial disease that has yet to be completely understood. Significant efforts in the basic and clinical sciences have unveiled numerous areas that appear to be critical in the pathogenesis of this disease. The alternative complement pathway, immune cell activation, and autoimmunity are all emerging as important themes in the suspected immunological origins of this disease. Advancement toward a complete understanding of these processes is important in the development of new techniques for disease monitoring and treatment.