cssi/SciSciGPT-SciSciNet huggingface dataset:
Adolescent Pregnancy in the United States

In the United States, adolescent pregnancy is largely conceptualized as stemming from sexual activity, which results in intentional or unintentional childbearing among teenagers between the ages of 12–19 years. The sexual development of adolescents and concurrent concerns over teenage pregnancy and reproductive health are inextricably linked within US culture. There are a host of factors—historical, developmental, environmental, religious, moral, social, cultural, economic, and political—which influence the degree to which adolescent pregnancy is experienced and socially accepted within the diverse cultural landscape of the USA. Whether related or unrelated to the wave of political attention, overall adolescent pregnancy rates have actually declined substantially in the USA over time, from 61.8 pregnancies per 1,000 girls age 15–19 during the late 1960s to 40.5 pregnancies per 1,000 by 2005. In contemporary US culture, these prevailing epidemiological and cultural norms have implicitly created a perceived social “picture” of adolescent pregnancy. In this chapter, we paint this picture not as prescriptive, but as a composite of the demographic, social, and cultural influences, which are commonly attributed to adolescent pregnancy in the United States. An adolescent parent in the United States is likely to be Black or of Hispanic/Latino origin, which also correlates with a likelihood of living in a low-income household or community where there is a greater concentration of teen parents. She or he is likely to be less educated and from a family in a low socioeconomic class, which irrespective of race, decreases access to preventative resources, healthcare, contraception, or abortion. As we will discuss in depth in this chapter, adolescent pregnancy rates and experiences vary greatly across geographic regions, cultural subgroups, and socioeconomic strata in the USA. The presence of diverse viewpoints and experiences related to adolescent pregnancy in the USA has multi-systemic implications for individuals, families, and communities.
The evolution of body size in birds. I. Evidence for non-random diversification

The hypothesis that evolution of body size in birds was a random process coupled with an absolute lower boundary on body mass was tested using data on 6217 species of extant birds. The test was based on the fact that subclades within birds that have body masses much larger than this minimum should not have skewed log body mass distributions, while clades close to this boundary should. Bird species were classified into 23 orders suggested by Sibley and Monroe (1988). Thirteen orders that had average log body masses greater than the average for all birds had significantly skewed log body mass distributions. This is inconsistent with the hypothesis that evolution of body size in birds is random, but is constrained only at the smallest body masses. Most orders of birds cannot be considered random samples from the parental distribution of all birds. When the pattern of body mass evolution in birds is reconstructed using an estimate of the phylogenetic relationships among orders, there are many more instances where a large taxon putatively originated from a smaller one than vice versa. The non-random nature of body mass evolution in birds is consistent with models that postulate that evolution is constrained by the ability of individuals to turn resources into offspring.
Uncuffed Endotracheal Tubes: Not Appropriate for Pediatric Critical Care Transport

Abstract Objective The effect of using uncuffed endotracheal tubes in children during interfacility critical care transport has not yet been assessed. We hypothesized that many children with uncuffed endotracheal tubes experience complications leading to replacement with a cuffed tube after arrival at a tertiary pediatric care facility. Methods We conducted a retrospective case review of all intubated patients transported by our dedicated pediatric critical care transport team to our pediatric intensive care unit over a 3-year period. The incidence of urgent reintubation was studied. Results A total of 213 children were referred for transport with an endotracheal tube in place, with 55 of those with an uncuffed endotracheal tube (25.8% of all intubated patients). Of those with uncuffed tubes, 24 patients needed their tubes replaced on an urgent basis by the medical team because of issues with ineffective ventilation (43.6% of patients with uncuffed tubes or 11.3% of all intubated patients). No cuffed tubes required replacement. Conclusion Placing an uncuffed endotracheal tube in the critically ill child who is referred to tertiary pediatric care results in a significant number of these patients undergoing a repeat laryngoscopy, with all associated risks, to replace the uncuffed tube with a cuffed tube.
Electrochemical Detection of Fertility Hormones

Fertility hormone levels are constantly changing, but it is crucial for a woman to be able to monitor her fertility levels if she is interested in conceiving. Women and physicians often have a difficult time determining ovulation windows due to fluctuating menstrual cycles and inaccurate interpretations of hormone levels. Current methods of fertility monitoring include physical or vaginal exams, laparoscopy, ultrasound scans, as well as evaluation of hormone levels. A rapid, at-home fertility monitoring tool can help alleviate the apprehensiveness associated with routine screenings and give women the privacy desired when trying to conceive. Herein, we discuss the development of an electrochemical biosensor for quantification of three fertility hormones: beta-estradiol, progesterone, and FSH. Each biomarker's MRE was immobilized onto a gold disk electrode through the use of self-assembled monolayer linking chemistry. Using electrochemical impedance spectroscopy (EIS), the biomarker concentration was correlated to impedance magnitude. An optimal binding frequency was identified for each biomarker, permitting simplistic hardware requirements and investigation into multimarker detection. Analytes were tested in both purified solutions and 1%-90% whole blood. Each biomarker exhibited a unique imaginary impedance peak and optimal binding frequency. The determination was made by assessing the response parameters including the linear fit correlation across the physiological hormone ranges. The existence of unique optimal frequencies permits for simultaneous detection of multiple hormones in a single test. Additionally, the identified frequency was robust across purified and complex solutions. Response characteristics were negatively impacted by the introduction of blood-based contaminants. However, the introduction of Nafion membranes, similar to ones used in commercial glucose sensors, is both feasible and beneficial.
The Impact of the Internet on Mesothelioma Patients: The Good, the Bad, and the Ugly

At this point, it is hard for most of us to imagine a world where information isn’t available to us at our fingertips. But the Internet, along with its ability to provide us with almost any knowledge we require in a matter of milliseconds, is a relatively new invention. Moreover, tools necessary to make the Internet actually useful are an even more recent occurrence. For perspective, Google, the most popular search engine, didn’t exist before 1998 and wasn’t quite helpful until the early 2000s when the company went public and underwent exponential improvements in its coverage as well as visibility (Wikipedia 2018). In terms of social media networks, it was 2006 when Facebook opened its product to the general public, though the network didn’t gain much prominence until about 2010, when for the first time it reported 400 million users (Wikipedia 2017). As of September 2017, Facebook users have reached 2.07 billion monthly active users (Facebook 2017).
Structural basis for power stroke vs. Brownian ratchet mechanisms of motor proteins

Two mechanisms have been proposed for the function of motor proteins: The power stroke and the Brownian ratchet. The former refers to generation of a large downhill free energy gradient over which the motor protein moves nearly irreversibly in making a step, whereas the latter refers to biasing or rectifying the diffusive motion of the motor. Both mechanisms require input of free energy, which generally involves the processing of an ATP (adenosine 5'-triphosphate) molecule. Recent advances in experiments that reveal the details of the stepping motion of motor proteins, together with computer simulations of atomistic structures, have provided greater insights into the mechanisms. Here, we compare the various models of the power stroke and the Brownian ratchet that have been proposed. The 2 mechanisms are not mutually exclusive, and various motor proteins employ them to different extents to perform their biological function. As examples, we discuss linear motor proteins Kinesin-1 and myosin-V, and the rotary motor F1-ATPase, all of which involve a power stroke as the essential element of their stepping mechanism.
Food Insecurity and Forgone Medical Care Among Cancer Survivors.

PURPOSE:Financial hardship is increasingly understood as a negative consequence of cancer and its treatment. As patients with cancer face financial challenges, they may be forced to make a trade-of...
Biodegradability and Toxicity of Cellobiosides and Melibiosides

In 2014, almost 16 million tons of surfactants were used globally for cleaning and industrial applications. As a result, massive quantities disperse into environmental compartments every day. There is great market interest in developing highly biodegradable, less-toxic, and renewable alternatives to currently used petroleum-based surfactants. Glycolipid surfactants, composed of a sugar head-group and lipid tail, are effective surfactants and emulsifiers with a high tolerance to electrolytes and are easily tailored to address specific needs. The green synthesis and surfactant characteristics of a suite of cellobiosides and melibiosides were recently described. The biodegradability and toxicity of 1°-alkyl-O-cellobiosides, 2°-alkyl-O-cellobiosides, and 1°-alkyl-O-melibiosides with straight-chain alkyl tails of 8, 10, and 12 are reported in this study. Biodegradability was assessed by quantifying mineralization (CO2 evolution). All of the glycosides were inherently biodegradable and most were readily biodegradable according to OECD and EPA definitions. The Microtox acute toxicity assay showed both chain length and head group had significant effects on toxicity, but most of the molecules were practically non-toxic according to EPA definitions with EC50 values > 100 mg L-1. Cytotoxicity to human lung (H1299) and keratinocyte cell lines (HaCaT) was measured by xCELLigence and MTS assays. Cytotoxicity values were comparable to similar glycosides previously reported. IC50 values were determined but, in general, exceeded surfactant concentrations that are found in the environment. These data demonstrate the promising nature of these molecules as green alternatives to petrochemical surfactants.
Nonlinear energy harvesting from vibratory disc-shaped piezoelectric laminates

ABSTRACT Implementing resonators with geometrical nonlinearities in vibrational energy harvesting systems leads to considerable enhancement of their operational bandwidths. This advantage of nonlinear devices in comparison to their linear counterparts is much more obvious especially at small-scale where transition to nonlinear regime of vibration occurs at moderately small amplitudes of the base excitation. In this paper the nonlinear behavior of a disc-shaped piezoelectric laminated harvester considering midplane-stretching effect is investigated. Extended Hamilton’s principle is exploited to extract electromechanically coupled governing partial differential equations of the system. The equations are firstly order-reduced and then analytically solved implementing perturbation method of multiple scales. A nonlinear finite element method (FEM) simulation of the system is performed additionally for the purpose of verification which shows agreement with the analytical solution to a large extent. The frequency response of the output power at primary resonance of the harvester is calculated to investigate the effect of nonlinearity on the system performance. Effect of various parameters including mechanical quality factor, external load impedance and base excitation amplitude on the behavior of the system are studied. Findings indicate that in the nonlinear regime both output power and operational bandwidth of the harvester will be enhanced by increasing the mechanical quality factor which can be considered as a significant advantage in comparison to linear harvesters in which these two factors vary in opposite ways as quality factor is changed.
Numerical investigation of occupant injury risks in car-to-end terminal crashes using dummy-based injury criteria and vehicle-based crash severity metrics.

Abstract Guardrails were designed to deter vehicle access to off-road areas and consequently prevent hitting rigid fixed objects alongside the road (e.g. trees, utility poles, traffic barriers, etc.). However, guardrails cause 10 % of deaths in vehicle-to-fixed-object crashes, which recently attracted attention in the highway safety community on the vehicle-based injury criteria used in regulations. The objectives of this study were to investigate both full-body and body-region driver injury probabilities using finite element (FE) simulations, to quantify the influence of pre-impact conditions on injury probabilities, and to analyze the relationship between the vehicle-based crash severity metrics currently used in regulations and the injury probabilities assessed using dummy-based injury criteria. A total of 20 FE impact simulations between a car (Toyota Yaris) with a Hybrid III M50 dummy model in the driver seat and an end terminal model (ET-Plus) were performed in various configurations (e.g. pre-impact velocities, offsets, and angles). The driver’s risk of serious injuries (AIS 3+) was estimated based on kinematic and kinetic responses of the dummy during the crashes. A non-linear regression approach was used to compare the injury probabilities assessed in this study to the vehicle-based crash severity metrics used in the testing regulations. In particular, the US Manual for Assessing Safety Hardware (MASH) guideline and European procedures (EN1317) were used for the study. All the recorded dummy-based injury criteria values pass the Federal Motor Vehicle Safety Standard (FMVSS) 208 limits which indicated a low driver risk of serious injury. Overall, the pre-impact vehicle velocity showed to have the highest influence in almost all injury probabilities (59 %, 79 %, 62 %, and 44 % in full-body, head, neck, and chest injuries, respectively). The offset between vehicle midline and the guardrail barrier was the most important variable for thigh injuries (56 %). The assessed injury probabilities were compared to vehicle-based severity metrics. The full-body and chest injuries showed the highest correlation with Occupant Impact Velocity (OIV), Acceleration Severity Index (ASI), and Theoretical Head Impact Velocity (THIV) (R2 > 0.6). Lower correlations of thigh injuries were recorded to OIV (R2 = 0.59) and THIV (R2 = 0.46). Meanwhile, weak correlations were observed between all the other regressions which indicated that no vehicle-based criteria could be used to predict head and neck injuries. Car-to-end terminal crash FE simulations involving a dummy model were performed for the first time in this study. The results pointed out the limitations of the standard vehicle-based injury methods in terms of head and neck injury prediction. The dummy-based injury assessment methodology presented in this study could supplement the crash tests for various impact conditions. In addition, the models could be used to design new advanced guardrail end terminals.
Renal Outcomes Following Left Ventricular Assist Device Placement: A Single Center Experience

Introduction Renal dysfunction is a prognostic factor in morbidity and mortality after left ventricular assist device (LVAD) placement. As a result, poor renal function often affects a patient's eligibility for LVAD implantation. However, in some, cardiac output augmentation following LVAD placement may improve renal perfusion. The extent of change in renal function and predictors of long-term renal function post-LVAD implantation have not been well studied. Methods This retrospective cohort included consecutive patients who underwent LVAD implantation (HeartMate[HM] II and HM3) between 2008-2018 at a single center for both bridge-to-transplant and destination therapy (DT) indications. We examined the relationship of clinical parameters with changes in renal function 6 months post-LVAD. Glomerular filtration rate (GFR) was calculated using Modification of Diet in Renal Disease Study equation. We performed multivariable logistic regression analyses to determine predictors of decreased renal function. Results We examined 91 patients (mean age 59.7± 13.2, female 11%, HM II 89%, DT 68%). Post-LVAD, 52 patients (57.1%) improved and 39 (42.9%) had deterioration in renal function (Table). Among all patients, 16 (17.6%) had more than 25% reduction in GFR, 6 (6.6%) had a post-LVAD GFR of less than 30 mL/min/1.73 m2, and 2 (2.2%) developed end stage renal disease (ESRD) requiring dialysis. Of those patients who had improved GFR post-LVAD, 30 (57.7%) had more than 25% improvement in their GFR. Among patients who had a GFR 25% reduction in GFR (OR: 3.96, 95% CI 1.4 - 13.8), p=0.03). None of the other clinical parameters listed in the Table were associated with worse renal outcomes. Pre-LVAD GFR was also not predictive of >25% post-implant GFR reduction or the development of ESRD. Conclusion Renal function may improve after LVAD placement. In patients with long-term decreased renal function post-LVAD, the reduction in GFR was rarely severe. Elevated RA pressure, a marker of right ventricular dysfunction and volume overload, is potential predictor of poor renal outcomes after LVAD placement.
Statistics Of Particle Diffusion Subject To Oscillatory Flow In A Porous Bed

Abstract An experimental study was conducted of particle diffusion within a porous bed when exposed to oscillatory flow. The particle oscillates up and down within the porous bed in response to the oscillatory flow, but also becomes intermittently stuck for time intervals of varying duration. The combination of oscillating flow and random hindering of the particle motion by the porous bed leads to a diffusive process called oscillatory diffusion. A variety of statistical measures are used to characterize the particle diffusion under the oscillatory flow. These measures show that the experimental data exhibit characteristics of both classical diffusive processes as well as oscillatory processes. The particle hold-up time duration was found to be well fit by a log-normal distribution for all experimental cases examined. A simple stochastic model that captures the key features of the oscillatory diffusion process is shown to yield statistical measures that compare well with experimental data.
Home price appreciation and residential lending standards

Abstract We explore the effect of home price appreciation on residential lending standards in the U.S. across different sample periods. Using housing supply elasticity measures as instrumental variables for home price changes, we find that rising home prices led to easing lending standards between 2001 and 2006. Mortgage acceptance rates increased more in MSAs that experienced higher home price appreciation, contributing to the credit boom. However, we find that home price appreciation is associated with tighter lending standards between 2012 and 2016, suggesting that banks took a more cautious view of home price appreciation after the financial crisis. To study the negative relationship between home price appreciation and lending standards during the post-crisis years, we examine loan acceptance rates of small and large banks separately. We find that it was the small banks who lowered loan acceptance rates in MSAs with higher home price appreciation, which caused the overall loan acceptance rates to decline.
Privacy Considerations of the Visually Impaired with Camera Based Assistive Technologies: Misrepresentation, Impropriety, and Fairness

Camera based assistive technologies such as smart glasses can provide people with visual impairments (PVIs) information about people in their vicinity. Although such ‘visually available’ information can enhance one’s social interactions, the privacy implications for bystanders from the perspective of PVIs remains underexplored. Motivated by prior findings of bystanders’ perspectives, we conducted two online surveys with visually impaired (N=128) and sighted (N=136) participants with two ‘field-of-view’ (FoV) experimental conditions related to whether information about bystanders was gathered from the front of the glasses or all directions. We found that PVIs considered it as ‘fair’ and equally useful to receive information from all directions. However, they reported being uncomfortable in receiving some visually apparent information (such as weight and gender) about bystanders as they felt it was ‘impolite’ or ‘improper’. Both PVIs and bystanders shared concerns about the fallibility of AI, where bystanders can be misrepresented by the devices. Our finding suggests that beyond issues of social stigma, both PVIs and bystanders have shared concerns that need to be considered to improve the social acceptability of camera based assistive technologies.
Illuminating the Role of Vitamin A in Skin Innate Immunity and the Skin Microbiome: A Narrative Review

Vitamin A is a fat-soluble vitamin that plays an important role in skin immunity. Deficiencies in Vitamin A have been linked to impaired immune response and increased susceptibility to skin infections and inflammatory skin disease. This narrative review summarizes recent primary evidence that elucidates the role of vitamin A and its derivatives on innate immune regulators through mechanisms that promote skin immunity and sustain the skin microbiome.
Reliability and validity of Midwifery - Obstetrics Collaboration (MOC) scale: A tool to improve collaborative practice.

Abstract Objective In recent decades, there has been a call to foster effective collaborative models of practice between midwives and obstetricians/gynecologists (OB/GYNs) in the United States in order to improve clinician satisfaction and outcomes for childbearing women. Currently, there is no existing validated scale that measures the collaboration between obstetricians and midwives on labor and birth units. We sought to develop and validate a Midwifery- Obstetrics Collaboration (MOC) Scale that measures obstetricians’ attitudes towards collaboration between obstetricians and midwives on labor and birth units. Design Validation study. The items in the questionnaire to be validated were developed de novo by the authors, based on their experiences and expertise in collaborative practice as well as by incorporating key principles of effective collaborative practice documented in the literature. The questionnaire was then piloted among 13 content experts. Setting Anonymous online survey conducted in the United States. Participants We validated the questionnaire among 471 obstetricians in the United States from Sept 2019 to March 2020. The respondents included general obstetrician and gynecologists (OB/GYN) attendings, OB/GYN hospitalists, maternal fetal medicine (MFM) fellows and MFM attendings who practice on a labor and birth unit in the United States. Measurements and findings We performed reliability analysis of the a priori items. We measured concurrent validity with an existing scale that measures inter-professional collaboration between nurses and physicians. We also correlated our scale with concerns for liability when working in a collaborative practice with midwives. Lastly, we measured discriminant validity with a single item burn out scale. The novel MOC Scale demonstrated construct and concurrent validity, and high inter-item reliability (a=0.93). The MOC Scale correlated with concerns about liability (r=0.63, p Key conclusions The MOC Scale is validated to assess collaboration between obstetricians and midwives on labor and birth units from an obstetrician's perspective Implications for practice The MOC Scale can be used as a tool in clinical practice, to assess and foster effective collaboration between obstetricians and midwives from an obstetricians’ perspective especially when used in conjunction with other tools that take into the account the perspectives of midwives and childbearing women.
The Value of an Orthoplastic Approach to Management of Lower Extremity Trauma: Systematic Review and Meta-analysis.

Background Management of traumatic lower extremity injuries requires a skill set of orthopedic surgery and plastic surgery to optimize the return of form and function. A systematic review and meta-analysis was performed comparing demographics, injuries, and surgical outcomes of patients sustaining lower extremity traumatic injuries receiving either orthoplastic management or nonorthoplastic management. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analysis, Cochrane, and GRADE certainty evidence guidelines were implemented for the structure and synthesis of the review. PubMed, Embase, Cochrane Library, Web of Science, Scopus, and CINAHL databases were systematically and independently searched. Nine studies published from 2013 through 2019 compared 1663 orthoplastic managed patients to 692 nonorthoplastic managed patients with traumatic lower extremity injuries. Results Orthoplastic management, compared to nonorthoplastic management likely decreases time to bone fixation [standard mean differences: -0.35, 95% confidence interval (CI): -0.46 to -0.25, P < 0.0001; participants = 1777; studies = 3; I2 = 0%; moderate certainty evidence], use of negative pressure wound therapy [risk ratios (RR): 0.03, 95% CI: 0.00-0.24, P = 0.0007; participants = 189; studies = 2; I2 = 0%; moderate certainty evidence] with reliance on healing by secondary intention (RR: 0.02, 95% CI: 0.00-0.10, P < 0.0001; participants = 189; studies = 2; I2 = 0%; moderate certainty evidence), and risk of wound/osteomyelitis infections (RR: 0.37, 95% CI: 0.23-0.61, P < 0.0001; participants = 224; studies = 3; I2 = 0%; moderate certainty evidence). Orthoplastic management likely results in more free flaps compared to nonorthoplastic management (RR: 3.46, 95% CI: 1.28-9.33, P = 0.01; participants = 592; studies = 5; I2 = 75%; moderate certainty evidence). Conclusion Orthoplastic management of traumatic lower extremity injuries provides a synergistic model to optimize and expedite definitive skeletal fixation and free flap-based soft-tissue coverage for return of extremity form and function.
The theory of liberal dependency care: a reply to my critics

This author’s reply addresses critiques by Daniel Engster, Kelly Gawel, and Andrea Westlund about my 2020 book, Freedom to Care: Liberalism, Dependency Care, and Culture. I begin with a statement o...
Patient Health Questionnaire-9 Is a Valid Assessment for Depression in Minimally Invasive Lumbar Discectomy.

OBJECTIVE The Patient Health Questionnaire-9 (PHQ-9) is a screening tool for evaluating depressive symptoms. Research is scarce regarding the validity and correlation of PHQ-9 scores with other patient-reported outcomes of mental health after minimally invasive lumbar discectomy (MIS LD). We aim to validate PHQ-9 as a metric for assessing mental health in MIS LD patients. METHODS A database was retrospectively reviewed for patients who underwent elective, single-level MIS LD. Patients were excluded if they had incomplete preoperative PHQ-9, 12-item Short Form Health Survey (SF-12), or Veterans RAND 12-item health survey (VR12). Survey scores were collected preoperatively and postoperatively through 1 year. Mean scores were used to calculate postoperative improvement from preoperative scores. Correlation of PHQ-9 with SF-12 mental composite score (MCS) and VR-12 MCS scores was also calculated. Correlation strength was assessed by the following categories: 0.1 ≤ |r| < 0.3 = low; 0.3 ≤ |r| < 0.5 = moderate; |r| ≥ 0.5 = strong. RESULTS A total of 239 patients underwent single-level MIS LD. PHQ-9, VR-12 MCS, and SF-12 MCS all demonstrated statistically significant increases from preoperative scores at all postoperative timepoints (p ≤ 0.001). SF-12 MCS and VR-12 MCS were each observed to have strong and significant correlations with PHQ-9 at all timepoints when evaluated with both Pearson correlation coefficients and partial correlation coefficients. CONCLUSION We observed that PHQ-9, SF-12 MCS and VR-12 MCS all significantly improve following lumbar discectomy and that PHQ-9 scores strongly correlated with these previously established measures. Our results substantiate evidence from other surgical fields that PHQ-9 scores are a valid tool to evaluate pre- and postsurgical depressive symptoms.
Preadolescent multisport athlete with hip and heel pain

11 yo male with history of Osgood Schlatter presented to Sports Medicine with hip pain after playing in a basketball tournament 5 days prior. No discreet injury. Nocturnal pain occurred the night before his sports medicine visit. This was his second episode of hip pain in 6 months. NSAIDs, rest, and stretching improved his pain. No other symptoms. Exam remarkable for normal vitals, well appearing African American boy, antalgic gait, mild pain with hip flexion and rotation. Differential diagnosis includes - Leg Calve …
Impact of a medical scribe on clinical efficiency and quality in an academic general internal medicine practice.

Scribes have been proposed as an intervention to decrease physician electronic health record (EHR) workload and improve clinical quality. We aimed to assess the impact of a scribe on clinical efficiency and quality in an academic internal medicine practice. Six faculty physicians worked with one scribe at an urban academic general internal medicine clinic April through June 2017. Patient visits during the 3 months prior to intervention (baseline, n = 789), unscribed visits during the intervention (concurrent control, n = 605), and scribed visits (n = 579) were included in the study. Clinical efficiency outcomes included time to close encounter, patient time in clinic, and number of visits per clinic session. Quality outcomes included EHR note quality, rates of medication and immunization review, population of patient instructions, reconciliation of outside information, and completion of preventative health recommendations. Median time to close encounter (IQR) was lower for scribed visits [0.4 (4.8) days] compared to baseline and unscribed visits [1.2 (5.9) and 2.9 (5.4) days, both p < 0.001]. Scribed notes were more likely to have a clear history of present illness (HPI) [OR = 7.30 (2.35–22.7), p = 0.001] and sufficient HPI information [OR = 2.21 (1.13–4.35), p = 0.02] compared to unscribed notes. Physicians were more likely to review the medication list during scribed vs. baseline visits [OR = 1.70 (1.22–2.35), p = 0.002]. No differences were found in the number of visits per clinic session, patient time in clinic, completion of preventative health recommendations, or other outcomes. Working with a scribe in an academic internal medicine practice was associated with more timely documentation.
Immunomodulatory Arming Factors-The Current Paradigm for Oncolytic Vectors Relies on Immune Stimulating Molecules.

The dogma of engineering oncolytic viral vectors has shifted from emphasizing the viral lysis of individual cancer cells to the recruitment and coordination of the adaptive immune system to clear the tumor. To accomplish this, researchers have been adding several classes of transgenes to their preferred viral platforms. The most prevalent of these include antibodies and targeting moieties, interleukins and cytokines, and genes which rely on small molecule co-administration for tumor killing. Most current vectors rely exclusively on one of these types of transgenes to elicit the desired immune response to clear tumors, but are not mutually exclusive, with several larger OVs armed with several of these factors. The common theme of emerging armed vectors is to simply initiate or enhance infiltration of effector CD8+ T cells to clear the tumor locally at OV infection sites, and systemically throughout the body where the OV has not infected tumor cells. The precision of oncolytic vectors to target a cell type or tissue remains its key advantage over small-molecule drugs. Unlike chemo- and other drug therapies, viral vectors can be made to specifically infect and grow within tumor cells. This ensures localized expression of the therapeutic transgene to the diseased tissue, thereby limiting systemic toxicity. This review will examine the immunomodulating transgenes of current OVs, describe their general effect on the immune system, and provide the rationale for each vector’s use in clearing its targeted tumor.
Commentary on gender differences in prevalence, treatment, and quality of life of patients with chronic rhinosinusitis

ObjectiveTo examine the existing evidence on gender differences in the prevalence, treatment, and quality of life of patients with chronic rhinosinusitis (CRS).MethodsReview of the literature and e...
Towards an agent middleware framework for e-commerce

A number of challenges face the developers of distributed agent-based solutions. This is especially true for those developing agent-based solutions for electronic commerce. Key challenges include secure and efficient software agent deployment, secure communications and the difficulties of developing and monitoring agent systems deployed across a network. This paper reports on the development of a Java-based agent distribution framework which provides the following advantages for developing agent-based electronic commerce applications: (1) a secure agent dispatch mechanism based upon agent authentication and role-based security levels, (2) inter-agent communication means that include peer-to-peer communication via its own published objects as well as a multicast event service, (3) encrypted object streams for unicast and multicast communications, (4) reflective communication monitoring for agent system development and visualization, (5) mechanisms for efficient agent distribution, and (6) an easy-to-use environment for making small footprint agents.
An Opinion Model for Evaluating Malicious Activities in Pervasive Computing Systems

Pervasive computing applications typically involve cooperation among a number of entities spanning multiple organizations. Any security breach in any single entity can have very far-reaching consequences. In addition, a number of factors make the task of defending against malicious attacks in pervasive systems even more complex than conventional systems. Foremost among them is that a significant number of the devices deployed in such environments are frequently severely resource constrained. Thus strong security controls cannot be easily deployed on these devices. A second factor is that since a large number of such devices are also involved, attacks can propagate very fast in pervasive environments. These prompt us to propose a model for predicting malicious activities in pervasive systems. Our model is based on a logic of opinion that has been proposed elsewhere. Ours is not an intrusion detection system for pervasive systems but works in tandem with one. The system we propose can be used as a standard interface to analyze pervasive system activities in general and generate an opinion about the possibility of an attack.
Direct Fabrication of Custom Orthopedic Implants Using Electron Beam Melting Technology

Metal orthopedic implants have been used for many decades with great success. Replacement joints and plates for bone fractures are usually made from titanium, cobaltchromium or stainless steel. Through recent advancements in biomodeling, custom orthopedic implants can be designed. However, fabrication of these custom implants can be prohibitively expensive with traditional processes. With the introduction of Electron Beam Melting (EBM), direct fabrication of fully dense metal components is possible. In this paper, the development of titanium for the EBM-process will be discussed, and direct fabrication of custom designed orthopedic implants made out of steel and titanium will be demonstrated.
Out of the Depths Have I Cried: Aesthetic Opposition at the Gateway to Auschwitz

AbstractTerezin, the gateway to Auschwitz, a town commandeered by the Nazis to serve as a “model” relocation camp to demonstrate the Third Reich's generosity and kindness toward the Jews, was an elaborate hoax. In an environment where truth was twisted beyond recognition, artists, writers, actors, and musicians used their work to revive the spirits of the condemned and to leave a legacy of truth in the face of an insidious lie. The arts became the foundation for a “curriculum” that shaped the lives of the inmates surviving in hell.
Replacing trapezoidal membership functions by triangular membership functions for /spl otimes/-transitivity

Although trapezoidal and /spl Pi/-shaped membership functions are frequently used as generalizations of triangular membership functions in fuzzy modeling, they lead to the violation of /spl otimes/-transitivity: /spl mu/(x, z)/spl ges/max{0, /spl mu/(x, y)+/spl mu/(y, z)-1}, which is one of the weakest forms of transitivity. The triangular membership functions do not have this problem. We show that for any fuzzy relation /spl mu/(x, y) there is a unique smallest /spl otimes/-transitive relation /spl mu//sup /spl otimes//(x,y)/spl ges//spl mu/(x, y). We show that under fairly general conditions, a trapezoidal membership function can be replaced by a triangular membership function. This also leads to a representation theorem for an arbitrary /spl otimes/-transitive relation /spl mu/(x, y), which may not be symmetric.
Maximum entropy methods for biological sequence Modeling

Many of the same modeling methods used in natural languages, specifically Markov models and HMM's, have also been applied to biological sequence analysis. In recent years, natural language models have been improved upon by using maximum entropy methods which allow information based upon the entire history of a sequence to be considered. This is in contrast to the Markov models, whose predictions generally are based on some fixed number of previous emissions, that have been the standard for most biological sequence models. To test the utility of Maximum Entropy modeling for biological sequence analysis, we used these methods to model amino acid sequences. Our results show that there is significant long-distance information in amino acid sequences and suggests that maximum entropy techniques may be beneficial for a range of biological sequence analysis problems.
The Turbulence Criterion in Stably Stratified Shear Flow and the Origin of Sporadic E

Abstract This article explores the hypothesis that sporadic E and other stratification phenomena are caused by aerodynamic processes which distort the normal electron-density gradient in such a way as to produce partially reflecting layers. Measurements of winds in the upper atmosphere have shown that exceptionally high wind shears, of the order 100 (m/sec)/km, are confined to narrow layers with roughly the same geometrical properties as the layers responsible for discrete radio reflections. Since high wind shears tend to promote and maintain turbulence, the question naturally arises whether these high-shear layers are turbulent, and if so whether turbulence can render such a layer partially reflecting to radio waves of appropriate wavelengths. In order to answer the first question, we give in Section II a detailed discussion of the turbulence criterion in stably stratified shear flow. Previous work on this subject is reviewed and a somewhat simplified derivation of Townsend's criterion is given. A new necessary condition for the maintenance of turbulence is suggested, namely that the lifetime of turbulent eddies be smaller than the characteristic period of gravitational oscillations in the fluid. This condition turns out to be more stringent that the usual energy requirement. The resulting value of the critical Richardson number is Ri c = 1/25. If this value is correct, turbulence in the 80–120 km region will be confined to the high-shear layers, if it occurs at all. In Section III we investigate the effect of a narrow turbulent layer on the electron-density profile. As a result of turbulent mixing, the electron-density profile may develop a shelf-like near-discontinuity capable of reflecting radio waves. Finally, the effects of meteor ionization are studied. It is shown that the ionization generated by meteors may be regarded as spatially homogeneous and that the contribution of meteor-generated ionization to the electron-density profile does not change its character in a qualitative way.
Impact of Liposomal Bupivacaine Administration on Postoperative Pain in Patients Undergoing Total Knee Replacement

Study Objective To determine whether liposomal bupivacaine, a long-acting anesthetic indicated for single-dose wound infiltration to produce postoperative analgesia, has an impact on postoperative pain in patients undergoing total knee arthroplasties (TKAs). Design Single-center retrospective cohort study. Setting Large tertiary and quaternary care hospital. Patients A total of 120 adults who underwent TKA between March 1, 2013, and October 31, 2013; of those patients, 55 patients received an intraoperative dose of liposomal bupivacaine 266 mg (active treatment group), and 65 did not receive the drug (control group). Measurements and Main Results The primary end point was the mean area under the curve (AUC) of numeric rating scale (NRS) pain scores from the end of surgery to 48 hours after surgery. Secondary end points included measures of postoperative pain up to 24 hours after surgery, opioid consumption within 48 hours after surgery, duration of hospitalization, and ambulation distance from the end of surgery to discharge. No significant differences were noted in the primary or secondary end points between patients who received or did not receive an intraoperative dose of liposomal bupivacaine. The mean ± SD AUC of NRS pain scores was 199.59 ± 67.11 and 192.94 ± 70.41 for the liposomal bupivacaine and control groups, respectively (p=0.658). Use of adjunctive analgesics was higher among patients in the control group, particularly for those receiving celecoxib, pregabalin, and continuous regional ropivacaine infusions, which may have minimized any differences in pain control between the treatment groups. Conclusion Liposomal bupivacaine did not improve pain control in patients undergoing TKA when compared with historical management strategies; however, differences may have been obscured by increased utilization of adjunctive analgesics among patients in the control group.
The Neuroscience of Religious Experience

1. Religion as seen through the eyes of the self 2. On the self and the divided self 3. Mechanisms and dynamics of decentering 4. Neurology of the self 5. Neurology of religious experiences 6. Neurochemistry of religiosity 7. Self-transformation as a key function of performance of religious practices 8. Self-transformation through spirit possession 9. God concepts and religious language 10. Ritual 11. Lifespan development of religiosity and the self 12. The evolution of self and religion.
Interaction of Peptides Related to Secretin with Hormone Receptors on Pancreatic Acinar Cells

Three analogues of the carboxyl-terminal tricosapeptide of secretin (S5-27, one with glutamine replacing glutamic acid in position 9 (9-Gln-S5-27), a second with asparagine substituted for aspartic acid in position 15 (15-Asn-S5-27), and a third with both replacements (9-Gln-15-Asn-S5-27) were tested for their ability to interact with hormone receptors on dispersed pancreatic acinar cells. Each of these analogues inhibited binding of 125I-labeled vasoactive intestinal peptide (VIP). None of the analogues increased cellular cyclic AMP but each inhibited the increase in cellular cyclic AMP produced by secretin or VIP. At the high affinity VIP receptor (the low affinity secretin receptor) each analogue had an apparent affinity which was greater than that for S5-27, whereas at the low affinity VIP receptor (the high affinity secretin receptor), each of the analogues had an apparent affinity which was the same as that for S5-27. Thus, in S5-27, substituting glutamine in position 9 or asparagine in position 15 makes the fragment more VIP-like but not less secretin-like. These results also provide additional evidence that the receptor having a low affinity for secretin and a high affinity for VIP is functionally distinct from the receptor having a high affinity for secretin and a low affinity for VIP.
Allylic Chlorides from Allylic Alcohols: Geranyl Chloride

Allylic chlorides from allylic alcohols: geranyl chloride product: geranyl chloride product: neryl chloride Keywords: halogenation, chlorination; replacement reactions, hydroxy by halogen; hexamethylphosphoric triamide (HMPA); hexamethylphosphoric triamide (HMPA), toxicity
The Low Molecular Weight GTPase RhoA and Atypical Protein Kinase Cζ Are Required for TLR2-Mediated Gene Transcription

The Rho GTPases are molecular switches that regulate many essential cellular processes, including actin dynamics, gene transcription, cell cycle progression, cell adhesion, and motility. In this study, we report that stimulation of TLR2 in human epithelial and monocytic cells leads to rapid and transient activation of RhoA. RhoA cooperated with the canonical I-kappaB kinase-mediated pathway that induces the release of NF-kappaB, in regulating the trans activation of the NF-kappaB subunit p65/RelA by affecting Ser(311) phosphorylation, and subsequent cytokine production. Another consequence of TLR2 stimulation by bacterial derived products was the activation of atypical protein kinase C (PKC) zeta and association of this protein kinase with RhoA. Inhibition of PKCzeta decreased NF-kappaB activation and p65/RelA trans activation without affecting I-kappaBalpha degradation. The observation of a transient, stimulus-dependent association of RhoA with PKCzeta suggests that RhoA mediates at least partially its effect on gene transcription through atypical PKC. In contrast to previous studies, identifying Rac1-PI3K as an upstream element in TLR2-initiated response to NF-kappaB, PI3K signaling was not required for RhoA or PKCzeta activity. These results indicate that multiple GTPase-regulated pathways emerge from stimulated Toll receptors, controlling different aspects of NF-kappaB-mediated gene transcription.
Potential functions for hydrogen bonds in protein structure prediction and design.

Abstract Hydrogen bonds are an important contributor to free energies of biological macromolecules and macromolecular complexes, and hence an accurate description of these interactions is important for progress in biomolecular modeling. A simple description of the hydrogen bond is based on an electrostatic dipole–dipole interaction involving hydrogen‐donor and acceptor–acceptor base dipoles, but the physical nature of hydrogen bond formation is more complex. At the most fundamental level, hydrogen bonding is a quantum mechanical phenomenon with contributions from covalent effects, polarization, and charge transfer. Recent experiments and theoretical calculations suggest that both electrostatic and covalent components determine the properties of hydrogen bonds. Likely, the level of rigor required to describe hydrogen bonding will depend on the problem posed. Current approaches to modeling hydrogen bonds include knowledge‐based descriptions based on surveys of hydrogen bond geometries in structural databases of proteins and small molecules, empirical molecular mechanics models, and quantum mechanics‐based electronic structure calculations. Ab initio calculations of hydrogen bonding energies and geometries accurately reproduce energy landscapes obtained from the distributions of hydrogen bond geometries observed in protein structures. Orientation‐dependent hydrogen bonding potentials were found to improve the quality of protein structure prediction and refinement, protein–protein docking, and protein design.