cssi/SciSciGPT-SciSciNet huggingface dataset:
Analysis and Countermeasures on nosocomial infection in 132 local medical institutions

Objective To know the management of nosocomial infections in some basic medical institutions currently,then to propose the improving measure.Methods By unified questionnaire and rapid monitoring on the spot,we investigate the management of nosocomial infections,including organization,rules and regulations,disinfection and sterilization,using and disposal after using of disposable medical products in some basic medical institutions.The data are analyzed statistically by using SPSS 113.0statistics software.Results Some basic medical institutions are deficient in organization,rules and regulations about the management of nosocomial infections,lack of disinfection appliances and disinfectants which are often used incorrectly,dispose of medical wastes and disposable medical products inappropriately.Conclusion To normalize the management of nosocomial infections,we should reinforce training,increase investment,elevate ones’ thought and enhance health supervision and punishment.
Growth and development of children and adolescent from urban and rural areas of Qingdao in 2010 and dynamic change in 10 years

Objective To compare the growth and development of children and adolescent from urban and rural areas of Qingdao in 2010,and to analyze the dynamic change in 10 years. Methods The data of height,weight and chest circumference of students aged 7-18 years were retrieved from Qingdao student physical constitution survey and ververck index was calculated.t-test was used for data analysis. Results The average height,weight,chest circumference and ververck index were all legged behind along with age among both boys and girls from rural areas compared with those from urban areas,except for height of boys,and the differences were significant among boys aged 9,14 and 15years(t=-2.250,2.178,4.031,P0.05).All developmental indicators for both boys and girls were higher in 2010 than those in 2000,except for the height of urban boys. Conclusions There is developmental difference between children and adolescents from urban and rural areas in 2010,and the overall status of growth and development has improved since 2000.
Postoperative wound infections following cardiac surgery: significance of contaminated cases performed in the preceding 48 hours.

Postoperative wound infections following open heart cardiac surgery increased markedly after hospital relocation (7 of 77 v 4 of 320; p = .0007). Of the multiple identified risk factors, significant patient and procedural association included prolonged operative time of infected patients (384 minutes +/- 115 SD v 318 +/- 67, p = .025) and operation in a room used within the previous 48 hours for a contaminated case (4/7 infected v 10/67 not infected; p = .023). Several defects were discovered in the air handling system. After appropriate changes, the infection rate decreased in the next 12 months (1 of 109; p less than .02). Other concurrent surgical wound infection rates remained unchanged suggesting that defective air handling may have impacted only on the open heart cardiac surgery patients. Preceding contaminated surgery and prolonged operative time were associated with postoperative wound infections in cardiac surgery.
The value of palliative spinal surgery in metastatic urogenital tumors.

AbstractThere were 22 patients with vertebral metastases and impending neurologic damage from prostatic, vesical and renal cell carcinoma treated by decompressive laminectomy combined with local radiotherapy and chemotherapy. The neurological recovery was complete in the prostatic carcinoma patients (10 of 10), partial in the vesical carcinoma patients (2 of 5) and unsatisfactory in the renal cell carcinoma patients (1 of 7).
A quasi-experimental evaluation of a juvenile justice reinvestment initiative

AbstractThere is an increasing movement throughout the United States and abroad to develop cost-effective and evidence-based strategies that enhance public safety, decrease recidivism, and reduce the number of inmates held in correctional facilities. One such recent approach to achieve these goals is the use of justice reinvestment strategies, which promote the reallocation of funds initially designated for imprisonment into other community-based alternatives. Although the available research generally indicates many of the reinvestment initiatives undertaken so far are effective in achieving these goals, much less empirical attention focuses on what aspects of these programs are effective. In response, this study fills a critical gap in this literature by evaluating how different treatment services and offender risk levels influence the recidivism of youth involved in a justice reinvestment program in Ohio. The findings of this study indicate youth who were incarcerated were nearly two times as likely to ...
Fecal microbiota transplantation via fluoroscopy-guided nasojejunal catheter placement: indications, technique, and the role of radiology

Clostridium difficile is a well-established cause of nosocomial gastrointestinal disease. Although antibiotics remain an effective first-line treatment for C. difficile colitis (CDC), relapse and recurrence are common. FMT has emerged as one of the safest and most effective known therapies available for recurrent or refractory CDC, which is likely due to restoration of the protective microbiotic barrier of the gastrointestinal tract. FMT varies greatly across institutions by route of delivery, dose, and protocol. We present our experience with FMT via fluoroscopic-guided nasojejunal catheter placement. The discussion will include indications and contraindications, protocol, and procedural technique, and include a case presentation incorporating original CT and fluoroscopic images. Specifically, we will address the advantages and disadvantages of image-guided FMT via the upper GI tract with respect to nasogastric-, colonoscopic-, and enema-based delivery. The efficacy of FMT for the treatment of C. difficile has been widely demonstrated in several prospective and case studies. We feel that nasojejunal FMT is an underutilized radiologic procedure which can benefit selected patients, particularly given the advantages in risk profile, cost, convenience, and lack of routine sedation.
Modeling “Off the Books” Consumption

In order to better understand and explain “off the books” consumption at the household level, I developed a predictive model based upon the 2010 survey results of 357 respondents covering 126 informal and underground goods and services in South Texas. Utilizing household demographics (e.g., gender, ethnicity, income, cultural assimilation) as predictor variables while including the moderating effects of facilitating mechanisms (e.g., morality, payment method), the model is designed to assist in the prediction of “off the books” consumption. The model provides general reference to informal and underground consumption including special reference to health care, cross-border activities, street vending, household work substitution, everyday household goods consumption, specialty consumption, and underground goods and services consumption along a risk continuum.
P219 Quantifying heat stress and strain in summer tree fruit harvesters in yakima valley, washington

Outdoor workers performing heavy physical labour in hot conditions are at increased risk for developing occupational heat-related illness. Seasonal harvesting of certain tree fruits in Washington occurs during summer months. In addition to environmental heat exposure, harvesting involves internal heat generation from physical work. We sought to characterise heat stress and physiological effects of heat stress (heat strain) in workers performing harvest activities. During the summer of 2015, 46 pear and apple harvesters participated in a cross-sectional study in Yakima Valley, Washington for one work shift during warmer periods in August (n = 34) and cooler periods in September (n = 12). Heat stress and strain were characterised using American Conference of Governmental Hygienist (ACGIH) guidelines, which recommend thermal Action Limits and Threshold Limit Values based on several factors including: environmental temperatures, metabolic rate of task, clothing ensembles, core body temperature, and heart rate. Heat exposure was measured near individual workers using hand-held Wet Bulb Globe Temperature (WBGT) monitors, metabolic rate was estimated using field observations and hip-mounted accelerometers, and research staff observed workers’ clothing. Heart rate and core body temperature were monitored using heart rate monitors and ingestible core body temperature sensors. Of the 46 participants, 25 (54.4%) exceeded the ACGIH Action Limit (WBGT 25°C), and 16 (34.8%) exceeded the Threshold Limit Value (WBGT 28°C) for a moderate work task (300 Watts). All participants exceeding the Threshold Limit Value were working in August. Using accelerometer data (n = 39), 12 (30.8%) exceeded the Action Limit and 4 (10.3%) exceeded the Threshold Limit Value. Heat strain data are currently being analysed. Under current conditions, workers are exposed to hazardous thermal environments. Future climate conditions may further impact physically intensive outdoor occupations. Effective approaches for reducing heat exposure and/or promoting biological adaptation to heat are needed to prevent heat-related illness in vulnerable working populations.
Effects of adrenomedullin on load and myocardial performance in normal and heart-failure dogs.

Myocardial actions of the vasodilator peptide adrenomedullin (ADM) in the intact animal are unknown. Negative and positive inotropic actions have been reported in ex vivo experiments. Myocardial an...
A murine model of a novel surgical architecture for proprioceptive muscle feedback and its potential application to control of advanced limb prostheses.

Objective Proprioceptive mechanisms play a critical role in both reflexive and volitional lower extremity control. Significant strides have been made in the development of bionic limbs that are capable of bi-directional communication with the peripheral nervous system, but none of these systems have been capable of providing physiologically-relevant muscle-based proprioceptive feedback through natural neural pathways. In this study, we present the agonist-antagonist myoneural interface (AMI), a surgical approach with the capacity to provide graded kinesthetic feedback from a prosthesis through mechanical activation of native mechanoreceptors within residual agonist-antagonist muscle pairs. Approach (1) Sonomicrometery and electroneurography measurement systems were validated using a servo-based muscle tensioning system. (2) A heuristic controller was implemented to modulate functional electrical stimulation of an agonist muscle, using sonomicrometric measurements of stretch from a mechanically-coupled antagonist muscle as feedback. (3) One AMI was surgically constructed in the hindlimb of each rat. (4) The gastrocnemius-soleus complex of the rat was cycled through a series of ramp-and-hold stretches in two different muscle architectures: native (physiologically-intact) and AMI (modified). Integrated electroneurography from the tibial nerve was compared across the two architectures. Main results Correlation between stretch and afferent signal demonstrated that the AMI is capable of provoking graded afferent signals in response to ramp-and-hold stretches, in a manner similar to the native muscle architecture. The response magnitude in the AMI was reduced when compared to the native architecture, likely due to lower stretch amplitudes. The closed-loop control system showed robustness at high stretch magnitudes, with some oscillation at low stretch magnitudes. Significance These results indicate that the AMI has the potential to communicate meaningful kinesthetic feedback from a prosthetic limb by replicating the agonist-antagonist relationships that are fundamental to physiological proprioception.
Tritium aspects of the fusion nuclear science facility

Abstract The Fusion Nuclear Science Facility (FNSF) is intended to bridge the technical gaps from ITER to DEMO, and provide a fully nuclear environment for the advancement of materials and blanket science, among other missions. Though smaller (∼500 MW fusion power) than the envisioned DEMO, our FNSF design still seeks to test DEMO-relevant components and technologies, and to that end one of its goals is to achieve a tritium breeding ratio near one using a dual-cooled lead lithium (DCLL) blanket. We explore here the migration of bred tritium through in-vessel components and coolant loops, which is exacerbated by the relatively low solubility of tritium in PbLi and the high operating temperatures envisioned in later phases of operation. Some features inherent to the design of the DCLL help limit tritium losses, namely the relatively high PbLi flow rates; coupled with efficient tritium extraction, the DCLL potentially achieves low tritium permeation losses without the use of permeation barriers. We outline here the design of such an extraction system, and some of the materials challenges that must be met in order to realize it. The efficacy of these and other design features, such as coaxial piping, is demonstrated via a series of parameter studies. We also investigate the effect of parameter uncertainties, and find that the imprecise knowledge of the tritium solubility in PbLi in particular leads to very disparate estimates of tritium losses. Depending on the experimental value used, losses range from ∼0.05 to over 6 g of tritium per year. The former is acceptable based on estimated environmental releases and resultant dose to members of the public; the latter exceeds regulatory limits
Reading Critical Theory in Alvesson & Willmott (2012): Or, Critique is Dynamite!

This paper studies the use of critical theory in Making sense of management: A critical introduction (Alvesson & Willmott, 2012) (henceforth abbreviated as MSM). The book’s arguments (in first and ...
Association Between Medicare’s Mandatory Hospital Value-Based Purchasing Program and Cost Inefficiency

The Patient Protection and Affordable Care Act instituted pay-for-performance programs, including Hospital Value-Based Purchasing (HVBP), designed to encourage hospital quality and efficiency. While these programs have been evaluated with respect to their implications for care quality and financial viability, this is the first study to assess the relationship between hospitals’ cost inefficiency and their participation in the programs. We estimate a translog specification of a stochastic cost frontier with controls for participation in the HVBP program and clinical and outcome quality for California hospitals for 2012–2015. The program-participation indicators’ parameters imply that participants were more cost inefficient than their peers. Further, the estimated coefficients for summary process of care quality indexes for three health conditions (acute myocardial infarction, pneumonia, and heart failure) suggest that higher quality scores are associated with increased operating costs. The estimated coefficients for the outcome quality variables suggest that future determination of HVBP payment adjustments, which will depend solely on mortality rates as measures of clinical care quality, may not only be aligned with increasing healthcare quality but also reducing healthcare costs.
Speciation analysis of arsenic in seafood and seaweed: Part I—evaluation and optimization of methods

Several extraction and chromatographic methods were evaluated to identify optimum conditions for arsenic speciation analysis in seafood and seaweed. The extraction systems, which include aqueous, aqueous-organic, acidic, basic, and enzymatic solutions, were examined for their efficiency in extracting arsenic from finfish, crustaceans, molluscs, and seaweed keeping the chemical forms of the native arsenicals intact. While dilute solutions of nitric acid, hydrochloric acid, and tetramethylammonium hydroxide (TMAH) extract high fractions of arsenic from most of the matrices, the extractants oxidized arsenite (As3+) to arsenate (As5+) and converted some arsenosugars and non-polar arsenicals to known and/or unknown forms. Hot water (90 °C) effectively maintained the integrity of the native arsenic species and enabled analysis of the extracts with no further manipulation than filtration and dilution. Stepwise extraction of water-soluble and non-polar arsenic with hot water and a mixture of dichloromethane and methanol, respectively, resulted in sufficiently quantitative (> 75%) arsenic extraction from seafood and seaweed. Anion and cation exchange chromatographic methods were optimized for separation and quantitation of the arsenicals extracted into hot water. The non-polar arsenicals were collectively determined after digesting the extract in acid. The application of the optimum extraction and chromatographic conditions was demonstrated by analyzing certified reference materials of tuna fish tissue (BCR 627), lobster hepatopancreas (TORT-2) and oyster tissue (SRM 1566b), and a sample of hijiki seaweed. For all the matrices, good agreement (80–92%) was found between the total water-soluble arsenic and the sum of the concentrations of the chromatographed species. Limits of quantification (LOQ) were in the range 4–11 ng g−1 for 16 arsenicals.
Numerical solution of the Saint-Venant equations by an efficient hybrid finite-volume/finite-difference method

A computationally efficient hybrid finite-volume/finite-difference method is proposed for the numerical solution of Saint-Venant equations in one-dimensional open channel flows. The method adopts a mass-conservative finite volume discretization for the continuity equation and a semi-implicit finite difference discretization for the dynamic-wave momentum equation. The spatial discretization of the convective flux term in the momentum equation employs an upwind scheme and the water-surface gradient term is discretized using three different schemes. The performance of the numerical method is investigated in terms of efficiency and accuracy using various examples, including steady flow over a bump, dam-break flow over wet and dry downstream channels, wetting and drying in a parabolic bowl, and dam-break floods in laboratory physical models. Numerical solutions from the hybrid method are compared with solutions from a finite volume method along with analytic solutions or experimental measurements. Comparisons demonstrates that the hybrid method is efficient, accurate, and robust in modeling various flow scenarios, including subcritical, supercritical, and transcritical flows. In this method, the QUICK scheme for the surface slope discretization is more accurate and less diffusive than the center difference and the weighted average schemes.
Characterization of Hierarchical Manifold Microchannel Heat Sink Arrays under Simultaneous Background and Hotspot Heating Conditions

Abstract A hierarchical manifold microchannel heat sink array is fabricated and experimentally characterized for uniform heat flux dissipation over a footprint area of 5 mm × 5 mm. A 3 × 3 array of heat sinks is fabricated into the silicon substrate containing the heaters for direct intrachip cooling, eliminating the thermal resistances typically associated with the attachment of a separate heat sink. The heat sinks are fed in parallel using a hierarchical manifold distributor that delivers flow to each of the heat sinks. Each heat sink contains a bank of high-aspect-ratio microchannels; five different channel geometries with nominal widths of 15 μm and 33 μm and nominal depths between 150 μm and 470 μm are tested. The thermal and hydraulic performance of each heat sink array geometry is evaluated using HFE-7100 as the working fluid, for mass fluxes ranging from 600 kg/m2 s to 2100 kg/m2 s at a constant inlet temperature of 59 °C. To simulate heat generation from electronics devices, a uniform background heat flux is generated with thin-film serpentine heaters fabricated on the silicon substrate opposite the channels; temperature sensors placed across the substrate provide spatially resolved surface temperature measurements. Experiments are also conducted with simultaneous background and hotspot heat generation; the hotspot heat flux is produced by a discrete 200 μm × 200 μm hotspot heater. Heat fluxes up to 1020 W/cm2 are dissipated under uniform heating conditions at chip temperatures less than 69 °C above the fluid inlet and at pressure drops less than 120 kPa. Heat sinks with wider channels yield higher wetted-area heat transfer coefficients, but not necessarily the lowest thermal resistance; for a fixed channel depth, samples with narrower channels have increased total wetted areas owing to the smaller fin pitches. During simultaneous background and hotspot heating conditions, background heat fluxes up to 900 W/cm2 and hotspot fluxes up to 2700 W/cm2 are dissipated. The hotspot temperature increases linearly with hotspot heat flux; at hotspot heat fluxes of 2700 W/cm2, the hotspot experiences a temperature rise of 16 °C above the average chip temperature.
Multipoint analysis of human quantitative genetic variation.

Abstract A unique method of partitioning human quantitative genetic variation into effects due to specific chromosomal regions is presented. This method is based on estimating the proportion of genetic material, R, shared identical by descent (IBD) by sibling pairs in a specified chromosomal region, on the basis of their marker genotypes at a set of marker loci spanning the region. The mean and variance of the distribution of R conditional on IBD status and recombination pattern between two marker loci are derived as a function of the distance between the two loci. The distribution of the estimates of R is exemplified using data on 22 loci on chromosome 7. A method of using the estimated R values and observed values of a quantitative trait in a set of sibships to estimate the proportion of total genetic variance explained by loci in the region of interest is presented. Monte Carlo simulation techniques are used to show that this method is more powerful than existing methods of quantitative linkage analysis based on sib pairs. It is also shown through simulation studies that the proposed method is sensitive to genetic variation arising from both a single locus of large effect as well as from several loosely linked loci of moderate phenotypic effect.
Kinematics and Statistics of Breaking Waves Observed Using SWIFT Buoys

Surface wave instrumentation floats with tracking were deployed by helicopter ahead of five large storms off the Oregon coast. The buoys drifted freely with the wave motions, surface currents, and wind. The buoys use a 9-DoF inertial measurement unit that fuses the measurements of accelerometers, magnetometers, and gyroscopes to measure acceleration in the global North-West-Up reference frame. Rapid sampling (25 Hz) allows for the observation of both propagating wave motions and wave breaking events. Bulk wave parameters and wave spectra are calculated from the motion of the buoys using conventional methods, and breaking wave impacts are identified in the raw acceleration data using a new algorithm based on a short-time Fourier transform. The number of breaking waves is used to infer breaker fraction, which is found to depend on bulk wave steepness as previously shown in the literature. The magnitude and duration of acceleration during breaking is used in a new quantification of breaker intensity, which increases with wave height, period, and steepness. There is significant variance of breaker intensity in a given wave field, such that intense breakers still occur in relatively mild wave fields. The buoy observations are compared to the output of the WaveWatch III forecast model, with evaluation of an empirical breaker prediction scheme applied to WaveWatch III output.
Preadolescent Suicide: How to Ask and how to Respond:

Studies of preadolescents strongly suggest that the prevalence of depression and suicidal activity among them has been seriously underestimated. The authors review current thinking about preadolesc...
Expanding the Role of STING in Cellular Homeostasis and Transformation

The cytosolic DNA-sensing cGAS–STING pathway was originally characterized as a key innate immune mediator responsible for the induction of antiviral genes in response to foreign DNA species in the cytosol. Mounting evidence, however, points to a complex role for cGAS and STING in cancer. Two recent reports, by Ranoa et al. (Cancer Research, 2018;https://doi.org/10.1158/0008-5472.CAN-18-1972) and Nassour et al. (Nature 2019;565:659–663), dissect the function of this pathway during the early steps of cellular transformation and shed light on the complexity and context-dependence of cGAS–STING signaling in cancer.
Intake of whole grain foods and risk of type 2 diabetes: results from three prospective cohort studies

Abstract Objective To examine the associations between the intake of total and individual whole grain foods and the risk of type 2 diabetes. Design Prospective cohort studies. Setting Nurses’ Health Study (1984-2014), Nurses’ Health Study II (1991-2017), and Health Professionals Follow-Up Study (1986-2016), United States. Participants 158 259 women and 36 525 men who did not have type 2 diabetes, cardiovascular disease, or cancer at baseline. Main outcome measures Self-reports of incident type 2 diabetes by participants identified through follow-up questionnaires and confirmed by a validated supplementary questionnaire. Results During 4 618 796 person years of follow-up, 18 629 participants with type 2 diabetes were identified. Total whole grain consumption was categorized into five equal groups of servings a day for the three cohorts. After adjusting for lifestyle and dietary risk factors for diabetes, participants in the highest category for total whole grain consumption had a 29% (95% confidence interval 26% to 33%) lower rate of type 2 diabetes compared with those in the lowest category. For individual whole grain foods, pooled hazard ratios (95% confidence intervals) for type 2 diabetes in participants consuming one or more servings a day compared with those consuming less than one serving a month were 0.81 (0.77 to 0.86) for whole grain cold breakfast cereal, 0.79 (0.75 to 0.83) for dark bread, and 1.08 (1.00 to 1.17) for popcorn. For other individual whole grains with lower average intake levels, comparing consumption of two or more servings a week with less than one serving a month, the pooled hazard ratios (95% confidence intervals) were 0.79 (0.75 to 0.83) for oatmeal, 0.88 (0.82 to 0.94) for brown rice, 0.85 (0.80 to 0.90) for added bran, and 0.88 (0.78 to 0.98) for wheat germ. Spline regression showed a non-linear dose-response association between total whole grain intake and the risk of type 2 diabetes where the rate reduction slightly plateaued at more than two servings a day (P Conclusion Higher consumption of total whole grains and several commonly eaten whole grain foods, including whole grain breakfast cereal, oatmeal, dark bread, brown rice, added bran, and wheat germ, was significantly associated with a lower risk of type 2 diabetes. These findings provide further support for the current recommendations of increasing whole grain consumption as part of a healthy diet for the prevention of type 2 diabetes.
Nanostructure-enabled longer lock-on time GaAs photoconductive semiconductor switches

We reported a new type of GaAs photoconductive semiconductor switch (PCSS) with nanostructured surface. Since the light could be entered not only from the top surface but also the side surface of the nanostructures, the effective penetration depth was significantly increased. This resulted in a longer lock-on time, which could be highly useful for a variety of applications that require longer lock-on time.
Substrate metabolism during recovery from circuit resistance exercise in persons with spinal cord injury

Whole body energy expenditure and lipid oxidation (Lox) are upregulated during and after exercise. Persons with spinal cord injury (SCI) generally have a blunted ability to utilize fat during exercise, but it is unknown if their substrate partitioning is affected during recovery from exercise. To determine the effect of a single session of upper body circuit resistance exercise (CRE) on energy expenditure and Lox during exercise recovery in persons with and without SCI. Twenty four persons (3 groups; 7 male and 1 female per group) without paralysis (neurologically intact; N) or with chronic (≥ 1 yr) paraplegia (P) or tetraplegia (T) participated. Energy expenditure and substrate partitioning were assessed via indirect calorimetry before, during, and three times after (up to 120 min after) a single session of CRE, or time-matched seated control (CON). During CRE, all groups experienced a similar relative increase in oxygen consumption (49 ± 13, 55 ± 11, and 48 ± 15% VO2peak for N, P, and T, respectively). The Post0-120 energy expenditure was greater following CRE vs. CON (P < 0.01) and independent of injury characteristics (10.6, 22.6, and 14.3% higher than CON for N, P, and T; P = 0.21). The absolute increase in Lox above CON during recovery was similar for N, P, and T (5.74 ± 2.81, 6.62 ± 3.10, and 4.50 ± 3.91 g, respectively; P = 0.45). Energy expenditure and lipid utilization was increased similarly following circuit exercise in persons without and with spinal cord injury in a manner independent of level of injury.
“Extraño todo”: el palomar de las Soledades de la A a la Z

«All of it strange, / design, structure and style», says the poem in reference to the dovecote described in the second Solitude. Strange compared to what? What did a pigeon house in the sixteenth and seventeenth centuries look like, how were they represented in literature, emblematics, and painting, and what does the pigeon house in The Solitudes have to do with Gongora’s poetics? I would like to approach these questions from three different angles: traditional Philology, Art History, and Philosophy, including Adorno’s Aesthetic Theory, Agamben’s notion of the «power-of-not», and Heidegger’s concept of «unveiling». The paper is divided into ten parts: The Artistic Farm, The Poem’s Original Version, «Common Things», «Design», «Structure», The Tree-House of the Prince of Caserta, «Style», The Poetics of Strangeness, The «beautiful strangeness» of the Alba Castle in Garcilaso’s Second Eclogue and Pigeon Houses in Flemish and Dutch Art—in other words, Gongora’s pigeon house from A to Z.
Barriers to care in urban and rural dwelling adults with congenital heart disease.

INTRODUCTION Adults with congenital heart disease (CHD) face a unique set of medical, psychological, and social challenges, and access to specialised adult congenital heart disease care has been associated with improved outcomes. Rural adults with CHD may represent a uniquely disadvantaged group given additional challenges when accessing specialised care. The aim of this study was to investigate the challenges faced by adults with CHD in accessing outpatient cardiac care, with a specific focus on understanding differences between urban- and rural-dwelling patients. METHODS This cross-sectional, survey-based study took place in the adult congenital heart disease clinic at an urban academic medical center. Additional medical information was abstracted in a retrospective manner from the electronic health record. In addition to descriptive statistics, t-tests and Chi-square tests were performed to investigate differences between urban and rural dwelling patients. RESULTS A total of 100 patients participated in the study (mean age 40 ± 13 years, 60% female, 18% rural dwelling). Across the total sample, the median driving distance to clinic was 20 miles (interquartile range 12-77); it was 15 miles for urban dwellers and 77 miles for rural dwelling patients (p < 0.001). The most commonly identified barriers to cardiac clinic visits were financial losses related to taking time off from work (39%), distance of clinic from home (33%), and weather (33%). Compared to urban dwelling patients, on average those who were rural dwelling had a lower level of education (p = 0.04), more difficulty paying insurance premiums (p < 0.001) and copays (p = 0.005), and were more likely to identify the distance from clinic (p = 0.05) and having to go into the city (p = 0.02) as barriers to clinic appointments. CONCLUSIONS The financial impact and distance to clinic were the most commonly identified barriers to outpatient cardiac care in this cohort of adults with CHD. These barriers, along with difficulty paying insurance premiums, are more common in rural dwelling patients. Initiatives such as telemedicine visits or providing financial subsidies for travel and treatment could help to expand specialty adult congenital heart disease care and better serve this growing patient population.
Milestones and Comparative Perspective

The previous chapters have examined the purpose of budgeting, fiscal conservatism and fiscal conservatives, patterns and trends in revenue and spending, the executive budget model, the annual budget process, performance budgeting, the line-item veto in executive-legislative relations, and the budget priorities and accomplishments of nine modern-era governors. This concluding chapter identifies several milestones in the evolution of the state’s budget process and in the patterns and trends of its taxing and spending. It concludes by placing Georgia’s budget process and its patterns and trends in revenue and spending in comparative perspective.
Minimum size Q = 1 and ignited spherical tokamak devices

The authors find minimum sized Spherical Tokamak (ST) configurations capable of Q{approximately}1 (scientific break-even) and ignition. For Q{approximately}1 cases, the authors normalize their models to the JET device. They find comparable plasma power balance performance in an ST configuration of major radius {approximately}0.7 m, using both global and 3/2 D plasma transport modeling. For ignited plasma, they first normalize the plasma modeling to the ITER device. They find similar ignited plasma performance capabilities in an ST configuration of major radius 1.2 m. These are much smaller size plasmas than the standard tokamak counterparts, indicating a potentially easier path towards commercial applications. Also, they find that the quantity IA is not a good figure-of-merit for comparing performance of widely different tokamak configurations.
Chronic stress and decreased physical exercise: impact on weight for African American women

OBJECTIVE: African American women continue to have the highest prevalence of obesity in the United States and in the state of Maryland they are disproportionately affected by overweight and obesity. There are many contributing factors including chronic stress and the use of health behaviors such as physical exercise that play a role in increased weight for African American women. We examined the relationship of stress to weight and the role of physical exercise in African American paraprofessional women. DESIGN: Cross-sectional study SETTING: African American paraprofessionals were asked about their perspectives regarding association with chronic stress and physical exercise. RESULTS: The three most salient stressors for the women were finances (33%), work (28%) and family/friends (19%). Ninety percent of the women were overweight or obese. Significant predictors of increased BMI were lack of physical exercise (P = .004) and health compared to others (P = .006). Ethnic discrimination was a form of chronic stress (r = .319) but was not correlated with BMI (r = .095). Decreased physical exercise (P = .02) mediated the relationship between chronic stress and BMI. CONCLUSION: Findings regarding finance and work stress suggest the need for employers to consider the impact of job strain when implementing employee health programs to decrease stress and improve health. A focus on decreased physical exercise, unhealthy eating habits and misperceptions regarding increased risk for obesity related diseases with health status may be helpful to include in intervention strategies to decrease obesity for this population. Ethn Dis . 2012 Spring;22(2):185-91.
Overview of Speaker Identification with Privacy

Speaker identification is the task of determining the identity of the speaker given a test speech sample. We typically associate the identity of the speaker with a predetermined set of speakers and we refer to this task as closed-set speaker identification. If we augment the set of speakers with a none of the above option, i.e., consider the speaker to be outside the predetermined set of speakers, this task becomes open-set speaker identification. Speaker verification can be considered as a generalization of open-set speaker identification, where the set of speakers is restricted to one speaker. As a consequence, the algorithms used in speaker verification can be extended for speaker identification. The main difference between the two tasks is their application scenarios and this results in different evaluation metrics for the two tasks. Speaker verification is mainly used for authentication; speaker identification finds use in surveillance applications and also as a preliminary step for other speech processing applications as we discuss below.
Polaron energy spectrum in a magnetic field

A study is made of the energy spectrum of a polaron in a magnetic field for the case of weak and intermediate couplings. The results obtained are compared with those of a numerical calculation of the self-energy of an electron in a magnetic field interacting with the optical phonons of a polar crystal. The method used is based on the approach first given by Onsager. The results obtained are compared with those of previous variational calculations. We also investigate the numerical change of the polaron mass with magnetic field and compare it with that due to the nonparabolicity of the conduction band in GaAs and CdTe. In CdTe the first effect produces a change which is about three times larger than the one produced by the second, whereas in GaAs it is the latter effect which is more important.
Genetic Analysis of an Interspecific Hybrid Swarm of Populus: Occurrence of Unidirectional Introgression

Restriction fragment length polymorphisms were used to distinguish genotypes of two species of Populus, P. fremontii ('Fremont') and P. angustifolia ('narrowleaf'). Both inter- and intraspecific polymorphisms were detected in these cottonwood trees. The interspecific variation was much greater than the intraspecific variation. This permitted identification of parental genotypes within individual trees of a hybrid swarm which exists in an overlap zone between the two species. Within this hybrid swarm, individual trees are either F1 hybrids or backcrosses with a pure 'narrowleaf' parent; no progeny were found that could be attributed to crossing between F1 hybrid trees, or to backcrossing between F1 hybrid trees and 'Fremont'.
Robust partial-volume tissue classification of cerebral MRI scans

In magnetic resonance images (MRI) a voxel may contain multiple tissue types (partial volume effect). We concentrate in the classification of these voxels using an adaptive Bayesian approach and pay particular attention to practical implementation problems induced by the modeling of partial volume voxels. Moreover, we show that this algorithm is suitable to perform tissue classification of brain MRI scans that in turn can be used for visualization or quantitative analysis, or for further purposes such as brain image registration. Results are presented showing the efficacy of the method as compared to a binary classification process.
The effect of anthropogenic noise on male advertisement call rate in the neotropical treefrog, Dendropsophus triangulum

Anthropogenic change such as road construction and subsequent traffic noise in pristine habitats has been shown to be detrimental to a range of vertebrate taxa. The effect of anthropogenic noise on anuran communication is not well known, and has only recently been a topic of investigation. We tested the effect of anthropogenic noise on the calling behaviour of the Amazonian treefrog Dendropsophus triangulum . We performed four experiments. We first presented frogs with the noise of a pre-recorded motorcycle engine, and recorded the call rates of focal frogs for 5 min, then for another 5 min during which they were presented with a broadcast of noise, and again for 5 min post-stimulus. We repeated this experiment using music as the stimulus. We then tested the effect of intermittent engine noise, recording baseline call rate and response to six cycles of intermittent noise. In all experiments, call rates nearly doubled during playbacks. Finally, we compared frogs' responses to anthropogenic noise to responses to chorus noise broadcast at the same intensity; call rates did not differ between treatments. These results demonstrate a clear effect of exogenous noise on male D. triangulum .
Weekly 24-hour continuous infusion interleukin-2 for metastatic melanoma and renal cell carcinoma: a phase I study.

Twenty-nine patients with biopsy-confirmed metastatic melanoma (17) or metastatic renal cell carcinoma (12) were treated with escalating doses or recombinant human interleukin-2 (IL-2) administered as weekly 24-h intravenous infusions. Patients received from 3 to 12 x 10(6) C.U./m2 (18-72 x 10(6) I.U./m2) weekly over a treatment period of 1 to 16 weeks, with a median of eight weekly cycles administered. Patients in all treatment groups experienced non-life-threatening systemic side effects consisting of fever, nausea, vomiting, fluid retention, and diarrhea. Grade III hypotension was seen in four of six patients (67%) at 12 x 10(6) C.U./m2, and represented the dose-limiting toxicity. Grade IV hypotension occurred in 1 of 14 patients at 6 x 10(6) C.U./m2; no other grade IV toxicities were observed. Grade III fever occurred in 3 of 11 patients (27%) treated at 3 x 10(6) C.U./m2, 3 of 14 patients (21%) at 6 x 10(6) C.U./m2, and 3 of 6 patients (50%) at 9 x 10(6) C.U./m2. An objective response was observed in 3 of 28 evaluable patients (10%): 1 complete response and 1 partial response in renal cell cancer, and 1 partial response in a melanoma patient. We conclude that for future studies, the recommended dose of IL-2 given as a weekly 24-h infusion is 9 x 10(6) C.U./m2 and that a low rate of objective tumor response can be obtained in patients with melanoma and renal cell carcinoma using this regimen.
Commentary: Unmasked and Uncontrolled Medication Trials in Child and Adolescent Psychiatry

The four open and uncontrolled pharmacological trials published in this issue of the Journal are timely and of interest to the psychiatrist who treats children and adolescents. These articles include important informa­ tion on dosage, tolerability, and usefulness of four dif­ ferent medication treatments used in children and adolescents. Each of these clinical trials is unmasked, i.e., unblinded (Meinert, 1986), and none of the studies uses a concurrent control group, i.e., a placebo or com­ parison treatment group. The subjects in each trial were given the medication, and the treating physician, the rater of symptoms, the subject, and family were all aware that the patient was taking active medication. The problem with unmasked and uncontrolled trials is the potential for introducing bias that can influence the results of the study. Of most concern is bias that results in inflated estimates of efficacy and unrealistic reporting of adverse events. We do not suggest that authors of open trials intend to bias the outcome of a study. Rather, in uncontrolled trials, nonspecific treat­ ment effects and the natural course of illness can often account for the observed clinical improvement and be falsely attributed to the active treatment. In addition, the publication of unmasked and uncontrolled trials can create the impression that a medication is effective or lead uniformed readers to conclude that because the trial was published, the results must be "true." The authors must therefore be very clear about the limitation of interpreting the results, and the reader must be skeptical of claims made on the basis of unmasked and uncontrolled trials (Meinert, 1986). Why are these studies published, if there is some chance that bias affected the outcome of the study? The
Mechanical power output of locust flight muscle

1. The mechanical work and power output of locust flight muscle were measured during cyclic contraction at normal flight frequency and operating temperature by subjecting muscle to sinusoidal length change and phasic stimulation at selected points in the length cycle. 2. With a single stimulus per cycle, work output averaged 2.1 J/kg muscle inSchistocerca nitens and 2.4 J/kg muscle inS. americana gregaria (power output 52 and 49 W/kg respectively) (Table 1). 3. Work was maximal at imposed length changes of about 4% of resting muscle length and at stimulus phases such that maximum tension occurred at the midpoint of the shortening phase of the length change (Table 1). 4. With multiple stimulation, power output can be increased about 20% above that obtained with a single stimulus per cycle (up to about 73 W/kg muscle) (Fig. 2).
Comparison of multicenter study designs for investigation of carotid endarterectomy efficacy.

Our report summarizes and compares the characteristics of six prospective, multicenter, randomized clinical trials of carotid endarterectomy underway in North America and Europe.Three trials are designed to evaluate the safety and efficacy of endarterectomy in patients with asymptomatic carotid artery stenosis. The other three trials enroll patients who have had transient ischemic attacks or a minor cerebral infarction in the distribution of the randomized artery. Considered together, these six clinical trials span the range of candidates for carotid endarterectomy. The inclusion and exclusion criteria, methodology, and statistical considerations of each study are detailed in tables.The results from these trials will be helpful in resolving some of the questions surrounding endarterectomy, provided the similarities and differences in the study designs are considered when interpreting the results.
Influence of crystallography and bonding on the structure and migration of irrational interphase boundaries

Interphase boundary structure developed during precipitation from solid solution and during massive transformations is considered in diverse alloy systems in the presence of differences in stacking sequence across interphase boundaries. Linear misfit compensating defects, including misfit dislocations, structural disconnections, and misfit disconnections, are present over a wide range of crystallographies when both phases have metallic bonding. Misfit dislocations have also been observed when both phases have covalent bonding (e.g., US:β US2 by Sole and van der Walt). These defects are also found when one phase is ionic and the other is metallic (Nb:Al2O3 by Ruhle et al.), albeit when the latter is formed by vapor deposition. However, when bonding is metallic in one phase but significantly covalent in the other, the structure of the interphase boundary appears to depend upon the strength of the covalent bonding relative to that in the metallically bonded phase. When this difference is large, growth can take place as if it were occurring at a free surface, resulting in orientation relationships that are irrational and conjugate habit planes that are ill matched (e.g., ZrN:α Zr-N by Li et al. and Xe(solid):Al-Xe by Kishida and Yamaguchi). At lower levels of bonding directionality and strength, crystallography is again irrational, but now edge-to-edge-based low-energy structures can replace linear misfit compensating defects (γm:TiAl:α Ti-Al by Reynolds et al.). In the perhaps still smaller difference case of Widmanstatten cementite precipitated from austenite, one orientation relationship yields plates with linear misfit compensating defects at their broad faces whereas another (presumably nucleated at different types of site) produces laths with poorly defined shapes and interfacial structures. Hence, Hume-Rothery-type bonding considerations can markedly affect interphase boundary structure and thus the mechanisms, kinetics, and morphology of growth.