cssi/SciSciGPT-SciSciNet huggingface dataset:
Empirical Determinants of Bicameral Sequence in State Legislatures

In a previous article (Rogers 1998), I showed that the bicameral chamber that originates enacted legislation tends to realize policy outcomes closer to the preference of its median legislator than does the chamber that votes second on legislation. All things being equal, this �first-mover advantage� implies that each chamber could be expected to originate roughly half of all enacted legislation. But all other things are not equal in U.S. state bicameral legislatures. Drawing on an expanded dataset, I innovate and test a number of additional hypotheses related to bicameral voting sequence. My results account for the effects of constitutional, institutional, and electoral variables on bicameral sequence.
A Note on the Speed-Amplitude Function in Movement Control

An experiment is reported that documents the maximum average speed-amplitude relationship across the full range of motion for elbow flexion. Minimum movement time increased as a negative exponential within the movement range up to 94-97% of the maximum range of motion. At this point a discontinuity occurred with movement time increasing at an increasing rate probably due to anatomical and morphological constraints. These results suggest that the maximum average velocity-amplitude boundary to the movement speed-accuracy relationship is curvilinear. Kinematic analysis of the movements as a function of range of motion suggests that a simple pulse-step model of movement control cannot account for the present findings.
Career Thoughts, Indecision, and Depression: Implications for Mental Health Assessment in Career Counseling

This study investigated the relationships among dysfunctional career thoughts and career indecision with respect to symptoms of depression. Such information could be useful to counselors in identifying individuals at the outset of career counseling who may be experiencing emotional distress from life stressors in addition to career stress. One-hundred fifty-eight college students enrolled in a career development course completed measures of dysfunctional career thoughts, an occupational alternative question, and a measure of depression symptoms. Results indicated that dysfunctional career thoughts and occupational indecision were related to depression symptoms, with decision-making confusion being the best predictor. Implications of the findings for practice and research are discussed.
Deconstructing Candy Crush: what instructional design can learn from game design

Purpose – The purpose of this paper is to explore four general design features of King Digital Entertainment’s game “Candy Crush Saga” – structural, social, cognitive, and emotional – that reflect the principles of Universal Design for Learning and discusses how these features can be applied to course design in order to motivate learner persistence and increase student success. Design/methodology/approach – Both authors are casual Candy Crush game players intrigued by how the game motivates users to continue. The methodology began with participant observation and expanded to “deconstruction” of game features and application of research findings in multiple disciplines to build the argument that game design strategies can be applied to course design to enhance learning outcomes. Findings – Many factors influence game play, but it is crucial for each level to provide increasing challenges that motivate increased mastery but do not frustrate a player to the point of quitting. Similarly, course design that pr...
Long-Term Presence of Virus-Specific Plasma Cells in Sensory Ganglia and Spinal Cord following Intravaginal Inoculation of Herpes Simplex Virus Type 2

The tissue sites of long-term herpes simplex virus type 2 (HSV-2)-specific antibody production in mice and guinea pigs were identified. In addition to secondary lymphoid tissue and bone marrow, HSV-specific plasma cells were detected in spinal cords of mice up to 10 months after intravaginal inoculation with a thymidine kinase-deficient HSV-2 strain and in lumbosacral ganglia and spinal cords of guinea pigs inoculated with HSV-2 strain MS. The long-term retention of virus-specific plasma cells in the peripheral and central nervous systems following HSV infection may be important for resistance to reinfection of neuronal tissues or may play a role in modulation of reactivation from latency.
Effects of intraaortic balloon augmentation in a porcine model of endotoxemic shock.

Abstract Objective: Patients with septic shock commonly have myocardial dysfunction associated with lactic acid production and troponin I release. The purpose of this study was to evaluate the effects on intraaortic balloon pump (IABP) support on myocardial dysfunction. Design: Prospective, randomized controlled study. Setting: Animal research laboratory. Methods: Ten pigs had arterial, pulmonary arterial, and coronary catheters inserted. After receiving endotoxin infusion over 30 min, half the animals received IABP support. Results: Coronary sinus lactic acid levels ( P P Conclusion: IABP had no benefits in this porcine model of endotoxemic shock.
Hydrogen Storage in Metal–Organic Frameworks

Metal-organic frameworks (MOFs) are highly attractive materials because of their ultra-high surface areas, simple preparation approaches, designable structures, and potential applications. In the past several years, MOFs have attracted worldwide attention in the area of hydrogen energy, particularly for hydrogen storage. In this review, the recent progress of hydrogen storage in MOFs is presented. The relationships between hydrogen capacities and structures of MOFs are evaluated, with emphasis on the roles of surface area and pore size. The interaction mechanism between H(2) and MOFs is discussed. The challenges to obtain a high hydrogen capacity at ambient temperature are explored.
Photodefinable Metal Oxide Dielectrics II: Direct Fabrication of Patterned High-k Dielectrics for Low Cost RF Capacitive MEMS Switches

In this paper, recent advancements related to a novel approach for fabricating low cost capacitive radio frequency microelectromechanical (RF MEMS) switches using directly photodefinable high dielectric constant metal oxides are discussed. In this approach, a radiation sensitive metal-organic precursor is deposited via spin coating and converted patternwise to a metal oxide using exposure to ultraviolet light. The feasibility of this approach has previously been demonstrated by fabricating bridge-type and cantilever-type RF MEMS switches. These early experiments showed that the photopatterned oxides displayed dielectric breakdown strengths that were insufficient for reliable operation of MEMS switches which required actuation voltages on the order of 20 V to 30 V. Recent work has focused on developing advanced processes based on the photodefinable metal-organic approach that can produce oxides with higher dielectric breakdown strengths and higher dielectric constants. A variety of post-patterning processes, including thermal baking and oxygen plasma annealing, were investigated and the impact of such processing on the resulting dielectric properties are discussed in this paper. It is shown that a combination of thermal annealing and oxygen plasma treatment can substantially improve the dielectric breakdown strength of the metal oxides produced using the photosensitive metal-organic process.
Electric measurements of charged sprays emitted by cone-jets

We use time-of-flight and energy analysis techniques to measure in a vacuum the charge, specific charge and stopping potential of primary and satellite droplets generated by electrosprays of tributyl phosphate solutions. This information, of interest in itself, is subsequently analysed to obtain the following relevant parameters of the jet emanating from the Taylor cone: the velocity of the fluid at the breakup point, the voltage difference between the liquid cone and jet breakup location, and the most probable wavelength for varicose breakup. A large fraction of the electrospray needle voltage is used to accelerate the jet. Indeed, for the solutions of lowest electrical conductivities studied here, the voltage difference between electrospray needle and jet breakup location becomes approximately 90% of the needle voltage. In addition, the pressure of the jet fluid at the breakup point is negligible compared to its specific kinetic energy. The specific charge distribution function of the main droplets produced in the varicose breakup is remarkably narrow. Hence, the limiting and commonly accepted case of varicose breakup at constant electric potential is not consistent with this experimental observation. On the other hand, a scenario in which the electric charge is bound to the jet surface seems to be a good approximation to simulate the effect of charge on capillary breakup. It is also found that the effect of viscosity on the formation of droplets is paramount in electrosprays of moderate and high electrical conductivity. We expect that these measurements will guide the analytical modelling of cone-jets.
Functional Neural Systems Analyzed by Use of Interregional Correlations of Glucose Metabolism

In order to learn which brain regions are functionally associated with one another in a specific group of subjects during a particular experimental paradigm, a computer-assisted quantitative method was developed for analyzing regional rates of glucose uptake. For each pair of brain regions, the partial correlation coefficient, controlling for whole brain glucose utilization, is calculated between the regional cerebral metabolic rates for glucose for all the subjects. A mathematically derived correlation matrix is constructed in which the statistically significant relationships are displayed. Applications of this novel approach to both human and animal studies are discussed. Similar techniques using electrical data (obtained from both micro-electrodes and scalp electrodes) are reviewed, and the strengths and weaknesses of these approaches are examined.
Shift-register synthesis and BCH decoding

It is shown in this paper that the iterative algorithm introduced by Berlekamp for decoding BCH codes actually provides a general solution to the problem of synthesizing the shortest linear feedback shift register capable of generating a prescribed finite sequence of digits. The shift-register approach leads to a simple proof of the validity of the algorithm as well as providing additional insight into its properties. The equivalence of the decoding problem for BCH codes to a shift-register synthesis problem is demonstrated, and other applications for the algorithm are suggested.
Population experiences of primary care in 11 Organization for Economic Cooperation and Development countries

Objective To develop a measure of individual user assessments of primary care and test its association with health system performance and quality indicators. Design Cross-sectional analysis of secondary survey data collected in 2013. Setting Australia, Canada, France, Germany, Netherlands, New Zealand, Norway, Sweden, Switzerland, the UK and the USA. Study Participants 20 045 respondents. Main Outcome Measures Individual report of financial protection (out of pocket expenses over USD 1000), lack of receipt of appropriate/timely care (use of the emergency room in the past 2 years, having consulted three of more doctors in the past year) and clinical prevention (blood pressure check in past year, cholesterol checked in the past 5 years, receipt of influenza vaccination in past year and report of any medical error). Methods A score of users' primary care experiences was constructed from 14 individual survey questions. Multivariable Poisson and augmented inverse-probability weighted regression assess the relationship between the primary care experience score and outcomes. Results Countries differed regarding the proportion of the population experiencing problems with primary care. In analyses controlling for age, sex, health status, chronic disease, income level and health insurance, users experiencing poorer primary care were significantly more likely to report significant out of pocket expenses, emergency room use in the past 2 years, having consulted more than three doctors in the past year, lower likelihood of blood pressure or cholesterol screening, an annual flu shot and higher reports of medical error. Conclusions The measure of individual primary care experience can be used to differentiate among different country's primary care approaches and is strongly associated with overall health system performance and quality indicators.
Race and mass murder in the United States: A social and behavioral analysis:

In the popular discourse, it is commonly assumed that mass murderers and mass shooters are different from most criminals in the United States, because they are almost always white. The present study uses data on 308 mass murderers who attacked from 2006 to 2014 to evaluate this assumption, test for racial differences between mass murderers and all other murderers, and identify characteristics of mass murderers’ behavior by race and ethnic group. Findings suggest that, overall, the racial composition of mass murderers is similar to that of other murderers, and thus may be largely explained by similar social forces, such as structural disadvantages and social inequalities. However, there are significant differences across racial and ethnic groups in attack subtype, victims killed, and attack resolution. In particular, the structural advantages and aggrieved entitlement experienced by whites may help explain their involvement in public mass shootings. Further research in both the United States and other coun...
Lapatinib in Gastric Cancer: What Is the LOGiCal Next Step?

2–Positive Advanced or Metastatic Gastric, Esophageal, or Gastroesophageal Adenocarcinoma) trial, which tested the activity of capecitabine and oxaliplatin with or without lapatinib in the firstline setting in HER2-positive esophagogastric cancer. LOGiC is a well-designed study, with appropriate end points, enrollment criteria, chemotherapy backbone, and toxicity management schema. Two-drug chemotherapy backbones are the preferred approach due to the excessive toxicity (and potential lack of benefit) from three-drug regimens when combined with targeted agents. Initially, the primary end point in LOGiC was progression-free survival. However, during the conduct of the trial, ToGA results showed that trastuzumab improved OS (13.8 v 11.1 months; hazardratio, 0.74;P 5.0046). Therefore, the primary endpointinLOGiCwaschangedtoOS,andthestudywaspowered for a hazard ratio of 0.74 in the experimental arm. Although the trial results will be considered negative because the primary end point of a statistically significant improvement in OS was not met (12.2 v 10.5 months; hazard ratio, 0.91; 95% CI, 0.73 to 1.12; P 5 .3492), the response rate was significantly higher in the lapatinib arm(53%v39%;P5.0031).Inaddition,apreplanned exploratory subgroup analysis demonstrated robust OS benefit in Asian patients (16.5 v 10.9 months; hazard ratio, 0.68; 95% CI, 0.48 to 0.96;P5.0261) and inyounger patients (12.9v9.0 months; hazard
Abstract 321: Impact Of Chronic Kidney Disease On Heart Failure Outcomes In A Minority Cohort

BACKGROUND: Heart failure (HF) and Chronic kidney disease (CKD) are major public health problems that often co-exist with a resultant high mortality and morbidity. Most of the studies evaluating their reciprocal prognostic impact have focused on mortality in majority populations. There is limited literature on the impact of CKD on HF morbidities in ethnic minorities. AIMS: Our study seeks to compare HF outcomes in patients with or without CKD in an African-American predominant cohort. METHODS: We obtained data from the NGH at Meharry Heart Failure Cohort; a comprehensive retrospective HF database comprised of patient care data (HF admissions, non-HF admissions, and emergency room visits) were assessed from January 2006 to December 2008. The study group consist of 306 subjects with a mean age of 65±15 years. 81% were African-American (AA), 19% Caucasian and 48.5% are females. Following the NKF KDOQI guidelines, 5 stages of CKD were outlined based on GFR. RESULTS: The overall prevalence of CKD in this popul...
Cardiovascular Complications in End-Stage Renal Disease Patients

As we conclude 20 years of successful treatment of end-stage renal disease (ESRD) with either intermittent hemodialysis or renal transplantation, it seems appropriate to reflect on past accomplishments while identifying future challenges. Although the life expectancy for patients with terminal renal failure has been extended by these therapeutic interventions, premature cardiovascular disease still ranks as the number one threat to the longevity of this patient population. When the rate of cardiovascular mortality for end-stage renal disease patients is compared to that of the United States population, a death rate increase of between 10 and 30 times is evident (Table 1). In this setting this problem will be discussed—from the standpoint of both what is known about the pathophysiology of cardiovascular disease in end-stage renal disease, and what therapeutic manipulations are available that might modify this particular outcome.
Robust synchronization of two linear systems over intermittent communication networks

The property of synchronization between two identical linear time-invariant (LTI) systems connected through a network with stochastically-driven isolated communication events is studied. More precisely, the goal is to design feedback controllers that, using information obtained over such networks, asymptotically drive the values of their state to synchronization and render the synchronization condition Lyapunov stable. To solve this problem, we propose a dynamic controller with hybrid dynamics, namely, the controller exhibits continuous dynamics between communication events while it has variables that jump at such events. Due to the additional continuous and discrete dynamics inherent in the networked systems and communication structure, we utilize a hybrid systems framework to model the closed-loop system. The problem of synchronization is then recast as a set stabilization problem and, by utilizing recent Lyapunov stability tools for hybrid systems, sufficient conditions for asymptotic stability of the synchronization set are provided for two network topologies: a cascade (unidirectional) network and a feedback (bidirectional) communication network with independent transmission instances. Furthermore, we study the robustness of synchronization by considering a class of perturbations on the transmitted data. Numerical examples are provided.
Geologic provenience analysis of agate and carnelian beads using laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS): A case study from Iron Age Cambodia and Thailand

Abstract Agate and carnelian beads, imported from South Asia, were widely exchanged in Southeast Asia during the Iron Age period (500 BCE–500 CE). Recent studies have identified changes in bead types and manufacturing methods over time, as well as evidence for possible local production. In order to understand the broader implications of these developments, geochemical analysis using laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) was undertaken on 73 beads from 10 Iron Age sites in Cambodia and Thailand and 64 geologic samples from four sites in India, Iran, and Thailand. The results show that many of the beads were produced from raw material derived from the Deccan Traps, India and that there is not yet strong evidence for bead production using a Southeast Asian source. Secondly, we find that there is not yet clear evidence for a change in the different geologic sources used to produce beads over time. This study adds to the growing body of literature highlighting the utility of LA-ICP-MS in differentiating and assigning provenience to agate/carnelian and other silicates.
A dominant predator, a predator, and a prey

A two-predator, one-prey model in which one predator interferes significantly with the other predator is analyzed. The dominant predator is harvested and the other predator has an alternative food source. The response functions used are Holling type II and they are predator-dependent and include the effects of interference. The analysis centers on bifurcation diagrams for various levels of interference in which the harvesting is the primary bifurcation parameter. There are different attractors for the high-interference and no- interference cases and these are discussed within an ecological context.
Brønsted activity of two-dimensional zeolites compared to bulk materials

Different reactivity parameters yield different results for the relative acidity of zeolitic Bronsted sites in thin films and in bulk materials. Whereas the adsorption energies of ammonia and pyridine are about the same, the energy of deprotonation is much lower for two-dimensional systems than for three-dimensional systems. It is shown that this is due to the smaller effective dielectric constant of two-dimensional systems, which leads to much lower deprotonation energies, but also to much lower interaction energies between the protonated molecule and the negatively charged surface site. In the total adsorption energies, both effects nearly compensate each other.
Analysis on the Screening Results of Tuberculosis in Patients with HIV/AIDS

Objective To observe the infection of tuberculosis in patients with HIV/AIDS.Methods Sputum slice were smeared,PPD-test were tested to screen and diagnose tuberculosis according to the national active tuberculosis diagnosis stand- ard in patients with HIV/AIDS who were alive and registered and managed in our district.RecuRs Thirty-six cases,9.23%, active tuberculosis in 390 cases of HIV/AIDS were found,in which,sputum smear positive rate were 5.38%(21 cases),neg- ative 3.83%(15cases);23 cases were in male group with an incidence of 10.60%,and 13 cases in female with an incidence of 7.51%,there were no significance difference between the group of gender(x~2=1.09,P0.05),and of age(P0.05). The positive rate of PPD-test was 15.1%.Conclusion Higher infection rate of tuberculosis in patients with HIV/AIDS suggest that monitoring of tuberculosis in patients with HIV/AIDS should be stressed.
Abstract B004: Expansion of lineage negative, CD24high, CD61+ mammary cells is an early step in mammary tumorigenesis in NRL-TGFalpha and MMTV-c-neu but not MMTV-c-myc models of luminal breast cancer

Our goal was to define the balance of normal, healthy mammary epithelial cell subpopulations, including putative stem, progenitor and mature cells, in mouse models of luminal breast cancer prior to tumor development. We isolated mammary cells using flow cytometric analysis, first by removing immune cells through negative lineage selection followed by labeling of remaining cells with CD24, CD61 and CD49f fluorescently tagged antibodies. We distinguished the presence of cell subpopulations and determined relative fractions of cells with expression patterns of enriched presumptive luminal progenitor cells (CD24 high, CD61positive), mature luminal cells (CD24high, CD61positive) and mammary stem cells (CD24 medium, CD49f high). Mammary glands from 3-4 month TGFalpha mice contained similar fractions of mammary cell subpopulations as wild type mice but at 7-8 month TGFalpha mice had an expanded CD24 high CD61positive fraction associated with hyperplasias and tumors. Four-month-old c-neu mice had expanded CD24 medium, CD49f high cell fractions and by the time tumors developed, both nontumorous glands and tumors also displayed an expanded CD24 high, CD61+ cell fraction. The cell surface marker expression pattern of mammary cells was unique in c-myc mice in that CD24 high (luminal) versus CD24 medium (myoepithelial) populations were not distinguishable at any time point. Our results indicate that early phases of tumorigenesis can be recognized by the disproportion presence of otherwise “normal” epithelial cell subpopulations or by the presence of novel subpopulations. Citation Format: Olga Zhdankin, Melanie Bomier, Donna Parke, Jon Holy, Teresa Rose-Hellekant. Expansion of lineage negative, CD24high, CD61+ mammary cells is an early step in mammary tumorigenesis in NRL-TGFalpha and MMTV-c-neu but not MMTV-c-myc models of luminal breast cancer. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Breast Cancer Research: Genetics, Biology, and Clinical Applications; Oct 3-6, 2013; San Diego, CA. Philadelphia (PA): AACR; Mol Cancer Res 2013;11(10 Suppl):Abstract nr B004.
One Region, Four Movements: Constructing Cascadia through Rhetoric

Through traditional rhetorical analysis, this thesis examines arguments made for a ―Cascadia‖ regional identity (roughly located around Washington, Oregon, and British Columbia) made by four strands of Cascadian thought: Cascadia as a bioregion, as a nation, as a culture, and as an economic region. From each concept, two texts are analyzed to find the audience being targeted and the arguments being made. Examining how each Cascadia attempts to define itself and draw members—often by contrasting or coordinating with the other versions—shows some similarities, like pride in the natural environment, as well as clear distinctions, like differing opinions as to the boundaries of the region itself. The separate notions of Cascadia come with their own sets of values, and by looking at an overview of the arguments being made, this thesis provides insights into Cascadia specifically as well as regional identities in general.
Clinical and spyrometric follow-up from 4 to 9 years after lobectomy for congenital lung malformations in children

Background: Asymptomatic Congenital Lung Malformations (CLM) are often electively resected on the assumption that lobectomy has low impact on respiratory health and function. A recent meta-analysis showed that elective resection is safe and prevents the risk of symptoms development, which may result in a higher rate of postoperative complications. Aim of the study: To assess respiratory symptoms and lung function at school age in children who underwent lobectomy for asymptomatic CLM. Materials and Methods: We retrospectively reviewed performance, symptoms (open interview) and spirometric values of FEV1, FVC, FEV1/FVC and FEF75-25 with comparison to z-scores (Stanojevic S. et al., Am J Crit Care Med 2008;177(3):253-60) of 18 patients between 4-9 years of age. Results: Between 2000-2009, 18 patients (9 female, 9 male) underwent elective lobectomy (8 upper left, 3 lower left, 6 lower right, 1 middle lobe) in our hospital, 13 patients within the first year of life and 5 after . The pathologic diagnoses were: 6 congenital lobar emphysema, 2 pulmonary sequestration and 10 Congenital Pulmonary Airway Malformation (CPAM). At follow-up observation at 4-9 years of age, 14 patients were symptoms free and their effort tolerance was comparable to peers; 3 patients had effort dyspnea and reduced effort tolerance, 1 had occasional wheeze controlled with inhaled corticosteroids therapy. Mean and median of FEV1, FVC and FEV1/FVC were within normal range if compared to z-scores, while FEF75-25 was lower (mean 1%, median 3.2%). Conclusions: The majority of our 18 patients were symptoms free, 4 had mild symptoms and limitations. Lung function was essentially within predicted values.
Barriers to evidence-based physician decision-making at the point of care: a narrative literature review.

We conduct a narrative literature review using four real-world cases of clinical decisions to show how barriers to the use of evidence-based medicine affect physician decision-making at the point of care, and where adjustments could be made in the healthcare system to address these barriers. Our four cases constitute decisions typical of the types physicians make on a regular basis: diagnostic testing, initial treatment and treatment monitoring. To shed light on opportunities to improve patient care while reducing costs, we focus on barriers that could be addressed through changes to policy and/or practice at a particular level of the healthcare system. We conclude by relating our findings to the passage of the Medicare Access and Children’s Health Insurance Program Reauthorization Act in April 2015.
Fitness consequences of habitat variability, trophic position, and energy allocation across the depth distribution of a coral-reef fish

Environmental clines such as latitude and depth that limit species’ distributions may be associated with gradients in habitat suitability that can affect the fitness of an organism. With the global loss of shallow-water photosynthetic coral reefs, mesophotic coral ecosystems (~30–150 m) may be buffered from some environmental stressors, thereby serving as refuges for a range of organisms including mobile obligate reef dwellers. Yet habitat suitability may be diminished at the depth boundary of photosynthetic coral reefs. We assessed the suitability of coral-reef habitats across the majority of the depth distribution of a common demersal reef fish (Stegastes partitus) ranging from shallow shelf (SS, <10 m) and deep shelf (DS, 20–30 m) habitats in the Florida Keys to mesophotic depths (MP, 60–70 m) at Pulley Ridge on the west Florida Shelf. Diet, behavior, and potential energetic trade-offs differed across study sites, but did not always have a monotonic relationship with depth, suggesting that some drivers of habitat suitability are decoupled from depth and may be linked with geographic location or the local environment. Feeding and diet composition differed among depths with the highest consumption of annelids, lowest ingestion of appendicularians, and the lowest gut fullness in DS habitats where predator densities were highest and fish exhibited risk-averse behavior that may restrict foraging. Fish in MP environments had a broader diet niche, higher trophic position, and higher muscle C:N ratios compared to shallower environments. High C:N ratios suggest increased tissue lipid content in fish in MP habitats that coincided with higher investment in reproduction based on gonado-somatic index. These results suggest that peripheral MP reefs are suitable habitats for demersal reef fish and may be important refuges for organisms common on declining shallow coral reefs.
The Effect of Utilization Review on Emergency Department Operations

Study objective Increasingly, hospitals are using utilization review software to reduce hospital admissions in an effort to contain costs. Such practices have the potential to increase the number of unsafe discharges, particularly in public safety-net hospitals. Utilization review software tools are not well studied with regard to their effect on emergency department (ED) operations. We study the effect of prospectively used admission decision support on ED operations. Methods In 2012, Los Angeles County + University of Southern California Medical Center implemented prospective use of computerized admission criteria. After implementation, only ED patients meeting primary review (diagnosis-based criteria) or secondary review (medical necessity as determined by an on-site emergency physician) were assigned inpatient beds. Data were extracted from electronic medical records from September 2011 through December 2013. Outcomes included operational metrics, 30-day ED revisits, and 30-day admission rates. Excluding a 6-month implementation period, monthly summary metrics were compared pre- and postimplementation with nonparametric and negative binomial regression methods. All adult ED visits, excluding incarcerated and purely behavioral health visits, were analyzed. The primary outcomes were disposition rates. Secondary outcomes were 30-day ED revisits, 30-day admission rate among return visitors to the ED, and estimated cost. Results Analysis of 245,662 ED encounters was performed. The inpatient admission rate decreased from 14.2% to 12.8%. Increases in discharge rate (82.4% to 83.4%) and ED observation unit utilization (2.5% to 3.4%) were found. Thirty-day revisits increased (20.4% to 24.4%), although the 30-day admission rate decreased (3.2% to 2.8%). Estimated cost savings totaled $193.17 per ED visit. Conclusion The prospective application of utilization review software in the ED led to a decrease in the admission rate. This was tempered by a concomitant increase in ED observation unit utilization and 30-day ED revisits. Cost savings suggest that resources should be redirected to the more highly affected ED and ED observation unit, although more work is needed to confirm the generalizability of these findings.
Use of the probably benign (BI‐RADS category 3) assessment for masses on breast MRI: Is it transferable to general clinical practice?

The purpose of this study was to identify potential BI-RADS 3 mass descriptors on breast magnetic resonance imaging by systematically defining positive predictive values (PPV). In a blinded retrospective review of BI-RADS 4 masses, reader 1 identified 132 masses and reader 2 identified 76 masses. PPV for mass descriptors and for descriptor combinations was determined. No mass descriptor resulted in a PPV ≤2% (BI-RADS 3 threshold). Descriptors with the lowest PPVs were circumscribed margin (8%), rim internal enhancement and persistent kinetics (13% each), and oval shape (15%). The results demonstrate the difficulty in transferring the theoretical concept of lesion surveillance to systematic clinical use.
Is the Affordable Care Act Cultivating a Cross-Class Constituency? Income, Partisanship, and a Proposal for Tracing the Contingent Nature of Positive Policy Feedback Effects

Social Security and Medicare enjoy strong political coalitions within the mass public because middle-class Americans believe they derive benefits from these programs and stand alongside lower-income beneficiaries in defending them from erosion. By pooling data from nine nationally representative surveys, this article examines whether the Affordable Care Act (ACA) is cultivating a similar cross-class constituency. The results show that middle-income Americans are less likely than low-income Americans to say the ACA has helped them personally so far. On the other hand, partisanship conditions the relationship between income and beliefs about benefits likely to be derived from the ACA in the long run. In total, the results suggest that cross-class Democratic optimism about long-run benefits may enable the ACA to reap positive beneficiary feedbacks, but a large and bipartisan cross-class constituency appears unlikely. Drawing on these results, this article also makes theoretical contributions to the policy feedback literature by underscoring the need for research on prospections' power in policy feedbacks and proposing a strategy for researchers, policy makers, and public managers to identify where partisanship intervenes in the standard policy feedback logic model, and thereby to better assess how it fragments and conditions positive feedback effects in target populations.
О протестантских влияниях действительных и мнимых: православные катехизисы от Стефана Зизания до Феофана Прокоповича

Feofan Prokopovich’s contemporaries believed that his catechetical works contained elements of Protestant dogma. And in historiography it is commonly considered that Feofan’s theological treatises became the channel for the penetration of Protestant dogma into Russian religious thought. Similar accusations were addressed to some Orthodox authors of the Polish-Lithuanian Commonwealth in the first half of the 17th Century (Stefan Zizani and others), whose catechetical works received wide distribution in Russia and determined the vector of development of the Russian catechetical tradition. This article analyses what specific arguments were put forward by critics and from which theological position, and whether these accusations testify to the actual presence of elements of Protestant dogma in the Orthodox literature of the era, or whether we are dealing with a polemical argument.
Heat Resistance and Fatty Acid Composition of Listeria monocytogenes: Effect of pH, Acidulant, and Growth Temperature

The objective of this study was to determine the influence of pH, acidulant, and growth temperature history on the heat resistance and fatty acid composition of Listeria monocytogenes Scott A. Cells were grown to late exponential phase (OD600 = 0.6) at 10, 19, or 37 degrees C in brain heart infusion broth acidified to pH 5.4 or 7 with either acetic or lactic acid. Thermal death times at 60 degrees C subsequently were determined by using a submerged-coil heating apparatus. The surviving cell population was enumerated by spiral-plating heated samples onto tryptic soy agar supplemented with 0.6% yeast extract and 1% sodium pyruvate. The thermal resistance of cells cultured at a particular temperature was significantly lower (P < 0.05) when lactic acid was used to acidify the medium of pH 5.4. Regardless of acid identity, D values significantly decreased (P < 0.05) with increased growth temperature when the pH of the growth medium was 5.4, whereas D values significantly increased (P < 0.05) with increased temperature at pH 7. At pH 5.4 adjusted with lactic acid, D values were 1.30, 1.22, and 1.14 min for cells grown at 10, 19, and 37 degrees C, respectively. At pH 5.4 adjusted with acetic acid, L. monocytogenes failed to grow at 10 degrees C; the D values were 1.32 and 1.22 min when the cells were grown at 19 and 37 degrees C, respectively. At pH 7, the D values were 0.95, 1.12, and 1.28 min with lactic acid and 0.83, 0.93, and 1.11 min with acetic acid at 10, 19, and 37 degrees C, respectively. The most abundant fatty acids (44 to 82%) were branched-chain saturated fatty acids (anteiso-and iso-C15:0 and iso-C17:0) regardless of pH, acidulant, or growth temperature. However, there was an increase in C15:0 isomers at the expense of iso-C17:0 when the growth temperature was lowered from 37 to 10 degrees C. While variable changes in longer-chain fatty acids were found, the percentage of longer-chain (C16 and C18) fatty acids was greatest when L. monocytogenes was grown at 37 degrees C regardless of pH or acidulant. This study demonstrates that the heat resistance of L. monocytogenes depends upon its growth conditions.
Type 2 diabetes — who is conducting the orchestra?

The prevalence of type 2 diabetes has been progressively increasing, worldwide, during the last few decades with serious complications and increased mortality among the vast number of people afflicted. As a model complex disease (or trait), it poses a classical problem for scientists. In their efforts to dissect its genetic components, they have created transgenic mice, hoping that elucidation of gene effect will help to unravel the complex pathophysiology of a disease whose manifestation is also influenced by environmental factorsespecially diet and exercise. In 'full-blown' diabetes, hyperglycaemia results from multiple defects in insulin action and glucose sensing. Insulin action on glucose uptake in muscle, glucose production by the liver and kidneys, and lipolysis in adipose tissue, is impaired, while the ability of glucose to stimulate insulin secretion, inhibit hepatic glucose production, and promote its own uptake in muscle is diminished1, 2. Insulin resistance does not cause overt hyperglycaemia as long as the pancreatic -cell compensates by hyperplasia and increased insulin secretion (Fig. 1). When this compensation fails, diabetes occurs3. Thus, a variety of susceptibility traits, genetic modifiers, and environmental factors determine whether a primary defect in insulin action manifests as overt diabetes.
HRCT imaging of airway responsiveness: effects of anesthetics.

The noninvasive imaging method, high resolution computed tomography (HRCT), has been developed in animal models and applied to humans with obstructive lung disease for assessing regional and individual airway responsiveness. The ability to directly view airway responses during provocations such as tracheal intubation in an asthmatic could greatly enhance our understanding and treatment of airway hyperresponsiveness. HRCT uses increased kilovoltage peak (kVp) and milliamperage (mAs) settings, thin slices, high spacial frequency reconstruction algorithms, and small fields of view to resolve structures as small as 200 µm. Therefore, airways as small as 1–2 mm in diameter can be viewed and measured. HRCT is a more sensitive technique for resolving airway caliber changes than clinical or research methods of pulmonary function tests. HRCT allows direct in vivo measurement of airway responsiveness to pharmacological and physiological stress that induces bronchoconstriction or bronchodilation. Using HRCT, we are able to measure airway dilation at baseline airway tone with inhalation anesthetics, differentiate the bronchodilating properties of inhalational agents in airways with tone, assess bronchodilating agents commonly used as premedications prior to anesthesia, and measure airway heterogeneity at baseline tone and their response to a variety of stimuli. This ability of HRCT to measure airway caliber and response heterogeneity in vivo noninvasively will dramatically improve our understanding of pulmonary physiology in general and the effects of anesthetics on the airways specifically.
Edetate Disodium–Based Treatment in a Patient With Diabetes and Critical Limb Ischemia After Unsuccessful Peripheral Arterial Revascularizations: A Case Report

Peripheral artery disease (PAD) is a progressive form of atherosclerosis that affects the lower extremities, particularly in patients with diabetes. Critical limb ischemia (CLI), the end-stage manifestation of this disease, is associated with an increased risk of chronic leg ulcerations, infections, amputations, and mortality. At presentation, 30% of CLI patients require amputation, and 25% will die within 1 year (1). Toxic metal exposure, particularly to cadmium, has been associated with an increased risk of vascular disease in epidemiological studies and PAD severity in patients with coronary artery disease (CAD) (2–4). Toxic metals are ubiquitous and can induce increased oxidative stress, endothelial dysfunction, and inflammation (4). Similarly, chronic cadmium exposure has been found to play a role in the acceleration of vascular disease in animal models (5,6). Edetate disodium is a chelating agent with high affinity for lead and cadmium (7). The Trial to Assess Chelation Therapy (TACT) demonstrated that edetate disodium–based chelation reduced cardiovascular events, especially in patients with diabetes after myocardial infarction (8,9). An 81-year-old man with a 35-year history of insulin-dependent diabetes, a 20 pack-year smoking history (quit date October 2001), atrial fibrillation, and CAD requiring coronary artery bypass in 2001 presented to the vascular service. His medications at baseline included sotalol, rivaroxaban, pentoxifylline, clopidogrel, aspirin, insulin, pregabalin, and atorvastatin. His baseline serum creatinine was 0.77 mg/dL, and his BMI was 22 kg/m2. He had progressive CLI with nonhealing ulcers and pain unimproved by medical therapy. Noninvasive tests demonstrated abnormal ankle-brachial indices bilaterally. Lower-extremity angiography revealed total occlusions of the left external iliac artery, left superficial femoral artery, distal right …
The emission and propagation of ∼40keV solar flare electrons

Observations of prompt ∼ 40 keV solar flare electron events by the IMP series of satellites in the period August, 1966 to December, 1967 are tabulated along with prompt energetic solar proton events in the period 1964–1967. The interrelationship of the various types of energetic particle emission by the sun, including relativistic energy electrons reported by Cline and McDonald (1968) are investigated. Relativistic energy electron emission is found to occur only during proton events. The solar optical, radio and X-ray emission associated with these various energetic particle emissions as well as the propagation characteristics of each particle species are examined in order to study the particle acceleration and emission mechanisms in a solar flare. Evidence is presented for two separate particle acceleration and/or emission mechanisms, one of which produces ∼ 40 keV electrons and the other of which produces solar proton and possibly relativistic energy electrons. It is found that solar flares can be divided into three categories depending on their energetic particle emission: (1) small flares with no accompanying energetic phenomena either in particles, radio or X-ray emission; (2) small flares which produce low energy electrons and which are accompanied by type III and microwave radio bursts and energetic (∼ 20 keV) X-ray bursts; and (3) major solar flare eruptions characterized by energetic solar proton production and type II and IV radio bursts and accompanied by intense microwave and X-ray emission and relativistic energy electrons.
Research in General Academic Pediatrics

The evolution of the academic generalist can be viewed either as a relatively recent phenomenon or as reincarnation of an older clinical model.1 The latter individuals can still be found in most medical schools as a small number of faculty whose status derives from extensive clinical experience and who are respected for their clinical expertise in diagnosing or managing the individual patient. Their contribution to the intellectual content of medicine evolves from thoughtful, questioning observation more often than for formal research endeavors.
Caregiver Burden in Gastroparesis and GERD: Correlation with Disease Severity, Healthcare Utilization and Work Productivity.

Caregiver burden can be significant in chronic gastrointestinal diseases. No studies have been performed to evaluate caregiver burden in gastroparesis or gastroesophageal reflux disease (GERD). (1) Assess the caregiver burden in gastroparesis and GERD patients and healthy volunteers (HVs); (2) correlate the caregiver burden of these patients to the severity of patients’ symptoms, healthcare utilization, and work productivity of the patients and the caregivers. Patients with gastroparesis and GERD, seen between June 2018 and November 2018, completed Patient Assessment of Gastrointestinal Symptoms, Work Productivity and Activity Impairment (WPAI) and healthcare utilization questionnaires. The caregivers of these patients completed Zarit Burden Interview (ZBI) and WPAI questionnaire. HVs and their potential caregivers also completed these questionnaires. Forty-seven patients (gastroparesis = 31, GERD = 17), 12 HVs, and their caregivers completed questionnaires. Caregivers of gastroparesis patients reported high burden on ZBI (27.7 ± 2.9), greater than the caregivers of GERD (14.9 ± 2.5) and HVs (5.5 ± 1.6, p < 0.01). Among all patients, the caregiver burden had a strong correlation with patients’ Gastroparesis Cardinal Symptom Index (GCSI) total score (rs = 0.63, p < 0.01) and moderate correlations with the number of patients’ physician office visits (rs = 0.46, p < 0.01) and the number of work hours missed by caregivers due to patients’ symptoms (rs = 0.36, p = 0.04). Using multivariable regression, both presence of gastroparesis and other comorbidities significantly predicted caregiver burden, F(2, 33) = 15.94, p < 0.0001, R2 = 0.491. Caregivers of gastroparesis patients have high caregiver burden that strongly correlates with patients’ GCSI total score. Interventions to reduce symptom severity of Gp patients may reduce the caregiver burden.