cssi/SciSciGPT-SciSciNet huggingface dataset:
Beliefs About Science and News Frames in Audience Evaluations of Embryonic and Adult Stem Cell Research

This study investigates the influence of demographic variables, beliefs about science, and news frames on ratings of ethics, credibility, and usefulness of embryonic and adult stem cell research. Framing affected only ratings of ethics, in interaction with type of stem cell, with a large difference between embryonic and adult stem cells in a political conflict frame and no difference in a scientific progress frame. Belief that science is neutral with respect to religion and morality was positively associated with ethics and usefulness ratings for embryonic research; frequency of religious attendance was positively associated with ethics, credibility, and usefulness ratings for adult research only. Humanities and social science majors tended to rate both the embryonic and adult research as more credible, as did participants with higher self-reported science interest and exposure. Quantitative analyses are supplemented with qualitative interview data.
On the Hypothesis of No Interaction on a Linear Scale in Contingency Tables

The purpose of this paper is to review briefly the three main formulations of no Interaction hypotheses in contingency tables and to consider the formulation on a linear scale in some detail.More specifically we (i) present a situation in 2×2 tables where such a formulation may be more appropriate than others, (ii) study the geometry for this problem, (iii) give contrast-type or parametric ANOVA type formulations in the general n-dimensional tables, (iv) discuss estimation and testing procedures and (v) consider collapsibility of contingency tables in relation to the hypotheses of no interaction on a linear scale.
Adult patients with respiratory syncytial virus infection: impact of solid organ and hematopoietic stem cell transplantation on outcomes.

Background Respiratory syncytial virus (RSV) is a common community-acquired pathogen responsible for a substantial disease burden in adults. We investigated the outcomes after RSV infection in hospitalized adults over a 3-year period. Methods This single-center, retrospective study identified 174 patients hospitalized with RSV upper or lower respiratory tract infection (LRTI) between January 1, 2009 and June 30, 2012. Clinical data were extracted from medical records. The primary outcome analyzed was all-cause mortality, defined as death during the index hospital admission. Subjects were divided into 3 groups for comparison: hematopoietic stem cell transplant (HSCT) patients, solid organ transplant (SOT) patients, and non-transplant patients. Results In our study, 41/174 (23.6%) were HSCT recipients and 28/174 (16.1%) were SOT recipients. Twelve of 174 (6.9%) died. Death occurred in 2/41 (4.9%) HSCT and 3/28 (10.7%) SOT recipients, compared to 7/106 (6.6%) non-transplant patients. When compared to the non-transplant cohort, HSCT and SOT were not found to be significant risk factors for mortality (P = 0.685 and 0.645, respectively). In multivariate logistic regression, age >60 was associated with mortality (P = 0.019), while lymphopenia on admission trended toward an association with death (P = 0.054). HSCT patients were less likely to be admitted to an intensive care unit (odds ratio [OR] 0.26, P = 0.04), but were significantly more likely to receive ribavirin therapy (OR 11.62, P < 0.0001). Conclusion Adults hospitalized with RSV LRTI are at significant risk of mortality, and this risk may be increased in patients age >60 or with lymphopenia on admission. This study did not identify any significant increased mortality or morbidity associated with RSV infection in immune suppressed transplant recipients vs. patients who had not received a transplant.
Penrose inequality and apparent horizons

A spherically symmetric spacetime is presented with an initial data set that is asymptotically flat, satisfies the dominant energy condition, and such that on this initial data $Ml\sqrt{A/16\ensuremath{\pi}}$, where $M$ is the total mass and $A$ is the area of the apparent horizon. This provides a counterexample to a commonly stated version of the Penrose inequality, though it does not contradict the true Penrose inequality.
Studies in the heat integration of chemical process plants

A method for solving the problem of heat exchanger network synthesis in chemical process plants is presented based on the use of the out-of-kilter algorithm. The method represents an extension of previous approaches based on network flow problem formulations. A new approach to overcome the constraints in forbidden-match problems, termed the dual stream approach, has been developed based on the use of a stream as both a hot and a cold stream. This approach results in considerable savings in utility costs in certain forbidden-match problems. An algorithm to deal with heating or cooling utilities that undergo temperature changes, termed non-point-temperature utilities, is presented using the transshipment model. The new algorithm determines the utility mass flow rates and pinch points accurately.
Predatory Patent Litigation: How Patent Assertion Entities Use Reputation to Monetize Bad Patents

Despite their expertise in patent law, the most litigious patent assertion entities (PAEs) frequently file dubious infringement claims on which they are ostensibly very unlikely to turn a profit. Thus one might conjecture that these PAEs are mistaken to follow through on their litigation threats when their chances of coming out ahead are so scant. To the contrary, this paper demonstrates that this is in fact a calculated strategy of predatory patent litigation: by following through on its threats of seemingly irrational litigation, the PAE develops a litigious reputation that convinces other producers that these threats are credible, leading them to accept licensing offers they would ordinarily rebuff. This allows the PAE to garner substantial licensing revenues using low quality patents that would otherwise be difficult or impossible to monetize. This paper develops a stylized dynamic model of patent assertion and reputation building by a PAE with low quality patents. The model has a unique equilibrium that involves predatory patent litigation, and in which the PAE intermittently forfeits and rebuilds its litigious reputation over time. Predatory patent litigation generates substantial social costs, and creates a perverse incentive for patent applicants to seek coverage of technologies so obvious or non-novel that they are likely to be widely unintentionally infringed by unsuspecting producers. Importantly, fee shifting will not solve the problem. Rather, it will lead predatory PAEs to focus their ire on small, vulnerable targets, such as technology startups, for whom litigation may be crippling even if attorney’s fees are ultimately recouped. Potential defendants could better deter predatory PAEs by entering a litigation cost-sharing agreement in which members jointly pay one another’s litigation costs and litigate all meritless claims to judgment. If properly limited in scope, such an arrangement is lawful and will not materially undermine meritorious infringement actions.
Prevalence and Identity of Coccidia in Pen-Raised Wild Turkeys

One hundred nineteen pen-raised wild turkeys (Meleagris gallopavo) from 12 locations in nine states in the United States were examined for coccidia by sugar flotation of intestinal contents and mucosa or by subinoculating the contents into uninfected domestic turkeys. Seventy-eight (66%) of the turkeys were positive for coccidia. There were no differences in the frequency of coccidia among adult, subadult or juvenile turkeys. More females (75%) were infected than males (48%). The species of coccidia from 30 of the turkeys were identified based on microscopic examination of oocysts, fresh scrapings, stained sections and inoculations of bobwhites (Colinus virginianus). The frequency of each species was Eimeria meleagrimitis (97%), E. gallopavonis (47%), E. meleagridis (27%), E. dispersa (17%), E. innocua–E. subrotunda (13%), E. adenoeides (7%) and an undescribed species (3%). Of the 30 turkeys in which the species of coccidia was determined, 30% had a single species infection, 40% had two species, 20% had t...
Evaluation and enhancement of medical knowledge competency by monthly tests: a single institution experience.

In-training examination (ITE) has been used as a predictor of performance at the American Board of Internal Medicine (ABIM) certifying examination. ITE however may not be an ideal modality as it is held once a year and represents snapshots of performance as compared with a trend. We instituted monthly tests (MTs) to continually assess the performance of trainees throughout their residency.To determine the predictors of ABIM performance and to assess whether the MTs can be used as a tool to predict passing the ABIM examination.The MTs, core competencies, and ITE scores were analyzed for a cohort of graduates who appeared for the ABIM examination from 2010 to 2013. Logistic regression was performed to identify the predictors of a successful performance at the ABIM examination.Fifty-one residents appeared for the ABIM examination between 2010 and 2013 with a pass rate of 84%. The MT score for the first year (odds ratio [OR] =1.302, CI =1.004-1.687, P=0.04) and second year (OR =1.125, CI =1.004-1.261, P=0.04) were independent predictors of ABIM performance along with the second-year ITE scores (OR =1.248, CI =1.096-1.420, P=0.001).The MT is a valuable tool to predict the performance at the ABIM examination. Not only it helps in the assessment of likelihood of passing the certification examination, it also helps to identify those residents who may require more assistance earlier during their residency. It may also highlight the areas of weakness in program curriculum and guide curriculum development.
Frequent CpG Island Methylation in Sporadic and Syndromic Gastric Fundic Gland Polyps

We studied methylation of 2 tumor suppressor genes (p14, p16) and 4 MINT (methylated in tumor) clones (MINT1, MINT2, MINT25, MINT31) among 51 fundic gland polyps (FGPs) and 27 normal gastric body biopsy samples using bisulfite treatment of genomic DNA followed by methylation-specific polymerase chain reaction. Thirty-two FGPs were syndromic polyps from 14 patients with familial adenomatous polyposis (FAP); 19 were sporadic FGPs from 15 patients without FAP. Significantly higher mean methylation indices were found between FGPs and normal gastric mucosa (P = .012). FGPs arising in a background of proton pump inhibitor (PPI) effect had significantly higher mean methylation indices than those that did not (P = .023). Perhaps because sporadic FGPs were more likely to be associated with PPI effect than were FAP-associated FGPs, they also demonstrated higher mean methylation indices than syndromic polyps (P = .024). Among FAP-associated FGPs, there was no statistical difference in methylation indices between polyps that were dysplastic, indefinite for dysplasia, or nondysplastic (P = .87). Epigenetic alterations involving methylation of CpG islands might have a role in the development of some FGPs, particularly those with a PPI effect. They do not account for the presence or absence of a dysplastic phenotype in FGPs.
Resolving Current Controversies in Analysis of Variance

Abstract Definition of effects and calculation of sums of squares for various tests of hypotheses in unbalanced analysis of variance has been a topic of considerable interest for at least 10 years. Conceptually, these concerns apply to balanced cases as well. It is suggested that proceeding logically from highest-order effects to lowest-order effects in a careful fashion helps to resolve the difficulties pointed out by various writers, including those concerned about completely missing cells.
BLOOD PLASMA PROTEIN PRODUCTION AS INFLUENCED BY VARIOUS DEGREES OF HYPOPROTEINEMIA AND BY AMINO ACIDS

When blood plasma proteins are depleted by bleeding with return of the washed red blood cells (plasmapheresis) it is possible to bring dogs to a steady state of hypoproteinemia and a uniform plasma protein production on a basal low protein diet. These dogs are clinically normal but their resistance to infection is distinctly below normal. Introduction of variables into this standardized existence gives information relative to plasma protein production. Plasma protein production under these conditions with a plasma protein concentration of 3.5 to 4.2 gm. per cent is relatively constant. As the plasma protein concentration rises the plasma protein removed falls rapidly (Table 1). At 4.6 gm. per cent the protein removed is less than 50 per cent of the amount removed at a plasma protein level of 4.0 gm. per cent. Cystine appears to be an important amino acid for plasma protein formation. This shows in Table 2 and is supported by data coming from published experiments. These experiments related to the factors which control plasma protein production bear on the problems of shock, hemorrhage, and protein wastage and their treatment by plasma injections which hold the attention of surgeons and physiologists at the moment. Again we would emphasize the fluidity of body protein including plasma protein-an ebb and flow between protein depots and plasma protein-a "dynamic equilibrium" of body protein. A discussion of the passage of large protein molecules through cell borders is submitted.
A Web-Based Environment for Explanatory Biological Modeling

In this paper, we describe an interactive environment for the representation, interpretation, and revision of explanatory biological models. We illustrate our approach on the systems biology of aging, a complex topic that involves many interacting components, and discuss our experiences using this environment to codify an informal model of aging. We close by discussing related efforts and directions for future research.
Morera Theorems for Spheres through a Point in CN

We prove Morera theorems for the Radon transform integrating on spheres through a point in ℂ n . The proofs use spherical functions and integral equations techniques as well as a support theorem for a generalized Radon transform on hyperplanes.
Feeding Differences by Pre- and Postaestival Cereal Leaf Beetles on First and Third Blades of Seedling Corn

Preaestival cereal leaf beetles, Oulema melanopus (L.), that fed on the 1st blade of corn died significantly sooner than starved beetles. Approximately ⅔ of the preaestival beetles that fed on the 3rd blade of corn died with the remaining beetles aestivating. Postaestival beetles that fed on the 1st blade of corn died at the same rate as postaestival starved beetles, although they ate significantly more and lived longer than preaestival beetles. An anomaly exists between the feeding and survival of pre- and postaestival beetles in that preaestival beetles, although they ate less of the 1st blade of corn, died sooner than postaestival beetles that had eaten more. Although the 1st blade was apparently less toxic to postaestival beetles, postaestival survival on 1st-blade corn was very similar to the survival of starved beetles. Corn appears to be nutritionally unusable by postaestival beetles which may be the reason beetles avoid seedling corn in the spring. Newly emerged preaestival beetles can be distinguished from postaestival beetles because the tergites under the elytra of preaestival beetles are light yellow and remain so until several days after feeding is initiated; the tergites of postaestival beetles are dark.
Prediction method of sound field in the rectangular long enclosure

A high-frequency numerical algorithm is proposed to predict the sound field in the rectangular enclosures based on the ray-tracing method.In this algorithm,according to some boundary condition parameters such as the length,width,height and absorption coefficient of the sound space,the sound energy of any sound ray at any time,as well as the three dimensional arrival coordinates of any sound ray at any time,can be calculated.Through calculating the arrival coordinates and sound energy of every sound ray at a certain time and getting the statistical result,the sound space energy distribution at this time can be obtained.Through calculating the arrival time and sound energy of every sound ray at a certain place and getting the statistical result,the impulse response of this place can be obtained.In the new algorithm the sound rays need not be traced,so the calculation time is shortened greatly,and the prediction accuracy is very high.The sound field of a reverberation room with a long enclosure is meas-ured,and compared with the results of the new algorithm.The good coincidence between the two kinds of results verifies the validity of the new algorithm.
Analysis ultrasonic heartbeat graph to evaluate right heart function on senile pulmonary artery hypertension patients

Objective To explore the clinical effect of ultrasonic heartbeat graph to evaluate right heart function on senile pulmonary artery hypertension patients. Methods Randomly selected 30 cases of senile pulmonary artery hypertension patients as the observation group,and 30 healthy aged as the control group.Ultrasonic heartbeat graph examination of two groups of right ventricle anteroposterior diameter,transverse diameter of right atrium, pulmonary artery trunk diameter and right ventricular Tei index calculation were compared. Results Right ventricle anteroposterior diameter,transverse diameter of right atrium,pulmonary artery trunk diameter of the observation group were increased significantly compared with the control group(P0.05);Sm,Em,Am of the observation group were lowered significantly compared with the control group(P0.05), but Tei index of the observation group increased than the control group. Conclusion Ultrasound heartbeat graph to evaluate right heart function on senile pulmonary artery hypertension patients has high clinical value.
Functional interleukin-2 receptors are expressed on natural killer-like leukemic cells from a dog with cutaneous lymphoma

We identified a dog with large granular lymphocytic leukemia and cutaneous lymphoma that exhibited constitutive expression of interleukin-2 (IL-2) receptors by the leukemic peripheral blood lymphocytes. The leukemic cells phenotypically resembled natural killer (NK) cells, and their surface IL-2 receptors were functional, as determined by the capacity to bind human recombinant IL-2 with high-affinity resulting in the transduction of proliferation signals and in the development of lymphokine-activated killer cell activity. These cells produced IL-2 spontaneously, and they may have maintained their proliferative state through an IL-2-dependent autocrine growth pathway. Our results indicate that neoplastic lymphocytes of syndromes that involve circulating leukemic cells with dermotropism can originate from NK-like cells. Additionally, the data also suggest that proliferative conditions such as these may be the result of the aberrant production of IL-2. Further, this case illustrates the potential for the use of hematopoietic malignancies in the dog as a suitable animal model for immune targeting of IL-2 receptors as a novel treatment approach for similar malignancies of human beings.
Metaphors of regional policy: cities as engines, multilevel governance in gardens

ABSTRACTMetaphors of regional policy: cities as engines, multilevel governance in gardens. Regional Studies. Recent work in cognitive science and evolutionary psychology suggests a much greater communicative role for metaphor: good metaphor links a paradigmatic way of knowing the world with our hard-wired programmes for surviving in it. From this perspective, the engines-of-growth metaphor underlying the World Bank’s World Development Report 2009: Reshaping Economic Geography (2009) naturalizes the new economic geography paradigm. In contrast, the alternative place-based approach espoused in the Organisation for Economic Co-operation and Development’s (OECD) Promoting Growth in All Regions (2012) remains largely inaccessible to laypersons. The productiveness of a garden metaphor for linking the place-based paradigm to some primitive functions is assessed.
Racial differences in glucose control among patients with type 2 diabetes: a survey on dietary temptations, coping, and trust in physicians.

OBJECTIVE: A quantitative evaluation of self-care behaviors, psychosocial stressors, and patient relationships to health care to better understand racial disparities in these domains. RESEARCH DESIGN AND METHODS: A cross-sectional study of adult patients with type 2 diabetes in University of Pennsylvania Healthcare System who had a HbA1c test within one month of survey administration. The survey instrument included among other items, the Dieter's Inventory of Eating Temptations Self-Efficacy instrument (DIET-SE), the Jalowiec Coping Scale (JCS), and the Trust in Physician (TIP) scale. RESULTS: 332 individuals completed the survey. Poor glucose control was significantly associated with Black race, lower income level, other demographic variables, non-perfect medication adherence, and poorer diet quality. It was also associated with lower self-efficacy to resist social dietary temptations, and among White patients it was associated was decreased use of a confrontive coping style. However, these factors did not explain the racial differences in glucose control between Blacks and Whites. CONCLUSIONS: Interventions aimed at dietary temptations, coping styles, or trust in physicians may not reduce racial disparities in glucose control. However, interventions that focus on dietary temptations may positively affect all diabetic patients.
Osteolysis Complicating Total Knee Arthroplasty.

Osteolysis has long been an issue in joint arthroplasties. The early durability problems associated with Teflon (polytetrafluoroethylene) acetabular components as described by Charnley could be considered as the first manifestations of osteolysis, which he described as tissue “caseation and
Conductance Modulation in Silicon-on-Insulator Solid-State Nanopores Coated with Electroactive Polymers

Solid-state nanopores are an ideal platform for bioanalytical studies. However, only very few solid-state nanopores allow the ionic conductance through the nanopore to be modulated, which is a feature of most transmembrane protein channels. Using silicon-on-insulator (SOI) substrates, a substrate bias can be applied to the top silicon layer in which cylindrical nanopores have been formed, leading to a modulation of the ionic conductance through the nanopore.The effect of the electrostatic modulation on the nanopore conductance, however, is small unless the electrolyte concentration is low (<100 μM) or the pore diameter is below 10 nm. To increase the effect of the conductance modulation, polyelectrolyte brushes tethered to the inside of the nanopore can be used, which actively change the diameter of the lumen of the nanopore. Since the polymer brushes are charged, a change in surface charge due to an electrostatic bias is expected to influence the length of the brushes extending into the nanopore, thereby changing its diameter.In our experiments, poly[2-(dimethylamino) ethyl methacrylate] (PDMAEMA) polyelectrolyte brushes were deposited on the inner walls of thermally oxidized SOI cylindrical nanopores using surface-initiated atom transfer radical polymerization (SI-ATRP). After polymerization, the ionic conductance of the nanopore was characterized using DC conductance and Electrochemical Impedance Spectroscopy (EIS). The EIS data allowed a separation of the influence of the polyelectrolyte brushes on the nanopore conductance from the influence on the capacitance of the complete device, enabling the development of an equivalent electrical circuit model. Ion transport studies under both pH and gate bias stimuli revealed a significant conductance increase in strong acidic solutions (100 mM HCl) and a conductance modulation upon application of a positive gate bias in 100 μM HCl solutions, which was not observable without the polyelectrolyte brush layer.
Downregulation of NEDD9 by apigenin suppresses migration, invasion, and metastasis of colorectal cancer cells

Apigenin is a natural flavonoid which possesses multiple anti-cancer properties such as anti-proliferation, anti-inflammation, and anti-metastasis in many types of cancers including colorectal cancer. Neural precursor cell expressed developmentally downregulated 9 (NEDD9) is a multi-domain scaffolding protein of the Cas family which has been shown to correlate with cancer metastasis and progression. The present study investigates the role of NEDD9 in apigenin-inhibited cell migration, invasion, and metastasis of colorectal adenocarcinoma DLD1 and SW480 cells. The results show that knockdown of NEDD9 inhibited cell migration, invasion, and metastasis and that overexpression of NEDD9 promoted cell migration and invasion of DLD1 cells and SW4890 cells. Apigenin treatment attenuated NEDD9 expression at protein level, resulting in reduced phosphorylations of FAK, Src, and Akt, leading to inhibition on cell migration, invasion, and metastasis of both DLD1 and SW480 cells. The present study has demonstrated that apigenin inhibits cell migration, invasion, and metastasis through NEDD9/Src/Akt cascade in colorectal cancer cells. NEDD9 may function as a biomarker for evaluation of cancer aggressiveness and for selection of therapeutic drugs against cancer progression.
The Ethics of the Fall: Restoring the Divine Image through the Pursuit of Biblical Wisdom:

God's displeasure with the primordial couple for seeking the knowledge of good and evil in Genesis 3 is often explained as the result of humanity's transgression of a divine boundary intended to re...
Survival of and Tag Retention in Southern Redbelly Dace Injected with Two Sizes of PIT Tags

AbstractPassive integrated transponder tags are a common method used in fish ecology research, and their feasibility for use has been well studied in salmonids. Several studies suggest that effects of PIT tagging may be species dependent and these effects should be addressed prior to conducting large-scale tagging studies. In a series of laboratory experiments, we tested factors influencing survival and tag retention in Southern Redbelly Dace Chrosomus erythrogaster. In the first experiment, we tested the effects of tagger and fish length on survival and retention over 30 d for dace tagged with 9-mm PIT tags. Survival was high (84%) while retention of tags was low (30%). We detected no significant effect of tagger experience on survival or tag retention. Logistic regression determined that tag retention increased with fish length. A second experiment showed similar trends for survival (80%) and retention of 9-mm tags (25%) as observed in experiment 1, but retention (86%) was significantly higher for dace ...
Viral influenza-like illnesses: dynamic interrelationships during the 2015–2016 influenza season in hospitalized patients

In hospitalized children and adults, the temporal relationship of viruses causing influenza-like illnesses (ILIs) and influenza has not been well described. During the 2015-2016 influenza season at our hospital, the dynamic interrelationships between ILI viruses (human metapneumovirus, respiratory syncytial virus, human parainfluenza viruses 3 and 4, rhinoviruses/enteroviruses, and coronaviruses) and influenza A were characterized in 768 hospitalized children and adults.
Vulnerability to Cumulative Hazards: Coping with the Coffee Leaf Rust Outbreak, Drought, and Food Insecurity in Nicaragua

Summary Recurrent food insecurity in the highlands of Central America has been exacerbated by the recent convergence of a coffee leaf rust outbreak that began defoliating crops in 2011 and a drought that started in 2014. In the context of these multiple challenges, this paper explores how seasonal hunger is related to smallholder organizational affiliation, farm and farmer characteristics, and post-hazard household-level coping strategies. The study integrates qualitative research, hydro-climatic data analysis, and a survey of 368 households completed in 2014. A number of household capacities correlate significantly with shorter periods of seasonal hunger: households with larger farms, with off-farm employment, and that produce more than half of their food, maintain more fruit trees, and harvest more coffee reported fewer lean months. We find evidence consistent with path dependence in how households cope with a sequence of environmental hazards, as the reported use of less preferred coping responses to past events (e.g., Hurricane Mitch and the 2009 drought) tended to correlate with their continued use after subsequent hazards. A comparison of coping responses of households affiliated with a farmer-to-farmer institution promoting subsistence-oriented production with those affiliated with cooperatives prioritizing sustainable coffee exports shows that farmer institutions were not strongly correlated with the number of lean months or coping mechanisms.
Emerging chemical therapies targeting 5-hydroxytryptamine in the treatment of Alzheimer's disease.

ABSTRACTIntroduction: Alzheimer’s disease (AD) is a major neuropsychiatric disorder affecting more than 5 million Americans over age 65. By the year 2050, AD is expected to affect over 30 million. Characterized by neuronal cell death accompanied by the accumulation of neurofibrillary tangles and neuritic plaques, AD results in devastating clinical symptomatology with a lasting psychosocial and financial impact. Studies have shown that the current treatments for AD, cholinesterase inhibitors (ChEI’s) and NMDA receptor antagonists, have limited efficacy. The 5-HT-6 receptor antagonists Idalopirdine and Intepirdine have shown the most progress in current clinical trials and warrant consideration as emerging treatments for AD.Areas covered: This review discusses 5-HT6 antagonists currently in clinical trials as potential treatments for AD symptomatology and how 5-HT6 physiology may play a positive role in alleviating AD symptom pathophysiology. A literature search using PubMed was conducted using the terms Id...
A Cost-Effectiveness Analysis of Pediatric Intraosseous Infusion as a Prehospital Skill

Purpose:To determine the clinical efficacy, patient volume, and program costs that justify pediatric intraosseous (IO) infusion as a routine skill for the treatment of patients with cardiac arrest in a prehospital system.Methods:A decision analytic model was constructed to include patient outcomes and costs to society. Critical variables for the analysis were: 1) time to vascular access; 2) success of vascular access; 3) clinical efficacy (i.e., the percentage of lives saved by early vascular access); 4) number of patients requiring IO annually; and 5) the cost of an IO program. Program costs included training and equipment expenses. Sensitivity analysis, which repeatedly evaluates the model using different values for the critical variables, identified those values at which IO would be cost-effective.Results:With an estimated 80% success rate for IO access within five minutes, the cost-per-life-saved would be [US] 2,000 and one patient per year needing IO. The cost-effectiveness ratio also required a clinical efficacy of 2% for vascular access. To prove that the clinical efficacy of vascular access is in fact 2%, epidemiologic studies would require a sample of nearly 9,000 patients.Conclusions:This analysis suggests IO probably is cost-effective given a clinical efficacy above 2%. While the true efficacy may be below this value, clinical studies are unlikely to have sufficient size to prove it. Therefore, emergency medical services (EMS) medical directors must make the decision to utilize IO based on their own beliefs about its clinical efficacy. Further, it must be considered in the context of other prehospital programs which may be more cost-effective. Such analyses permit establishment of rational priorities to rank programs in prehospital systems.
Why Do Long-Distance Travelers Have Improved Pancreatectomy Outcomes?

Background Centralization of complex surgical care has led patients to travel longer distances. Emerging evidence suggested a negative association between increased travel distance and mortality after pancreatectomy. However, the reason for this association remains largely unknown. We sought to unravel the relationships among travel distance, receiving pancreatectomy at high-volume hospitals, delayed surgery, and operative outcomes. Study Design We identified 44,476 patients who underwent pancreatectomy for neoplasms between 2004 and 2013 at the reporting facility from the National Cancer Database. Multivariable analyses were performed to examine the independent relationships between increments in travel distance mortality (30-day and long-term survival) after adjusting for patient demographics, comorbidity, cancer stage, and time trend. We then examined how additional adjustment of procedure volume affected this relationship overall and among rural patients. Results Median travel distance to undergo pancreatectomy increased from 16.5 to 18.7 miles (p for trend Conclusions Our large national study found that the beneficial effect of longer travel distance on mortality after pancreatectomy is mainly attributable to increase in procedure volume. However, it can have additional benefits on rural patients that are not explained by volume. Distance can represent a surrogate for rural populations.
Measurement of the through thickness compression of a battery separator

Abstract The mechanical integrity of the separator is critical to the reliable operation of a battery. Due to its minimal thickness, compression experiments with a single/a few layers of separator are difficult to perform. In this work, a capacitance based displacement set-up has been developed for the measurement of the through thickness direction (TTD) compression stress-strain behavior of the separator and the investigation of its interaction with the electrode. The experiments were performed for a stack of two layers of Celgard 2400 separator, NMC cathode, and separator/NMC cathode/separator stack in both dry and wet (i.e. submersed in dimethyl carbonate DMC) conditions. The experimental results reveal that the separator compression modulus can be significantly affected by the presence of DMC. The iso-stress based rule of mixtures was used to compute the compressive stress-strain curve for the stack from that of the separator and NMC layer. The computed curve agreed with the experimental curve reasonably well up to about 0.16 strain but deviated significantly to a softer response at higher strains. The results suggest that, in the stack, the TTD compressive deformation of the separator is influenced by the NMC cathode.
Factors Associated with Functional Decline in Elderly Female Breast Cancer Patients in Appalachia.

Background Functional status has been previously shown in the elderly cancer population to predict both mortality as well as treatment tolerance. The goal of this study was to determine if there are certain subsets of the elderly breast cancer population that are at higher risk of experiencing functional decline following treatment. Methods Patient charts from the Edwards Comprehensive Cancer Center in Huntington, West Virginia, from January 2006 - January 2016 were reviewed. Relevant inclusion criteria included patients of 65 years of age and older with a new diagnosis of Stage 0-III breast cancer. Functional decline was defined as an increase of at least one point in Eastern Cooperative Oncology Group (ECOG) scores within one year of diagnosis. ECOG performance status was subjectively determined by the physician. Fisher's exact test and Pearson's Chi-squared test were initially utilized to assess potential factors associated with functional decline such as pretreatment ECOG score, age at diagnosis, stage, hormone receptor status, type of surgery received, whether radiation therapy, chemotherapy, or hormonal therapy was received, medical comorbidities, body mass index (BMI), complaints of weakness at diagnosis, and ambulatory status. Factors that were found to be significant were further assessed via multivariate logistic regressions. Results Three-hundred and fourteen patients were identified as meeting inclusion criteria. At one-year follow-up, 45 patients (14.3% of the cohort) had documented functional decline. On initial analysis, factors associated with functional decline included Stage III disease (p=0.002) and complaints of weakness at diagnosis (p=0.004). Following multivariate analysis, Stage III disease (p = 0.02), complaints of weakness at diagnosis (p = 0.04), and bilateral mastectomy (p = 0.03) were significantly associated with functional decline. Conclusion Patients who were diagnosed with Stage III breast cancer, had complaints of weakness at time of diagnosis, or had bilateral mastectomies were more likely to have a decline in functional status at one-year follow-up. Awareness of factors associated with functional decline in the elderly Appalachian population with Stage 0-III breast cancer will be useful during discussions regarding patient expectations, treatment, and goals of care. Elderly breast cancer patients for whom bilateral prophylactic mastectomies are not indicated may be better served by lumpectomy alone (based on patient age, hormone receptor status, and tumor size), lumpectomy followed by radiation therapy, or unilateral mastectomy to maximize the likelihood of functional preservation following treatment.
Enhancing the sensitivity of colorimetric lateral flow assay (CLFA) through signal amplification techniques

Colorimetric lateral flow assay (CLFA) is one of a handful of diagnostic technologies that can be truly taken out of the laboratory for point-of-care testing without the need for any equipment and skilled personnel. Despite its simplicity and practicality, it remains a grand challenge to substantially enhance the detection sensitivity of CLFA without adding complexity. Such a limitation in sensitivity inhibits many critical applications such as early detection of significant cancers and severe infectious diseases. With the rapid development of materials science and nanotechnology, signal amplification techniques that hold great potential to break through the existing detection limit barrier of CLFA have been developed in recent years. This article specifically highlights these emerging techniques for CLFA development. The rationale behind and advantages and limitations of each technique are discussed. Perspectives on future research directions in this niche and important field are provided.
Developing populations of software breast phantoms for virtual clinical trials

Virtual Clinical Trials (VCTs) of breast imaging have been used as a tool for the evaluation and optimization of novel imaging systems through computer simulations of breast anatomy, image acquisition, and interpretation. VCTs offer significant advantages over clinical trials in terms of cost, duration, and radiation risk. The performance of VCTs depends on the selection of simulated breasts to represent the population of interest. We have developed a method for selecting populations of software breast phantoms to match the clinical distribution of compressed breast thickness and breast percent density. We extracted the compressed thickness information from anonymized DICOM headers of mammography images from 10,705 women who had their breast screening exams within a year (09/2010-08/2011). Percent density was estimated using an open source software tool. Characteristic clinical sub-populations were identified by performing k-means clustering, and represented by separate sets of phantoms. The corresponding thickness of uncompressed phantoms was selected assuming 50% thickness reduction during mammographic compression. The phantom volumetric density was selected based upon a relationship between mammographic (2D) percent density and volumetric (3D) density, estimated from clinical images. Using a set of 24 representative phantoms, we were able to match the analyzed clinical population completely for the compressed breast thickness, and within two percentage points of the volumetric breast density. Representative phantoms can be used to generate the full population of virtual patients, of a size determined by the power-analysis of the specific VCT, by random variations of the internal phantom composition.
The Defect Chemistry of Donor-Doped BaTiO3: A Rebuttal

It has recently been asserted that the donor charge in La+3 -doped BaTiO3 is always compensated by Ti vacancies, and that electrons are never the primary compensating defect. It was also stated that the conductivity observed in reduced, donor-doped BaTiO3 results from the loss of a very small amount of oxygen not directly related to the donor content. However, the observed reproducible and reversable weight loss on reduction, or gain on oxidation, is exactly that expected for a change between ionic and electronic compensation. It corresponds to the loss or gain of the “excess” oxygen contained in the donor oxide, e.g. LaO1.5 vs. the BaO it replaces. The amount of this weight change is proportional to the donor concentration. This is in agreement with the observation that the equilibrium conductivity in the P(O2)-independent region of electronic compensation is proportional to the donor concentration. Thus the conductivity observed in reduced samples is directly coupled to the donor concentration, and the carrier concentration is equal to the net donor content. In fact, the equilibrium conductivity of donor-doped BaTiO3 conforms to the behavior expected from classical defect chemistry, and exhibits regions of both ionic and electronic compensation of the donor charge, as expected. Phase studies by TEM have shown that donor-doped BaTiO3 sintered in air self-adjusts its composition, by splitting out a second phase if necessary, so that the appropriate amount of compensating Ti vacancies are formed. However, when sintered in a reducing atmosphere, the composition self-adjusts to accommodate charge compensation by electrons.
A novel mHealth application for improving HIV and Hepatitis C knowledge in individuals with opioid use disorder: A pilot study.

Abstract Aims There is a critical need to reduce infectious disease transmission among individuals with opioid use disorder (OUD). Here we examine the ability of a novel, automated educational intervention, delivered via iPad in a single visit, to improve human immunodeficiency virus (HIV) and Hepatitis C (HCV) knowledge among adults with OUD. Methods Participants were 25 adults enrolled in a 12-week trial evaluating the efficacy of an Interim Buprenorphine Treatment for reducing illicit opioid use and other risk behaviors during delays to opioid treatment. Participants completed baseline HIV and HCV knowledge assessments with corrective feedback. They then completed an interactive HIV flipbook and HCV video followed by a second administration of the knowledge assessments. The knowledge assessments were repeated at post-intake Weeks 4 and 12. Results At baseline, participants answered 69% and 65% of items correctly on the HIV and HCV assessments, respectively. The educational intervention was associated with significant increases in knowledge (86% and 86% correct on the HIV and HCV assessments, respectively; p’s Conclusion This HIV+Hepatitis Education intervention was associated with significant and sustained improvements in knowledge of HIV + HCV transmission and risk behaviors in this vulnerable group of individuals with OUD. Given the continuing opioid epidemic, efforts are urgently needed to reduce HIV and HCV contraction and transmission among individuals with OUD. Mobile health educational interventions may offer a time- and cost-effective approach for addressing these risks.
Insulin infusion responses in diabetic ketoacidosis alone and with a mixed hypochloremic alkalosis.

Abstract Aims Although diabetic ketoacidosis (DKA) commonly presents as a pure diabetic ketoacidosis (PDKA), up to 30% of cases may be associated with a mixed hypochloremic metabolic alkalosis (HMA). It is unknown whether there is a difference in treatment outcomes between these two entities. We evaluated an insulin infusion protocol (IIP), previously validated for hyperglycemia management in ICU's, for the management of PDKA and HMA. Materials and methods A retrospective case series/cohort study of 41 DKA admissions was further characterized as having PDKA or HMA. HMA was defined in those having an elevated delta-delta gradient (ΔAG-ΔHCO3) ≥ 5 mmol/L and base excess chloride (BECl) > 2.7 mmol/L. The main outcome measures were times to recovery of glucose levels to ≤250 mg/dL and of anion gap to ≤12 mmol/L. Results The initial serum glucose was 553 ± 265 mg/dL, serum bicarbonate of 8.8 ± 5.1 mmol/L, and venous pH 7.13 ± 0.2). Recovery of glucose occurred in 5 h: 25 min (±3 h:39min), and for anion gap in 11 h:25 min (±6 h:56min). HMA compared with PDKA had a delayed recovery of serum glucose (7 h: 23min ± 3 h: 35min vs. 4 h: 31min ± 3:h:21min, p = 0.017), which was due to the higher initial level of glucose (p = 0.02) rather than level of BECl (p = 0.17). There was no difference in time to anion gap closure between the PDKA and HMA. Conclusions Correction of hyperglycemia and acidosis in PDKA as well as in HMA was managed through the IIP. The simultaneous fluid and electrolyte management corrected the hypochloremic alkalosis.
Grass invasion and drought interact to alter the diversity and structure of native plant communities.

Understanding the interactive effects of species invasions and climate change is essential for predicting future shifts in biodiversity. Because multiple stressors can interact in synergistic or antagonistic ways, it is notoriously difficult to anticipate their combined effects on species assemblages. However, some hypotheses predict that plant invasions will become increasingly problematic as climate change improves conditions for invaders or lowers the biotic resistance of native communities. In a 4-yr field experiment, we quantified the individual and interactive effects of invasion by a globally problematic C4 grass, Imperata cylindrica, and chronic simulated drought imposed by rainout shelters on the whole plant communities of regenerating longleaf pine forest. Invasion both inhibited plant colonization and enhanced plot-level extinctions, resulting in a severe (60%) loss of plant diversity across all functional groups, including perennial grasses and forbs, annual forbs, and woody species and dramatic shifts in community composition. Experimental drought reduced diversity by 20%, and caused a shift in the dominant functional groups, but had no significant effect on cover of the invader. The invader partially ameliorated water stress in the drought treatment such that invaded plots had higher soil moisture than uninvaded plots. Consequently, the combined effects of invasion and drought were lower than expected from an additive model of multiple stressors. These findings, which may have broader implications for how other C4 grass invaders will interact with drought to shift native community dynamics, challenge the perception that climate change will exacerbate invasions. In revealing that invasive species pose a major threat to the diversity and structure of native communities despite their moderating effects on abiotic stress, this work also highlights that management of aggressive invaders may be critical to preserving biodiversity regardless of future climate.
Performance of PROMIS Global-10 Compared With Legacy Instruments for Rotator Cuff Disease.

Background:The Patient-Reported Outcomes Measurement Information System (PROMIS) Global-10 was recently developed to assess physical and mental health and provide an estimated EuroQol-5 Dimension (...