cssi/SciSciGPT-SciSciNet huggingface dataset:
Chest Disease in Patients with Agammaglobulinemia

1. Agammaglobulinemia—a relatively new disease is discussed from the standpoint of the chest physician. 2. Eight cases studied at the University of Minnesota during the past two years are briefly presented. 3. The available literature on agammaglobulinemia is reviewed to emphasize the importance of pulmonary manifestations in the clinical expression of this metabolic disorder. 4. Among the 43 cases reported to date, 24 have been of the congenital type which is transmitted as a sex-linked recessive trait and 19 have been of the acquired type. 5. The most consistent clinical finding in both groups of agammaglobulinemia patients is recurrent bacterial respiratory infection often expressed as lobar or bronchiopneumonia. 6. Bronchiectasis occurred in four of 24 cases of congenital agammaglobulinemia and four of 13 completely reported cases of acquired agammaglobulinemia. 7. Other pulmonary complications reported to date in agammaglobulinemic patients include empyema, lung abscess, atelectasis, pulmonary fibrosis and diffuse pulmonary calcifications. 8. The inflammatory exudate of the bronchiectatic processes of an agammaglobulinemic patient and of immunologically normal persons are compared. The characteristic absence of plasma cells from the exudate in the agammaglobulinemic patient is recorded. 9. The development of “acquired” agammaglobulinemia associated with the occurrence of a large thymoma in a 54 year old male is described. 10. The hematological basis of agammaglobulinemia is mentioned. 11. The therapeutic approach to agammaglobulinemia is discussed.
Mammalian SWI/SNF chromatin remodeling complexes and cancer: Mechanistic insights gained from human genomics

Over the past 4 years, nearly 100 exome sequencing studies have revealed the high frequency of mutations in the genes encoding the subunits of ATP-dependent chromatin remodelers in human cancer. Most of these mutations are within the genes encoding subunits of the BAF (Brg/Brahma-associated factors) or mSWI/SNF complex, which is one of two dozen predicted ATP-dependent chromatin remodeling complexes in mammals. Considering BAF complexes as a single entity, the 15 subunits encoded by 29 genes are mutated in >20% of human cancer, across a broad range of tumor types. These observations demonstrate that there is little redundancy in the oncogenic function of BAF complexes with the other remodeling complexes, underscoring their unique roles. Several important conclusions emerge from these genomic data: specific subunits appear to be mutated in specific cancers, highlighting tissue-specific protective roles; mutations can function as tumor suppressors or oncogenes; mutations can be homozygous or, more commonly, heterozygous, implying their dosage-sensitive roles in an unknown yet fundamental process used to suppress the genesis of cancer. These new human genetic findings paired with biochemical studies are challenging old ideas on how chromatin remodeling complexes function, generating new hypotheses with respect to their normal and oncogenic mechanisms and highlighting potential avenues for therapeutic intervention in human cancer.
Scope and Outcomes of Surrogate Decision Making Among Hospitalized Older Adults

Importance Hospitalized older adults often lack decisional capacity, but outside of the intensive care unit and end-of-life care settings, little is known about the frequency of decision making by family members or other surrogates or its implications for hospital care. Objective To describe the scope of surrogate decision making, the hospital course, and outcomes for older adults. Design, Setting, and Participants Prospective, observational study conducted in medicine and medical intensive care unit services of 2 hospitals in 1 Midwestern city in 1083 hospitalized older adults identified by their physicians as requiring major medical decisions. Main Outcomes and Measures Clinical characteristics, hospital outcomes, nature of major medical decisions, and surrogate involvement. Results According to physician reports, at 48 hours of hospitalization, 47.4% (95% CI, 44.4%-50.4%) of older adults required at least some surrogate involvement, including 23.0% (20.6%-25.6%) with all decisions made by a surrogate. Among patients who required a surrogate for at least 1 decision within 48 hours, 57.2% required decisions about life-sustaining care (mostly addressing code status), 48.6% about procedures and operations, and 46.9% about discharge planning. Patients who needed a surrogate experienced a more complex hospital course with greater use of ventilators (2.5% of patients who made decisions and 13.2% of patients who required any surrogate decisions; P P P P P Conclusions and Relevance Surrogate decision making occurs for nearly half of hospitalized older adults and includes both complete decision making by the surrogate and joint decision making by the patient and surrogate. Surrogates commonly face a broad range of decisions in the intensive care unit and the hospital ward setting. Hospital functions should be redesigned to account for the large and growing role of surrogates, supporting them as they make health care decisions.
Stack Sizing for Optimal Current Drivability in Subthreshold Circuits

Subthreshold circuit designs have been demonstrated to be a successful alternative when ultra-low power consumption is paramount. However, the characteristics of MOS transistors in the subthreshold region are significantly different from those in strong inversion. This presents new challenges in design optimization, particularly in complex gates with stacks of transistors. In this paper, we present a framework for choosing the optimal transistor stack sizing factors in terms of current drivability for subthreshold designs. We derive a closed-form solution for the correct sizing of transistors in a stack, both in relation to other transistors in the stack, and to a single device with equivalent current drivability. Simulation results show that our framework provides a performance benefit ranging up to more than 10% in certain critical paths.
CANTAB delayed matching to sample task performance in juvenile baboons

This study reports the administration of the Cambridge Neuropsychological Test Automated Battery system's delayed matching to sample (DMTS) task to juvenile baboons. Nine subjects (female=5, male=4) were trained with delay intervals ranging from 0 to 80s. Trial unique stimuli were utilized in combination with matching to sample, in contrast to non-matching to sample, to more accurately assess components of medial temporal lobe (hippocampal formation) mediated working memory. These parameters force subjects to rely on recognition for matching stimuli and overcome their innate tendency to choose novel stimuli (non-matching), thus increasing task difficulty. Testing with delays intervals of 0-2, 4, 8, and 16s revealed decreased percent correct responding as delay intervals increased. An effect of 1 vs. 3 distractor stimuli on accuracy was also noted. Increasing the number of distractors resulted in decreased observing response latencies. The increase in choice response latency seen with increasing delay interval was independent of number of distractor stimuli presented. There were no sex differences in task performance. Our laboratory is focused on understanding the functional consequences of suboptimal conditions during pregnancy and early postnatal life in offspring. The ability of juvenile baboons to perform the DMTS task demonstrates the utility of this non-human primate model in examining pre- and post-natal conditions that impact the development of working memory. Evaluation of causes and consequences of impaired working memory in a variety of human diseases will be assisted by the use of this task in nonhuman primate models of human health and disease.
K12 CS Teaching Methods Courses (Abstract Only)

CS teacher development has become a major effort for the SIGCSE community in part due to NSF's CS10K efforts and expanding CSTA involvement. However there are few examples of university courses explicitly designed to train CS teachers. We do not yet have clarity on the topics CS education methods courses should cover and how best to prepare teachers to teach learners new to computational problem solving and programming. As an interdisciplinary field of study, CS education must necessarily draw on domain knowledge in CS, research in computing education, as well as research in education and the learning sciences about how students learn, both generally and in computing. At the same time, a methods course must provide prospective teachers with practical, hands-on experiences wherein they integrate research-based best practices with age-appropriate content for their target student population.BOF attendees are asked to bring materials from their classes and be ready to discuss multiple viewpoints about topics, pedagogical strategies and readings from a rich history of research in computing education and the learning sciences. Such a session will also afford attendees an opportunity to start an important conversation, connect with others who are currently developing and/or teaching CS methods courses, and form a community to share ideas, literature, and syllabi on an ongoing basis. Materials will be shared with the SIGCSE community.
Robust variable structure and adaptive control of single-arm dynamics

The authors present a control law which is a combination of the continuous variable structure control (VSC) law and the switching- sigma modification control law for the control of a single-arm manipulator with rigid links holding a rigid object. In the analysis, it is shown that this new control law has a smaller error bound than a simply continuous VSC law or switching- sigma modification control law. Some simulation results are presented in which the proposed control law has better tracking precision performance both in a transient state and a steady state and which agree with the theoretical analysis are presented. The control law still maintains good tracking precision even if the actuator unmodeled dynamics are considered. >
Consumer Perceptions of Heart-Health Claims for Cooking Oils and Vegetable Oil Spreads

This working paper presents the findings of copy test research on consumer perceptions of heart-health claims in print advertisements for a fictitious cooking oil low in saturated fat, and a vegetable oil spread containing no trans fatty acids. FDA regulations currently ban potentially useful heart-health claims in labeling for many such products, and this restriction also appears to have discouraged similar claims in advertising. One deception-based motivation for the ban would be that the heart-health claims might mislead consumers to believe that the products are healthy in all respects, when in fact they are high in total fat and calories, and their regular use could cause weight gain and associated heart problems unless the products are substituted for less healthy alternatives. Our research tested this deception hypothesis and found no support for it. Adding an explicit heart-health claim to a nutrient content claim (such as "low in saturated fat" or "no trans fats") did not change consumer perceptions of the caloric content of the tested products or otherwise distort perceptions of the products' overall healthiness. These conclusions not withstanding, our results also suggest that respondents as a whole, including those who did not see a nutrient content claim or a heart-health claim, underestimate the caloric content of cooking oils. Further, respondents did not appear to understand the significant impact that relatively small daily increases in caloric intake can have on long-term weight gain. Our findings emphasize the need for increased consumer education concerning the caloric content of cooking oils, and the implications of even modest changes in caloric intake, from whatever source, on weight gain and heart health.
EVALUATION OF THE OXYGEN DELIVERY ABILITY OF PEG- HEMOGLOBIN IN SPRAGUE-DAWLEY RATS DURING HEMODILUTION

Polyethylene glycol (PEG) conjugation allows bovine hemoglobin (Hb) to retain its oxygen delivery capability while increasing its plasma expansion capacity. To determine whether PEG-Hb's ability to sustain life is due to its oxygen delivery capability rather than its plasma expansion capacity, Sprague-Dawley rats were exchange-transfused up to an 85% hematocrit reduction with either PEG-Hb, PEG-50%-methemoglobin (PEG-mHb), PEG-carbon monoxide hemoglobin (PEG-CoHb) or PEG-human serum albumin (PEG-HSA). Survival and respiratory rates were monitored during the exchange transfusion, at five minutes, 24 hours and 48 hours post operative. Rats surviving 14 days were evaluated for hematology, blood chemistry and histopathology. Rats infused with PEG-Hb had a survival rate of 100% during the transfusion and 79% at 24 hours, as compared to 24 hour survival rates of 30% for PEG-mHb, and 0% for both PEG-COHb and PEG-HSA. PEG-Hb treated rats that survived the 2 week observation period had normal hematological and blo...
Stereoselective Phosphorylation of Cyclopropavir by pUL97 and Competitive Inhibition by Maribavir

Human cytomegalovirus (HCMV) is a widespread pathogen that can cause severe disease in immunologically immature and immunocompromised individuals. Cyclopropavir (CPV) is a guanine nucleoside analog active against human and murine cytomegaloviruses in cell culture and efficacious in mice by oral administration. Previous studies established that the mechanism of action of CPV involves inhibition of viral DNA synthesis. Based upon this action and the structural similarity of CPV to ganciclovir (GCV), we hypothesized that CPV must be phosphorylated to a triphosphate to inhibit HCMV DNA synthesis and that pUL97 is the enzyme responsible for the initial phosphorylation of CPV to a monophosphate (CPV-MP). We found that purified pUL97 phosphorylated CPV 45-fold more extensively than GCV, a known pUL97 substrate and the current standard of treatment for HCMV infections. Kinetic studies with CPV as the substrate for pUL97 demonstrated a Km of 1,750 ± 210 μM. Introduction of 1.0 or 10 nM maribavir, a known pUL97 inhibitor, and subsequent Lineweaver-Burk analysis demonstrated competitive inhibition of CPV phosphorylation, with a Ki of 3.0 ± 0.3 nM. Incubation of CPV with pUL97 combined with GMP kinase [known to preferentially phosphorylate the (+)-enantiomer of CPV-MP] established that pUL97 stereoselectively phosphorylates CPV to its (+)-monophosphate. These results elucidate the mechanism of CPV phosphorylation and help explain its selective antiviral action.
Applying human factors principles to alert design increases efficiency and reduces prescribing errors in a scenario-based simulation

Objective To apply human factors engineering principles to improve alert interface design. We hypothesized that incorporating human factors principles into alerts would improve usability, reduce workload for prescribers, and reduce prescribing errors. Materials and methods We performed a scenariobased simulation study using a counterbalanced, crossover design with 20 Veterans Affairs prescribers to compare original versus redesigned alerts. We redesigned drug– allergy, drug–drug interaction, and drug–disease alerts based upon human factors principles. We assessed usability (learnability of redesign, efficiency, satisfaction, and usability errors), perceived workload, and prescribing errors. Results Although prescribers received no training on the design changes, prescribers were able to resolve redesigned alerts more efficiently (median (IQR): 56 (47) s) compared to the original alerts (85 (71) s; p=0.015). In addition, prescribers rated redesigned alerts significantly higher than original alerts across several dimensions of satisfaction. Redesigned alerts led to a modest but significant reduction in workload (p=0.042) and significantly reduced the number of prescribing errors per prescriber (median (range): 2( 1–5) compared to original alerts: 4 (1–7); p=0.024). Discussion Aspects of the redesigned alerts that likely contributed to better prescribing include design modifications that reduced usability-related errors, providing clinical data closer to the point of decision, and displaying alert text in a tabular format. Displaying alert text in a tabular format may help prescribers extract information quickly and thereby increase responsiveness to alerts. Conclusions This simulation study provides evidence that applying human factors design principles to medication alerts can improve usability and prescribing outcomes.
Substrate Deformation Studies on Impact Erosion and Plowing by Photoelasticity

Static and dynamic photoelasticity methods were applied in studying the mechanisms of erosion. A multiple spark camera and a linear gas gun were used to photograph impact-induced dynamic stress waves. The propagation of stress waves in a polycarbonate material was analyzed upon impact of a 3-mm diameter rigid ball traveling at 50 m/s velocity. The role of pressure, shear, and Rayleigh waves in causing damage was found to be low. The residual stress field generated due to particle impact was determined using a circular polari scope. It was found that the plastic deformation at impact-induced high strain rates and the residual stress field generated by repeated impacts produce crack ing, and the interaction of these cracks results in erosion loss. Impact on brittle Columbia resin produced lateral, circumferential, and radial cracks, resulting in material removal. The stress gradient and cracking were also studied during plowing on the above two materials.
Spectroscopic study of the formation and structure of polyselenacyclobutane

Selenacyclobutane (trimethylene selenide) readily undergoes photochemical reaction to give polymeric products. Also, the material polymerizes rapidly when the polycrystalline solid film liquifies on a salt substrate in vacuum. Upon polymerization of the sample, infrared and Raman spectra exhibit profound changes which definitely establish ring cleavage. The Raman spectra of the polymer reveal strong C–Se stretching peaks but little or no scattering in the region of Se–Se stretching, strongly suggesting that the polymerization process proceeds in a regular head-to-tail fashion. An EPR study of the monomer exposed to ultraviolet radiation at −180°C supports this fact, since the resulting spectrum is indicative of an intermediate radical species, (CH2CH2-CH2Se)n., where n is sufficiently large that the terminal electrons do not interact. No triplet spectra were observed. Molecular oxygen apparently plays an important role in the polymerization kinetics, since it is found that degassed samples of the substance, in contrast to those which have not been degassed, polymerize rapidly even under room illumination. Freezing-point depression measurements fix a lower limit to the average molecular weight of the polymer at 2700 (n = 23 monomer units).
Deoxyribonucleic Acid Polymerase Activity Associated with a Plasma Particulate Fraction from Patients with Chronic Lymphocytic Leukemia

Plasma from two cases of chronic lymphocytic leukemia have been examined for deoxyribonucleic acid (DNA) polymerase activity. In both cases, detectable enzyme activity was present. In the plasma from a patient known to have chronic lymphocytic leukemia for 10 years, the enzyme activity was sufficiently high to study product formation, buoyant density of the enzyme activity, deoxyribonucleoside triphosphate requirements, and kinetics of DNA synthesis. These studies are presented in this report.
Sequential Oxidative Damage, and Changes in Iron-Binding and Iron-Oxidising Plasma Antioxidants During Cardiopulmonary Bypass Surgery

Cardiopulmonary bypass patients undergoing heart valve replacement surgery appear to be under oxidative stress, when compared with normal healthy controls, by showing increased levels of protein and lipid damage. During bypass surgery two further episodes of oxidative stress occur. The first is seen when patients are placed on extracorporeal blood circulation and oxygenation which results in a rise in lipid peroxides and thiobarbituric acid-reactive substances. The second phase of oxidative stress occurs during reperfusion of the myocardium following removal of the aortic cross clamp. Coincident with evidence of increased oxidative damage to lipids during these latter phases of oxidative stress were decreases in plasma iron-binding and iron-oxidising antioxidant activities.
A Mentors Role in the Advancement of Black Women in and to Senior Administrator Positions

In the corporate world, women hold less than 5% of key executive leadership positions. The disparity is also prevalent within higher education. One of the strategies for reducing the barriers to career advancement for women and specifically women of color is mentoring. Using resilience theory as a theoretical framework, this year-long qualitative study explored the experiences of four Black senior student affairs officers at small (enrollment under 5,000), private, predominantly White institutions in the United States. The findings revealed the impact of mentors on the career trajectory of Black women professionals through acknowledgment and validation of potential or transferable skills and provision of opportunities for networking. Study participants indicated that the informal tap on the shoulder by mentors was a catalyst that led them to consider leadership positions they might not have otherwise pursued. A key finding from the study is that the dominant model of mentoring (where a person intentionally seeks a mentor for guidance) actually reinforced hegemonic practices. The new model that emerged was for potential mentors, supervisors, or colleagues to make the initial connection to women and women of color not because they lack skills or from a presumption of needing help but because the campus climate may not support them if they ask for support.
Prefiguring the Common: Strategies of Sociality in Spinoza

'Politics without metaphysics must be nonsense'. This slightly reformulates a claim of Stuart Hampshire's regarding Spinoza's ethics - namely, that we cannot speak intelligently about human happiness and freedom without a grasp of our potentialities and situation as parts of Nature. Can we speak intelligently about justice without a grasp of how metaphysical assumptions (e.g., about law or national boundaries) prefigure the political field of possibilities? For much current scholarship, the answer is no. Indeed, debates around 'political ontology' - understood as an explicit or implicit interpretation of the constituents, conditions, and range of possibilities in the social-political world - are now a key node of inquiry. With an eye to such debates, this paper revisits Spinoza's writings to explore the hypothesis that political struggle is always ontological, and to probe the limits of ontology as a grammar for gauging political possibility. Spinoza shows collective life to be driven by an affective conflict that forms and transforms selves and communities alike. From this discord, different modalities of politics emerge as efforts to cultivate, in varying degrees, divergent desires for mastery or mutual empowerment. If his ontology fruitfully pushes politics beyond the juridical confines of the state to the terrain of affect and imagination, how might this same ontology, and appeals to political ontology generally, risk obscuring the specificity of political practice?
Brazil's Big Tariff Problem with the United States

Although the majority of Brazilians supported Barack Obama in the latest presidential election, members of the Brazilian Sugar Cane Industry Association (or UNICA, the acronym in Portuguese) were thrilled by what his opponent said during the third presidential debate. Senator John McCain promised to eliminate tariffs on Brazilian ethanol, while also arguing that subsidies for the corn-based ethanol industry distort the market and contribute to inflation. Subsidies for corn-based ethanol production in the United States are currently acting as “life-support” to an inefficient industry. If free trade, perfect competition, lower gas prices and global warming are the criteria chosen to evaluate tariffs, the United States is definitely on the wrong track.
The temperature dependence of the Mössbauer hyperfine parameters in Nd2Fe14B

We have determined the temperature dependence of the internal hyperfine field, isomer shift, and quadrupole shift at each of the six iron sites in Nd2Fe14B. The hyperfine parameters are consistent with the local iron site environments. The quadrupole and isomer shifts and their temperature dependences support our assignments of the relative ordering of the internal hyperfine fields as j2>k2>c≊k1>j1>c. We obtain a Mossbauer temperature of 390 K for Nd2Fe14B, which compares well with the Debye temperature of 420K for pure iron.
Genomic Resolution of Outbreak-Associated Legionella pneumophila Serogroup 1 Isolates from New York State.

ABSTRACT A total of 30 Legionella pneumophila serogroup 1 isolates representing 10 separate legionellosis laboratory investigations (“outbreaks”) that occurred in New York State between 2004 and 2012 were selected for evaluation of whole-genome sequencing (WGS) approaches for molecular subtyping of this organism. Clinical and environmental isolates were available for each outbreak and were initially examined by pulsed-field gel electrophoresis (PFGE). Sequence-based typing alleles were extracted from WGS data yielding complete sequence types (ST) for isolates representing 8 out of the 10 outbreaks evaluated in this study. Isolates from separate outbreaks sharing the same ST also contained the fewest differences in core genome single nucleotide polymorphisms (SNPs) and the greatest proportion of identical allele sequences in a whole-genome multilocus sequence typing (wgMLST) scheme. Both core SNP and wgMLST analyses distinguished isolates from separate outbreaks, including those from two outbreaks sharing indistinguishable PFGE profiles. Isolates from a hospital-associated outbreak spanning multiple years shared indistinguishable PFGE profiles but displayed differences in their genome sequences, suggesting the presence of multiple environmental sources. Finally, the rtx gene demonstrated differences in the repeat region sequence among ST1 isolates from different outbreaks, suggesting that variation in this gene may be useful for targeted molecular subtyping approaches for L. pneumophila. This study demonstrates the utility of various genome sequence analysis approaches for L. pneumophila for environmental source attribution studies while furthering the understanding of Legionella ecology. IMPORTANCE We demonstrate that whole-genome sequencing helps to improve resolution of Legionella pneumophila isolated during laboratory investigations of legionellosis compared to traditional subtyping methods. These data can be important in confirming the environmental sources of legionellosis outbreaks. Moreover, we evaluated various methods to analyze genome sequence data to help resolve outbreak-related isolates.
Use of Heating Degree Day and Physiological Day Equations for Predicting Development of the Parasitoid Trissolcus basalis

The suitability of physiological day (PD) and heating degree day (HDD) models for predicting development of Trissolcus basalis (Wollaston), an egg parasitoid of the southern green stink bug, Nezara viridula (L.) (Hemiptera: Pentatomidae), was determined under laboratory and field conditions. Predictions of peak numbers of parasitoid emergency by both HDD and PD models were similar and closely correlated with observed peak development for constant temperatures between 21 and 32°C. The use of HDD equation more closely predicted the development of T. basalis in the field. Percent emergence of parasitoids was significantly increased by precipitation.
Strained SiC: Ge Layers in 4H SiC formed by Ge Implantation

The ion implantation of germanium into 4H-SiC at 1000 o C resulted in crystalline SiC:Ge layers that are coherently strained to the (0001) oriented 4H-SiC substrates. Germanium implantation energies of 140 keV and 50 keV were chosen to form approximately 100nm thick step-like SiC:Ge layers with Ge atomic fractions ranging from 0.0007 to 0.006. High-resolution x-ray diffraction (HRXRD) and reciprocal space mapping reveal a high-quality, compressively strained SiC:Ge layer. High-temperature annealing resulted in partial relaxation of the macroscopic layer strain, however the SiC:Ge layer remained strained with a coherent interface for annealing up to at least 1650 o C. Because Ge is a group-IV atom like Si and C, its incorporation into the lattice is expected to act as an isoelectronic impurity, rather than a charged donor or acceptor. Thus, high-quality, SiC:Ge layers have the potential for bandgap and strain engineered electronics such as SiC-based high electron mobility transistors (HEMTs) for RF-power electronics. Currently there is no established heterojunction pair in SiC material technology for fabricating HEMTs and other heterojunction devices.
Jacobian Free Computation of Lyapunov Exponents

The purpose of this paper is to present new algorithms to approximate Lyapunov exponents of nonlinear differential equations, without using Jacobian matrices. We first derive first order methods for both continuous and discrete QR approaches, and then second order methods. Numerical testing is given, showing considerable savings with respect to existing implementations.
Providing health care in rural and remote areas: lessons from the international space station.

Circumnavigating the globe every 90 minutes, 400 km above the Earth’s surface and at a speed of 27 600 km per hour, the international space station typically does not evoke thoughts of rural Haiti. This aerospace behemoth contains some of the most expensive, most advanced technology ever designed. An isolated extraterrestrial outpost of humanity, it represents a marvel of human engineering and ingenuity. It is this very isolation, ironically, that gives it something in common with rural areas in low- and middle-income countries here on Earth. In many parts of the world, basic emergency and acute medical care is lacking. 1 Comparing the international space station’s systems with efforts underway to address the lack of rural and remote health-care services may help clinicians, researchers and policy-makers develop new ideas and improve on existing practices. What happens when an astronaut on the space station has a medical emergency? Certainly, the entire space station cannot gently glide its way down to Earth. At least one Soyuz spacecraft is usually docked for evacuation but there are usually only a few astronauts in the space station at a time. It is not practical for several astronauts to return to Earth accompanying the patient. It would take up to 24 hours for an astronaut to return to the ground to receive medical care – precious time lost for someone in a critical condition. 2 The United
Designer genes: three photographs of the future and a call for debate.

Snapshot:A small, windowless doctor's examining room. A hip-high examination table in the center of the room is covered by a disposable paper sheet. Someone has painted the walls a soothing shade of mauve. At the far end of the room are a sink, a cabinet above the sink, a sterilizer and needle disposal unit on the counter top (all stainless steel). The opposite corner of the room holds a reproduction mission oak chair, the seat upholstered in leather, and a matching magazine stand. A pair of jeans and a white T-shirt hang from a row of wooden hooks above the chair.Brenda Calloway, a stylishly career-dressed woman of about fifty, sits on the chair holding a portfolio-style purse and a denim bag. Her make-up and hair are impeccable. Her daughter Samantha, age 17, sits on the end of the examining table; she is wearing a short green paper gown. Her hair is blond, straight and very long. She thumbs through an old copy of People magazine, glancing somewhat nervously at the door every few seconds.Brenda is the c...
Factors which can make Patients Difficult to Treat

Despite considerable advances in the treatment of schizophrenia, there remains a sizeable subgroup of individuals with this illness who are considered difficult to treat. There are a number of factors which may contribute to this phenomenon and given increasing pressure to reduce health care expenditures, the challenge of managing this patient population is becoming increasingly pressing.
Section 1: General Remarks

The preceding part concerned the frequencies of vibrations in general; but here it will be a question of the nature of the vibratory motions with regard to changes in shape and corresponding frequencies in each kind of motion of any sounding body whatsoever.
An Empirical Investigation of the Universal Effectiveness of Quality Management Practices: A Structural Equation Modeling Approach

Institutional theory argues that the isomorphic nature of quality management (QM) practices leads to similar QM implementation and performance among QM-embedded firms. However, contingency theory questions such 'universal effectiveness of QM practices'. Considering these conflicting arguments, this study tests samples from the U.S. and China to examine whether the 'universal effectiveness of QM practices’ across national boundaries actually exists. First, the confirmatory factor analysis was performed to examine the validity of the survey instruments developed in this study. Then, the hypotheses were tested using the structural equation modeling (SEM) analysis. The SEM test results indicated that the positive effect of behavioral QM on firm performance was more significant in the U.S. sample than in the China sample. The test results also presented that the relative effect of behavioral QM versus technical QM on firm performance was noticeably different in service firms, according to national economic maturity. The study’s findings demonstrated that a firm's contingency factors, such as national economic maturity and industry type, could result in the heterogeneous implementation of the firm’s QM program; consequently, the findings weakened the 'universal effectiveness of QM practices'.
Assessing musculoskeletal examination skills and diagnostic reasoning of 4th year medical students using a novel objective structured clinical exam.

Medical students have difficulty performing and interpreting musculoskeletal physical examinations and interpreting the findings. Research has focused on students' knowledge deficits, but there are few direct assessments of students' ability to perform a hypothesis-driven physical examination (HDPE). We developed a novel musculoskeletal Objective Structured Clinical Exam (OSCE) focusing on HDPE skills for disorders of the shoulder, back and knee, and used it to explore medical student diagnostic reasoning. A multidisciplinary group of musculoskeletal specialists developed and gathered validity evidence for a three station OSCE focusing on the HDPE of the shoulder, back and knee, emphasizing the ability to anticipate (identify pre-encounter) expected physical exam findings, and subsequently perform discriminatory physical examination maneuvers. The OSCE was administered to 45 final year medical students. Trained faculty observed and scored students’ ability to anticipate exam findings and perform diagnostic examination maneuvers on simulated patients. Encounters were digitally recorded and scored again by another trained faculty member. Inter-rater reliability for each maneuver was estimated using type-2 intra-class correlations (ICC). Percentages of perfect scores for anticipation and performance were calculated. Pearson’s correlation between anticipation and performance scores was computed for each maneuver and their relationship to diagnostic accuracy was tested with logistic regression. Inter-rater reliability was good (ICC between .69 and .87) for six exam maneuvers. Maneuver performance was overall poor, with no discriminatory maneuver performed correctly by more than two thirds of students, and one maneuver only performed correctly by 4 % of students. For the shoulder and knee stations, students were able to anticipate necessary discriminatory exam findings better than they could actually perform relevant exam maneuvers. The ability to anticipate a discriminatory finding correlated with the ability to perform the associated maneuver correctly, with the exception of the ability to perform maneuvers needed to diagnose a torn anterior cruciate ligament of the knee. Neither the ability to anticipate or perform was predictive of identifying correct diagnoses for the different cases. A novel musculoskeletal OSCE, based on principles of the hypothesis-driven physical examination, was able to identify significant deficiencies in examination skills needed to diagnose common disorders of the shoulder, back and knee amongst graduating medical students. In addition, the OSCE demonstrated that accurate anticipation of discriminatory examination findings correlates with ability to perform the associated maneuver; however, the ability to anticipate exceeds the ability to perform. Students do not appear to be using the physical exam to inform their diagnostic reasoning. The findings of this study have implications for both assessment and teaching of the musculoskeletal exam.
Retrospective analysis of neoadjuvant chemoradiotherapy with carboplatin/ paclitaxel versus FOLFOX in newly diagnosed esophageal or junctional cancers: A single instituition experience.

168Background: The retrospective study aimed to evaluate carboplatin / paclitaxel (CP) versus FOLFOX in the neoadjuvant combined modality setting for newly diagnosed esophageal or junctional cancers. Methods: Patients with esophageal or junctional cancers treated in combined modality setting were included. During the study period, there were seventy three patients who had T2-4N0-1M0 esophageal and junctional carcinomas. Results: 49 (67%) patients received CP and 24 (33%) patients received FOLFOX. Concurrent radiation was delivered 5400-cGy in CP arm and 5040-cGy in FOLFOX arm. 38 (78%) patients in CP arm and 19 ( 79 %) in FOLFOX arm underwent curative resection. In CP arm, 11(12%) did not undergo curative resection due to disease progression (5/11), death secondary to infection (2/11) and poor functional status post chemotherapy (4/11). In FOLFOX arm, 5(21%) patients did not have surgery due to progressive disease (3/ 5), sepsis ( 1/ 5) and Tracheo–esophageal fistula ( 1 / 5). In patients who underwent cu...
Size-based quality-informed framework for quantitative optimization of pediatric CT.

The purpose of this study was to formulate a systematic, evidence-based method to relate quantitative diagnostic performance to radiation dose, enabling a multidimensional system to optimize computed tomography imaging across pediatric populations. Based on two prior foundational studies, radiation dose was assessed in terms of organ doses, effective dose (E), and risk index for 30 patients within nine color-coded pediatric age-size groups as a function of imaging parameters. The cases, supplemented with added noise and simulated lesions, were assessed in terms of nodule detection accuracy in an observer receiving operating characteristic study. The resulting continuous accuracy–dose relationships were used to optimize individual scan parameters. Before optimization, the nine protocols had a similar E of 2.2±0.2 mSv with accuracy decreasing from 0.89 for the youngest patients to 0.67 for the oldest. After optimization, a consistent target accuracy of 0.83 was established for all patient categories with E ranging from 1 to 10 mSv. Alternatively, isogradient operating points targeted a consistent ratio of accuracy–per-unit-dose across the patient categories. The developed model can be used to optimize individual scan parameters and provide for consistent diagnostic performance across the broad range of body sizes in children.
Chapter 36 – Chordomas and Chondrosarcomas in Children

Abstract Chordomas and chondrosarcomas are rare tumors in children, even more so than in adults. Pediatric chordomas predominantly occur in the head and neck. In children, chondrosarcomas occur more frequently in the craniofacial region and in more unusual sites than they do in adults. Tumors of younger children (less than 5 years of age) are more likely to behave aggressively. Management consists of surgery as the primary treatment and postoperative focused radiation of residual disease or tumor margin. In children, as in adults, chemotherapy currently has unclear benefits.
Analysis on Influencing Factors on Cultivation of Graduate Innovation Ability Based on System Dynamics

The purpose of this paper is to clarify and determine the influencing factors on cultivation of graduate innovation ability. It is of great theoretical and practical significance to the graduate educational quality improvement and to the social and economic development as well as improvement of international competence. The present research applies the systematic thinking to propose the utilization of government-customer-industry-university-institute (GCIUI) practical cultivation mode to discuss the influencing factors on cultivation of graduate innovation ability. In the research, the systematic essence of cultivation of graduate innovation ability is firstly defined, and the systematic structural model for graduate innovation ability cultivation is constructed; then, the impacts which graduate enterprise, GCIUI practical cultivation mode and innovative environment have on graduate innovation ability are analyzed; finally, the System Dynamics software is applied to establish the System Dynamics flow chart for influencing factors on graduate innovation ability, and the dynamic modeling and simulation analysis are carried out. Simulation results show that, the graduate innovation ability improves as the government and university profit distribution ratios increase, and reduces as institute and customer profit distribution ratios increase. However, the influence from enterprise is lower compared to other entities. The influences of other parameters on graduate innovation ability rank from knowledge protection, enrollment examination, teacher-student relationship, knowledge system, research projects and funds, incentive mechanism, construction of research platforms, technological exchange and cooperation to trust mechanism. Consequently, the formulation of each relevant policy should be systematically considered from graduate entity, cultivation of graduate innovation ability system structure and cultivation of graduate innovation ability environment.
Evaluation of a Mobile Phone App for Providing Adolescents With Sexual and Reproductive Health Information, New York City, 2013-2016

The New York City (NYC) Department of Health and Mental Hygiene released the Teens in NYC mobile phone application (app) in 2013 as part of a program to promote sexual and reproductive health among adolescents aged 12-19 in NYC. The app featured a locator that allowed users to search for health service providers by sexual health services, contraceptive methods, and geographic locations. We analyzed data on searches from the Where to Go section of the app to understand the patterns of use of the app’s search functionality. From January 7, 2013, through March 20, 2016, the app was downloaded more than 20 000 times, and more than 25 000 unique searches were conducted within the app. Results suggest that the app helped adolescents discover and access a wide range of sexual health services, including less commonly used contraceptives. Those designing similar apps should consider incorporating search functionality by sexual health service (including abortion), contraceptive method, and user location.
Asymptotic Normality of Posterior Distributions

Suppose X 1,..., X n are independent observations from P θ , θ ∈ R. Suppose that P θ has density f θ (x) with respect to some measure v. The maximum likelihood estimate of θ (or the value of θ that maximizes the density of the posterior probability relative to the prior probability), maximizing Π i=1 n f θ (X i ) is denoted by \( {at heta _n}\) . As n → ∞, Fisher established that\( {at heta _n}\)is asymptotically normal with mean θ 0 and variance (nI(θ 0))−1, where θ 0 is the true value of θ, and I(θ 0) is Fisher’s information— \({ - ({d^2}/d{heta ^2}){P_{{heta _0}}}[og {f_heta }(X)] _{heta = {heta _0}}}\). The asymptotic normality requires a tedious list of regularity conditions, first promulgated by Wald.
Cartilage grafts for bone repair and regeneration

Abstract: During embryonic development and fracture repair the majority of bone is formed indirectly from a cartilage intermediate in a process called endochondral ossification. In contrast, the majority of therapeutic strategies to promote bone regeneration aim to stimulate direct osteogenesis through intramembranous ossification. Clinically this has led to failures associated with osteonecrosis and poor osseointegration of the bone graft. In this chapter we discuss how using cartilage to stimulate bone repair may be a better therapeutic strategy than current bone grafting techniques.
Telepharmacy: A New Paradigm for Our Profession:

Telepharmacy is a rapidly growing area of communication within pharmaceutical care delivery, especially in rural areas. The purpose of this literature review is to determine how telepharmacy is currently being practiced within community and ambulatory pharmacy settings, its effectiveness, and how it is being regulated across the United States. A literature review was performed using PubMed, Ovid MEDLINE, and the Google search engine. State-specific rules were researched using board of pharmacy and legislative online resources. Telepharmacy has been successfully implemented within community pharmacy settings through the creation of remote dispensing sites. The increasing focus of state regulations on telepharmacy services and practices shows the growth and acceptance of this modality of pharmacy practice. There is wide variation among state regulations pertaining to the setup and operation of telepharmacies. Trends in telemedicine show that telepharmaceutical care is likely to continue to expand as it allows for a better allocation of resources and access to more patients. However, research needs to be conducted to specifically analyze the value and place for telepharmacy services.
Disentangling the association of depression on the anti-fatigue effects of ketamine.

Abstract Background Fatigue and depression are closely associated. The purpose of this secondary analysis was to understand the relationships between depression and improvements in specific depression domains on the anti-fatigue effects of ketamine, which we previously reported. Methods This secondary analysis re-evaluated data collected longitudinally from 39 patients with treatment-resistant Major Depressive Disorder (MDD) enrolled in a double-blind, randomized, placebo-controlled, crossover trial using a single intravenous infusion of ketamine hydrochloride (0.5 mg/kg over 40 minutes) or placebo. A mediation model assessed the effect of depression on the anti-fatigue effects of a single dose of intravenous ketamine versus placebo at Day 1 post-infusion. Fatigue was measured using the National Institutes of Health–Brief Fatigue Inventory (NIH-BFI), and depression was assessed by the Montgomery–Ǻsberg Depression Rating Scale (MADRS). Results Compared to placebo, ketamine significantly improved fatigue (p = .0003) as measured by the NIH-BFI, but the anti-fatigue effects of ketamine disappeared (p = .47) when controlling for depression as measured by MADRS total score. In this study sample, the anti-fatigue effects of ketamine were mostly accounted for by the changes in amotivation and depressed mood scores. Conclusions In this study, ketamine did not have a unique effect on fatigue outside of its general antidepressant effects in patients with treatment-resistant depression. Specifically, the anti-fatigue effects of ketamine observed in this study seem to be explained by the effects of ketamine on two symptom domains of depression: amotivation and depressed mood. The study findings suggest that the anti-fatigue effects of ketamine should be assessed by fatigue-specific measures other than the NIH-BFI or future studies should enroll fatigued patients without depression.