cssi/SciSciGPT-SciSciNet huggingface dataset:
Using the weighted area under the net benefit curve for decision curve analysis

Risk prediction models have been proposed for various diseases and are being improved as new predictors are identified. A major challenge is to determine whether the newly discovered predictors improve risk prediction. Decision curve analysis has been proposed as an alternative to the area under the curve and net reclassification index to evaluate the performance of prediction models in clinical scenarios. The decision curve computed using the net benefit can evaluate the predictive performance of risk models at a given or range of threshold probabilities. However, when the decision curves for 2 competing models cross in the range of interest, it is difficult to identify the best model as there is no readily available summary measure for evaluating the predictive performance. The key deterrent for using simple measures such as the area under the net benefit curve is the assumption that the threshold probabilities are uniformly distributed among patients. We propose a novel measure for performing decision curve analysis. The approach estimates the distribution of threshold probabilities without the need of additional data. Using the estimated distribution of threshold probabilities, the weighted area under the net benefit curve serves as the summary measure to compare risk prediction models in a range of interest. We compared 3 different approaches, the standard method, the area under the net benefit curve, and the weighted area under the net benefit curve. Type 1 error and power comparisons demonstrate that the weighted area under the net benefit curve has higher power compared to the other methods. Several simulation studies are presented to demonstrate the improvement in model comparison using the weighted area under the net benefit curve compared to the standard method. The proposed measure improves decision curve analysis by using the weighted area under the curve and thereby improves the power of the decision curve analysis to compare risk prediction models in a clinical scenario.
Climate-driven range shift prompts species replacement

Climate change prompts warm-tolerant species upward and poleward to either displace or replace cold-tolerant species. Warm-tolerant species may replace cold-tolerant individuals with upward migration, or cold-tolerant genes if the species hybridize. We examined genetic and morphological differences between low elevation, warm-tolerant (Aphaenogaster rudis) and high elevation cold-tolerant (A. picea) ant species that form an upward-shifting ecotone in the southern Appalachian Mountains (USA). The A. picea/A. rudis ecotone shifted upward ca. 200 m between the decades 1970 and 2010, and characteristic morphological traits appeared muddled where the species met, suggesting hybridization. However, we found no evidence of genetic hybridization, and the trait most associated with species identity, pigmentation, remained so across the environmental gradients. Conversely, femur length did not differentiate well between species identities, and it shifted across the environmental gradients. These results suggest that the cold tolerant A. picea, associated with high-elevation and high-latitude, was replaced by the warm-tolerant, low elevation A. rudis species. As such, these results suggest that less competitive cold-tolerant species may be replaced by more competitive cold-intolerant species with climate warming.
The on‐again, off‐again relationship between mitochondrial genomes and species boundaries

The study of reproductive isolation and species barriers frequently focuses on mitochondrial genomes and has produced two alternative and almost diametrically opposed narratives. On one hand, mtDNA may be at the forefront of speciation events, with co-evolved mitonuclear interactions responsible for some of the earliest genetic incompatibilities arising among isolated populations. On the other hand, there are numerous cases of introgression of mtDNA across species boundaries even when nuclear gene flow is restricted. We argue that these seemingly contradictory patterns can result from a single underlying cause. Specifically, the accumulation of deleterious mutations in mtDNA creates a problem with two alternative evolutionary solutions. In some cases, compensatory or epistatic changes in the nuclear genome may ameliorate the effects of mitochondrial mutations, thereby establishing coadapted mitonuclear genotypes within populations and forming the basis of reproductive incompatibilities between populations. Alternatively, populations with high mitochondrial mutation loads may be rescued by replacement with a more fit, foreign mitochondrial haplotype. Coupled with many nonadaptive mechanisms of introgression that can preferentially affect cytoplasmic genomes, this form of adaptive introgression may contribute to the widespread discordance between mitochondrial and nuclear genealogies. Here, we review recent advances related to mitochondrial introgression and mitonuclear incompatibilities, including the potential for cointrogression of mtDNA and interacting nuclear genes. We also address an emerging controversy over the classic assumption that selection on mitochondrial genomes is inefficient and discuss the mechanisms that lead lineages down alternative evolutionary paths in response to mitochondrial mutation accumulation.
Defining the diagnostic value of hyperlipasemia for acute pancreatitis in the critically ill.

Abstract Background/objectives Hyperlipasemia is frequently encountered in patients in the intensive care unit (ICU). The degree to which it should be valued in making the diagnosis of acute pancreatitis (AP) in critically ill patients remains uncertain. We sought to determine the diagnostic accuracy of hyperlipasemia and the optimal lipase cutoff for diagnosing AP in critically ill patients. Methods Four hundred and seventeen ICU patients with hyperlipasemia, defined as lipase greater than three times the upper limit of normal from 2009 to 2012 were retrospectively identified. A diagnosis of AP was confirmed by the additional presence of either characteristic abdominal pain or cross-sectional imaging. Results The overall positive predictive value (PPV) of hyperlipasemia was 38.1%. Median initial lipase levels were 1164 IU/L in patients with AP and 284.5 IU/L in patients without AP (p Conclusions Physicians should maintain caution when interpreting hyperlipasemia in the critically ill due its relatively low PPV. However, a greater lipase cutoff improves its diagnostic value in AP and helps to reduce unnecessary imaging in these patients.
Administering Polyethylene Glycol Electrolyte Solution Via a Nasogastric Tube: Pulmonary Complications

Background Patients sometimes require insertion of a nasogastric tube for the administration of a large volume of a polyethylene glycol electrolyte solution. If the tube is malpositioned, the risk for direct instillation of the solution into the lung increases. The risk for aspiration also increases if the infusion rate exceeds gastrointestinal tolerance. Purpose To review published cases of patients' experiencing adverse pulmonary events after administration of polyethylene glycol electrolyte solution via a nasogastric tube and to offer suggestions to prevent these outcomes. Methods A search of the literature from 1993 through 2014 was performed by using the PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, and Scopus databases. Results In the 12 case reports located, none of the patients had radiographs to verify tube location before infusion of polyethylene glycol electrolyte solution. After symptoms developed in 3 children (ages 8-11 years), radiographs showed their tubes incorrectly positioned in the bronchus, lung, or esophagus; ports of a fourth child's tube were in the oropharynx. The remaining 8 patients (ages 5-86 years) never had radiographs to determine tube placement. Pulmonary complications from the infusions of polyethylene glycol electrolyte solution contributed to the death of 5 of the patients. Conclusion Relatively simple maneuvers to reduce the likelihood of adverse pulmonary events following the administration of large volumes of polyethylene glycol electrolyte solution via a nasogastric tube are well worth the cost and effort to protect patients from potential serious injury.
Strokes of a Garden Gate

The purpose of this design was to virtually create a prototype in Optitex 2D/3D and design an engineered garment that incorporate digital printing and laser cutting to explore the effects of depths within a dress. The source of inspiration was a caged garden gate. The patterns of the gate were laser cut and placed on top of the digitally printed floral petal prints. The design and construction process for the dress include: 1) creating the garment pattern pieces on OptiTex, 2) creating and printing textile prints, 3) designing and cutting laser cut prints, and 4) constructing the garment. This design contributes to a new way of integrating emerging technologies into an innovative design process. Documentation of this process can give new insights on the use of 2D and 3D by apparel design students and also provides a new way of applying technologies and creativity into one complex garment.
Spirituality, Spiritual Well-Being, and Spiritual Coping in Advanced Heart Failure: Review of the Literature:

Heart failure is a chronic and terminal disease that affects a significant portion of the U.S. population. It is marked by considerable suffering, for which palliative care has been recommended. Palliative care standards require the inclusion of spiritual care, but there is a paucity of literature supporting effective spiritual interventions for the heart failure population. A literature search resulted in 30 articles meeting the criteria for review of spirituality and spiritual coping in the heart failure population. Findings within this body of literature include descriptive evidence of the uniqueness of spirituality in this population, quantitative and qualitative approaches to inquiry, theoretical models of spiritual coping, and proposed interventions. The article concludes with implications for future research and practice.
Gaining Community Entree to Assess Service Needs of Hispanics

Human service providers are increasingly interested in developing culturally appropriate programs to meet the needs of a growing Hispanic population throughout the United States. This article exami...
Oxygenation of Tryptophane Catalyzed by Polyamine Cobalt Dioyxgen Complexes

The catalytic conversion of tryptophane to an oxygenated product has been accomplished with a polyamine cobalt dioxygen complex, [Co2(TETREN)O2]+4(TETREN = tetraethylenepentaamine), as the catalyst. The apparent reaction rates measured by molecular oxygen consumption are the same in pure methanol and methanol that contains IM tetramethylammonium chloride at 40°C reaction temperature. The reaction is first order in tryptophan, and the primary product has been tentatively identified as a dioxygenated substrate.
Cytotoxicity of Native-and Surface-Modified Asbestos

The increased risk of developing pneumoconiosis and/or lung cancer from occupational exposure to asbestos is a major health concern (Craighead et al. 1983). Because of its heat and fire resistant properties, asbestos is extensively used in industrial and commercial applications. Substitutes for this versatile mineral that possess its desirable properties, but devoid of harmful health effects, have not been readily available. Several chemical processes were attempted to commercially detoxify asbestos and retain its physical properties. It is not known whether this chemically modified asbestos is less toxic in biologic test systems (Flowers 1880). This report provides an in vitro comparative evaluation of amosite, crocidolite and chrysotile asbestos in native- and surface-modified forms with regard to their biologic toxicity. Lactate dehydrogenase (LDH), a cytoplasmic enzyme, and (s-glucuronidase (s-GLUC) and s-N acetyl glucuronidase (s-NAG), two lysosomal enzymes, were measured as markers of cellular toxicity after exposure of alveolar macrophages to native- and surface-modified asbestos. Hemolytic activity of both types of asbestos was measured as an index of cell membrane damage. The effect of native- and surface-modified asbestos on the induction of viral interferon system was monitored as a biologic marker of potential adverse effect on cellular defense mechanisms.
Discharge Destination as a Predictor of Postoperative Outcomes and Readmission Following Posterior Lumbar Fusion.

Background Posterior lumbar fusions are performed to treat various spinal deformities, degenerative diseases, fractures, infections, and tumors. The possibility of episode-based bundled payments for spine surgery necessitates analysis of the factors predicting readmissions and postoperative complications. Methods Patients undergoing posterior lumbar fusion in the American College of Surgeons National Surgical Quality Improvement Program were queried via Current Procedural Terminology codes 22630, 22633, and 22612. Patients were grouped based on discharge destination, either to home/home health care or to a facility. Relevant demographics, comorbidities, perioperative statistics, and predischarge and postdischarge complications were compared. Multivariable logistic regression models for severe postdischarge complications and 30-day readmissions were created with the exposure of nonhome discharge. Results Patients discharged to nonhome destinations were significantly older (68.42 vs. 58.15 years; P 2 vs. 44.25%; P 40 vs. 7.63%; P Conclusions Nonhome discharge patients experienced higher rates of complications and 30-day readmissions.
An Ontology for Facilitating Discussion of Catalytic Strategies of RNA-Cleaving Enzymes

A predictive understanding of the mechanisms of RNA cleavage is important for the design of emerging technology built from biological and synthetic molecules that have promise for new biochemical and medicinal applications. Over the past 15 years, RNA cleavage reactions involving 2'-O-transphosphorylation have been discussed using a simplified framework introduced by Breaker that consists of four fundamental catalytic strategies (designated α, β, γ, and δ) that contribute to rate enhancement. As more detailed mechanistic data emerge, there is need for the framework to evolve and keep pace. We develop an ontology for discussion of strategies of enzymes that catalyze RNA cleavage via 2'-O-transphosphorylation that stratifies Breaker's framework into primary (1°), secondary (2°), and tertiary (3°) contributions to enable more precise interpretation of mechanism in the context of structure and bonding. Further, we point out instances where atomic-level changes give rise to changes in more than one catalytic contribution, a phenomenon we refer to as "functional blurring". We hope that this ontology will help clarify our conversations and pave the path forward toward a consensus view of these fundamental and fascinating mechanisms. The insight gained will deepen our understanding of RNA cleavage reactions catalyzed by natural protein and RNA enzymes, as well as aid in the design of new engineered DNA and synthetic enzymes.
Immune Checkpoint Inhibitor Outcomes for Patients With Non-Small-Cell Lung Cancer Receiving Baseline Corticosteroids for Palliative Versus Nonpalliative Indications.

PURPOSEBaseline use of corticosteroids is associated with poor outcomes in patients with non–small-cell lung cancer (NSCLC) treated with programmed cell death-1 axis inhibition. To approach the que...
On the Formation of Solid States Beyond Perfect Crystals: Quasicrystals, Geometrically-Frustrated Crystals and Glasses

There are three kinds of solid states of matter that can exist in physical space: quasicrystalline (quasiperiodic), crystalline (periodic) and amorphous (aperiodic). Herein, we consider the degree of orientational order that develops upon the formation of a solid state to be characterized by the application of quaternion numbers. The formation of icosahedral quasicrystalline solids is considered alongside the development of bulk superfluidity, characterized by a complex order parameter, that occurs by spontaneous symmetry breaking in three-dimensions. Crystalline solid states are viewed as higher-dimensional analogues to phase-coherent topologically-ordered superfluid states of matter that develop in restricted dimensions (Hohenberg-Mermin- Wagner theorem). Lastly, amorphous solid states are viewed as dual to crystalline solids, in analogy to Mott-insulating states of matter that are dual to topologically-ordered superfluids.
Update on splitting of lifetimes of c and b hyperons within the heavy quark expansion and decays Ξ Q → Λ Q π

It is argued that the results of recent precision measurements by LHCb of the lifetimes of charmed and bottom hyperons are very well consistent with the description within heavy quark expansion and allow to accurately determine matrix elements of light-flavor nonsinglet four-quark operators over the hyperons and to accurately reproduce the difference of lifemes of ${\mathrm{\ensuremath{\Lambda}}}_{b}$ and ${\mathrm{\ensuremath{\Xi}}}_{b}^{\ensuremath{-}}$. When combined with the recent LHCb results on the decay ${\mathrm{\ensuremath{\Xi}}}_{b}^{\ensuremath{-}}\ensuremath{\rightarrow}{\mathrm{\ensuremath{\Lambda}}}_{b}{\ensuremath{\pi}}^{\ensuremath{-}}$ this leads to a prediction of a lower bound on the rate of the decays ${\mathrm{\ensuremath{\Xi}}}_{c}\ensuremath{\rightarrow}{\mathrm{\ensuremath{\Lambda}}}_{c}\ensuremath{\pi}$.
Gastrointestinal stents: Thinking outside the box

Abstract While traditionally employed to manage malignant gastrointestinal (GI) obstruction, a variety of luminal stents have been employed in the management of refractory benign GI strictures with varying safety and efficacy profiles. These include: self-expanding metal stents (SEMS), self-expanding plastic stents (SEPS), biodegradable stents and lumen-apposing metal stents (LAMS). LAMS have become instrumental as an alternate strategy to treat benign gastric outlet obstruction in the setting of native and postsurgical anatomy. This includes transpyloric placement as well as EUS-guided gastrojejunostomy creation as an alternative to laparoscopic gastrojejunostomy and endoluminal stenting. The novel application of LAMS for complete endoscopic management with anastomotic decompression of afferent loop syndrome has also been met with success in case reports and series. This approach with LAMS obviates the need for external drains and complex repeat surgeries. Finally, SEMS have been used to address benign and malignant strictures of the small bowel. However, SEMS use for this indication has been hindered by limitations in endoscopic accessibility of target sites and the current state of stent delivery systems. Whereas the role of colonic stenting for malignant colonic obstruction is well-established, the use of stents to treat benign colonic strictures continues to evolve. While the existing armamentarium of GI luminal stents has revolutionized the management of a variety of clinical conditions, additional advances could further broaden the potential applications of these devices.
Oxygen isotope fractionation between water and the aqueous hydroxide ion

Abstract The stable oxygen isotope fractionation factor between water and the aqueous hydroxide ion is a fundamental geochemical parameter widely used in the Earth Sciences and other fields. Studies from the 1960s reported α ( H 2 O ( l ) - OH - ( aq ) ) , the fractionation factor between liquid H2O and aqueous OH−, theoretically as 1.046 and ∼ 1.048 (46‰ and 48‰ at 15 °C and 25 °C) and experimentally as 1.045 (45‰) at 15 °C. These, or similar values have been used in the literature for almost 60 years. Here I present quantum-chemical (QC) calculations, showing that the above theoretical values are fundamentally wrong as they pertain to free OH− (incorrectly assumed equivalent to aqueous OH−) and ignore intermolecular vibrational modes in solution. As a result, the theoretical values from the 1960s are off by a factor of ∼ 2 (when expressed in ‰), suggesting that the experimental value is also wrong. QC computations of OH−-water clusters with up to n = 22 water molecules demonstrate that hydrogen bonding in solution significantly affects the fundamental vibrational modes associated with OH− and substantially reduces the oxygen isotope fractionation between water and OH - ( aq ) , compared to the fractionation between water and free OH−. The most accurate QC methods tested here yield values for the fractionation factor between H2O and OH− in water clusters with n = 7 to 22 water molecules of ∼ 1.019 to ∼ 1.024 (19 to 24‰) at 25 °C based on the harmonic approximation. Estimated effects due to anharmonicity (from numerically demanding computations) could add uncertainties of up to ∼ 3‰ to these values.
Erratum to: Laparoscopic management of a posterior mediastinal tumor mimicking an adrenal neoplasm

Background: Rarely, a posterior mediastinal mass may mimic an adrenal tumor on preoperative computed tomography (CT) scan. The intraoperative discovery that a mass thought to be associated with the adrenal gland actually is above the diaphragm in the posteroinferior mediastinum poses a challenge for the laparoscopic surgeon. Conversion to a thoracotomy or to videothoracoscopy incurs additional morbidity and risk for the patient. Materials and Methods: We describe a technique for the transdiaphragmatic removal of a benign mass from the posterior mediastinum. A posterior mediastinal tumor was detected during a laparoscopic procedure for a suspected right adrenal tumor. Frozen section proved benign, and the mass was resected laparoscopically via transdiaphragmatic access to the posterior mediastinum. Results: No complications were noted during or after surgery. The patient was ready for discharge from the hospital postoperative day 1. Conclusions: Transdiaphragmatic resection was used successfully instead of conversion to a thoracotomy or thoracoscopic procedure for a benign posterior mediastinal tumor found incidentally during laparoscopic surgery for a presumed adrenal lesion. This transdiaphragmatic approach can be applied to selected benign mediastinal masses.
Association of counselor weight status and demographics with participant weight loss in a structured lifestyle intervention.

Abstract Objective There is substantial variability in the effectiveness of group lifestyle interventions for weight loss. We examined associations between intervention weight loss counselors and participant weight loss and program engagement in a structured lifestyle intervention. Methods Data were from 575 adults (87% female, 51 (12) years, baseline BMI: 32.4 (7.2) kg/m2) in an 11-week structured group lifestyle program. Participants self-enrolled in groups led by 11 weight loss counselors based on meeting times. All weight loss counselors received the same training. Linear mixed models were used to evaluate counselor predictors of participant percent (%) weight loss and program engagement (weight reporting throughout 11 weeks). Results Of the 575 participants, 415 (72%) defined as complete reporters, i.e. reported weight weekly, lost a mean 7.3% weight (range: +3.1% to 16.2%). Participant weight loss differed between weight loss counselors (p = 0.003), and adjusted mean participant weight loss by weight loss counselor ranged from 6% to 9%. Weight loss was greater for weight loss counselors with a graduate degree in nutrition than weight loss counselors with another graduate degree (8.3% versus 6.4%, p = 0.05), but was not different between weight loss counselors with and without graduate degrees. Higher counselor BMI was associated with higher participant weight loss (p = 0.005). Conclusions These results demonstrate the potential for quantitatively important effects of weight loss counselor characteristics on participant success and engagement in structured lifestyle interventions, indicating a need for research in this area.
Competition for Medical Supplies Under Stochastic Demand in the Covid-19 Pandemic: A Generalized Nash Equilibrium Framework

The Covid-19 pandemic has negatively impacted virtually all economic and social activities across the globe. Presently, since there is still no vaccine and no curative treatments for this disease, medical supplies in the form of Personal Protective Equipment and ventilators are sorely needed for healthcare workers and certain patients, respectively. The fact that this healthcare disaster is not limited in time and space has resulted in intense global competition for medical supplies. In this paper, we construct the first Generalized Nash Equilibrium model with stochastic demands to model competition among organizations at demand points for medical supplies. The model includes multiple supply points and multiple demand points, along with prices of the medical items and generalized costs associated with transportation. The theoretical constructs are provided and a Variational Equilibrium utilized to enable alternative variational inequality formulations. A qualitative analysis is presented and an algorithm proposed, along with convergence results. Illustrative examples are detailed as well as numerical examples that are solved with the implemented algorithm. The results reveal the impacts of the addition of supply points as well as of demand points on the medical item product flows. The formalism may be adapted to multiple medical items both in the near term and in the longer term (such as for vaccines).
The Tema Shipyard, Dry Dock Company Limited – a Leadership Consulting Lessons

The case study is focused on Tema Shipyard - the location of a once vibrant and one of the largest shipyards and drydocks on the African Continent in the port city of Tema, Ghana. Due to a significant global market decline, mismanagement, corruption, and partisan political interference, the once Africa’s premier dry-dock has lost its luster, and many operations have fallen into disrepair. The Government of Ghana (GOG), the sole shareholder in the company hired a Leadership Consultant to recommend how “the Tema Shipyard, Dry Dock Company Limited (TSDDCL) could be effectively operated for the economic potential to be best be exploited.” Ultimately, the recommendations made by the consultant were not well received by the MDU, TSDDCL management, and the Workers Association all of which were key stakeholders necessary to the success of any future opportunities for TSDDCL. This case study which is a real case was designed to help students think through the importance of the dynamics of doing business in an emerging economy, public-private Business Partnerships, and to grasp more profoundly the challenges of leadership consulting. This case is intended for use in upper-level undergraduate, MBA/MS Organizational Leadership (OL) and Executive Leadership programs.
TF-CBT Group Intervention for Children in High Conflict Custody Disputes:

This article proposes a conceptual group approach using trauma-based cognitive behavioral therapy for children involved in high conflict custody disputes. Traditionally, interventions for this popu...
Dexamethasone transiently enhances transgene expression in the liver when administered at late phase post long term AAV transduction.

Glucocorticoids have anti-inflammatory and immunosuppressive functions and have commonly been used for preventing liver toxicity after the systemic application of a high dose of adeno-associated virus (AAV) vector for gene therapy. Clinical studies have reported that glucocorticoids have rescued Factor IX (FIX) expression in hemophilia B patients who showed a reduced FIX expression at 6 to 10 weeks post-AAV vector administration. In this study, we explored whether glucocorticoids could affect transgene expression in AAV targeted livers in animal models. When dexamethasone was applied before AAV9/FIX vector administration in the wild-type C57BL/6 mice, FIX expression was much higher than that of the control mice at any time points. More importantly, FIX expression transiently increased after dexamethasone was administered at week 6 or later post-AAV injection regardless of the various dexamethasone treatments applied. The transient enhancement in transgene expression was observed once there were one to several consecutive dexamethasone treatments completed. A similar result was also achieved in another wild type BALB/c and hemophilia B mice that were treated with AAV9/FIX and dexamethasone. This mechanism study demonstrated that the administration of dexamethasone did not change either AAV genome copy number or transgene expression at the transcription level but transiently decreases IFN-β and TNF-α expression in the livers of mice at a later time after AAV injection. Next, we studied the effect of dexamethasone on late transgene expression in hemophilia B dogs. Dexamethasone was administered 1 year after AAV9/FIX injection. Inconsistent with the results in mice, no significant change of FIX expression was observed in hemophilia B dogs. In summary, the results from this study indicate that dexamethasone may have various effects on transgene expression in AAV transduced livers in different species, which provides valuable information about the rational application of dexamethasone in future clinical studies.
Medical oncology: Chemoradiotherapy for NSCLC-does a 'standard' exist?

The optimal chemotherapy regimen to be used concurrently with thoracic radiation for locally advanced non-small-cell lung cancer remains uncertain. Studies investigating this question are ongoing.
Acute idiopathic pericarditis.

Excerpt INTRODUCTION Acute idiopathic pericarditis has been recognized with increasing frequency during recent years.1-4Because this benign disorder is so frequently confused with acute myocardial ...
BALLOON TRAWL; A SAFE AND EFFECTVE WAY OF REMOVING COMMON BILE DUCT (CBD) EMBEDDED STENTS

Biliary stenting has been used since the 1970’s to relieve biliary obstruction for a variety of causes including benign and malignant biliary strictures (1). Migration of stents proximally into the biliary tree or distally into the intestinal tract is relatively uncommon (2). We report a case of a 64 year old female with a peri-ampullary tumour, who had symptomatic obstructive jaundice following ERCP and plastic stent insertion. Follow up imaging showed proximal migration of the plastic stent and blockage of the distal CBD secondary to the peri-ampullary tumour. The biliary stent was safely removed endoscopically using balloon trawl. This case highlights that while biliary stenting for strictures is generally safe and effective, but stent migration to proximal CBD can occur. Balloon trawl is safe and effective way of removing such stents.
Eigenfunctions and Eigenvalues of a generalized two-mode squeeze operator

In this paper we have constructed the continuum eigenfunctions and eigenvalue spectra for a generalized two-mode squeeze operator. Our analyses also show explicitly that proper eigenstates of the generalized two-mode squeeze operator do not exist, which implies that the generalized two-mode squeeze operator does not have a discrete spectrum.
Examining the amine functionalization in dicarboxylates: photoelectron spectroscopy and theoretical studies of aspartate and glutamate.

Aspartate (Asp 2− ) and glutamate (Glu 2− ), two doubly charged conjugate bases of the corresponding amino acids, were investigated using low-temperature negative ion photoelectron spectroscopy (NIPES) and ab initio calculations. The effect of amine functionalization was studied by a direct comparison to the parent dicarboxylate species ( − CO2−(CH2)n−CO2 − ,D C n 2− ), succinate (DC2 2− ) and propionate (DC3 2− ). Experimentally, the addition of the amine group for the n = 2 case (DC2 2− , Asp 2− ) significantly improves the stability of the resultant Asp 2− dianionic species, albeit that NIPES shows only a small increase in adiabatic electron detachment energy (ADE) (+0.05 eV). In contrast, for n = 3 (DC3 2− , Glu 2− ), a much larger ADE increase is observed (+0.15 eV). Similar results are obtained through ab initio calculations. The latter indicates that increased stability of Asp 2− can be attributed to the lowering of the energy of the singlet dianion state due to hydrogen bonding effects. The effect of the amino group on the doublet monoanion state is more complicated and results in the weakening of the binding of the adjacent carboxylate group due to electronic structure resonance effects. This conclusion is confirmed by the analysis of NIPES results that show enhanced production of near-zero kinetic energy electrons observed experimentally for amine-functionalized species.
Factor XII stimulates ERK1/2 and Akt through uPAR, integrins, and the EGFR to initiate angiogenesis.

Factor XII (FXII) and high molecular weight kininogen (HK) mutually block each other's binding to the urokinase plasminogen activator receptor (uPAR). We investigated if FXII stimulates cells by interacting with uPAR. FXII (3-62nM) with 0.05mM Zn2+ induces extracellular signal-related kinase 1/2 (ERK1/2; mitogen-activated protein kinase 44 [MAPK44] andMAPK42) and Akt (Ser473) phosphorylation in endothelial cells. FXII-induced phosphorylation of ERK1/2 or Akt is a zymogen activity, not an enzymatic event. ERK1/2 or Akt phosphorylation is blocked upstream by PD98059 or Wortmannin or LY294002, respectively. An uPAR signaling region for FXII is on domain 2 adjacent to uPAR's integrin binding site. Cleaved HK or peptides from HK's domain 5 blocks FXII-induced ERK1/2 and Akt phosphorylation. A β1 integrin peptide that binds uPAR, antibody 6S6 to β1 integrin, or the epidermal growth factor receptor (EGFR) inhibitor AG1478 blocks FXII-induced phosphorylation of ERK1/2 and Akt. FXII induces endothelial cell proliferation and 5-bromo-2′deoxy-uridine incorporation. FXII stimulates aortic sprouting in normal but not uPAR-deficient mouse aorta. FXII produces angiogenesis in matrigel plugs in normal but not uPAR-deficient mice. FXII knockout mice have reduced constitutive and wound-induced blood vessel number. In sum, FXII initiates signaling mediated by uPAR, β1 integrin, and the EGFR to induce human umbilical vein endothelial cell proliferation, growth, and angiogenesis.
Strategies of Habitat Use by Mountain Gorillas

Patterns of home range use by a mountain gorilla group are examined here in relation to variation in food abundance and quality, diet quality and rainfall, to interactions between different social units and to the distribution of hazards (poaching risk). Variation in habitat quality influenced both long-term area occupation densities and shorter-term movement parameters (day journey length and the distance moved between consecutive feeding sites). Observed home range use patterns increased the gorillas' foraging efficiency. Rainfall influenced the evenness of home range use slightly, but this was the only seasonal variability. Interactions with other gorillas and poaching risk had proximate effects superimposed on the fundamental influence of food distribution patterns. Data from a larger sample of groups show a positive influence of group size on day journey length, but this was apparent only at very small and relatively large group sizes. The absolute distance travelled per day tends to be short even for large groups. The data support arguments that the costs of social foraging are low for mountain gorillas.
Empirically supported comprehensive treatments for young children with autism

Describes treatment of autism, a severe, chronic developmental disorder that results in significant lifelong disability for most persons, with few persons ever functioning in an independent and typical lifestyle. Within the past decade, a number of studies have reported significant changes in the outcomes of very young children with autism following intensive comprehensive treatment. The criteria for empirically supported treatments, as described by Lonigan, Elbert, and Johnson (this issue), were applied to reports of eight treatment efficacy studies published in peer-reviewed journals. Whereas positive outcomes are reported in every case, the field does not yet have a treatment that meets the present criteria for well-established or probably efficacious treatment. Hypothesized variables affecting outcomes that need to be rigorously tested include age at start of treatment, type of treatment used, intensity of treatment, and IQ and language levels at the start of treatment.
Screening mammography: proven benefit, continued controversy.

Screening mammography, despite its limitations, remains the best means for diagnosing breast cancer in asymptomatic women. Regarding the continuing controversies concerning the age at which screening should start, evidence supports beginning regular screening at age 40 in women at average risk . Similarly, evidence suggests that the screening interval should be yearly, especially in younger women. Rather than an arbitrary age at which screening should stop, the decision on screening elderly women should be made on an individual basis, taking into account level of health and life expectancy. More work needs to be done on determining the optimum screening strategies for high-risk women. As to the interpretation of screening mammography, a certain level of observer variability and of false-negative and false-positive readings are inherent in the process. These should be kept to a minimum through efforts by the interpreting radiologist to improve performance through auditing of individual results and continuing education. The impact of double reading and computer-aided detection in the interpretation of screening mammograms warrants further evaluation in terms of efficacy and cost-effectiveness. Despite these continuing controversies, mortality from breast cancer in the United States has been decreasing steadily for the past 25 years. The magnitude of the decrease has been reported to range from 8% to 25%. Although some of this decrease may be attributable to improvements in the treatment of breast cancer, early detection through screening mammography has undoubtedly played a role in this mortality reduction. The controversies that surround the issue of screening should not detract from the fact that screening mammography has proved to save lives.
Suspected congenital centronuclear myopathy in an Arabian-cross foal.

6-week-old, Arabian-cross male foal was referred to the Veterinary Teaching Hospital at the Louisiana State University School of Veterinary Medicine for a 1-week history of progressive weakness and intermittent right thoracic limb lameness. The foal had a normal birth, was healthy, had been active, and had not exhibited any abnormalities of gait before presentation. The current owner had acquired the mare just before foaling. The foal presented in sternal recumbency and was unable to rise without assistance. Physical examination identified a quiet, moderately responsive foal with dull mentation and body weight of 64 kg. Rectal temperature was 101.0°F, heart rate was 64 beats/min, and respiratory rate was 28 breaths/min. Mucous membranes were tacky, there was mild decreased skin turgor, and capillary refill time (CRT) was 2 seconds. There was a grade II/VI holosystolic murmur over the left heart base that was considered functional. Increased bronchovesicular sounds were present bilaterally. Lameness (grade 1/5) was evident in the right thoracic limb with pain on palpation and manipulation of the caudal aspect of the distal phalangeal and elbow joints. The lameness resolved after injection of lidocaine (Lidocaine 2%, VetOne a ) (2,000 U) into the elbow joint. Joint fluid analysis and radiographs of the distal phalangeal and elbow joints were considered normal. Spinal radiographs, evaluated because of rear limb weakness, also were considered normal. Radiographs of the thorax disclosed ventral alveolar opacities, consistent with aspiration pneumonia. The foal was somnolent on neurological examination and in sternal recumbency, but when assisted it/he could stand and walk. The lower lip drooped bilaterally and the palpebral fissures were decreased bilaterally because of upper eyelid ptosis. Normal palpebral reflexes were
Relaxation Training and Written Emotional Disclosure for Tension or Migraine Headaches: A Randomized, Controlled Trial

Background and Purpose Behavioral medicine interventions that directly reduce arousal and negative emotions, such as relaxation training (RT), are conceptually different from interventions that temporarily increase negative emotions, such as written emotional disclosure (WED), but no studies have directly compared their efficacy. We compared the effects of RT and WED on people with tension or migraine headaches.
Biology of aging as related to cancer

The relationship of the biology of aging to cancer in older patients is of importance at several levels. The striking increase of cancer incidence with age may be related to a number of biologic factors. Potential age-related etiologic factors include decreased immune surveillance, longer duration of carcinogenic exposure, increased susceptibility of cells to carcinogens, decreased DNA repair, oncogene activation or amplification, and defects in tumor-suppressor genes. Moreover, at the cellular level, the uncontrolled proliferation characteristic of cancer and the reduced proliferation characteristic of senescence may be "opposite sides of the coin," governed by similar mechanisms of gene regulation. The biologic behavior of neoplasma, once initiated, may vary in different age groups depending on tumor type, immune system status, and alterations in other regulatory factors such as angiogenesis. In the clinical approach to the older cancer patient, attention to age-related biologic changes leading to decreased homeostatic reserve, especially in such areas as the hematopoietic, renal, immune, and cardiovascular systems, is essential to the designing of successful therapies.
Identification of mutations in the transgluataminase 1 gene in lamellar ichthyosis

: Lamellar ichthyosis (LI) is an autosomal recessive disorder of cornification. Mutations in the transglutaminase 1 gene (TGM1) have been identified in several families with this disorder. We analyzed two unrelated families with offspring affected with LI. Family 1 included affected monozygotic twins, in which a homozygous G-to-T transversion was identified in exon 6 at amino acid residue R315L. This mutation was also identified in the unaffected mother. In family 2, which consisted of one affected infant, a T-to-G transversion in exon 8 resulted in a change of phenylalanine to valine, F400V, and a C-to-T transition in exon 4 resulted in a change of proline to leucine, P248L. In this family, the mutation F400V was found in the unaffected father, and the mutation P248L was identified in the unaffected mother. These findings extend the growing body of literature documenting mutations in the TGM1 gene as the molecular basis of certain cases of lamellar ichthyosis.
A global perspective on railway inefficiency and the rise of state ownership, 1880–1912

Abstract The rise of state ownership was one of the most significant policy changes in the railway sector in the early 20th century. This paper estimates the cost inefficiency of railway sectors across countries using stochastic frontier models and examines whether the rise of state ownership affected inefficiency. The results show that the trends in inefficiency differed substantially across countries from the 1880s to 1912. They also show that inefficiency increased with greater nationalizations and decreased with greater state railway construction. A counterfactual analysis suggests that the rise of state ownership contributed to lower inefficiency in most countries, but the effects within countries varied depended on whether state ownership increased through nationalizations or new construction.
A Method for Severely Constrained Item Selection in Adaptive Testing

Previous attempts at incorporating expert test construction practices into computerized adaptive testing paradigms are described. A new method is presented for incorporating a large number of con straints on adaptive item selection. The meth odology emulates the test construction practices of expert test specialists, which is a necessity if com puterized adaptive testing is to compete with con ventional tests. Two examples—one for a verbal measure and the other for a quantitative measure— are provided of the successful use of the proposed method in designing adaptive tests.
Design of a Continuous Digital-Output Environmental Radon Monitor

A new field instrument for the continuous measurement of radon concentrations has been developed to investigate the magnitude and variability of environmental levels of 222Rn. Passive diffusion of radon, but not its daughters, occurs through an open pore polyurethane foam into a sensitive volume where a static electric field directs the positively ionized radon daughter products to a central collecting electrode. Pulses in a ZnS(Ag) scintillator, resulting from the alpha emission of 218Po and 214Po, are observed with a photomultiplier tube and counted using standard NIM electronics. The detector unit has been fabricated into a small, convenient package for indoor air sampling without the use of air movers or pumps. The unit is unobtrusive and acceptable into a daily routine without disrupting normal family or business activities. The monitor can detect as little as 0.5 pCi/l for a 40-min. count (?=.05). The equilibrium detection efficiency of the instrument is 0.7 cpm/pCi/l.
Daily spiritual experiences of older adults with and without arthritis and the relationship to health outcomes.

Objective Strategies to improve coping with chronic disease are increasingly important, especially with the aging US population. For many, spirituality serves as a source of strength and comfort. However, little is known about the prevalence of daily spiritual experiences (DSE) and how they may relate to physical and mental health. Methods We surveyed older adults age >50 years with chronic health conditions seen in a primary care setting about their DSE, health perceptions, pain, energy, and depression. Results Of 99 patients, 80% reported DSE most days and many times per day. Women had significantly lower DSE scores than men (reflecting more frequent DSE, mean ± SD 37.3 ± 15.0 versus 45.8 ± 17.5; P = 0.012). African American women reported the most frequent DSE and white men reported the least frequent DSE (mean ± SD 35.9 ± 13.6 versus 52.2 ± 19.1). Frequent DSE were significantly associated with a higher number of comorbid conditions (P = 0.003), although not with age, education, or employment status. Persons with arthritis reported significantly more DSE than those without arthritis (mean ± SD 35.2 ± 12.1 versus 47.1 ± 18.6; P < 0.001). After adjustment for age, race, sex, pain, and comorbid conditions, more frequent DSE were associated with increased energy (P < 0.009) and less depression (P < 0.007) in patients with arthritis. Conclusion DSE are common among older adults, especially those with arthritis. Increased DSE may be associated with more energy and less depression. DSE may represent one pathway through which spirituality influences mental health in older adults.
Attitudes of students and accounting practitioners concerning the ethical acceptability of earnings management

There are many ways that accountants and managers can influence the reported accounting results of their organizational units. When such influence is directed at changing the amount of reported earnings, it is known as earnings management. The purpose of this paper is to present the results of surveys of undergraduate students, MBA students, and practicing accountants concerning their attitudes on the ethical acceptability of earnings management. Analysis of the survey results reveals how the attitudes of the three groups differ and what variables are associated with these differences. Based on the analysis, the authors suggest changes in accounting education curriculum and ethics awareness programs in business which might increase students' and practitioners' sensitivity to the ethical ramifications of earnings management.