cssi/SciSciGPT-SciSciNet huggingface dataset:
A comparison of the incidence of hypercapnea in non-obese and morbidly obese peri-operative patients using the SenTec transcutaneous pCO 2 monitor

Obese patients are at increased risk for hypoventilation, leading to hypercapnea and acidosis. The primary objective of this study was to compare the incidence of perioperative hypercapnea in non-obese and morbidly obese patients using the SenTec transcutaneous PCO2 (tcPCO2) monitor. 10 morbidly obese subjects (BMI > 40 kg/m2) undergoing laparoscopic bariatric surgery, and 10 non-obese subjects (BMI < 30 kg/m2) undergoing laparoscopic abdominal procedures were studied, using a standardized anesthesia regimen. TcPCO2 and SpO2 were monitored continuously intraoperatively, and during the first 24 h postoperatively. Opiate consumption, respiratory rate (RR), and pain scores were collected from postanesthesia care unit (PACU) and ward nursing notes. RR, SpO2, and tcPCO2 did not differ significantly between groups during PACU or ward time periods. End-tidal CO2 (EtCO2) values were similar between groups during the intraoperative period, but tcPCO2 was significantly higher in the obese group at specific time points, and trended towards being higher throughout the case. Our study did not show significant tcPCO2 differences between non-obese and obese post-surgical patients, however, it did allow for continuous, trendable, nonobtrusive monitoring throughout the perioperative period. As V/Q mismatch increases with the PaCO2/EtCO2 gradient, and this effect is most pronounced in morbidly obese patients, tcPCO2 monitoring may prove to be a useful additional monitor in these patients during the intraoperative period.
An Oracle: Antituberculosis Pharmacokinetics-Pharmacodynamics, Clinical Correlation, and Clinical Trial Simulations To Predict the Future

Antimicrobial pharmacokinetic-pharmacodynamic (PK/PD) science and clinical trial simulations have not been adequately applied to the design of doses and dose schedules of antituberculosis regimens because many researchers are skeptical about their clinical applicability. We compared findings of preclinical PK/PD studies of current first-line antituberculosis drugs to findings from several clinical publications that included microbiologic outcome and pharmacokinetic data or had a dose-scheduling design. Without exception, the antimicrobial PK/PD parameters linked to optimal effect were similar in preclinical models and in tuberculosis patients. Thus, exposure-effect relationships derived in the preclinical models can be used in the design of optimal antituberculosis doses, by incorporating population pharmacokinetics of the drugs and MIC distributions in Monte Carlo simulations. When this has been performed, doses and dose schedules of rifampin, isoniazid, pyrazinamide, and moxifloxacin with the potential to shorten antituberculosis therapy have been identified. In addition, different susceptibility breakpoints than those in current use have been identified. These steps outline a more rational approach than that of current methods for designing regimens and predicting outcome so that both new and older antituberculosis agents can shorten therapy duration.
Aluminum diffusion and Al-vacancy association in periclase

Trivalent cations in periclase are attracted to cation vacancies and these defects tend to associate on adjacent sites to form mobile pairs. A theory has been developed to describe the concentration-dependent diffusion of Al in the presence of Al-vacancy pairs, and has been applied to experiments conducted at 1577–2273 K and 1 atm to 25 GPa. In all but one experiment, the Gibbs free energy of binding, inferred from the diffusion profiles, is between −44 and −60 kJ/mol, with an average value of −50 kJ/mol. The absolute value of the entropy of binding is constrained to be less than 50 J mol −1 K −1 , and the volume of binding is constrained to be between −1.8 and 0 cm3/mol. The diffusion coefficient of the Al-vacancy pair can be described by the equation D2 = D2,0 exp(−(E + PV)/RT), with E =2 13± 32 kJ/mol, V = 3.22 ± 0.25 cm 3 /mol, and log10 D2,0 = −6.17 ± 0.99 (in m 2 /s; all uncertainties 2� ). Calculations are presented for the diffusion of Al and Mg as functions of Al concentration, temperature and pressure.
Ten years in the evolution of the internet ecosystem

Our goal is to understand the evolution of the Autonomous System (AS) ecosystem over the last decade. Instead of focusing on abstract topological properties, we classify ASes into a number of "species" depending on their function and business type. Further, we consider the semantics of inter-AS links, in terms of customer-provider versus peering relations. We find that the available historic datasets from RouteViews and RIPE are not sufficient to infer the evolution of peering links, and so we restrict our focus to customer-provider links. Our findings highlight some important trends in the evolution of the Internet over the last decade, and hint at what the Internet is heading towards. After an exponential increase phase until 2001, the Internet now grows linearly in terms of both ASes and inter-AS links. The growth is mostly due to enterprise networks and content/access providers at the periphery of the Internet. The average path length remains almost constant mostly due to the increasing multihoming degree of transit and content/access providers. In recent years, enterprise networks prefer to connect to small transit providers, while content/access providers connect equally to both large and small transit providers. The AS species differ significantly from each other with respect to their rewiring activity; content/access providers are the most active. A few large transit providers act as "attractors" or "repellers" of customers. For many providers, strong attractiveness precedes strong repulsiveness by 3-9 months. Finally, in terms of regional growth, we find that the AS ecosystem is now larger and more dynamic in Europe than in North America.
Etiologic and preventive aspects of epilepsy in the child--bridging the gap between laboratory and clinic.

Summary: Four broad categories of basic phenomena are pertinent to developing ways to prevent epilepsy. These include mechanisms of epileptogenesis, ictal initiation and temporary entrainment by the seizure discharge of normally functioning brain, seizure propagation, and control mechanisms that function both to restrain the cascade of epileptic events culminating in a seizure and to arrest the epileptic event and restore the interictal state. In newborns and children, hypoxia-ischemia is a major factor leading to epileptogenesis, and several schemes are proposed to classify, quantify, and prevent hypoxic-ischemic encephalopathy. Control mechanisms must be better understood in order to develop prophylactic recommendations for epilepsy, and an experimental model of “kindling antagonism” may increase our understanding of these. Programs of prevention of seizures in children will evolve only if basic researchers and clinicians work productively together to develop an adequate understanding of factors important in epileptogenesis and antiepileptogenic control mechanisms.
Models of Brainstem Responses to Bilateral Electrical Stimulation

A simple, biophysically specified cell model is used to predict responses of binaurally sensitive neurons to patterns of input spikes that represent stimulation by acoustic and electric waveforms. Specifically, the effects of changes in parameters of input spike trains on model responses to interaural time difference (ITD) were studied for low-frequency periodic stimuli, with or without amplitude modulation. Simulations were limited to purely excitatory, bilaterally driven cell models with basic ionic currents and multiple input fibers. Parameters explored include average firing rate, synchrony index, modulation frequency, and latency dispersion of the input trains as well as the excitatory conductance and time constant of individual synapses in the cell model. Results are compared to physiological recordings from the inferior colliculus (IC) and discussed in terms of ITD-discrimination abilities of listeners with cochlear implants. Several empirically observed aspects of ITD sensitivity were simulated without evoking complex neural processing. Specifically, our results show saturation effects in rate–ITD curves, the absence of sustained responses to high-rate unmodulated pulse trains, the renewal of sensitivity to ITD in high-rate trains when inputs are amplitude-modulated, and interactions between envelope and fine-structure delays for some modulation frequencies.
Preterm infants' behavioural indicators of oxygen decline during bottle feeding.

Background During the time when preterm infants' oral feeding skills are developing they often experience physiological instability and need assistance from caregivers to maintain adequate oxygenation. Assisting infants to maintain optimal oxygenation during oral feeding requires an understanding of how they express and aim to self-regulate their oxygen status.
Agenda for Medieval Studies

At a time when so many people under thirty regard most people over thirty as hopeless dotards, an almost sexegenarian cannot feel too comfortable as the caster of horoscopes for future medieval research. Surely David Herlihy would have been a more suitable prophet, had he not been assigned the traditionally historiographic role of inspecting the past; so would Harry Miskimin, were he not otherwise employed. Here I am, nevertheless, with no choice but trying to race ahead as fast as I can; fifteen minutes, one and a half per century of the middle ages, are quickly gone.
Evolution of marketable permits: the US experience with sulphur dioxide allowance trading

The Sulfur Dioxide Allowance Programme, created under Title IV of the Clean Air Act Amendments of 1990, is the first national market–based approach to environmental management employed in the United States and represents a radical departure from both the traditional regulatory approach to environmental policy and from previous emissions trading efforts. This paper reviews the goals of the SO2 allowance programme and the results after its first full year of operation, discusses the context for the establishment of the programme and its critical design features, and identifies some lessons learned from implementing this large–scale emissions trading programme.
The structural requirements of organophosphorus insecticides (OPI) for reducing chicken embryo NAD(+) content in OPI-induced teratogenesis in chickens.

Abstract The objective of this study was to determine the structural requirements of organophosphorus insecticides (OPI) for reducing chicken embryo nicotinamide adenine dinucleotide (NAD + ) content in OPI-induced teratogenesis and compare them with those needed for OPI inhibition of yolk sac membrane kynurenine formamidase (KFase), the proposed primary target for OPI teratogens in chicken embryos. The comparative molecular field analysis (COMFA) of three-dimensional quantitative structure–activity relationship (3D QSAR) revealed the electrostatic and steric fields as good predictors of OPI structural requirements to reduce NAD + content in chicken embryos. The dominant electrostatic interactions were localized at nitrogen-1, nitrogen-3, nitrogen of 2-amino substituent of the pyrimidinyl of pyrimidinyl phosphorothioates, and at the oxygen of crotonamide carbonyl in crotonamide phosphates. Bulkiness of the substituents at carbon-6 of the pyrimidinyls and/or N-substituents of crotonamides was the steric structural component that contributed to superiority of those OPI for reducing embryonic NAD + levels. Both electrostatic and steric requirements are similar to those defined in our previous study for OPI inhibition of chicken embryo yolk sac membrane KFase. The findings of this study provide another piece of evidence for the cause-and-effect relationship between yolk sac membrane KFase inhibition and reduced embryo NAD + content in NAD-associated OPI-induced teratogenesis in chickens.
Disentangling the influence of cell phone usage in the dilemma zone: An econometric approach

This paper focuses on developing an analysis framework to study the impact of cell phone treatment (cell phone type and call status) on driver behavior in the presence of a dilemma zone. Specifically, we examine how the treatment influences the driver maneuver decision at the intersection (stop or cross) and the eventual success of the maneuver. For a stop maneuver, success is defined as stopping before the stop line. Similarly, for a cross maneuver, success is defined as clearing the intersection safely before the light turns red. The eventual success or failure of the driver's decision process is dependent on the factors that affected the maneuver decision. Hence it is important to recognize the interconnectedness of the stop or cross decision with its eventual success (or failure). Toward this end, we formulate and estimate a joint framework to analyze the stop/cross decision with its eventual success (or failure) simultaneously. The study is conducted based on driving simulator data provided online for the 2014 Transportation Research Board Data Contest at http://depts.washington.edu/hfsm/upload.php. The model is estimated to analyze drivers’ behavior at the onset of yellow by employing exogenous variables from three broad categories: driver characteristics, cell phone attributes and driving attributes. We also generate probability surfaces to identify dilemma zone distribution associated with different cell phone treatment types. The plots clearly illustrate the impact of various cellphone treatments on driver dilemma zone behavior.
A Software for Kinetostatic Synthesis of Compliant Mechanisms

This paper presents a computer program for kinetostatic synthesis for design automation of compliant mechanisms. Kinetostatic synthesis is solving the geometric (e.g. link lengths) and elastic parameters (e.g. spring constants) for a prescribed set of kinematic and static force specifications. Although many kinematic synthesis algorithms and methods for compliant mechanism synthesis are available, a unified software tool that integrates algorithms and methods is yet to be developed. In our previous work, we have developed a unified framework for kinematic and static analysis of rigid body and compliant mechanisms. In this work, we extend this framework to kinetostatic synthesis of compliant mechanisms. Optimization algorithms for kinetostatic synthesis problems are presented and examples from different kinetostatic synthesis modules such as the bistable and constant force compliant mechanisms are given to demonstrate the current capability.Copyright © 2015 by ASME
Riemann Integration on Subspaces of the Reals

(1962). Riemann Integration on Subspaces of the Reals. The American Mathematical Monthly: Vol. 69, No. 6, pp. 492-498.
A parallel processor designed for artificial neural systems simulation

Artificial Neural Systems (ANS) technology has shown great promise as a means of addressing some of the very complex pattern matching problems that have heretofore eluded solution by computer; examples of such problems include resource allocation for battle management, real-time target identification and classification, and other "open-world" problems. However, it is difficult to implement a realistic ANS solution to these problems due to the inherent differences between ANS architectures and the computers used to simulate them. Eventually, this problem will be solved by the development of integrated circuits designed specifically for ANS applications. In the interim, researchers and applications developers are faced with having to use software techniques on uniprocessor systems to simulate the parallelism of an ANS model. This approach allows development of "proof-of-concept" applications for the technology, but generally precludes the integration of ANS processing techniques into operational systems. To alleviate this situation, a parallel processing computer system with an architecture specifically tailored to ANS processing requirements has been designed and implemented at Ford Aerospace. This machine, dubbed the "Neural Emulation Tool" (NET), is based on an extensible array processor design that allows the user to add computer and/or memory capacity to the system in a modular fashion. The parallelism provided by this architecture, coupled with the ANS simulation software developed for NET, provides the computer resources needed to implement large scale ANS simulations in laboratory or operational applications. This paper describes the problems associated with simulating an ANS on traditional computing platforms, including many parallel processing systems, and shows how the architecture of the NET computer addresses these issues to provide fast and flexible ANS simulations in a small computer system.
Ten Percent Electrode System for Topographic Studies of Spontaneous and Evoked EEG Activities

ABSTRACT.An 81-electrode system is described which is designed for topographic studies of spontaneous and evoked EEG activities. This method combines the standard leads of the International 10–20 System with supplementary electrodes applied midway between leads of the 10–20 system or electrodes in turn situated between 10–20 leads. Auxiliary electrode designations refer to the underlying brain areas and to adjacent leads of the 10–20 method. The utilization of this “10% system” is suggested to promote standardization.
Three-dimensional nonequilibrium Potts systems with magnetic friction.

We study the nonequilibrium steady states that emerge when two interacting three-dimensional Potts blocks slide on each other. As at equilibrium the Potts model exhibits different types of phase transitions for different numbers $q$ of spin states, we consider the following three cases: $q=2$ (i.e., the Ising case), $q=3$, and $q=9$, which at equilibrium yield, respectively, a second-order phase transition, a weak first-order transition, and a strong first-order transition. In our study we focus on the anisotropic character of the steady states that result from the relative motion and discuss the change in finite-size signatures when changing the number $q$ of spin states.
Mobile technology-based interventions for adult users of alcohol: A systematic review of the literature

Abstract Background Worldwide, 16% of people aged 15 and older engage in harmful use of alcohol. Harmful alcohol use leads to a host of preventable negative social and health consequences. Mobile technology-based interventions provide a particularly promising avenue for the widespread and cost-effective delivery of treatment that is accessible, affordable, individualized, and destigmatized to both alcohol-dependent and nondependent individuals. Aims The present review sought to summarize the current literature on mobile technology-based interventions among adult users of alcohol and determine the efficacy of such interventions. Methods Five databases were searched in December 2015 (Jan. 2004–Dec. 2015). Inclusion criteria were: participants aged 18 or older, interventions delivered through mobile-technology, and outcome measurement of alcohol reduction/cessation. Findings Eight studies met inclusion criteria. The majority of the studies reviewed found positive effects of the intervention, even though the interventions themselves varied in design, length, dosage, and target population, and were pilot or preliminary in nature. Conclusions Findings from this review highlight the promising, yet preliminary state of research in this area. Studies with adequate power and valid design are necessary to evaluate the potential of mobile technology-based interventions on long-term alcohol behavior outcomes. Furthermore, future research should elucidate what the most effective length of time is for a mobile technology-based intervention, how often individuals should receive messages for maximum benefit, and determine the comparative effectiveness of mobile technology interventions with other efficacious interventions.
Optimal power flow-based generation shedding for dynamic remedial action scheme

An optimal power flow (OPF)-based generation shedding for dynamic remedial action scheme (RAS) is proposed in this paper. A straightforward generation-shedding cost function is developed using pre-RAS and post-RAS OPF costs. The proposed method updates RAS control actions online based on the system operating conditions and cost functions. The proposed method is tested on a modified IEEE 39-Bus system. Test results demonstrate effectiveness of the proposed generation-shedding method.
Clinical features, outcomes, and prognostic factors in patients with extraskeletal osteosarcoma.

10565 Background: Extraskeletal osteosarcoma (ESOS) is a rare subtype of osteosarcoma. We investigated patient characteristics, overall survival for ESOS as compared to skeletal osteosarcoma, and p...
Sleep, synaptic homeostasis and neuronal firing rates

The synaptic homeostasis hypothesis (SHY) states that wake brings about a net overall increase in synaptic strength in many brain circuits that needs to be renormalized by sleep. I will review recent studies that were either specifically designed to test SHY or were interpreted accordingly, including several experiments that focused on changes in neuronal firing rates. I will emphasize that central to SHY is the idea that what is being regulated across the sleep/wake cycle is synaptic strength, not firing rate, and firing rate taken in isolation is not necessarily an adequate proxy for synaptic strength.
Assessment of Low-Temperature Cracking in Asphalt Materials Using an Acoustic Emission Approach

An acoustic emission (AE)-based approach to evaluate low-temperature cracking susceptibility of both asphalt binders and asphalt mixtures is presented. The AE binder testing approach consists of a thin film of asphalt binder bonded to a granite substrate exposed to decreasing temperatures ranging from 20°C to −50°C. Because of the differential thermal contraction between the granite substrate and the asphalt binder, thermal cracks develop in the asphalt binder. The initiation/propagation of these thermal cracks leads to a release of mechanical elastic energy in the material, i.e., acoustic emission activity that is recorded and used in determining the embrittlement temperature of the binder material. The AE-based embrittlement temperature showed excellent correlations with thermal cracking predictions based upon the binder rheological properties. Similar results were also obtained when asphalt concrete mixture samples were exposed to temperatures ranging from 20°C to −50°C. The AE-based approach for low-temperature characterization of binders and asphalt concrete mixtures is a rapid and reliable testing method that yields results with better repeatability (lower coefficient of variation) than the traditionally used methods based upon the binder rheological properties. Current results using AE source location also indicate that the AE approach could be used to quantitative evaluate the effectiveness of rejuvenators on aged asphalt pavements.
Oral Cavity Malignancies : A clinicopathological study

Introduction: Oral cancers are the commonest of head and neck tumours. They share common etiological factors, which are often the personal habits of the patients. Human papillomavirus is increasingly being reported in patients with oral malignancies, especially in Western population. However in India, smoking, alcohol consumption and tobacco chewing are the common etiological factors. Material and Method: The present study comprises of 379 patients who attended the out patient department or were admitted in the wards of associated hospital of N.S.C.B. Medical College, Jabalpur during the period from July 2003 to July 2005 with the presenting complaint of Tumour/Mass in Head and Neck region. Out of 379 patients of Tumour/Mass in Head and Neck region, 213 patients were having tumour / mass in the oral cavity. Tissue biopsy for histopathological examination was done in all cases. Results: On histopathological examination of oral cavity tumours , benign tumours were common in females while Majority of the patients of malignancy were males, highest incidence of malignanacy was seen in age group (55-75) years. Incidence of oral malignancy was predominantly more in cheek (buccal mucosa) it constitutes 80 cases (42.8 percent) followed by tongue 42 cases (22.5 percent) in alveolus 33 cases (17.6 percent) , in palate 17 cases (9 percent) in lip 11 cases (6 percent) and lowest incidence was seen in floor of mouth 4 cases (2.1 percent), Histologically Squamous cell carcinoma is seen in all cases. Conclusion: Oral cancers are among the most common malignancies encountered in clinical practice. Males are more commonly affected than females usually in 5th to 7th decade of life. However, there is a rising incidence noted in female patients as they are hardcore tobacco chewers and less educated than men in the rural setup. Oral cancers are also increasing in younger population due to the habit of consuming alcohol and tobacco.
Hidden heterogeneity in Alzheimer's disease: Insights from genetic association studies and other analyses

Abstract Despite evident success in clarifying many important features of Alzheimer's disease (AD) the efficient methods of its prevention and treatment are not yet available. The reasons are likely to be the fact that AD is a multifactorial and heterogeneous health disorder with multiple alternative pathways of disease development and progression. The availability of genetic data on individuals participated in longitudinal studies of aging health and longevity, as well as on participants of cross-sectional case-control studies allow for investigating genetic and non-genetic connections with AD and to link the results of these analyses with research findings obtained in clinical, experimental, and molecular biological studies of this health disorder. The objective of this paper is to perform GWAS of AD in several study populations and investigate possible roles of detected genetic factors in developing AD hallmarks and in other health disorders. The data collected in the Framingham Heart Study (FHS), Cardiovascular Health Study (CHS), Health and Retirement Study (HRS) and Late Onset Alzheimer's Disease Family Study (LOADFS) were used in these analyses. The logistic regression and Cox's regression were used as statistical models in GWAS. The results of analyses confirmed strong associations of genetic variants from well-known genes APOE, TOMM40, PVRL2 (NECTIN2), and APOC1 with AD. Possible roles of these genes in pathological mechanisms resulting in development of hallmarks of AD are described. Many genes whose connection with AD was detected in other studies showed nominally significant associations with this health disorder in our study. The evidence on genetic connections between AD and vulnerability to infection, as well as between AD and other health disorders, such as cancer and type 2 diabetes, were investigated. The progress in uncovering hidden heterogeneity in AD would be substantially facilitated if common mechanisms involved in development of AD, its hallmarks, and AD related chronic conditions were investigated in their mutual connection.
Is Repeat Pulmonary Metastasectomy Indicated for Soft Tissue Sarcoma

Background Because recurrence is high after pulmonary metastasectomy (PM) for soft tissue sarcoma (STS), repeat PM is commonly performed. Our objective was to define the selection criteria for repeat PM among patients experiencing recurrence and to identify factors associated with survival. Methods We reviewed a prospectively maintained database of 539 patients undergoing PM for STS. Characteristics of the primary tumor, metastatic disease, treatment, and recurrence were examined. Multivariable Cox models were constructed to identify factors associated with the likelihood of operative selection after recurrence. Overall survival between patients with or without repeat PM was estimated using the Kaplan-Meier method, with prognostic factors identified using Cox models. Both analyses incorporated propensity score-matching weights. Factors associated with survival after repeat PM were assessed with multivariable Cox models among patients who underwent repeat PM. Results After initial PM, 63% of patients (n = 341) experienced pulmonary recurrence; 141 (41%) underwent repeat PM. Patients who were younger ( p = 0.033) underwent minimally invasive resection at first PM ( p = 0.041), had a longer disease-free interval after first PM ( p = 0.009), were without extrapulmonary disease ( p p p = 0.008) and R1/R2 metastasectomy ( p Conclusions Although operative selection occurs, when prognostic factors are controlled for, repeat PM for STS remains independently associated with prolonged overall survival.
Monopoly Profits, Efficiency Profits, and Teaching Strategic Management

Structure-conduct-performance (SCP) and resource-based logics are two prominent theoretical explanations within strategic management for how firms gain and sustain competitive advantages. Pedagogic...
Nanoscale Probing of Interaction in Atomically Thin Layered Materials.

We combine conductive atomic force microscopy (CAFM) and molecular dynamics (MD) simulations to reveal the interaction of atomically thin layered materials (ATLMs) down to nanoscale lateral dimension. The setup also allows quantifying, for the first time, the effect of layer number and electric field on the dielectric constant of ATLMs with few-layer down to monolayer thickness. Our CAFM-assisted electrostatic technique shows that high-quality mono- and bilayer graphene is reliably produced at significant yields only by the shear type of bond breaking between layers, whereas the normal type of bond breaking exhibits a very stochastic process mainly due to the coexistence of local delamination and interlayer twist. Our dielectric constant measurements also reveal a very weak dependence on the layer number and the electric field (up to our experimental limit of 0.1 V/A), which is in contrast with theoretical reports. Owing to unexpectedly large variations in the screening ability of pristine monolayer graph...
Mental Health Epidemiology (Psychiatric Epidemiology)

This article presents an overview of the epidemiology of mental and substance abuse disorders. It contains background information on the development of the field of mental health epidemiology and the advancement in assessment instruments used to conduct population surveys. Recent key epidemiological studies are described with important findings on prevalence of disorders, use of services, and public health burden. It includes a discussion of the important issues facing the field for the future.
Why the Affordable Care Act, as Construed by the U.S. Supreme Court, Will Fail

Proponents of the Patient Protection and Affordable Care Act of 2010 (ACA) set forth two primary goals: (1) to constrain health care costs and (2) to expand health insurance coverage. In its June 28, 2012 decision upholding the constitutionality of the ACA, the U.S. Supreme Court effectively re-wrote the statute so that it will attain neither of those objectives. By placing constitutional limits on the penalties (which it construed as “taxes”) for failure to carry health insurance, the Court exacerbated the adverse selection problem created by the ACA’s imposition of “guaranteed issue” and “community rating” restrictions on health insurers. That adverse selection problem, which now cannot be corrected by significantly increasing the penalties for failure to carry insurance, will substantially increase health insurance premiums. Those higher premiums will not be reduced by ACA provisions aimed at decreasing the cost of medical services, for the cost-reducing provisions in the Act are anemic, and the Act ignores altogether the primary driver of medical inflation: the absence of price competition among service providers, a problem created by a tax code that encourages overly generous third-party insurance arrangements. Finally, the Act, as modified by the Supreme Court, is unlikely to enhance insurance coverage by nearly as much as its proponents claimed and expected. The ACA’s provision of large subsidies for employees who lack access to employer-provided health insurance encourages employers to drop insurance coverage, but many employees who lose employer-provided coverage will, because of the ACA’s deficient “no insurance” penalties, lack adequate incentives to purchase their own insurance. In addition, the Supreme Court’s reduction of the sanctions on states that decline to expand their Medicaid rolls substantially disabled the main driver of coverage expansion. In sum, the ACA, as modified by the Supreme Court’s June 28, 2012 ruling, will increase health insurance premiums, will fail to reduce underlying medical costs, and will enhance insurance coverage by far less than the Act’s proponents promised.
Morphine antinociception is enhanced in mdr1a gene-deficient mice.

Purpose. Previous studies have suggested that P-glycoprotein (P-gp)modulates opioid antinociception for selected μ-and δ-agonists. Thisstudy was undertaken to assess morphine antinociception in micelacking the mdr1a gene for expression of P-gp in the CNS.
Self-Sustaining Metal-Sulfur Reactions Induced by Ball Milling

Combination reactions between chalcogen elements and metals are probably the most widely studied mechanically induced self-sustaining reactions (MSR). A series of five papers by Chakurov and his collaborators in the 1980s [1, 6–9] represents the first results on MSR. More recently, we performed detailed investigations on the Sn–Zn–S system [10, 12]. Those efforts resulted in hundreds of ignition time data, which exhibit systematic variation as a function of composition and milling conditions. It was shown that the degree of mechanical activation can be characterized by the mechanical dose received by the powder charge. Whether a reaction can become self-sustaining or not depends primarily on its thermodynamic properties, such as the adiabatic temperature. The ignition time, however, is more sensitive to the hardness of the reactants. The effect of inert additives is discussed, again contrasting thermodynamic and kinetic factors. The mutual suppression of ignition in mixtures of binary systems that show MSR by themselves is described.
Black Maternal and Infant Health: Historical Legacies of Slavery

The legacies of slavery today are seen in structural racism that has resulted in disproportionate maternal and infant death among African Americans.The deep roots of these patterns of disparity in maternal and infant health lie with the commodification of enslaved Black women's childbearing and physicians' investment in serving the interests of slaveowners. Even certain medical specializations, such as obstetrics and gynecology, owe a debt to enslaved women who became experimental subjects in the development of the field.Public health initiatives must acknowledge these historical legacies by addressing institutionalized racism and implicit bias in medicine while promoting programs that remedy socially embedded health disparities.
Making Sense of Numbers in School Mathematics

In this chapter, the author explores four curricular topics that are closely related to number sense: numeration, number magnitude, mental computation, and computational estimation. She also examines some other areas of learning that should be addressed when considering the role of instruction in developing number sense. A disposition toward making sense of numbers is discussed. An understanding of the many aspects and uses of numbers, particularly those related to cardinal and ordinal meanings and to the notion of place value, is fundamental to the acquisition of number sense. The foundations for the development of whole number sense were discussed in this chapter. The analysis of the foundations for rational number sense focuses on how fractions and decimal numbers are introduced, that is, how the texts attempt to link meaning to symbols, and then how numbers are compared and ordered.
Inhalable nanotherapeutics to improve treatment efficacy for common lung diseases

Respiratory illnesses are prevalent around the world, and inhalation-based therapies provide an attractive, noninvasive means of directly delivering therapeutic agents to their site of action to improve treatment efficacy and limit adverse systemic side effects. Recent trends in medicine and nanoscience have prompted the development of inhalable nanomedicines to further enhance effectiveness, patient compliance, and quality of life for people suffering from lung cancer, chronic pulmonary diseases, and tuberculosis. Herein, we discuss recent advancements in the development of inhalable nanomaterial-based drug delivery systems and analyze several representative systems to illustrate their key design principles that can translate to improved therapeutic efficacy for prevalent respiratory diseases. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Respiratory Disease.
Credit towards graduation: The impact of US bank deregulation on human capital accumulation

Abstract Credit markets affect the real economy. It is important to identify unintended consequences of financial policies. This paper studies the impact of bank branching deregulation on high school graduation. The use of National Longitudinal Survey of Youth 1979 geocoded data focuses the results on three deregulations: Ohio in 1979, Connecticut in 1980, and Alabama in 1981. Discontinuities in treatment assignment at borders between deregulated states and regulated states identify the effect of banking deregulation on high school graduation. Using a regression discontinuity type set up called differences-in-discontinuities, results indicate significant increases in the likelihood of high school graduation for treated individuals. Analysis provides evidence of heterogeneous effects of bank branching deregulation based on skill level and income level.
Therapeutic implications of the serotonin transporter gene in depression

Abstract Background A natural variant of the serotonin transporter gene has been studied in mood disorders and its treatment with serotonin transporter inhibitors. It is now available on gene testing profiles to help guide treatment. But the actual interpretation of the data regarding clinical actionable items is controversial. Methods A review is undertaken to understand the role of the short form in the biology of the brain and its effect on depression and response to serotoninergic antidepressants. Results There are naturally occurring variants of the serotonin reuptake transporter (SERT) gene that express approximately 50 % fewer SERT units in the synapse. People with these low-expressing variants (frequently referred to as the ‘short form’) are more likely to: 1) develop depression in the setting of adversity; 2) attempt or re-attempt suicide; 3) respond inadequately to an antidepressant; 4) develop side effects when taking an antidepressant; or 5) develop rapid cycling if they have bipolar illness. Emerging data suggest that due to the similarity between these natural variants and the mechanism of action of most antidepressants, chronic use of antidepressants may significantly worsen these consequences in patients with the low-expressing variants or induce similar outcomes in people that do not have the short form variants. Conclusions Greater caution is required regarding exposure to serotonin reuptake inhibitors (or serotonin/norepinephrine reuptake inhibitors) for people that have the low expressing short form variants of SERT.
Outcomes Following Stereotactic Body Radiotherapy with Intensity-Modulated Therapy versus Three-Dimensional Conformal Radiotherapy in Early Stage Non-Small Cell Lung Cancer

Introduction The treatment techniques used for stereotactic body radiation therapy (SBRT) for early-stage lung cancer continue to evolve. In this study, clinical outcomes following SBRT were evaluated according to the use of either 3D conformal radiotherapy (3DCRT) or intensity-modulated radiation therapy (IMRT). Patients and methods Patients with stage I NSCLC who received SBRT from 2007 to 2015 were retrospectively reviewed. Disease control and survival were assessed using Kaplan-Meier estimates. Dosimetric analyses for target dose heterogeneity and coverage were performed. Results A total of 297 patients with 351 lesions were included. 3DCRT was used in 52% and IMRT in 48%. IMRT was utilized at a higher rate in more recent years. The most common regimens were 48 Gy in 4 fractions and 54-60 Gy in 3 fractions. With a median follow up of 22.7 months, there were 17 local failures for a crude relapse rate of 5.7%. Local failure did not differ in patients treated with 3DCRT and IMRT (4.9% vs 6.5%, p=0.573). Mean dose to gross tumor volume (GTV) as a percent of prescription dose was higher with 3DCRT compared with IMRT (107.7% vs 103.6%, p < 0.0001). Tumor stage, histology, and SBRT regimen did not correlate with local tumor control. Overall survival for the entire population approximated 72% at 2 years. Treatment was well tolerated with 6 documented grade 3+ events. Conclusion In this single-institution cohort of SBRT for early-stage NSCLC, there was no discernible difference in clinical outcomes between those treated with 3DCRT and IMRT.
Effectiveness of ultrasound-guided botulinum toxin injection combined with orthosis training in the treatment of lower limb spasticity

Objective To observe the effect of ultrasound-guided injection of botulinum toxin type A (BTX-A) combined with orthosis training for the treatment of lower limb spasticity for children with cerebral palsy.Methods Fifty-four patients with spastic cerebral palsy were randomly divided into an observation group and a control group using a random number table.Patients in the control group were given conventional rehabilitation training,while those in the observation group were additionally given ultrasound-guided BTX-A injection,followed by daily knee-ankle-foot orthosis rehabilitation training 24 h after the injection.Before and 6 weeks after treatment the lower limb function of the 2 groups was evaluated using the modified Ashworth scale (MAS) and the gross motor function measure (GMFM).Adductor angles,popliteal angles and motor ranges of the ankle joint were also measured and compared.Results After 6 weeks the average MAS scores were lower than before treatment in both observation[(1.26±0.63) vs (3.07±0.68)] and control group [(2.56±0.71) vs (2.89±0.64).And in both groups the average GMFM scores,adductor angles and popliteal angles,as well as range of motion of the ankle were all much better than before treatment.The observation group,however,improved significantly more than the control group(P ＜ 0.05).Conclusion Ultrasound-guided injection of BTX-A can effectively alleviate spasticity of lower extremity for children with cerebral palsy with accurate positioning,obvious curative effect and less adverse reactions.Knee-ankle-foot orthosis rehabilitation training after the injection can further alleviate spasticity and improve the motor function of the limbs. Key words: Cerebral palsy; Botulinum toxin A; Ultrasound-guided; Spasticity; Orthosis
Bone Conduction Vibration Vestibular Evoked Myogenic Potential (VEMP) Testing: Reliability in Children, Adolescents, and Young Adults.

Objectives Bone conduction vibration (BCV) vestibular evoked myogenic potentials (VEMP) are clinically desirable in children for multiple reasons. However, no accepted standard exists for stimulus type and the reliability of BCV devices has not been investigated in children. The objective of the current study was to determine which BCV VEMP method (B-71, impulse hammer, or Mini-shaker) yields the highest response rates and reliability in a group of adults, adolescents, and children. It was hypothesized that the Mini-shaker would yield the highest response rates and reliability because it provides frequency specificity, higher output levels without distortion, and the most consistent force output as compared to the impulse hammer and B-71. Design Participants included 10 child (ages 5 to 10), 11 adolescent (ages 11 to 18), and 11 young adult (ages 23 to 39) normal controls. Cervical VEMP (cVEMP) and ocular VEMP (oVEMP) were measured in response to suprathreshold air-conducted, 500 Hz tone bursts and 3 types of BCV (B-71, impulse hammer, and Mini-shaker) across 2 test sessions to assess reliability. Results For cVEMP, response rates were 100% for all methods in all groups with the exception of the adult group in response to the impulse hammer (95%). For oVEMP, response rates varied by group and BCV method. For cVEMP, reliability was highest in adults using the Mini-shaker, in adolescents using the impulse hammer, and in children using the B-71. For oVEMP, reliability was highest in adults using the Mini-shaker, in adolescents using the Mini-shaker or impulse hammer, and in children using the impulse hammer. Age positively correlated with air-conducted oVEMP amplitude, but not cVEMP amplitude or cVEMP corrected amplitude. Age negatively correlated with all BCV VEMP amplitudes with the exception of cVEMP corrected amplitude in response to the Mini-shaker. Conclusions All BCV methods resulted in consistent cVEMP responses (response rates 95 to 100%) with at least moderate reliability (intraclass correlation coefficient ≥ 0.5) for all groups. Similarly, all BCV methods resulted in consistent oVEMP responses (89 to 100%) with at least moderate reliability (intraclass correlation coefficient ≥ 0.5) except for the B-71 in adults.
Predictors of osteonecrosis in systemic lupus erythematosus: A prospective cohort study

Objectives We determined the predictors of osteonecrosis in a longitudinal lupus cohort, emphasizing the role of maximal prednisone dose and duration. Methods Data from 2428 patients were included in the analysis based on 224295 person-months of follow-up. We used pooled logistic regression to assess the relationship between risk factors and rates of osteonecrosis. After identifying a set of variables related to osteonecrosis incidence, we fit a final multivariable model to identify the most important risk factors for incident osteonecrosis. Results In 18691 person-years of follow up after cohort entry, 122 incident osteonecrosis event were observed. In the multivariable analysis, African-Americans had twice the risk of osteonecrosis compared to Caucasians. Males and smokers had 80% and 50% increased risk of osteonecrosis compared to females and non-smokers, respectively. For every 10 year increase in the age of diagnosis, there was a 20% reduced risk of osteonecrosis. Patients diagnosed after the 1990's had a 50% reduced risk of osteonecrosis compared to those diagnosed before the 1990's. A daily dose of prednisone of 20-39 mg or higher, when administered for more than a month, or a daily prednisone dose of 40 mg or higher, even when administered for one month, significantly increased the risk of osteonecrosis. Use of pulse methylprednisolone or intramuscular triamcinolone was not associated with an increased risk of osteonecrosis. Conclusions Oral prednisone at 20-39 mg for more than one month, or 40 mg daily for even one month remained the most important corticosteroid predictor of osteonecrosis.