cssi/SciSciGPT-SciSciNet huggingface dataset:
Mobility identification and clustering in sparse mobile networks

Non-uniform distributions of mobile nodes are the norm for a mobile network. Often, there can be concentration areas or grouping of nodes. Early work has explored these features to help message disseminations. However, a mobile network application can generate complex mixing mobility patterns that render these work less effective and efficient. In addition, many applications run with in a sparse mode, namely, the network may not be connected all the time. In this paper, we propose two entropy based metrics to identify the nodes with different mobility patterns and further use the metrics to accomplish clustering. Aiming at low-end devices which have no inputs of velocity and location, we employ neighbor information through hello messages and draw speed implication through neighbor change rates. The entropy based metrics are used in a clustering algorithm to find stable nodes as cluster heads. According to the the simulation results, two metrics, namely, speed entropy and relation entropy can be applied to distinguish active nodes from stable nodes in different group mixing configurations. The simulations also show that our new metric-based clustering algorithm generates more stable clusters.
Efficient rate allocation for progressive image transmission via unequal error protection over finite-state Markov channels

This paper proposes a unified framework for addressing progressive image transmission over noisy channels based on the finite-state Markov channel (FSMC) model. FSMC models are simple yet general enough to model binary symmetric, Gilbert-Elliott, and fading channels. They allow error sequence analysis that facilitates quantifying the statistical characteristics of the embedded bitstreams transmitted over FSMC in closed form. Using a concatenation of rate-compatible puncturing convolutional code and cyclic redundancy check code for error protection, we use a concatenation of rate-compatible punctured convolutional code and cyclic redundancy check code for error protection, which results in an unequal error protection (UEP) system, and find (sub-)optimal rate allocation solutions for our setup. By mapping fading channels to FSMCs, the JSCC problem is thus solved without the burden of simulations using an image-dependent lookup table. Fast algorithms are proposed to search for the optimal UEP. Experiments on embedded image bitstreams over FSMCs confirm our analytical results.
Who Knows What About a Person? The Self-Other Knowledge Asymmetry (SOKA) Model

This article tests a new model for predicting which aspects of personality are best judged by the self and which are best judged by others. Previous research suggests an asymmetry in the accuracy of personality judgments: Some aspects of personality are known better to the self than others and vice versa. According to the self-other knowledge asymmetry (SOKA) model presented here, the self should be more accurate than others for traits low in observability (e.g., neuroticism), whereas others should be more accurate than the self for traits high in evaluativeness (e.g., intellect). In the present study, 165 participants provided self-ratings and were rated by 4 friends and up to 4 strangers in a round-robin design. Participants then completed a battery of behavioral tests from which criterion measures were derived. Consistent with SOKA model predictions, the self was the best judge of neuroticism-related traits, friends were the best judges of intellect-related traits, and people of all perspectives were equally good at judging extraversion-related traits. The theoretical and practical value of articulating this asymmetry is discussed.
Milwaukee Prehospital Chest Pain Project--phase I: feasibility and accuracy of prehospital thrombolytic candidate selection.

Abstract This study prospectively determined the feasibility and accuracy of prehospital thrombolytic therapy candidate selection by base station emergency physicians. During a 6-month period, paramedics acquired and transmitted prehospital 12-lead electrocardiograms (ECGs) and then applied a thrombolytic therapy contraindication checklist. Emergency physicians interpreted prehospital ECGs and prospectively selected candidates for thrombolytic therapy. A safety committee of cardiologists reviewed prehospital ECGs, checklists and hospital records to determine accuracy independently. Six hundred-eighty stable adult prehospital patients with a chief complaint of nontraumatic chest pain were initially evaluated. Two hundred forty-one patients were excluded because of (1) unsuccessful electrocardiographic transmission (149), (2) transport to nonparticipating facilities (72), and (3) unavailable medical records (20). No prehospital thrombolytic therapy was administered in this study. Of 439 cases, 91 (21%) had the final diagnosis of acute myocardial infarction, 38 (8.7%) had diagnostic prehospital ECGs, and 12 (2.7%) were selected by emergency physicians as candidates for thrombolytic therapy. Seventy percent of patients with myocardial infarction had checklist exclusions for thrombolytic therapy. Prehospital evaluation increased mean scene time (paramedic arrival on scene to scene departure) by 4 minutes. The median time from chest pain onset to paramedic arrival in patients with myocardial infarction was 60 minutes. The estimated average time saved if prehospital thrombolytic therapy had been available was 101 ± 81 minutes. The safety committee concluded that acceptable accuracy of emergency physician prehospital electrocardiographic interpretation, checklist and case selection was achieved. It is concluded that emergency physicians can accurately identify candidates for prehospital thrombolytic therapy.
Body-size dependence of resting energy expenditure can be attributed to nonenergetic homogeneity of fat-free mass.

An enduring enigma is why the ratio of resting energy expenditure (REE) to metabolically active tissue mass, expressed as the REE/fat-free mass (FFM) ratio, is greater in magnitude in subjects with...
The Effectiveness of Oraqix Versus TAC(a) for Placement of Orthodontic Temporary Anchorage Devices

Abstract Objective: To test the hypothesis that there is no difference in the actions and effectiveness of topical anesthetics TAC Alternate (TAC(a)) and Oraqix in placing temporary anchorage devices (TADs). Materials and Methods: Each topical anesthetic was placed on opposing sides in the maxilla or mandible using blinded applicators for 3–9 minutes followed by the TAD placement. A total of 21 patients ranging from 10–25 years old were studied. During the procedure the primary investigator (PI) used the sound, eye, and motor scale to measure the movements elicited by the patient. The PI also noted the time taken for the topical anesthetic to be effective and the amount that was applied. Following the placement of the TADs, the patients were given the Wong-Baker FACES Scale and the Visual Analog Scale to rate the degree of discomfort. The nonparametric Wilcoxon signed-rank test was used to test the effectiveness of the treatments based on the three ordinal scales, the dosage, and the onset time. Results: ...
Common attributes in an unusual context: predicting the desirability of a social match

Social matching systems recommend people to other people. With the widespread adoption of smartphones, mobile social matching systems could potentially transform our social landscape. However, we have a limited understanding of what makes a good social match in the mobile context. We present a theoretical framework which outlines how a user's context and the rarity of different affinity measures in various contexts (match rarity) can be used to provide valuable social matches. We suggest that if a user attribute is very rare in a particular context, users will generally be more interested in an affinity match. We conducted a survey study to assess this framework with 117 respondents. We found that both context and match rarity significantly influence interest in a social match. These results validate the key aspects of the framework. We discuss the results in terms of implications for social matching system design.
Suction for venomous snakebite: A study of “mock venom” extraction in a human model☆

STUDY OBJECTIVE: We determine the percentage of mock venom recovered by a suction device (Sawyer Extractor pump) in a simulated snakebite in human volunteers. METHODS: A mock venom (1 mL normal saline solution, 5.0 mg albumin, 2.5 mg aggregated albumin) radioactively labeled with 1 mCi of technetium was injected with a curved 16-gauge hypodermic needle 1 cm into the right lateral lower leg of 8 supine male volunteers aged 28 to 51 years. The Sawyer Extractor pump was applied after a 3-minute delay, and the blood removed by suction was collected after an additional 15 minutes. A 1991 Siemens Diacam was used to take measurements of the radioactive counts extracted and those remaining in the leg and body. RESULTS: The "envenomation load," as measured by mean radioactivity in the leg after injection, was 89,895 counts/min. The mean radioactivity found in the blood extracted in the 15 minutes of suction was 38.5 counts/min (95% confidence interval [CI] -33 to 110 counts/min), representing 0.04% of the envenomation load. The postextraction leg count was less than the envenomation load by 1,832 counts/min (95% CI -3,863 to 200 counts/min), representing a 2.0% decrease in the total body venom load. CONCLUSION: The Sawyer Extractor pump removed bloody fluid from our simulated snakebite wounds but removed virtually no mock venom, which suggests that suction is unlikely to be an effective treatment for reducing the total body venom burden after a venomous snakebite.
A hybrid method for the solution of scattering from inhomogeneous dielectric cylinders of arbitrary shape

A hybrid moment method/edge-element method (MM/EEM) is presented. The formulation is quite general; however, the method is applied to two-dimensional scattering problems. Such a hybrid formulation unites the advantages of finite and integral-equation methods and is able to handle unbounded problems in which complex inhomogeneities are present. The edge-element method is easily coupled to the moment method, and it doesn't introduce spurious modes. The equivalence principle is used to divide the original problem into two separate problems: an unbounded homogeneous one in which the moment method is used and a bounded inhomogeneous one in which the edge-element method is used. Several examples involving two-dimensional scattering with TE and TM plane wave excitation are presented. The RCS is computed and compared to results obtained by other numerical techniques. >
Ego development, psychopathology, and parenting problems in substance-abusing mothers.

The authors examined maternal ego development in relation to psychopathology and parenting problems in a sample of substance abusing mothers. Given predilections at higher levels of ego development for introspection and guilt, the authors expected mothers at higher levels to report more psychopathology. Given predilections at lower levels of ego development for dichotomous perceptions and limited conceptions of causation, the authors expected mothers at low levels to report more problematic parenting behaviors. Intelligence was expected to correlate but not overlap with ego development. Subjects were 182 mothers who expressed interest in a randomized clinical trial for a new parenting intervention. Measures included the Washington University Sentence Completion Task—Short Form, the Parental Acceptance-Rejection Questionnaire, the Brief Symptom Inventory and the Kaufman Brief Intelligence Test. Results of correlation and multivariate analyses of variance confirmed predictions. Implications for future development of interventions for substance abusing mothers are discussed.
CVB2 Development and Cross‐Validation of a Comorbidity Index for a Stroke Population

Comorbidity weights have become an important tool in longitudinal outcome studies. They should be tailored toward the population and the disease state under investigation. OBJECTIVES: The objectives of the study were to develop and validate a comorbidity index for ischemic stroke patients for use in longitudinal studies. METHODS: A 5-year retrospective review of all Georgia Medicaid claims data from 1990 to 1994 was used to detect first time ischemic stroke patients. Ischemic strokes were defined by three ICD-9-CM code series (433.XX, 434.XX, and 436.XX). Comorbid conditions were measured from all claims submitted within 12 months prior the first ischemic stroke event. Half of the stroke cohort was randomly selected, and multivariate logistic regression was used to derive a mortality stroke-specific weighted-index, controlling for age and gender. The Charlson and stroke-specific indexes were then tested on the second half of the stroke cohort for their ability to predict risk of death. RESULTS: We identified 3,784 ischemic stroke patients with a mean age of 65 years (range 40 B 102). Of all patients, 40% died within the 3-year follow-up and 73% were women. A more concise index with 7 comorbid disease states was identified. The original Charlson index has 16 comorbidities. The stepwise multiple logistic regression integer weights for the 7 comorbidities were 2 for CHF, dementia, neoplasia, and renal disease, and 6 for metastatic solid tumor, liver diseases, and AIDS. Finally, when tested on the second group, the stroke-specific index showed stepwise increases in the cumulative mortality attributable to comorbid diseases (p log rank ÷ 2 < 0.001), whereas the Charlson index did not. CONCLUSION: This shorter stroke-specific index allows for the development of more highly discriminant comorbidity models for risk adjustment.
Economic implications of transesophageal echocardiography-guided cardioversion of atrial fibrillation*

Ischemic stroke is the most feared complication of atrial fibrillation, and many studies have investigated strategies to reduce cerebral embolism. Anticoagulation with warfarin is remarkably effective in reducing the risk of ischemic stroke among patients with chronic atrial fibrillation [(1)][1]and
Abstract 3024: School is Out : Creating Stroke Detectives through Summer Challenge

Background: Childhood obesity and early-onset diabetes are on the rise. The American Heart Association Heart Disease and Stroke Statistics indicate that the unhealthy behaviors that are the risk factors for stroke begin with school-aged children. In 2009, our organization created a stroke awareness program for high schools and youth groups that demonstrated retention of knowledge in a pre-post test format. The content was developed to be relevant for that specific age group. Purpose: Building on that success and the need for earlier education, we developed a Stroke Detective Summer Challenge for elementary age children. Method: This independent, structured program was made available through the stroke center website. Packets were also placed at three local libraries and provided to 3 rd graders at a local summer day camp. The program content included the stroke detective pledge (written by the stroke program coordinator), an activity book, an exercise & healthy eating log, and a scavenger hunt. To qualify as a stroke detective, participants were required to: 1) sign the pledge; 2) share their stroke knowledge with 5 people by giving them a F.A.S.T. (face, arm, speech, time) card and getting their signatures; and 3) return the signature page along with their completed exercise & healthy eating log and their T-shirt size. Results: A summer’s end celebration for the 22 new “stroke detectives” included stations for making a healthy snack and for some simple physical activity competitions. They each received a detective bag, healthy snack recipes, giveaways, and a Stroke Detective T-shirt. These young detectives, along with their parents and siblings were greeted by our hospital mascot and were given a tour of our helicopter. The students, supported by their parents, enthusiastically described their pride in becoming stroke detectives. Conclusions: Our previous successful experience with making educational content relevant for specific age groups was repeated in this unique initiative. We demonstrated that stroke awareness education does NOT have to be complex or scary; in fact, by introducing simple facts at a young age, we may help eliminate the fear and ignorance that has made community awareness of stroke such a challenge in the past. They could become the first generation of adults to know that a stroke does not occur in the heart.
Drug forecast--solifenacin: an investigational anticholinergic for overactive bladder.

OBJECTIVE To review a new anticholinergic for overactive bladder undergoing review by the U.S. Food and Drug Administration, solifenacin. DATA SOURCE A MEDLINE/PUBMED search was conducted to identify pertinent studies in the English language. In addition, proceedings of meetings of the Incontinence Society, European Association of Urology, American Urological Association, and American College of Obstetrics and Gynecology were reviewed for relevant abstracts. Additional references were obtained from the bibliographies of these sources. Data over the time period of 1986 through October 2003 were reviewed. STUDY SELECTION All studies evaluating any aspect of solifenacin in animals and humans. DATA SYNTHESIS Preclinical studies demonstrated that solifenacin was an antagonist at muscarinic cholinergic M1, M2, and M3 receptors. On the basis of comparative preclinical studies evaluating the effects of solifenacin and oxybutynin on guinea pig detrusor muscle cells, mouse submandibular gland cells, and the intact rat, solifenacin was felt to be a "uroselective" antimuscarinic. Solifenacin is predominantly eliminated via metabolism, with urinary excretion of parent compound being less than 10%. Solifenacin, dosed once daily, is significantly superior to placebo in reducing the number of micturitions, urge episodes, and urge incontinence episodes per day and increasing the volume voided per micturition. In two active-controlled trials, solifenacin was at least equivalent to tolterodine in efficacy and tolerability. The most problematic adverse effects of solifenacin are the anticholinergic effects of dry mouth, blurred vision, and constipation. CONCLUSION Although promising in preclinical studies, the uroselectivity of the anticholinergic activity of solifenacin has not been validated in clinical trials. No comparative efficacy/tolerability data with oxybutynin are available. On the basis of available data, solifenacin does not appear to be a substantial advance upon existing anticholinergics in the management of overactive bladder.
Consumer perceptions of interpersonal equity and satisfaction in transactions: A field survey approach.

Automobile purchasers were surveyed about feelings toward their inputs to and outcomes from the sales transaction, as well as their perceptions of the inputs and outcomes of the salesperson. Struct...
A Serological Study of Some Orthoptera

Many different classifications have been devised relating insects, chiefly on the basis of their morphology. In their broader outlines these classifications show general agreement. When the systematic relations- of orders to each other, and the relations of different genera within an order are in question, almost as many arrangements can be found as there are authors on the subject. Whenever there is an uncertainty in the relations of these groups, a classification showng these of necessity express the views of the individual who devised it. Some taxonomists (Blatchley 1920) have expressed the opinion that one order could follow another in almost any sequence without serious loss to the expression of their systematic relationships. Fernald (1921), however, cited the need for a reliable, objective method in determining insect relationships.
THREE-DIMENSIONAL CONDITIONS OF SURF

Wave height variability along the crest of breaking waves is shown to be a significant factor in the assessment of surf zone dynamics. Variations in excess of 50 percent of the maximum wave height can occur along a single crest without significant variations in bathymetry. The horizontal scale of this longshore variability in crest height corresponds to the wave length of incident breaking waves. Four possible mechanisms for this variability are postulated and then evaluated individually on the basis of field observations. A major result of these evaluations is that two-dimensional shallow-water wave equations appear to be inappropriate for expressing natural surf zone wave transformations and water motions even under the condition of waves encroaching on a plane sloping bottom. Consequently, three-dimensional equations of surf should be used for describing most natural surf zone dynamics.
Self-regulation and gender within a game-based learning environment.

In this study, we examined how self-regulated learning (SRL) and gender influences performance in an educational game for 8th-grade students (N = 130). Crystal Island–Outbreak is an immersive, inquiry-based, narrative-centered learning environment featuring a microbiology science mystery aligned with 8th-grade science curriculum. SRL variables predicted successful in-game performance even after accounting for prior knowledge and perceived gaming skill. Content learning gains were found across both genders, and girls performed at similar levels as boys in the game despite incoming disadvantages for perceived skill and prior gaming experience. Boys were more effective than girls in using a cognitive tool that was critical for solving the Crystal Island–Outbreak mystery; however, these differences disappeared when prior gaming experience was taken into account. Overconfidence on monitoring judgments for boys but not girls was predictive of in-game performance. Findings related to motivational variables such as self-efficacy, situational interest, and goal orientation were mixed with regard to their consistency across genders.
Erythromycin associated hearing loss in a patient with prior cis-platinum induced ototoxicity

A case is reported of reversible sensorineural hearing loss associated with intravenous erythromycin treatment. Cis-platinum induced high frequency hearing loss developed nine months previously during treatment for stage IV papillary cystadenocarcinoma. Renal and hepatic function were normal; however, serum erythromycin levels were elevated. Clinical recovery promptly followed discontinuation of erythromycin.
Consumption of attention versus affect elicited by cognitions in modifying acute pain.

40 subjects were randomly assigned to conditions of high pleasure, low pleasure, high anger, or low anger in a 2 × 2 (intensity × affect) design. Although subjects used highly intense cognitions more than less intense ones, pleasant cognitions produced higher tolerance for pressure pain. Modification of pain may be mediated by specific affect rather than intensity or consumption of attention.
Skelemin association with αIIbβ3 integrin: a structural model.

Over the last two decades, our knowledge concerning intracellular events that regulate integrin’s affinity to their soluble ligands has significantly improved. However, the mechanism of adhesion-induced integrin clustering and development of focal complexes, which could further mature to form focal adhesions, still remains under-investigated. Here we present a structural model of tandem IgC2 domains of skelemin in complex with the cytoplasmic tails of integrin αIIbβ3. The model of tertiary assembly is generated based upon NMR data and illuminates a potential link between the essential cell adhesion receptors and myosin filaments. This connection may serve as a basis for generating the mechanical forces necessary for cell migration and remodeling.
A5 RNA targeted therapies, mechanisms, and the challenges of delivery in HD

Huntingtin protein (HTT) lowering is a key therapeutic strategy for Huntington’s disease (HD). Reducing the amount of the disease-causing expanded HTT protein in the brain of patients is predicted to slow the progression of the disease. Several approaches are being employed to lower HTT including antisense oligonucleotides and siRNAs, as well as gene therapy approaches using viral delivery of miRNAs, shRNAs, and zinc-finger repressor proteins. Each of these potential therapeutic agents has inherent distribution challenges requiring direct delivery to the CNS. These challenges will be discussed as well as the pharmacodynamic biomarkers aimed to validate that delivery of a HTT lowering therapy does, in fact, lower the amount of HTT protein in the brains of HD patients.
General Conclusions: Contributions, Limitations, Agenda

This book explores the broader pursuit of urban sustainability through the specific institutional and policy lens of multi-scalar planning for smart growth across Greater Seattle. The overall narrative attempts to offer a novel critical-geographical interpretation of the variegated, uneven spatialities of key regional planning policies focused collectively on sustainability by arguing mainly through the central theoretical concept of “intercurrence,” imported from the neo-Weberian field of American Political Development (APD). No one has attempted to theorize smart growth in this way. Nor have many scholars analyzed urban sustainability as the abutting and grading of the hypothesized “orders” that intercurrence invariably produces through time and across space. The book thus supports extant work on the emerging geographies of US planning regimes and territorial experiences. But the critical spatialization of APD in urban affairs and planning studies has just begun.
Association of Centers for Medicare & Medicaid Services Overall Hospital Quality Star Rating With Outcomes in Advanced Laparoscopic Abdominal Surgery.

Importance The Centers for Medicare & Medicaid Services (CMS) recently released the Overall Hospital Quality Star Rating to help patients compare hospitals based on a 5-star scale. The star rating was designed to assess overall quality of the institution; thus, its validity toward specifically assessing surgical quality is unknown. Objective To examine whether CMS high-star hospitals (HSHs) have improved patient outcomes and resource use in advanced laparoscopic abdominal surgery compared with low-star hospitals (LSHs). Design, Setting, and Participants Using the University HealthSystem Consortium database (which includes academic centers and their affiliate hospitals) from January 1, 2013, through December 31, 2015, this administrative database observational study compared outcomes of 72 662 advanced laparoscopic abdominal operations between HSHs (4-5 stars) and LSHs (1-2 stars). The star rating includes 57 measures across 7 areas of quality. Patients who underwent advanced laparoscopic abdominal surgery, including bariatric surgery (sleeve gastrectomy, Roux-en-Y gastric bypass), colorectal surgery (colectomy, proctectomy), or hiatal hernia surgery (paraesophageal hernia repair, Nissen fundoplication), were included. Risk adjustment included exclusion of patients with major and extreme severity of illness. Main Outcomes and Measures Main outcome measures included serious morbidity, in-hospital mortality, intensive care unit admissions, and cost. Results A total of 72 662 advanced laparoscopic abdominal operations were performed in patients at 66 HSHs (n = 38 299; mean [SD] age, 51.26 [15.25] years; 12 096 [31.5%] male and 26 203 [68.4%] female; 28 971 [75.6%] white and 9328 [24.4%] nonwhite) and 78 LSHs (n = 34 363; mean [SD] age, 49.77 [14.77] years; 9902 [28.8%] male and 24 461 [71.2%] female; 21 876 [67.6%] white and 12 487 [32.4%] nonwhite). The HSHs were observed to have fewer intensive care unit admissions (1007 [2.6%] vs 1711 [5.0%], P P P = .002). Conclusions and Relevance This study found that HSHs treat fewer ethnic minorities and have similar outcomes as LSHs for advanced laparoscopic abdominal operations. However, HSHs may represent hospitals with improved resource use and cost.
ASYMPTOTIC BEHAVIOR OF A CLASS OF DISCRETE-TIME MODELS IN POPULATION GENETICS

Publisher Summary This chapter focuses on asymptotic behavior of a class of discrete-time models in population genetics. It has been known since the time of R. A. Fisher that various one-dimensional models for the spread of an advantageous gene in a migrating population have associated with them certain wave speeds. These speeds have two characteristic properties. One property is that there is a traveling wave with this speed for each speed at least as great as the wave speed, a result due to Fisher himself. The second result, which was conjectured by Fisher, is that an initially confined population spreads out with a speed which is, in an asymptotic sense, the wave speed. This chapter discusses a few difficulties with the Fisher model.
Detection of CO2•– in the Electrochemical Reduction of Carbon Dioxide in N,N-Dimethylformamide by Scanning Electrochemical Microscopy

The electrocatalytic reduction of CO2 has been studied extensively and produces a number of products. The initial reaction in the CO2 reduction is often taken to be the 1e formation of the radical anion, CO2•–. However, the electrochemical detection and characterization of CO2•– is challenging because of the short lifetime of CO2•–, which can dimerize and react with proton donors and even mild oxidants. Here, we report the generation and quantitative determination of CO2•– in N,N-dimethylformamide (DMF) with the tip generation/substrate collection (TG/SC) mode of scanning electrochemical microscopy (SECM). CO2 was reduced at a hemisphere-shaped Hg/Pt ultramicroelectrode (UME) or a Hg/Au film UME, which were utilized as the SECM tips. The CO2•– produced can either dimerize to form oxalate within the nanogap between SECM tip and substrate or collected at SECM substrate (e.g., an Au UME). The collection efficiency (CE) for CO2•– depends on the distance (d) between the tip and substrate. The dimerization rate...
Structural and regulatory changes in PBP4 trigger decreased β-lactam susceptibility in Enterococcus faecalis

ABSTRACT Enterococcus faecalis strains resistant to penicillin and ampicillin are rare and have been associated with increases in quantities of low-affinity penicillin-binding protein 4 (PBP4) or with amino acid substitutions in PBP4. We report an E. faecalis strain (LS4828) isolated from a prosthetic knee joint that was subjected to long-term exposure to aminopenicillins. Subsequent cultures yielded E. faecalis with MICs of penicillins and carbapenems higher than those for wild-type strain E. faecalis JH2-2. Sequence analysis of the pbp4 gene of LS4828 compared to that of JH2-2 revealed two point mutations with amino acid substitutions (V223I, A617T) and deletion of an adenine from the region upstream of the predicted pbp4 −35 promoter sequence (UP region). Purified PBP4 from LS4828 exhibited less affinity for Bocillin FL than did PBP4 from JH2-2, which was recapitulated by purified PBP4 containing only the A617T mutation. Differential scanning fluorimetry studies showed that the LS4828 and A617T variants are destabilized compared to wild-type PBP4. Further, reverse transcription-PCR indicated increased transcription of pbp4 in LS4828 and Western blot analysis with polyclonal PBP4 antibody revealed greater quantities of PBP4 in LS4828 than in JH2-2 lysates and membrane preparations. Placing the promoter regions from LS4828 or JH2-2 upstream of a green fluorescent protein reporter gene confirmed that the adenine deletion was associated with increased transcription. Together, these data suggest that the reduced susceptibility to β-lactam antibiotics observed in E. faecalis LS4828 results from a combination of both increased expression and remodeling of the active site, resulting in reduced affinity for penicillins and carbapenems. IMPORTANCEEnterococcus faecalis is an important cause of community-acquired and nosocomial infections and creates therapeutic dilemmas because of its frequent resistance to several classes of antibiotics. We report an E. faecalis strain with decreased ampicillin and imipenem susceptibility isolated after prolonged courses of aminopenicillin therapy for a prosthetic joint infection. Its reduced susceptibility is attributable to a combination of increased quantities of low-affinity PBP4 and an amino acid substitution in proximity to the active site that destabilizes the protein. Our findings provide a cautionary tale for clinicians who elect to “suppress” infections in prosthetic joints and offer novel insights into the interaction of β-lactam antibiotics with low-affinity PBP4. These insights will help inform future efforts to develop therapeutics capable of inhibiting clinical enterococcal strains.
Techniques for Business Process Redesign: Tying it all Together

Automate, Integrate or Obliterate? What Is Business Reengineering? Where Do You Begin? How Do You Approach the Problem? BUSINESS REENGINEERING GUIDELINES Planning Phase Redesign Phase Transition Phase Implementation Phase RECAP/FINAL THOUGHTS There Is No Silver Bullet TECHNIQUES AND TOOLS TO HELP YOU REDESIGN YOUR PROCESSES Appendices References Index.
Intracytoplasmic sperm injection: a novel treatment for all forms of male factor infertility.

Objective To demonstrate the effectiveness of intracytoplasmic sperm injection to treat male factor infertility and to report on the achievement offertilization and pregnancy compared with standard in vitro insemination. Design Controlled clinical study. Setting Couples suffering from male factor infertility treated in an academic research environment. Patients Two hundred twenty-seven couples in whom the male partners were presumed to be the cause of repeated failed attempts at IVF or whose semen parameters were unacceptable for conventional IVF. Interventions Oocytes for this study were harvested after superovulation with GnRH agonist and gonadotropins. After removing the cumulus cells, a single spermatozoon was injected directly into the cytoplasm of metaphase II oocytes, and the outcome was analyzed in terms of semen parameters and origin of semen sample. Main Outcome Measures Fertilization and pregnancy rates (PRs) in relation to sperm parameters and origin of semen sample. Results Two hundred twenty-seven couples were treated by intracytoplasmic sperm injection resulting in an ongoing pregnancy rate of 37.0% per retrieval (84/227). There were 47 singleton pregnancies (5 of which were vanishing twin pregnancies), 30 twin gestations, 6 triplet pregnancies, and 1 quadruplet pregnancy. The concentration of the total motile spermatozoa present in the ejaculate as well as the origin of the samples influenced the fertilization rate but not the pregnancy outcome. Conclusions Intracytoplasmic sperm injection can be used successfully to treat couples who have failed IVF or who have too few spermatozoa for conventional methods of in vitro insemination. Sperm parameters do not clearly affect the outcome of this technique.
Synthesis of the Elements in Stars

According to Burbidge, Burbidge, Fowler and Hoyle (B2 FH), most of the elements were synthesized in the interior of stars by at least seven different types of nuclear processes. Deuterium, lithium, beryllium and boron are very unstable, however, at the temperatures of stellar interiors, so that they must have been produced in regions of low density and temperature. The nature of the x-process, which is responsible for the synthesis of these so-called “deficient” elements, has not yet been fully elucidated.
VISCOELASTIC BEHAVIOUR OF THE HUMAN SPINAL DISC AND THE VERTEBRA

Pressures in the nucleus pulposus and under the annulus fibrosus have been measured, using the specially developed miniature pressure transducers, when the vertebral segment was subjected to physiological loading. Strain data and stress-relaxation were also measured. Results show that pressures are linear with loading. Pressure variations within the nucleus are due to disc degeneration.
The Brief Psychotherapies

It is customary in overview chapters to dramatically proclaim that the subject matter of the work, in this case the brief, short-term or time-limited psychotherapies, has “come of age.” For better or worse, it is far too late to say this about the brief psychotherapies. They have been in active existence for 30 to 40 years and may more aptly be characterized as facing middle age, perhaps even a midlife crisis. The early roots of brief therapy can be traced back even further and, around the turn of the century, a former patient—a symphonic conductor suffering from psychogenic pain in his conducting arm—described the key session in his brief therapeutic treatment in the following words: His advice was—to conduct. “But I can’t move my arm.” “Try it, at any rate.” “And what if I should have to stop?” “You won’t have to stop.” “Can I take upon myself the responsibility of possibly upsetting a performance?” “I’ll take the responsibility.” And so I did a little conducting with my right arm, then with my left, and occasionally with my head. There were times when I forgot my arm over the music.... So, by dint of much effort and confidence, by learning and forgetting, I finally succeeded in finding my way back to my profession. (Walter, 1946, pp. 167–168)
Defiant Behavior During Adolescence across Cultures

A review of cross-cultural studies of defiant and other deviant behavior during adolescence is provided. Race, ethnicity, and nationality are considered as possible aspects of culture. Although deviant behavior is relatively common in the United States and other Western cultures, there are variations across racial and ethnic groups. Cross-nationally, there is little variation across Western cultures, although deviance is somewhat less prevalent in nonindustrialized societies where children gain adult responsibilities immediately after puberty.
Bullying Prevention in an Elementary School: An Exploration of Educator and Staff Perspectives

The implementation of school-wide anti-bullying programs has received mixed, though predominantly positive, results in the United States. The present study sought to investigate attributes of a successful anti-bullying campaign with specific interest in areas for continued improvement. The instructional faculty, content area specialists, staff employees, and administrators of a rural mid-Atlantic elementary school were solicited to participate in audio recorded interviews regarding their perceptions of the program at their school. All participants indicated the program was largely successful at their school and the recommendations for further improvements included expanding the bullying reduction training to non-teaching staff, continued emphasis on emotional skills, inclusion of information on varying perspectives regarding gender and culture, and expanding the training to emphasize employee interactions as an important component of the anti-bullying climate.
Prostate Disease in the Aging Male

Prostate cancer is commonly found in older men. Whether its presence is clinically significant, requiring screening or treatment has been intensely debated, fueled by the indolent nature of many cancers as well as the competing cardiovascular mortality of this age group. Risk factors include age, race and family history. Diet has been linked to prostate cancer risk and is being investigated both for understanding the pathogenesis of prostate cancer and for use in supplements in preventing prostate cancer. In the past two decades the advent of serum marker, Prostate Specific Antigen [PSA], and definitions of pre- neoplastic lesions have brought new understandings and questions to the etiology and epidemiology of prostate cancer. This chapter will focus on the function of the prostate, pathological definitions and grading, PSA and its role in the debate, epidemiology and risk factors of prostate cancer. Current treatments and prevention trials will be reviewed
Acute Pain Management for Patients Receiving Medication-Assisted Therapy

Evidence-based approaches for the treatment of opioid use disorder include the use of opioid medications (methadone, buprenorphine, or naltrexone), collectively referred to as medication-assisted therapy. Patients receiving medication-assisted therapy may present in the acute care setting with pain, often related to planned surgical procedures to treat health issues that were not addressed before entering treatment. Because these medications act on the same receptors as do analgesic opioids-and, in the cases of methadone and buprenorphine, have analgesic properties - managing acute pain in these patients can be challenging. Principles of effective pain management for these patients include continuing the usual medication-assisted therapy dose; using nonpharmacological and nonopioid pain management strategies as possible and immediate-release opioids, titrating to effect and monitoring for toxicity; anticipating tolerance and hyperalgesia; and establishing a collaborative treatment relationship with the medication-assisted therapy provider. Providing effective pain treatment supports ongoing recovery in patients with opioid use disorder.
Noninvasive Cellular Oxygenation Measurement During Graded Hypoxia Using Visible-Near-Infrared Spectroscopy

In critically ill patients, direct knowledge of intracellular pO2 would allow for identification of cellular hypoxia, which when prolonged leads to organ failure. We have developed a visible–near-i...
111. IMPLEMENTATION OF A NEONATAL QUALITY IMPROVEMENT SIMULATION PROGRAM FOR PEDIATRIC RESIDENTS

Background Simulation-Based Medical Education is important in curriculum development and training in order to promote adequate teaching for trainees. At Connecticut Children's, simulation training is incorporated into the inpatient curriculum for pediatric residents with the exception of the neonatal intensive care unit (NICU). By implementing delivery room (DR) simulations, we hope to improve residents’ confidence in neonatal resuscitation skills. Aim Statement From November 2018 to December 2019, we aimed to improve pediatric resident confidence as assessed by serial surveys by 40% and improve Neonatal Resuscitation Program (NRP) skill proficiency measured by the number of correctly performed NRP steps by 25%. Interventions Residents completed a survey before and after their NICU rotation asking the following: I am confident in my ability to 1) perform bag mask ventilation, 2) participate in neonatal mock codes (NMCs), and 3) be team leader during NMCs. We implemented twice monthly DR simulations using standardized cases. Three PDSA cycles were completed. During cycle 1, DR simulations were implemented using laminated cards to present clinical information. A digital app was used in cycle 2 to present vital signs. The 2016 NRP algorithm card was provided for cycle 3 as a tool for reference. Measures Outcome measures included number of correct NRP steps and changes in resident confidence in resuscitation skills. Process measures included time to initiate positive pressure ventilation (PPV), resident participation and time to adequate ventilation. Balancing measures included missed actual deliveries and procedures in the NICU. Results Thirty-one residents (17 PL-1 and 14 PL-2) participated in the project. Residents’ confidence in ability to participate in NMCs increased by 17% and 18% and confidence in ability to lead NMCs increased by 27% and 20% for PL-1 and PL-2, respectively. Overall, residents reported increased confidence in resuscitation skills when comparing pre- and post-survey results. There was no difference in number of correctly performed NRP steps. Mean time to initiate PPV during the first simulation was 99+36.7s and 65.5+46.3s during the second simulation, giving an average decrease in time to initiate PPV of 33.5+44s, (p Conclusions and Next Steps DR simulations increase resident confidence in ability to participate in and lead NMCs. Simulation may increase residents’ proficiency in NRP skills demonstrated by improvement in time to initiate PPV.
Dancing angels on the point of a needle: nanofabrication for subwavelength optics

As the field of subwavelength optics continues to boom and novel nanophotonic device designs emerge (as other chapters in this book highlight), existing nanofabrication methods will continue to evolve and new technologies will surface to keep pace with the increasingly sophisticated demands. We foresee that the crossroads of ingenious nanophotonic designs and nanofabrication techniques will thrive as a leading source of inspiration for researchers aspiring to explore the field. In this spirit, it is the authors' hope that this chapter can serve as a convenient solution guide to both theorists and experimentalists who are exploring unconventional subwavelength structures. Finally, we hope that the discussions here can further inspire design and process innovations in the dynamic field of subwavelength optics, where 'there is plenty of room at the bottom' for both dancing angels and optical engineers alike.
Individualized Study of Posterior Hemivertebra Excision and Short-Segment Pedicle Screw Fixation for the Treatment of Congenital Scoliosis.

Objectives To compare the surgical effect of children with symmetrical screw fixation and asymmetric screw fixation during posterior hemivertebra excision and short-segment pedicle screw fixation for the treatment of congenital scoliosis (CS). Methods A total of 30 children with CS who underwent posterior hemivertebra excision and short-segment bilateral pedicle screw fixation in our hospital from 2012 to 2018 were retrospectively included and were divided into two groups: symmetric fixation group (n = 18) and asymmetric fixation group (n = 12). The total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, coronal balance, and apical vertebra translation were measured in the coronal plane. The segmental kyphosis, thoracic kyphosis, lumbar lordosis, and sagittal balance were measured in the sagittal plane. Results Of the 30 children, 28 hemivertebrae were resected. Twenty-two children had one hemivertebra, three had two hemivertebrae, and five were rib deformities. The average operation time was 268 min (180-420 min). The average blood loss was 291 mL (150-550 mL). The average follow-up was 21.1 months (12-47 months). For symmetric fixation group and there were significant differences among postoperative and follow-up parameters including the total main curve, segmental main curve, cranial compensatory curve, caudal compensatory curve, apical vertebra translation and segmental kyphosis compared with those of preoperative parameters (P 0.05). There were three complications in 30 children in our study, including two cases who had poor wound healing, and the wound healed smoothly after half a month of sterile dressing change. Postoperative curve progression occurred in one case after T12 and L3 hemivertebra resection and thoracic hemivertebra resection was planned again. Conclusion For pedicles which were difficult for screw fixation, adjacent segments can be chosen for screw fixation and it is safe and effective for vertebral pedicles ≤3 without internal fixation.