cssi/SciSciGPT-SciSciNet huggingface dataset:
Incidence and treatment of severe primary mitral regurgitation in contemporary clinical practice.

BACKGROUND Mitral regurgitation (MR) is a common valvular disorder, occurring in up to 10% of the general population. Although surgery is the established treatment for primary MR, many patients do not receive appropriate therapy. The objective of this study was to determine the incidence and treatment pattern of patients with severe MR evaluated at a tertiary medical center and determine factors associated with receiving surgery. METHODS All patients with moderate-severe and severe MR undergoing transthoracic echocardiography from 2011 to 2016 were identified. Patients with prior mitral valve surgery were excluded. Treatment recommendations were classified as referral to cardiology, referral to cardiothoracic surgery (CTS), receiving mitral valve surgery or receiving MitraClip. A multivariate logistic regression model was used to evaluate factors associated with referral to CTS or receiving surgery. RESULTS During the study period, 1918 transthoracic echocardiogram were performed and 412 patients with moderate-severe or severe MR were identified. One hundred sixty-six patients (40%) had primary MR and 246 patients (60%) had secondary MR. For those with primary MR, 75 patients (45%) received treatment (surgery, n = 60 and MitraClip, n = 15) and 91 patients (55%) did not receive treatment. One hundred patients (60%) were referred to CTS and 128 patients (77%) were referred to cardiology. Patients undergoing surgery were younger (62.6 ± 14.2 years vs 72.0 ± 14 years, p < 0.001), with a higher prevalence of heart failure (57% vs 40%, p = 0.044) and a lower prevalence of stroke (3% vs 24%, p < 0.001) and hypertension (54% vs 74%, p = 0.012), compared to patients not undergoing surgery, respectively. Ejection fraction (60.4 ± 10.9% vs 56.3 ± 11.6%, p = 0.034), left ventricular end diastolic diameter (53.2 ± 10.3 mm vs 48.7 ± 10.9 mm, p = 0.040) and effective regurgitant orifice area (0.5 ± 0.4 cm2 vs 0.3 ± 0.1 cm2) were higher in patients undergoing surgery, compared to patients not undergoing surgery, respectively. The most common reason for not receiving surgery was that MR was not addressed by the treating physician and lost to clinical follow-up. Over 50% of patients that did not receive surgery had at least 1 indication based upon current practice guidelines. CONCLUSIONS In contemporary clinical practice, less than half of patients with moderate-severe and severe primary MR received surgery and many were not referred for surgical consultation.
Abstract 138: PRMT6 promotes lung tumor growth via the modulation of macrophage M2 polarization

Lung cancer kills more people in the United States than any other malignancy. High mortalities are in part due to the diagnosis at an advanced inoperable stage where the 5-year survival is only 4%. Therefore, improving survival will require increased knowledge of genes that drive the complex mechanisms of lung cancer initiation and progression. Emerging data implicate novel roles for protein arginine methylation in lung cancers. In protein arginine methylation, nitrogen/s of arginine can be post-translationally modified via the addition of a methyl group, catalyzed by a class of enzymes, protein arginine methyl transferases (PRMTs). Based on the computational analysis, tissue staining, and immunoblotting we have identified an increased expression of PRMT6 in lung tumors. To test the biologic relevance of PRMT6 in lung tumor development, we employed an inducible lung-targeted PRMT6 gain-of-function (GOF) mouse model. For the first time, we show that lung-targeted overexpression of PRMT6 results in spontaneous lung tumor development. We also observed a robust increase in lung tumors in the PRMT6 GOF mice in response to urethane, a KRas mutagen, and a prototypical model to study lung tumorigenesis. Excitingly, we detected an increase in the number of tumor-associated macrophages (TAMs) in the PRMT6 GOF mice. Further characterization of the TAMs from the PRMT6 GOF mice revealed that they were M2 polarized with immunosuppressive, angiogenesis-enhancing, and tumor-promoting activities. Taken together, these results demonstrate a novel role for PRMT6 in lung tumor development by way of macrophage M2 polarization. Therefore, defining the complete mechanism of PRMT6-mediated macrophage M2 polarization could lead to the development of novel therapeutic strategies to treat lung cancer. Citation Format: Sreedevi Avasarala, Pei-Ying Wu, Samia Q. Khan, Michelle Van Scoyk, Yanlin Su, Odile David, Vineet Gupta, Mark T. Bedford, Robert A. Winn, Rama Kamesh Bikkavilli. PRMT6 promotes lung tumor growth via the modulation of macrophage M2 polarization [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 138.
Improving the mortality index by capturing patient acuity through interprofessional real-time documentation improvement in a single hospital system.

Background The observed to expected mortality ratio is a standardized way for reporting inpatient mortality and is used as a measure for hospital quality rankings and Centers for Medicare & Medicaid Services value-based payments. The goal of this study is to describe a single institution's mortality index improvement initiative through improved documentation of patient severity. Methods Data were prospectively collected October 2016 through May 2017 on patients discharged from the acute care surgery, open heart surgery, neurosurgery, and University Hospital East. Mortalities were reviewed by a multidisciplinary committee for missed coding opportunities. These captured codes were adjusted based on the Vizient risk-adjustment model for mortality and the observed to expected mortality ratio was calculated. Results Every service reviewed showed improvement in the expected mortality rate. Additional coding opportunities were present in 55.6% of acute care surgery, 24.3% of neurosurgery, 18.3% of open heart surgery, and 35.3% of University Hospital East cases. A total of 70 codes were improved during the 8-month period. The acute care surgery service showed the most improvement, with a 0.45 improvement in the observed to expected mortality ratio, followed by neurosurgery, with 0.43 improvement. Conclusion Institutional observed to expected mortality ratio can be improved by targeting high-acuity services and capturing coding opportunities, leading to improvement in value-based payments and rankings.
Cascade Mapping: Optimizing Memory Efficiency for Flash-based Key-value Caching

Flash-based key-value caching plays an important role in Internet services. Compared to in-memory key-value caches, flash-based key-value caches can provide a 10 to 100 times larger cache space, allowing to accommodate more data for a higher hit ratio. However, the current design relies on a simple hash-based indexing structure, which maintains the entire mapping table in DRAM memory. As the cache capacity continues to grow, such an "all-in-memory" approach raises concerns on cost, power, and scalability. To address this critical memory challenge, we propose a hierarchical mapping scheme, called Cascade Mapping. This scheme exploits a widely existing phenomenon in key-value caches---only a small set of key-value items in the cache is frequently requested. Leveraging the strong temporal locality, we create a multi-tier mapping structure, aiming to serve the most popular key-value mappings within a small memory space and organize the majority in a highly optimized indexing structure in flash. We have implemented a prototype, called SlickCache, based on Twitter's Fatcache. Our experimental results show that we can achieve nearly identical performance as the conventional all-in-memory scheme, while using only a fraction (10%) of the required memory. Alternatively, this approach allows us to build a 10 times larger flash cache with the same amount of memory, which in turn increases the hit ratio by up to 8.2 times and the throughput by up to 125 times.
Cell phone use predicts being an “active couch potato”: results from a cross-sectional survey of sufficiently active college students:

Objective“Active couch potato” describes an individual who is sufficiently physically active yet highly sedentary. Cell phones promote activities understood as sedentary behaviors (e.g. watching vi...
Can the Environment have a Genetic Basis? A Case Study of Seedling Establishment in Arabidopsis thaliana

The timing of seed germination determines the environment experienced by a plant's most vulnerable life stage-the seedling. Germination is environmentally cued, and genotypes can differ in their sensitivity to environmental cues. When genotypes differ in their response to cues, and when cues accurately predict the postgermination environment, the postgermination environment experienced by seedlings can itself have a genetic basis and potential to evolve. We tested for genetic differences in the postgermination environment using Arabidopsis thaliana genotypes that vary in seed dormancy, a trait known to alter germination time. We dispersed seeds into the field in 5 seasonal cohorts over 1.5 years, observed germination timing for 5297 individuals, and measured the soil temperature and moisture experienced by individuals throughout their life cycle. We found that genotypes differed in the environments they experienced during seedling establishment. This environmental variation occurred because genotypes differed in their environmental sensitivity to germination cues, and pregermination cues were correlated with postgermination environments. Seeds exhibited temporal habitat selection by germinating into a nonrandom subset of environmental conditions available, and seed dormancy increased the consistency of habitat selection. Strikingly, the postgermination environment affected fitness by altering the probability of seedling survival such that genotypes that engaged in stronger habitat selection were less likely to reach reproduction. Our results suggest that environmentally cued development may be a widespread mechanism by which genotypes can differ in the environment they experience, introducing the possibility that the environment itself can be inherited and can evolve.
Improving community well-being through collaborative initiatives at a medical library

Background: In an increasingly digital age, the role of the library is changing to better serve its community. The authors’ library serves health care professionals who experience high levels of stress due to everyday demands of work or study, which can have negative impacts on physical and mental health. Our library is committed to serving the needs of our community by identifying opportunities to improve their well-being. Case Presentation: Librarians at the Harvey Cushing/John Hay Whitney Medical Library at Yale University developed a group mindfulness program and a space for self-defined personal care to assist health care professionals in alleviating stress. Surveys were used to evaluate the mindfulness program and self-care space. Conclusions: We successfully implemented two collaborative wellness and self-care initiatives with students and other stakeholders, as demonstrated by program attendance, diverse space use, and positive survey responses for both initiatives. While these endeavors do not replace the need to challenge structural problems at the root of stress in the health care professions, this case report offers a blueprint for other medical libraries to support the well-being of their communities.
The Hidden Rules of Race: Barriers to an Inclusive Economy

Why do black families own less than white families? Why does school segregation persist decades after Brown v. Board of Education? Why is it harder for black adults to vote than for white adults? Will addressing economic inequality solve racial and gender inequality as well? This book answers all of these questions and more by revealing the hidden rules of race that create barriers to inclusion today. While many Americans are familiar with the histories of slavery and Jim Crow, we often don't understand how the rules of those eras undergird today's economy, reproducing the same racial inequities 150 years after the end of slavery and 50 years after the banning of Jim Crow segregation laws. This book shows how the fight for racial equity has been one of progress and retrenchment, a constant push and pull for inclusion over exclusion. By understanding how our economic and racial rules work together, we can write better rules to finally address inequality in America.
Improving microplastic research

There has been a virtual explosion of research on microplastics. Every week new articles are published in scientific journals. However, not all of them are original or important. Dozens of papers come out monthly that report the number of microplastic particles found in some water body, but they cannot be compared because there are no standardized methods for collection or analysis. However, it has become clear that collecting microplastics with nets misses most of the microplastics, since microfibers, which are by far the most abundant type when whole water samples are analyzed, pass through nets. These microfibers are derived primarily from synthetic clothing via wastewater from washing machines. Another common study documents that some species consumes microplastics. It seems that every animal studied eats them; it would be of greater interest to find one that does not ingest them. Although animals consume them, few studies have examined how soon and how many are egested. Most may pass through the gut without causing any noticeable effects. This is an important area to study. Microplastics are considered vectors for transferring contaminants to animals and up the food chain, but few studies demonstrate this with realistic scenarios such as providing the animals some “real” food and time to egest. Effects attributed to microplastics may be symptoms of inadequate nutrition or a clogged digestive tract. It is also important to learn how much of the adsorbed contaminants the gut can desorb during the time that microplastics are passing through. Future feeding studies should not use spherical microplastics which are rare in aquatic environments but should use primarily microfibers which are the predominant shape found, provide real food, and allow time for egestion to occur. Other research needs include additional studies on soil and terrestrial biota and developing ways to modify the manufacture of textiles to shed fewer microfibers.
Management of Benign Paroxysmal Positional Vertigo in an Adult With Severe Osteogenesis Imperfecta

The purpose of this case report was to describe the evaluation and management of atypical benign paroxysmal positional vertigo (BPPV) in an adult with severe osteogenesis imperfecta. A 29-year-old male was referred to a physical therapist with extensive experience in vestibular rehabilitation who provided horizontal canal BPPV treatment with a canalith repositioning maneuver over two treatment sessions. The individual's symptoms had reduced by 65% and his nystagmus during the roll test was reduced. Extreme care is needed to safely reposition individuals living with severe osteogenesis imperfecta, but the repositioning can reduce symptoms and improve quality of life. Laryngoscope, 130:2241-2244, 2020.
HTLV-1 and HTLV-2

Abstract HTLV-1 is an oncogenic human retrovirus associated with several diseases including adult T-cell leukemia/lymphoma (ATL) and HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). The oncogenic potential of the virus is entwined with the Tax-1 and HBZ proteins. The closely related retrovirus HTLV-2 is not strongly linked to disease yet is highly similar both in sequence and protein functionality. This has led to research examining the differences between the two viruses, and how they may contribute to the different pathogenic outcomes.
Power, capital, and the poverty of farmers’ land rights in China

This article is intended to conduct a three-dimensional examination of China’s rural land rights and the complex dynamic among political power, economic capital, and farmers’ rights during the past seventy years. First, the study takes a close look at the historical changes in the nature, scope, and ownership of land property in rural China during four significant time periods from 1949 to 2019. Second, it uses Ronald Coase’s theory on property rights in dissecting the four paradoxes and dilemmas in China’s rural land ownership, including the extent of clarity and stability of land property rights, the “three rights system” (the rights to ownership, contracting and operation of land) and three stagnations in defining and exercising such three rights, the simultaneous shortage and waste of land resources, as well as the restrictions on land transactions and the requirement to protect collective property. With examples derived from selected evidence, the article documents how both political power and economic capital have worked together to deprive farmers’ land rights. It concludes with a critical analysis of the current status of China’s rural economy, the problem of applying Western economic theories to China’s reality, as well as the theoretical definition, legal protection and policy parameters of land property rights in China.
Ten simple rules to increase computational skills among biologists with Code Clubs.

Exploratory Science Center, Merck & Co , Inc , Cambridge, Massachusetts, United States of America Affiliation: Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, United States of America ORCID logo http://orcid org/0000-0003-3140-537X Patrick D Schloss * E-mail: pschloss@umich edu Affiliation: Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan, United States of America ORCID logo http://orcid org/0000-0002-6935-4275 Introduction For most biologists, the ability to generate data has outpaced the ability to analyze those data In addition to building upon material from traditional coursework and staying current on the literature, Journal Clubs help strengthen skills in critical thinking, communication, and integrating the literature [11] Because most Journal Clubs occur on a regular schedule, they are effective by virtue of repeated practice With this model in mind, over the past four years we have experimented with creating a Code Club model with the goal of improving reproducible data analysis skills in a laboratory environment [ ]presenters were reluctant to offer to present again
Accounting for Material Changes in Decellularized Tissue with Underutilized Methodologies

Tissue decellularization has rapidly developed to be a practical approach in tissue engineering research; biological tissue is cleared of cells resulting in a protein-rich husk as a natural scaffold for growing transplanted cells as a donor organ therapy. Minimally processed, acellular extracellular matrix reproduces natural interactions with cells in vitro and for tissue engineering applications in animal models. There are many decellularization techniques that achieve preservation of molecular profile (proteins and sugars), microstructure features such as organization of ECM layers (interstitial matrix and basement membrane) and organ level macrofeatures (vasculature and tissue compartments). While structural and molecular cues receive attention, mechanical and material properties of decellularized tissues are not often discussed. The effects of decellularization on an organ depend on the tissue properties, clearing mechanism, chemical interactions, solubility, temperature, and treatment duration. Physical characterization by a few labs including work from the authors provides evidence that decellularization protocols should be tailored to specific research questions. Physical characterization beyond histology and immunohistochemistry of the decellularized matrix (dECM) extends evaluation of retained functional features of the original tissue. We direct our attention to current technologies that can be employed for structure function analysis of dECM using underutilized tools such as atomic force microscopy (AFM), cryogenic electron microscopy (cryo-EM), dynamic mechanical analysis (DMA), Fourier-transform infrared spectroscopy (FTIR), mass spectrometry, and rheometry. Structural imaging and mechanical functional testing combined with high-throughput molecular analyses opens a new approach for a deeper appreciation of how cellular behavior is influenced by the isolated microenvironment (specifically dECM). Additionally, the impact of these features with different decellularization techniques and generation of synthetic material scaffolds with desired attributes are informed. Ultimately, this mechanical profiling provides a new dimension to our understanding of decellularized matrix and its role in new applications.
Association between whole grain food intake in Canada and nutrient intake, food group intake and diet quality: Findings from the 2015 Canadian Community Health Survey.

Whole grains have been associated with numerous beneficial health outcomes and are recommended in Canada’s Food Guide; however, there is little research on whole grains specific to Canada. Therefore, the objective of this study was to characterize the association between Canadians’ WG intake and nutrients, food groups and diet quality and to understand top sources of WG in the diets of Canadians. We used data from the Canadian Community Health Survey 2015: a cross-sectional survey that collected information on diet (using a 24-hour recall) and health from 20,487 Canadians 1 year and older. We classified study participants according to their WG intake: non-WG (n = 10,883) and three groups based on age-specific tertiles of WG intake, low-WG (n = 3,322), mid-WG (n = 3,180), and high-WG (n = 3,102). Results were analyzed using population-based survey methods and were adjusted for energy, age, gender, overweight/obesity, income, and supplement use. We found differences in nutrients and food groups by WG group: there was a significant linear trend across groups of increasing WG for increased fiber (children and adults), vitamin B6 (children), thiamin (adults), potassium (children and adults), zinc (adults), calcium (children and adults), iron (children and adults), magnesium (children and adults), fruit (adults), and legumes, nuts and seeds (adults); and decreased total fat (adults), saturated fat (adults), folate (children and adults), refined grains (adults and children), and meat and poultry (adults) intake. We found that there were no differences in total sugar or sodium intake across WG intake groups. The high WG intake group for both children and adults had higher diet quality, measured by the Nutrient Rich Food Index 9.3, compared to non-WG eaters. The top 2 food sources of WG across WG intake groups for children and adults were whole grain oat and high fiber breakfast cereal and whole grain and whole wheat bread. Other top sources of WG included rice, bread products, other breakfast cereals, salty snacks, cereal grains and flours, pasta, and sweet snacks. This research supports recommendations to increase WG foods intake as a means to improve diet quality of Canadians.
Fault Tree Analysis And Risk Mitigation Strategies For Autonomous Systems Via Statistical Model Checking

In order to assess the reliability of autonomous systems, fault tree analysis (FTA) technique is used extensively. Most of the traditional FTA approaches are based on simulation and often require extensive computing capabilities. This paper proposes a formal FTA approach that can investigate the probability of failure of autonomous systems. The proposed methodology takes advantage of both FTA and statistical model checking (SMC). In order to illustrate the proposed approach, the sources of communication failure in a fleet of UAVs are analyzed. After detecting the most critical causes of communication failure, several redundant architectures are examined to assess their potentials to mitigate the risks of system failure. The results illustrate that all of the investigated architectures are capable of mitigating the probability of failure of the fleet of UAVs under studies.
Maternal obesity trends in Egypt 1995-2005.

According to the World Health Organization (WHO), 46% of adult females in Egypt are obese. This research was aimed at documenting obesity trends and identifying the populations most at risk for obesity. Using data from the 1995 and 2005 Egyptian Demographic and Health Surveys a linear model was employed to seek associations between household wealth, urban/rural residence, governorate of residence, employment status, parity and age and increases in body mass index (BMI) among married Egyptian women between the ages of 15–49. Between 1995 and 2005, the mean BMI of women of reproductive age in Egypt increased from 26.31 to 28.52. Although there was an overall trend towards greater obesity between 1995 and 2005, older women residing in rural, poor households became obese at a faster rate than younger women residing in richer, urban households. Studies have shown that household wealth is a key determinant of food consumption patterns. Rising obesity rates among the poor in developed countries are linked to the relatively cheap price of high-calorie, nutrient-poor foods. One factor that may be contributing to the rapid increases in obesity among the rural poor in Egypt is the subsidisation of high-energy, low-nutritive value foods that form a larger part of the diet of poor, rural populations.
Wavenumber-frequency analysis of turbulent wall pressure fluctuations over a wide Reynolds number range of Turbulent Pipe Flows

Measurements of the autospectra and coherence of turbulent wall pressure fluctuations were made in the circular test section of the Quiet Water Tunnel Facility at the Naval Undersea Warfare Center in Newport, Rhode Island. The pipe diameter Reynolds numbers varied from 2.09 × 105 to 1.85 × 106. The coherence measurements are shown to collapse well with the similarity scaling over the entire range of Reynolds numbers. Wavenumber-frequency spectra are estimated by computing the spatial Fourier transform of the measured coherence, using the model of Corcos. The results are shown to accurately represent the convective ridge portion of the wavenumber-frequency spectra where the dominant energy exists.
Program quality and program effectiveness:: A Review of Evaluations of Programs to Reduce Excessive Medical Diagnostic Testing☆

Abstract A review of 61 interventions to reduce the rate of diagnostic testing revealed that many approaches to reducing test use yielded favorable results; the mean reduction observed was 22.0%. The heterogeneity of the interventions, target populations, and type of testing to be reduced did not permit carrying out a meta-analysis. However, this heterogeneity did permit the study of the relationship between indexes of program quality and effectiveness. Prior to implementation, few program developers measured the levels of excessive testing or developed conceptual foundations for the interventions. Interventions that were based on analyses of need and concerns about negative side effects tended to be more effective. It is suggested that focusing interventions on processes thought to foster the development of expert decision-making skills would improve the likelihood that interventions would show long-term effectiveness.
Open Access to Cancer Research in PubMed: June 1, 2006- May 31, 2011

AbstractObjective: This study investigated PubMed (PM), the free database index of references and abstracts on life science and bio-medical topics used to facilitate the lookup of scholarly information, to ascertain how PM’s percentage of free online articles, compared to the values given for open access (OA) in previous studies. This study also compared the general OA in PM of journal articles and cancer articles to the OA of specific types of cancer to assess OA availability in areas. Keywords: PubMed, cancer, open accessPrincipal Findings: At 28%, PM’s current level of OA in the life sciences lags behind other disciplines, dating back to 2001-2002 when 29% of the articles in political science, 37% in electrical engineering, and 69% in mathematics were open access (Antelman, 2004). Of the research articles on the fourteen types of cancers assessed in this study, five types, including the top three most prevalent cancers: prostate, lung and bronchus, and breast, showed higher percentages of OA in PM research article dealing with those cancers than the general level of OA in PM.Conclusions/Significance: Though the general OA in PM is higher than the values cited in previous research both for PM and for many other disciplines and databases, there is still a substantial need for increased OA in PM. The lack of OA for the majority of articles in PM is a significant limitation to patients suffering from, and doctors treating, cancer who seek information on PM about the disease to help them make informed decisions about treatment. Finally, at the current annual rate of growth of OA in PM of two percent, it will take between thirty-six and fifty years for OA to allow researchers full access to th previous year’s research without a subscription. Furthermore, under the current policy, researchers will never be able to access the research published non-OA from previous years without purchasing subscriptions.
Inhibitors of the Transhydrogenase Activity of Spinach Ferredoxin-Nicotinamide Adenine Dinucleotide Phosphate Reductase

Abstract Boiled spinach extracts reversibly inhibit the transhydrogenase activity of ferredoxin-nicotinamide adenine dinucleotide phosphate reductase. The inhibition is competitive with respect to NAD but noncompetitive with respect to NADPH. The inhibitor is most effective at a pH of about 8.0. The inhibitor is characterized as an organic acid but does not appear to be a carbohydrate or phosphoric acid derivative or phosphodoxin. A number of compounds with inhibitory activity have been found. These compounds share the common chemical feature of having a vic-carbonyl gouping and include a number of α-keto acids.
Recovering from erroneous inferences

Many models of natural language understanding make inference decisions as they process a text, but few models can correct their interpretation when later text reveals that earlier inference decisions are wrong. This paper describes how ATLAST, a markerpassing model of text understanding, addresses this problem. The keys to ATLAST's error recovery capability are a means for remembering the choices it could have made but did not, and a means for initiating the re-evaluation of those previously rejected choices at the appropriate times. This paper also discusses some of the arguments for and against the psychological validity of a theory of inference retention in human text understanding.
New method of direct percutaneous endoscopic jejunostomy tube placement using balloon-assisted enteroscopy with fluoroscopy

Background and Aim Direct percutaneous endoscopic jejunostomy (DPEJ) is a useful method to provide nutrition to patients with a variety of gastrointestinal (GI) problems. The present study describes a new method of DPEJ using balloon-assisted-enteroscopy. Methods This observational, retrospective, single-arm case study conducted at a tertiary care hospital during a 15-month period included 25 patients (12 females, 13 males, mean age 54 years, age range 31–79 years) with necrotizing pancreatitis, n = 7; complex upper GI surgery, n = 6; complex fistula, n = 6; impossibility to place a gastrostomy tube, n = 5; and bowel obstruction, n = 1. The new DPEJ technique focused on three key components: (i) use of balloon-assisted overtube; (ii) use of fluoroscopy; (iii) leaving the overtube in place during the entire procedure (and also for DPEJ removal). Results Technical success was 96%. Mean time of the procedure was 30.5 min (range 24 to 45 min). Clinical success was 100% (24/24); all DPEJ could be used for their intended purpose. Conclusions This new method of inserting a DPEJ using balloon enteroscopy and fluoroscopy was safe and successful. Future comparative studies are now warranted.
The Multicultural Learning Group: Shaking Up Cultural Myths.

There is a paucity of literature dealing with racial issues among adult learners in the context of the classroom. Much of the current re search has been focused on developing student autonomy (Boud 1981), train ing facilitators for adult learners (Brookfield 1986), the andragogy/ped agogy debate (Knowles 1980), the in crease in adult learners (Cross 1981), developing critical thinking (Mezirow and Associates 1990; Brookfield 1987), and self-direction in adults (Knowles 1984). As experienced facilitators of adult students in a formal, small group setting we have often observed behav ioral manifestations that precede theory. This article will explore how racial issues currently affect the facilitat ing/learning model with adults. We will examine a small group learning model and curriculum, and we will analyze and discuss actual classroom events involving racial issues. All of the events took place at the Atlanta Aca demic Center of National-Louis Uni versity (NLU). Suggestions for incor porating racial issues into the learning process and for facilitating a psycho logically healthy atmosphere will be ex plored.
Multilevel Information Presentation Strategy and Customer Reaction: An Empirical Investigation in an Online Setting

This study investigates the use of polyinstantiated information in management of customer relationships. Polyinstantiation can be used to present different information to different customers who are segmented according to some criterion, such as prior purchase behavior. An empirical study shows that presentation of multilevel benefits information affects customer satisfaction with the offer and information quality which, in turn, affect the overall Web satisfaction. This effect is independent of and comparable in size to the effect of customer prior attitude toward the Web and the Internet. Although the present study employs a Web-based retail setting, the relationships between this information presentation approach and measures of user/consumer satisfaction need not be limited to retail scenarios or to online interactions. We discuss the applicability of this technique of information control to different types of interactions between organizations and their constituents.
Many-body effects on the cyclotron resonance in a two-dimensional electron gas.

We consider optical absorption by an interacting two-dimensional electron system, with impurities, in a strong perpendicular magnetic field, at electron densities such that an integral number of Landau levels is filled. The Coulomb energy ${e}^{2}$/\ensuremath{\epsilon}${l}_{0}$ is assumed to be smaller than the cyclotron energy \ensuremath{\Elzxh}${\ensuremath{\omega}}_{c}$, and correlation effects are treated exactly to lowest order in (${e}^{2}$/\ensuremath{\epsilon}${l}_{0}$)/\ensuremath{\Elzxh}${\ensuremath{\omega}}_{c}$. The impurity scattering is treated in a self-consistent approximation for several different impurity potentials. The cyclotron resonance line is found to be significantly altered by electron-electron interactions. The line is shifted to lower frequencies and a line narrowing due to correlation effects is found.
Glucose metabolism and leg blood flow after pancreas/kidney transplantation

Patients with insulin-dependent diabetes mellitus (IDDM) who have undergone combined pancreas and kidney (P/K) transplantation, are hyperinsulinemic and have impaired insulin-stimulated whole body glucose uptake. We have investigated whether their reduced glucose uptake was due to insulin resistance at the tissue level or was caused by reduced muscle blood flow, previously reported to be present in patients with IDDM. Leg blood flow (LBF, determined with mercury strain-gauge plethysmography), glucose uptake (GRd, determined with 6,6 D2-glucose), and glucose oxidation (Gox, determined by indirect calorimetry) were obtained during euglycemic-hyperinsulinemic (approximately 500 pM) clamping in five P/K patients, five kidney transplant (K) patients, and six controls. Insulin-stimulated GRd was reduced in P/K patients compared to controls (23 +/- 4 vs. 44 +/- 6 mumol/kg/min, P < 0.05); Gox was comparable but glucose storage was reduced in P/K and K patients compared to controls (9 +/- 3 and 13 +/- 4 vs. 28 +/-...
Soil phosphorus mobilization in the rhizosphere of cover crops has little effect on phosphorus cycling in California agricultural soils

Phosphorus (P) is a key limiting factor in many terrestrial ecosystems because most soil P is bound to soil minerals or organic matter. Increasing P cycling rates can increase P availability, including in agricultural soils that receive external P inputs. For example, cover crops may increase P cycling rates via plant uptake and P release during microbial decomposition. Cover crops and associated microbes may also change rhizosphere properties and stimulate soil P mobilization. We studied the potential of legume – fava bean (Vicia faba), vetches (Vicia dasycarpa, Vicia sativa, Vicia benghalensis) pea (Pisum sativum) – and cereal – rye (Secale cereale), wheat (Triticum aestivum), oat (Avena sativa) – cover crops to stimulate P cycling across management practices in two long-term systems trials in California. We measured cover crop biomass and nutrient content, P-mobilizing capacity (pH, organic acids, phosphatase activity) and soil P fraction changes in the rhizosphere. Cereals generally produced more biomass with similar P content compared to legumes, but higher C:P in cereal residues could favor microbial immobilization, delay residue mineralization and reduce P cycling rates. Legumes, especially fava bean, had the largest effect on rhizosphere properties by reducing pH and increasing organic acids concentrations and phosphatase activity. However, these changes in rhizosphere properties had a modest impact on soil P and did not increase soil P availability. Furthermore, we found no strong effect of management practices or soil P concentrations on soil P mobilization. Our results suggest that P mobilization in the rhizosphere of legumes is unlikely to increase P cycling rates in these soils, whereas P uptake and release in cereal biomass could have stronger effects.
Concanavalin A binding induces association of possible mating-type receptors with the cytoskeleton in Tetrahymena.

Abstract The lectin concanavalin A (conA; 25 μg/ml) inhibits conjugation in the ciliate Tetrahymena, and binds to receptors localized at the junction between conjugating cells. We report here that succinyl-conA (30 μg/ml) has similar activity, but that two other mannosespecific lectins, lentil and pea lectins, have inhibitory activities more than tenfold lower in this system, indicating that factors other than mannose specificity are essential for biological activity. By using fluorescein-isothiocyanate (FITC)-conA, we have found that extraction of cells with the detergent Triton X-100 removes conA receptors from the extractionresistant cytoskeleton, but that the binding of conA to its receptor before extraction associates the ligand-receptor complex with the cytoskeleton. Under the hypothesis that the conA receptor may be a mating type receptor, we have used this ligand-induced differential cytoskeletal association, in conjunction with electrophoresis and Western blotting, to identify a glycoprotein with an apparent molecular weight (MW) of 23 000 D which may be a mating type receptor. Our data are consistent with a model in which a direct interaction between the conA receptor and the cytoskeleton, rather than receptor cross-linking, is the biologically significant activity of ligand binding.
The influence of catchment land use on stream integrity across multiple spatial scales

1. Despite wide recognition of the need for catchment-scale management to ensure the integrity of river ecosystems, the science and policy basis for joint management of land and water remains poorly understood. An interdisciplinary case study of a river basin in south-eastern Michigan is presented. 2. The River Raisin drains an area of 2776 km2, of which some 70% is agricultural land. The upper basin consists of till and outwash, and both topography and land use/cover are diverse. The lower basin consists of fine textured lake deposits, is of low relief, and land use is primarily agricultural. 3. The River Raisin basin historically was a region of oak-savannah and wetlands. It was deforested, drained and converted to farmland during the mid-nineteenth century. Human population reached a plateau at about 1880, and then underwent a second period of growth after 1950, mainly in small urban areas. More recently, the amount of agricultural land has declined and forested land has increased, in accord with a general decline in farming activity. 4. It could be suggested that the influence of land use on stream integrity is scale-dependent. Instream habitat structure and organic matter inputs are determined primarily by local conditions such as vegetative cover at a site, whereas nutrient supply, sediment delivery, hydrology and channel characteristics are influenced by regional conditions, including landscape features and land use/cover at some distance upstream and lateral to stream sites. 5. Sediment concentrations measured during low flows were higher in areas of greater agriculture. In a comparison of two subcatchments, sediment yields were up to ten times greater in the more agricultural location, in response to similar storm events. A distributed parameter model linked to a geographical information system predicted that an increase in forested land cover would result in dramatic declines in runoff and sediment and nutrient yields. 6. Habitat quality and biotic integrity varied widely among individual stream sites in accord with patterns in land use/cover. Extent of agricultural land at the subcatchment scale was the best single predictor of local stream conditions. Local riparian vegetation was uncorrelated with overall land use and was a weak secondary predictor of habitat quality and biotic integrity. 7. Investigation of the regulatory agencies involved in land and water management in the basin revealed a complex web of overlapping political jurisdictions. Most land-use decision-making occurs at the local level of township, city or village. Unfortunately, local decision-making bodies typically lack the information and jurisdictional authority to influence up- and downstream events.
Analysis of in vivo left atrial appendage morphology in patients with atrial fibrillation: a direct comparison of transesophageal echocardiography, planar cardiac CT, and segmented three-dimensional cardiac CT

Purpose Recent development of percutaneous left atrial appendage (LAA) occlusion devices has underscored the need for an accurate understanding of LAA morphology and the interchangeability of results from differing imaging modalities. The purpose of this study is to assess LAA morphology and location in AF patients, directly comparing transesophageal echocardiography (TEE), planar cardiac computed tomography (CT), and three-dimensional segmented CT reconstructions. Methods Fifty-three patients underwent adequate TEE and cardiac CT. Quantitative measurements of maximal LAA orifice diameters, widths, and depths were obtained from each imaging modality. Left atrial and LAA volumes were measured using segmented CT. Results The mean LAA orifice diameter for segmented CT, planar CT, and TEE was 28.5±4.5, 26.3±4.1, and 26.1±6.4 mm, respectively. Conclusions LAA orifice measurements among these imaging modalities are not interchangeable. This difference may be clinically significant because of the need for accurate sizing of LAA occlusion devices. Use of preprocedural segmented CT may improve initial device sizing.
A Framework for Analyzing the Microstructure Level Thermomechanical Response Polymer Bonded Explosives

A framework for quantifying the thermomechanical response of polymer bonded explosives (PBX) at the microstructural level is developed using a cohesive finite element method (CFEM). This framework allows the contributions of individual constituents, fracture and frictional contact along failed crack surfaces to heating to be analyzed and tracked. Digitized micrographs of actual PBX materials and idealized microstructures with various distributions of grain sizes are used in the analysis. The analysis concerns impact loading of HMX/Estane with strain rates on the order of 104 – 105 s-1. Issues studied include large deformation, thermomechanical coupling, failure in the forms of microcracks in both bulk constituents and along grain/matrix interfaces, and frictional heating. The Estane matrix is described by a thermo-elasto-viscoelastic constitutive formulation, accounting for temperature dependence, strain rate sensitivity and strain hardening. The HMX crystals are assumed to be elastic under the conditions analyzed. Energy localization leading to formation of local hot spots as potential ignition sites is primarily due to the viscoelastic dissipation in the matrix in early stages of deformation and frictional heating along crack surfaces in later stages of deformation. Microstructure-response relations that can be used in the design of soft energetic composites are established.
Effects of structural and kinetic parameters on the performance of chromatographic columns packed with perfusive and purely diffusive adsorbent particles

Abstract A mathematical model describing dynamic adsorption in columns with spherical bidisperse perfusive or spherical bidisperse purely diffusive absorbent particles is used to study the effects of the structural parameters of the adsorbent particles and of the parameters of the adsorption mechanism on the performance of chromatographic systems involving the adsorption of bovine serum albumin onto anion-exchange porous adsorbent particles. Four structural parameters are studied: the particle diameter, dp, the macropore void fraction, ϵp, the microparticle diameter, dm, and the parameter φ, which affects the value of the permeability of the adsorbent particle. Two parameters of the adsorption mechanism are studied: the maximum equilibrium concentration of adsorbate in the adsorbed phase of the adsorbent particle, CT and the rate constant k1, which characterizes the adsorption step of the interaction mechanism between the adsorbate molecules and the active sites on the surface of the pores of the adsorbent particles. The performance of columns packed with purely diffusive particles improves when the value of dp is decreased, when the value of ϵp is increased and when the value of dm is decreased; the effect of dm is much smaller than the effects of dp and ϵp. Intraparticle flow in perfusive particles can improve column performance of its is of sufficient magnitude; intraparticle flow increases when the value of dp is decreased, when the value of ϵp is increased, when the value of dm is increased and when the value of φ is decreased. The difference between the performance of a column packed with perfusive particles and that of a column packed with purely diffusive particles will depend upon the particular combination of the parameters dm, ϵp, dmm and φ. When the value of k1 is is small, an increase in k1 improves column performance. However, when the value of k1 becomes sufficiently large, further increases have no effect on column performance. Increasing the value of CT has a large effect on column performance by increasing the breakthrough time and the mass of adsorbate in the adsorbed phase at breakthrough. The performance of chromatographic systems with purely diffusive particles can be better than the performance of chromatographic systems with perfusive particles, if purely diffusive particles can be made that have higher values of CT than otherwise comparable perfusive particles.