cssi/SciSciGPT-SciSciNet huggingface dataset:
The Development of Moral Imagination

Creativity has been defined as the ability to generate ideas that are original and unexpected, but are considered useful or important (Sternberg, 1999). Moral imagination involves not only the ability to generate useful ideas, but also the abilities to form ideas about what is good and right, and to put the best ideas into action for the service of others. This involves sensitivity to the people and lifescapes at hand. The everyday world is populated with opportunities to steer consciously through the shoals of social relationships and decide what sort of agent to be. Research into mental preoccupations indicates that individuals ponder moral and relational issues much of the time (Klinger, 1978). Thus, on a daily basis, people employ one of humanity’s greatest gifts: moral imagination. But what fosters the development of moral imagination and determines to what extent it is used to benefit humanity? How does the morally imaginative individual utilize emotional and social experiences, reasoning, and selection to produce imaginative moral action? These are the questions that this chapter addresses.
More Than Ataxia: Hyperkinetic Movement Disorders in Childhood Autosomal Recessive Ataxia Syndromes

Background: The autosomal recessive ataxias are a heterogeneous group of disorders that are characterized by complex neurological features in addition to progressive ataxia. Hyperkinetic movement disorders occur in a significant proportion of patients, and may sometimes be the presenting motor symptom. Presentations with involuntary movements rather than ataxia are diagnostically challenging, and are likely under-recognized. Methods: A PubMed literature search was performed in October 2015 utilizing pairwise combinations of disease-related terms (autosomal recessive ataxia, ataxia–telangiectasia, ataxia with oculomotor apraxia type 1 (AOA1), ataxia with oculomotor apraxia type 2 (AOA2), Friedreich ataxia, ataxia with vitamin E deficiency), and symptom-related terms (movement disorder, dystonia, chorea, choreoathetosis, myoclonus). Results: Involuntary movements occur in the majority of patients with ataxia–telangiectasia and AOA1, and less frequently in patients with AOA2, Friedreich ataxia, and ataxia with vitamin E deficiency. Clinical presentations with an isolated hyperkinetic movement disorder in the absence of ataxia include dystonia or dystonia with myoclonus with predominant upper limb and cervical involvement (ataxia–telangiectasia, ataxia with vitamin E deficiency), and generalized chorea (ataxia with oculomotor apraxia type 1, ataxia-telangiectasia). Discussion: An awareness of atypical presentations facilitates early and accurate diagnosis in these challenging cases. Recognition of involuntary movements is important not only for diagnosis, but also because of the potential for effective targeted symptomatic treatment.
Price and Customers’ Perceptions of Value

This chapter summarizes the behavioral pricing research findings of price and how buyers respond to price. This includes the relationship between price and perceived value and the decision heuristics that help us understand how price influences perceptions of value and eventual product choice. Buyers also use price as an indicator of product quality, and customers’ perceptions of quality, benefits, and value affect how they will respond to a purchase situation. In addition, buyers’ perceptions of the sacrifice affect the purchase decision, that is the degree that consumers reflect on the amount that they would “give up” by paying the monetary price for a product may vary according to a variety of situations and conditions, such as type of product or service, or the perceived unfairness of the price, or if the buyer perceives a brand is superior to competing brands. The chapter also discusses how buyers trade off or compare the perceived gains arising from price-quality judgments versus the perceived sacrifice required to acquire the product or service, including whether buyers integrate price and other attribute information following a nonlinear (proportional) or linear (subtractive) process. It also summarizes research on price as a multidimensional attribute, considered with additional dimensions such as warranty coverage, and warrantor reputation. Finally, the chapter examines perceived product value as being decomposed into its (1) perceived acquisition value (the expected benefit to be gained from acquiring the product less the net displeasure of paying for it) and (2) perceived transaction value (the perceived merits or fairness of the offer or deal).
Stochastic Geometry for Wireless Networks: Appendix Introduction to R

Overview R is a software package for statistical computation and graphics. It is free and open-source and very flexible. It implements many modern statistical methods with good graphical support. The core of R is an interpreted computer language which allows branching and looping as well as modular programming using functions. It can be downloaded for different operating systems from the main website http://www.r-project.org/, which also contains links to manuals and documentation. For example, a relatively concise introduction to R is available at http://cran.r-project.org/doc/manuals/R-intro.pdf. The R language is enhanced by numerous libraries. For the purposes of spatial statistics, the spatstat library has been developed. It supports the following: Creation, manipulation, and plotting of point patterns Exploratory data analysis, including intensity maps, empty space functions, nearest-neighbor distance functions, and K , L , and J functions Model fitting All figures with point patterns in this book were created using the powerful commands of the spatstat library. To use it, it needs to be loaded after starting R by typing library(spatstat). A demo can be run by demo(spatstat), while typing help(spatstat) provides a help page. An introduction to spatstat is given in Baddeley & Turner (2005), and further documentation is available at www.spatstat.org. R is equipped with all standard data types, such as scalars, vectors, arrays, and lists. Additional spatstat data types are point patterns and windows. A point pattern records the locations of the points observed in a certain region, and a window is a region in a two-dimensional space representing the “study area.”
Synthesis of Fluorenones from Benzaldehydes and Aryl Iodides: Dual C–H Functionalizations Using a Transient Directing Group

The first synthesis of substituted fluorenones directly from benzaldehydes and aryl iodides via a Pd(II)-catalyzed C(sp2)–H functionalization cascade is reported. Featuring anthranilic acid as an inexpensive transient directing group, the process is compatible with a variety of benzaldehydes and aryl iodides. A three-step synthesis of the antiviral drug Tilorone was completed in an excellent overall yield (40%), demonstrating the utility of this method.
Barriers and Challenges to Treatment Alternatives for Early-Stage Cervical Cancer in Lower-Resource Settings.

Cervical cancer is one of the most common cancers among women worldwide, and approximately 85% of new diagnoses occur in less-developed regions of the world. Global efforts in cervical cancer to date have focused on primary and secondary prevention strategies of human papillomavirus vaccination and cervical cancer screening. Cervical cancer screening is effective to reduce the incidence of cervical cancer and can result in diagnosis at earlier stages, but it will take time to realize its full impact. With expansion of screening programs, there is now a greater imperative to increase access to treatment for women who have cervical cancer, particularly in earlier stages of disease, when it is still curable. Resources for multimodality treatment can be limited—or even absent—in many less-developed regions of the world and may be associated with geographic, social, and financial barriers for the patient. However, there is evidence that, in many cases, less-invasive and less–resource-intensive treatment option...
The Environment for Listening

Music, from the listener’s point of view, has many functions. In some of these music is one of several elements and is used to heighten an overall experience or to serve as a background to it. The objective of church music is to enhance a spiritual involvement, military marches are intended to augment the martial spirit, soft background music in supermarkets is supposed to soothe the harried shopper, movie music is designed to underscore the story, one’s stereo or radio playing softly while one is doing something else is meant only as a background sound for company, music for ballet serves to mark time and to add to the visual impression, and so forth. In other situations, however, music becomes the primary, or even sole, preoccupation of the listener, although the mind may wander—recalling, associating, and forming personal memories, images, and thoughts stimulated by the music. In all these functions, and particularly in the last one, the listener’s environment is of great importance.
Surveillance with duplex ultrasound in traumatic spinal cord injury on initial admission to rehabilitation.

AbstractObjective: To determine the prevalence of deep vein thrombosis (DVT) by surveillance duplex ultrasound in the traumatic spinal cord injury (SCI) population on admission to rehabilitation.De...
16 How Recreational Drugs Affect Asthma

Because of the recent epidemic, drugs of abuse have more opportunity to interact with a common disease such as asthma. Drugs of abuse have not been proven to cause asthma, but they may exacerbate preexisting asthma. Case reports of asthma exacerbations after recreational drug abuse continue to increase. Abuse of cocaine and the opioid heroin have the richest literature supporting an interaction with asthma and offer possible pathophysiological mechanisms. Marijuana use, like tobacco use, can lead to a progressive decline in lung function. Tobacco use, but not nicotine addiction, is associated with worsening of asthma and obstructive pulmonary function changes. Healthcare providers need to specifically question their patients with asthma about recreational drug use and educate them about potential interactions. The only definitive treatment to eliminate any potential interaction between drug abuse and asthma is abstinence.
Revisiting Monoamine Oxidase Inhibitors

Monoamine oxidase inhibitors (MAOIs) were among the first class of agents introduced for the treatment of depression. However, they have fallen out of favor among clinicians over the years, due mostly to an unfavorable safety profile, the need for restrictive dietary prohibitions, and the fear of hypertensive crisis. The development of a novel, transdermal MAOI system now offers clinicians an additional option for managing patients with unipolar, bipolar, atypical, and treatment-resistant depression.
Algorithms for Supercomputers

Better numerical procedures, improved computational power and additional physical insights have contributed significantly to progress in dealing with classical and quantum statistical mechanics problems. Past developments are discussed and future possibilities outlined.
Peopleware: the hiring and retention of IT personnel

The hiring and retention of IT personnel has remained a top priority for managers given the increasingly important role that information technology plays in the success of virtually all companies today. In this chapter, through a series of case studies, we report on a set of best practices that are designed to help organizations develop strategy, recruit, hire, develop, compensate, and ultimately retain valued IT personnel. In addition, a model is presented that describes the key drivers of job satisfaction, and ultimately determine turnover. It is suggested that the relative importance of these drivers, which include the quality of management, work attributes, compensation, and career development, will change for employees over time. Therefore, managing these drivers using the identified best practices can significantly assist organizations in attracting and retaining IT personnel.
Fluctuations and nuclear interactions in the energy loss of cosmic-ray muons

The processes concerned with energy losses of high-energy muons, expecially the nuclear interaction, are examined. From the energy loss relation — (dE/dt)=k +bE, the average range-energy relation is given, including the effects of nuclear interaction and without the assumption thatb is independent ofE. Effective quantitieskeff,beff are introduced. By using these, the average range-energy relation can be written in the same form as ifk andb were constant. The fluctuations in energy loss of muons passing through a great thickness of material are studied. Numerical values of some functions which enter into an expression for the factorR, which corrects for fluctuations, are calculated by adopting more exact expressions of differential cross-section of the processes than those in past works. The values ofR for standard rock are obtained and are compared with those given by other authors. The energy spectrum of muons at sea-level is discussed.
The hidden cost of code completion: understanding the impact of the recommendation-list length on its efficiency

Automatic code completion is a useful and popular technique that software developers use to write code more effectively and efficiently. However, while the benefits of code completion are clear, its cost is yet not well understood. We hypothesize the existence of a hidden cost of code completion, which mostly impacts developers when code completion techniques produce long recommendations. We study this hidden cost of code completion by evaluating how the length of the recommendation list affects other factors that may cause inefficiencies in the process. We study how common long recommendations are, whether they often provide low-ranked correct items, whether they incur longer time to be assessed, and whether they were more prevalent when developers did not select any item in the list. In our study, we observe evidence for all these factors, confirming the existence of a hidden cost of code completion.
Residential greenness and activities of daily living in the Chinese elderly: a prospective cohort study

Abstract Background Activities of daily living (ADL) is a measurement of the ability to care for one's self and body, including personal care, mobility, and eating. Greenness in the built environment has been shown to improve physical health and mental wellbeing. We hypothesise that greenness could delay declines in activities of daily living. Methods Using the prospective cohort of the China Longitudinal Healthy Longevity Survey (CLHLS) between 2000 and 2014, we explored the association between ADL and greenness in the oldest-old (people aged ≥80 years). We assessed exposure using satellite-derived Normalized Difference Vegetation Index (NDVI) in the 250 m radius around each participant's residential address and then categorised them into quartiles. Our study outcome was self-care capacity, measured by a six-item ADL survey (eating, bathing, dressing, toileting, transferring, and continence). We stratified our analysis of participants with complete independence at baseline (ADL score 0 out of 6). Both NDVI values and ADL scores were repeatedly measured in 2000, 2002, 2005, 2008, 2011, and 2014. We used mixed-effects logistic regression, adjusted for age, sex, ethnicity, marital status, childhood and adult socioeconomic status, smoking status, alcohol consumption, exercise, Mini-Mental State Examination scores, and time since study entry. Findings Among 3044 elderly participants at baseline, the mean age was 91 years (SD 7·1). 837 (27·5%) became dependent and needed assistance in performing any one of the ADL functions during follow-up. Participants who became dependent in ADL were more likely to be older, female, Han Chinese, and poor cognitive function at baseline. Participants in the highest quartile of greenness had an odds ratio of 0·54 (95% CI 0·43–0·68) of becoming dependent in ADL, compared with the lowest quartile. Interpretation The ageing of China's population is an irreversible trend, and poses a challenge to the care givers who care for the elderly. Our findings suggest that increasing green space, if properly introduced into city planning, might reduce the burden of long-term care for the Chinese elderly. Funding None
Equitable Learning Environments in K-12 Computing: Teachers’ Views on Barriers to Diversity

The current efforts to expand computer science (CS) education in K-12 schools, such as the “CS for All” initiative, highlight the need for all students to get an opportunity to study computing. However, as recent research has shown, diversity in computing at the K-12 level remains problematic, and additional research is needed to look at how computer science learning environments can impact minority student interest and retention in CS. In this article, we report results from an in-depth qualitative study of high school computer science teachers’ perspective on barriers to increasing diversity in their classes. Based on teachers’ experiences, we provide practical recommendations on how to encourage equitable learning environments in K-12 computer science courses.
The condensation of 2,6-dichloroimidazo[1,2-a]pyridine with ribonolactone gives a novel imidazo[1,2-a]pyridine C-nucleoside with an unexpected site of ribosylation

Abstract A novel ribosylated imidazo[1,2-a]pyridine C-nucleoside was synthesized by condensing a lithiated 2,6-dichloroimidazo[1,2-a]pyridine ( 1 ) with a protected ribonolactone ( 2 ), followed by acetylation to give the intermediate nucleoside 4 . This intermediate was reductively deacetoxylated and deprotected to give what was determined to be the novel and unexpected 2,6-dichloro-5-(β-D-ribofuranosyl)imidazo[1,2-a]pyridine ( 7 ) and the corresponding α-product ( 8 ). The site of ribosylation was established with long range proton-carbon decoupling experiments. This ribosylation at C5 was entirely unexpected in view of previously reported condensations with lithiated imidazo[1,2-a]pyridines which occurred only at the C3 position.
A Physician's Position on Physician-assisted Suicide

On April 29, 1996, Dr. Quill offered testimony at an Oversight Hearing on "Assisted Suicide in the United States," before the Subcommittee on the Constitution of the House of Representatives Committee on the Judiciary. That testimony is reproduced here, with permission of the author.
Spontaneous coronary artery dissection: etiology and recurrence

Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly appreciated cause of acute myocardial infarction (AMI) and sudden cardiac death most often affecting young to middle-aged women with few conventional cardiovascular risk factors. Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 04/30/2019). Authors review the key clinical features of SCAD and highlight what is known regarding its pathophysiology and associated factors. The relationship between SCAD and other systemic vasculopathies, notably fibromuscular dysplasia (FMD) is also discussed. Authors also mention the management of acute SCAD along with considerations for long term follow-up such as chest pain syndrome, extracoronary vasculopathy screening, and recurrent SCAD. Expert opinion: Our understanding regarding the association of SCAD and other arteriopathies such as FMD is anticipated to grow. In addition, progress is likely to be made in our efforts to predict recurrent SCAD risk and define potential preventative strategies, possibly through the incorporation of adjunctive imaging.
Mercury and selenium in the Brazilian subtropical marine products: food composition and safety

Abstract In this study we estimate the content of mercury (Hg) and selenium (Se) in 32 fish and 6 shellfish species that represent the most intensively caught, consumed, and exported seafood species from the Brazilian subtropics. The mean Hg contents in three species of large carnivorous fish (i.e., shortfin mako; 502 μg kg−1; dusky grouper, 789 μg kg−1; school shark, 806 μgkg−1) were above the allowable limit (500 μg kg−1) for human consumption. However, the content of Se in the fin fish, as well as the shellfish, were substantially below (147 μgkg−1 ≤ Se ≤ 688 μgkg−1) what is considered safe for human consumption (i.e., 2000 μgkg−1). The only exception was in the deep-sea red crab sample, which exhibited an elevated Se content of ca. 5400 μg kg−1. Nevertheless, all studied species had mean Se:Hg molar ratios greater than 1:1, suggesting that human consumption of the studied sea food species are relatively safe with respect to their Hg content. The highest Se:Hg molar ratios were found in the shellfish species investigated, as well as the most sought after commercial fish. The calculated Se health benefit value index (Se-HBV, HBVSe), which is a qualitative measure of the ability of Se to mute the toxic effects of Hg, exhibited high positive values in most of the studied fish species, suggesting human consumption of these species was safe. An exception was sardine, an important species for producing canned fish, which exhibited the lowest HBV.
A Fully Integrated 50–280-GHz Frequency Comb Detector for Coherent Broadband Sensing

Broadband sensing and spectroscopy in millimeter wave and subterahertz frequencies can be facilitated with CMOS coherent detectors as a low-power, low-cost solution. This article presents a fully integrated coherent detector with a broadband frequency comb as an on-chip reference signal. The receiver incorporates a frequency comb generator, which provides a broadband comb as a reference for heterodyne detection, and an NMOS field-effect transistor as the heterodyne detector. It also includes an on-chip elliptical antenna with a periodic structure that enhances its directivity up to +10 dBi without using a lens. The receiver detects any arbitrary spectrum from 50 to 280 GHz with a resolution of 2 Hz by tuning the comb spacing of the reference signal from 100 MHz to 5 GHz. The chip is implemented in a standard 65-nm-CMOS process and it consumes 34-mW dc power.
Hand–object configuration estimation using particle filters for dexterous in-hand manipulation:

We consider the problem of in-hand dexterous manipulation with a focus on unknown or uncertain hand–object parameters, such as hand configuration, object pose within hand, and contact positions. In...
More Contract Lore

Contract lore consists of “traditional beliefs” about contract law that judges, lawyers, and scholars applying and writing about contract law, employ so routinely and confidently that the principles demonstrate how we perceive contract law today. Previously, I presented three illustrations of contract lore: First, expectancy damages put the injured party in as good a position as if there were no breach. Second, the reasons for a breach, “whether willful, negligent, or unavoidable, are irrelevant to the rules of performance and remedies.” Third, contract formation and interpretation focus on the parties’ intentions. None of these principles are factually or historically even close to true and are nothing more than myths. For example, expectancy damages rarely if ever make the injured party whole. Important remedial rules, such as the obligation of injured parties to pay their lawyers win or lose, the bar to the recovery of prejudgment interest, the preclusion of unforeseeable and unquantifiable damages, and the high bar to recover emotional distress damages, means that injured parties usually recover well-short of their lost expectancy. When pressed, most people with knowledge about contract law would admit that contract lore is not law. Nevertheless, why do these people invoke these “traditional beliefs” even though they are, in reality, nothing more than myths? I reckoned that “contract lore represents contracts people’s aspirations—their strong preference for how contract law should operate if realities did not preclude it.” Further, people tend to seek consistency in their beliefs, which “leads them to believe things that are not true and to avoid conflicting information.” As such, contract lore represents an example of the psychological phenomenon of cognitive dissonance. In this symposium article, I delve deeper into the phenomenon of contract lore. I offer additional examples that focus on the contract lore of consent in the context of standard-form contracting, “intention of the parties” in the context of gaps in contracts, and the requirement of a “bargained-for exchange” in the context of promise enforcement. Based on these examples, I don’t abandon cognitive dissonance as one explanation of contract lore, but I offer additional explanations and show that context play an important role in explaining contract lore. My ultimate goal is to show how contract lore sheds light on possible areas of contract law in need of reform.
I'm tired and it hurts! Sleep quality and acute pain response in a chronic pain population.

Abstract Objective/Background There are bidirectional links between sleep quality and pain, with recent research suggesting that sleep impairment more strongly predicts future pain than vice versa. Relatively few studies have examined the relationship between sleep quality and acute pain among chronic pain patients. The purpose of the current study is to investigate relationships among subjective sleep quality and behavioral and physiological responses to a cold pressor pain task (CPT) in chronic pain patients. Patients/methods In sum, 120 individuals with chronic pain were included. Participants completed a series of questionnaires followed by the CPT. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). Physiological baseline state and stress response were assessed before and during the CPT using heart rate (HR), electromyography frontalis (EMGF), galvanic skin response conductance (GSR), and skin temperature (°C). Multiple linear regressions adjusting for opioid usage were performed. Results After adjusting for opioid use, PSQI global score explained significant variance in pain tolerance (B = −5.37, β = −0.23, p = 0.01), baseline GSR (B = −0.66, β = −0.24, p = 0.01), and HR change from baseline to CPT (B = 1.33, β = 0.25, p = 0.01). Conclusions Worse perceived sleep quality was associated with lower pain tolerance, lower baseline GSR conductance, and greater HR change from baseline to CPT. These findings underscore the importance of accounting for opioid usage and psychological dimensions of pain in the relationship between sleep and acute pain response in chronic pain populations.
Thoracoscopic debridement for empyema thoracis.

Abstract Background/Purpose The success rate of early thoracoscopic debridement (TD) for childhood empyema was reviewed in light of the increasing reported incidence of empyema associated with pulmonary necrosis (PN). Methods Data were collected from 106 patients who underwent thoracoscopic intervention from 2010 to 2016. Twenty additional patients with severe PN/Bronchopleural Fistula (BPF) were not suitable for TD requiring thoracotomy and Serratus anterior digitation flap. Results 106 patients with a median age of 4 years (IQR 2–6 years) were considered for TD as primary intervention of which 3 needed conversion to thoracotomy. TD alone was successful in 93/106 however, 10 patients required subsequent minithoracotomy for PN/BPF (managed with Serratus anterior digitation flap). Counting conversions as failure, the overall success rate of TD was 88%. No statistical difference was demonstrable in success rate compared to our previous series (93% (106/114) vs 88% (93/106)). Conclusions Primary TD in pediatric empyema is associated with an excellent outcome achieving adequate drainage and full expansion of the lung. The majority of failures in our series were attributable to PN/BPF, requiring thoracotomy and Serratus anterior digitation flap. This is likely a consequence of the increasing incidence of necrotizing pneumonia. Level of evidence Level IV.
Antineoplastic drugs prescription during visits by adult cancer patients with comorbidities: findings from the 2010–2016 National Ambulatory Medical Care Survey

Cancer treatment may be affected by comorbidities; however, studies are limited. The purpose of this study is to examine the frequency of comorbidities at visits by patients with breast, prostate, colorectal, and lung cancer and to estimate frequency of a prescription for antineoplastic drugs being included in the treatment received at visits by patients with cancer and concomitant comorbidities. We used nationally representative data on visits to office-based physicians from the 2010–2016 National Ambulatory Medical Care Survey and selected visits by adults with breast, prostate, colorectal, or lung cancer (n = 4,672). Nineteen comorbid conditions were examined. Descriptive statistics were calculated for visits by cancer patients with 0, 1, and ≥ 2 comorbidities. From 2010–2016, a total of 10.2 million physician office visits were made annually by adult patients with breast, prostate, colorectal, or lung cancer. Among US visits by adult patients with breast, prostate, colorectal, or lung cancer, 56.3% were by patients with ≥ 1 comorbidity. Hypertension was the most frequently observed comorbidity (37.7%), followed by hyperlipidemia (19.0%) and diabetes (12.3%). Antineoplastic drugs were prescribed in 33.5% of the visits and prescribed at a lower percentage among visits by cancer patients with COPD (21.3% versus 34.3% of visits by cancer patients without COPD) and heart disease (22.7% versus 34.2% of visits by cancer patients without heart disease). Our study provides information about comorbidities in cancer patients being treated by office-based physicians in an ambulatory setting.
Quality Advantage? Provider Quality and Networks in Medicare Advantage

Medicare Advantage plans have grown significantly over the past decade and the potential for their future growth seems unabated. Astonishingly, however, we know little about how Medicare beneficiaries access services, particularly whether those services are of high quality. This study explores access to cardiac surgeons for coronary artery bypass grafting (CABG) and heart valve surgery in California and New York. It is one of the first studies to analyze Medicare Advantage networks and interactions between provider networks and provider quality. Results of the study show that for large metropolitan areas, access is rather similar for traditional Medicare and Medicare Advantage beneficiaries. Limitations, however, exist for the latter. Important concerns emerge for Medicare Advantage beneficiaries outside of metropolitan areas where healthcare market challenges appear to be exacerbated by carrier restrictions. Results indicate no evidence that carriers selectively contract to improve quality. There is, however, significant diversity with regard to network breadth; and, this breadth does not stay static across distances. These results hold important implications for the future of the Medicare program, network adequacy regulations, and how consumers make choices about their insurance coverage.
Building Political Capital: Engaging Families in Child Health Policy

* Abbreviations: AAP — : American Academy of Pediatrics CHIP — : Children’s Health Insurance Program As we reflect on the recent election, it is relevant to consider the variety of roles that pediatricians can play in supporting and promoting public policies that benefit child health. Pediatricians have historically used their knowledge and experience to advocate for children and families in a number of forums, including authoring opinion pieces and editorials, participating in interviews with the media, and meeting with policy makers. Although these forms of advocacy are important, they lack a key characteristic: enhancing the agency of our patients and families. Although pediatricians often convey anecdotes to channel families’ experiences and perspectives in these forums, this type of advocacy does little to strengthen the voices and political capital of the families and communities we serve. To better ensure that future policy-making is informed by what is best for children’s health and welfare, should we consider it our duty to encourage families to engage in civic discourse and advocacy themselves? Advocacy on behalf of children and families is widely recognized as a central tenet of our field. The Accreditation Council for Graduate Medical Education emphasizes this aspect of the pediatrician’s role by mandating that all residency programs incorporate training in child advocacy.1 The American Academy of Pediatrics (AAP) has also highlighted this responsibility in their policy statement on poverty and child health, in which they recommend that community pediatricians “advocate for public policies that … Address correspondence to Polina Krass, MD, Department of Pediatrics, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104. E-mail: krassp{at}email.chop.edu
Hyperphosphatemic Familial Tumoral Calcinosis Hidden in Plain Sight for 73 Years: A Case Report

While dental pulp calcifications and root anomalies may be inconsequential incidental findings in dental radiographs, they can, especially in combination, represent a clue, hidden in plain sight, for the diagnosis of hyperphosphatemic familial tumoral calcinosis (HFTC). HFTC is an autosomal recessive disease of mineral metabolism characterized by sometimes massive, painful calcification around large joints, systemic inflammation, dental pulp calcification, and thistle-shaped roots. This paper describes a woman with HFTC who endured not only the symptoms of HFTC for decades, but also the frustration of not knowing the cause. The diagnosis was finally made at the age of 73 years, when the connection between a large right shoulder calcification and hyperphosphatemia was made. The dental findings were likely present on her initial radiographs taken in childhood. Increased awareness of the association between characteristic dental findings and HFTC may allow for earlier diagnosis and interventions to improve the care of patients with this rare condition.
Female Genital Mutilation/Female Cutting/Female Circumcision

FGM is a manifestation of violence on girls and a fundamental breach of their rights; this custom is still practiced in a number of Arab countries, but does not include all Arab communities. Female genital mutilation (FGM) is one of the major forms of violence against girls and constitutes a clear violation of their rights. This traditional practice still exists in a number of Arab nations, although some countries, such as Jordan, Bahrain, Tunisia, Algeria, Syria, Palestine, Qatar, Morocco, and Lebanon, have all reported that such practices are not performed within their borders. Egypt has passed legislation criminalizing female circumcision and genital mutilation. In Yemen, the practice is prevalent in some coastal cities. The draft amendments to the Rights of the Child submitted to the country’s House of Representatives include legal provisions on the prohibition of female genital mutilation. Other countries have not provided any information regarding this issue to the LAS. The practice is also found elsewhere in Asia, the Middle East, and among communities from these areas around the world.
Pathways from Childhood Abuse and Other Adversities to Adult Health Risks: The Role of Adult Socioeconomic Conditions

Adverse childhood experiences (ACEs), including child abuse, have been linked with poor health outcomes in adulthood. The mechanisms that explain these relations are less understood. This study assesses whether associations of ACEs and health risks are mediated by adult socioeconomic conditions, and whether these pathways are different for maltreatment than for other types of adversities. Using the Behavioral Risk Factor Surveillance System 2012 survey (N=29,229), we employ structural equation modeling to (1) estimate associations of the number and type of ACEs with five health risks-depression, obesity, tobacco use, binge drinking, and self-reported sub-optimal health; and (2) assess whether adult socioeconomic conditions-marriage, divorce and separation, educational attainment, income and insurance status-mediate those associations. Findings suggest both direct and indirect associations between ACEs and health risks. At high numbers of ACEs, 15-20% of the association between number of ACEs and adult health risks was attributable to socioeconomic conditions. Associations of three ACEs (exposure to domestic violence, parental divorce, and residing with a person who was incarcerated) with health risks were nearly entirely explained by socioeconomic conditions in adulthood. However, child physical, emotional, and sexual abuse were significantly associated with several adult health risks, beyond the effects of other adversities, and socioeconomic conditions explained only a small portion of these associations. These findings suggest that the pathways to poor adult health differ by types of ACEs, and that childhood abuse is more likely than other adversities to have a direct impact.
Unsedated transnasal esophagoscopy for monitoring therapy in pediatric eosinophilic esophagitis

Background and Aims Unsedated transnasal endoscopy (TNE) is safer and less costly than sedated EGD. The aim of this study was to evaluate the performance of TNE with biopsies in monitoring the esophageal mucosa of pediatric patients with eosinophilic esophagitis. Methods Patients between 8 and 17 years of age with eosinophilic esophagitis and their parents were enrolled. Unsedated TNE was performed. A 2.8-mm (1.2-mm channel) or a 4-mm flexible bronchoscope (2-mm channel) was used, and esophageal biopsy specimens were obtained. Biopsy specimen analysis, duration, adverse events, and billing charges of TNE were assessed. Immediately after TNE and a minimum of 2 weeks later, a modified Group Health Association of America 9 survey and a preference questionnaire were completed, respectively. Results Twenty-one of 22 enrolled patients underwent TNE. TNE was performed with no serious adverse events. Histopathological analysis revealed 0 eosinophils per high-power field (n = 12), fewer than 15 eosinophils per high-power field (n = 4), and more than 15 eosinophils per high-power field (n = 5). The total epithelial surface area of mucosal biopsy samples from either TNE Forceps (1.2 mm or 2 mm biopsy channel forceps) compared with those obtained during the subject's previous EGD by using standard endoscopic forceps was not statistically different ( P = .308 [1.2 mm]/ P = .492 [2 mm]). All parents and 76.2% of subjects would undergo the TNE again. TNE was preferred over EGD by 85.7% of parents and 52.4% of subjects. The modified Group Health Association of America 9 survey revealed a high degree of satisfaction (average, 43.19 ± 2.6; maximum score, 45). Charges associated with TNE were 60.1% lower than for previous EGDs. Conclusions Unsedated TNE is an effective, lower-cost procedure for monitoring the esophageal mucosa of children with eosinophilic esophagitis.
Development of "organotypic" bioelectric activities in central nervous tissues during maturation in culture.

Publisher Summary This chapter discusses the bioelectric activities that develop in explants of vertebrate central nervous tissues during differentiation and maturation in vitro . The chapter also focuses on the remarkable degree of intrinsic self-differentiation, which has been demonstrated in long-term cultures of explants from various parts of the vertebrate neuraxis—spinal cord to cerebral cortex. Correlative electrophysiological and electron-microscopic analyses demonstrate that neurons in embryonic spinal-cord explants can form organized synaptic networks in vitro . Dorsal-root ganglia attached to these cord cross sections can develop functional connections with cord neurons. Axons from the latter may, in turn, grow into attached skeletal muscle tissue, leading to characteristic neuromuscular transmission. The entire spinal reflex arc is thus available for direct study during its formation in vitro . Bioelectric and ultrastructural data obtained during the growth of neonatal mouse cerebral cortex in culture reveal that a similar process of self-differentiation occurs. Primary evoked potentials and secondary oscillatory afterdischarges develop in cerebral explants and display a remarkable similarity to recordings from cerebral cortex in situ . Characteristic sensitivity of these complex bioelectric activities to various neuropharmacological agents provides further evidence of their organotypic nature.
Understanding tropism and immunopathological mechanisms of relapsing fever spirochaetes

Mice infected with relapsing fever (RF) spirochaetes survive recurrent waves of high-level bacteraemia with little, if any, clinical complications or tissue injury. In the absence of B-cells, peak bacteraemia does not resolve, resulting in multi-organ complications. During peak bacteraemia, large amounts of interleukin-10 (IL-10) are produced in blood and tissues. In mice unable to clear peak bacteraemia, exogenous IL-10 greatly reduced the clinical manifestations, serum levels of CXCL13, cerebral microgliosis, and the pathogen load. In contrast, IL-10 deficiency in mice unable to clear peak bacteraemia resulted in microvascular complications with distinct severities, depending on the serotype: serotype 2 (Bt2), which causes peak bacteraemia of c. 108/mL, resulted in rapid death from subarachnoid and intraparenchymal haemorrhage; in contrast, serotype 1, which causes peak bacteraemia of c. 107/mL, resulted in milder multi-organ haemorrhage and thrombosis. IL-10 deficiency also resulted in multi-organ haemorrhage and thrombosis with infarction in wild-type mice despite lower peak bacteraemia. Two mechanisms for pathogen control have been identified: antibody clearance of peak bacteraemia, and antibody-independent lowering of bacteraemia via phagocytosis in the spleen. IL-10 plays opposite roles in pathogen control, depending on the severity of bacteraemia: during persistent high bacteraemia, IL-10 helps to control it by protecting innate immune cells from apoptosis; in contrast, during transient peak bacteraemia, IL-10 slows down antibody-mediated clearance. A successful outcome from RF depends on a balanced immune response to clear bacteraemia while avoiding microvascular injury, in which production of IL-10, in response to the pathogen load, plays a critical role.
Integrated path planning and power management for solar-powered unmanned ground vehicles

This paper examines an integrated path planning and power management problem for a solar-powered unmanned ground vehicle (UGV). The proposed method seeks to minimize the travel time of the UGV through an area with a known energy density by designing an optimal path and allocating the vehicle's power among its electrical components, while the UGV operates under strict power constraints and harvests ambient environmental energy along the designed path. A scalar field is first established to evaluate the solar radiation density at discrete locations. A modified Particle Swarm Optimization method is applied to search for a minimal time path wherein the energy gathered is equal to or greater than the energy expended. The proposed modeling and optimization strategy is verified through computer simulation and experimental demonstration.
Extended N-Sulfated Domains Reside at the Nonreducing End of Heparan Sulfate Chains

Heparan sulfate (HS) serves as a cell-surface co-receptor for growth factors, morphogens, and chemokines. These HS and protein binding events depend on the fine structure and distribution of domains along an HS chain. A given domain can vary in terms of uronic acid epimer, N- and O-sulfate, and N-acetate content. The most highly sulfated regions of HS chains, N-sulfated (NS) domains, play prominent roles in HS and protein binding. We have analyzed HS oligosaccharides from various mammalian sources and provide evidence that NS domains residing at the nonreducing end (NRE) are, on average, longer than those residing in the internal regions of the chain. Additionally, they are more highly sulfated than their internal counterparts. These features are independent of the sulfation pattern of the bulk HS chains. From disaccharide analysis, it is clear that NS domains do not always occupy HS NREs. However, when they do, they tend to terminate in a subset of N-sulfated disaccharides. Our observations are consistent with a significant role of NRE NS domains in HS-growth factor interactions.
Integrated Care: Applying Theory to Practice

As integrated care (IC) continues to gain momentum, educators have recognized the need to explicitly teach the next generation of mental health professionals, and those already practicing in a trad...
Chapter 35. The Protein Structure Project, 1950–1959: First Concerted Effort of a Protein Structure Determination in the U.S.

Publisher Summary In the United States, protein crystallography was started in 1950, with the formation of the protein structure project (PSP) under the leadership of David Harker. At the beginning of the research, Harker and his men faced overwhelming problems including some technical obstructions also. By mid-fifties, it had become clear that the study of shrinkage stages of protein crystals was not going to lead to a structure. In principle, three isomorphous crystals are a necessary and sufficient condition to determine all the phases of a noncentrosymmetrical protein crystal. The derivation and mathematics of the multiple isomorphous replacement method was first described completely by Harker in a classic paper appearing as the first article of the first issue of Acta crystullographica in 1956. All that remained was to prepare several suitable heavy atom isomorphous derivatives of ribonuclease crystals to solve the protein phase angles and compute an electron density map that would reveal the structure at the atomic level. An unexpected by-product of the work was the very early observation of bonding electrons and the general acceptance of beryllium acetate crystals as an intensity standard. Many potential heavy atom derivatives were measured and analyzed with high hopes over a 2-3 year period only to spawn discouragement. But very soon, the 2.0Ǻ resolution map and structure of myoglobin was published. The effort received a significant boost in 1963 and the structure was solved at 2.0Ǻ resolution. It can be said safely that the tremendous progress and growth of protein crystallography worldwide over the last 30-40 years is probably stunning even to those with whom it originated. However, interactive computer graphics might well be the most crucial and important development of protein crystallography. Protein crystallography is indeed wondrous and is attracting the finest intellectual talent in the world.
Hsp90 chaperone complexes are required for the activity and stability of yeast protein kinases Mik1, Wee1 and Swe1

The Wee1 protein kinase negatively regulates entry into mitosis by mediating the inhibitory tyrosine phosphorylation of Cdc2-cyclin B kinase. The stability and activity of Wee1 from the fission yeast Schizosaccharomyces pombe is critically dependent on functional Hsp90 chaperones. Here we identify two related tyrosine protein kinases, Mik1 from fission yeast and its Saccharomyces cerevisiae homolog Swe1, as Hsp90 substrates and show that the kinase domain is sufficient to mediate this interaction. Morphological and biochemical defects arising from overexpression of the kinases in fission yeast are suppressed in the conditional Hsp90 mutant swo1-26. A subset of all three kinases is associated with the Hsp90 cochaperones cyclophilin 40 and p23. Under conditions of impaired chaperone function or treatment with the Hsp90 inhibitory drug geldanamycin, intracellular levels of the kinases are reduced and the proteins become rapidly degraded by the proteasome machinery, indicating that Wee1, Mik1 and Swe1 require Hsp90 heterocomplexes for their stability and maintenance of function.