cssi/SciSciGPT-SciSciNet huggingface dataset:
Profiling Substance Abuse Provider Trends in Health Care Delivery Systems

In profiling of health care providers, distinguishing extreme behavior from random variation with incomplete risk adjustment requires multiple observations on each profiling unit. Unlike typical health care delivery system studies, the US Department of Veterans Affairs (VA) information system does provide longer time series of data at individual, institutional and system levels. This information resource allows us to develop incisive profiling analyses that isolate and highlight system wide improvements and institution-specific profiles in the context of risk adjustments using several covariates. This is illustrated here in the context of substance abuse care. One common process monitor for systems delivering substance abuse care is follow-up outpatient care within a certain number of days after inpatient substance abuse discharges. The VA system provides ten years of such data, at the individual level, and we employ this to build hierarchical models that profile providers within the system. Our models use logistic regression, longitudinal random effects models at the individual patient level, combined with simple time series models of institutional effects across years. This structure effectively captures variability across hospitals within each year as well as systematic dependencies within hospitals from year to year. Analysis depends on Markov chain Monte Carlo methods to derive posterior inferences for all parameters. Results indicate significant system wide improvement in the monitor in addition to large amounts of variation in this improvement across medical centers. Covariates such as age of patient, VA treatment priority, and diagnoses (where psychotic patients have lower return rates) help to illustrate important potential new health policy interventions and the outcomes of previous interventions.
Relating Health Locus of Control to Health Care Use, Adherence, and Transition Readiness Among Youths With Chronic Conditions, North Carolina, 2015.

Introduction Health locus of control refers to the belief that health is in one's control (internal control) or is not in one's control (external control). Among adults, external locus of control is associated with negative health outcomes, whereas internal locus of control is associated with favorable outcomes. Few studies examined these associations among youths. The objective of our study was to determine how locus of control relates to health care use, medication adherence, missed school, and readiness for transition to adult medical care for youths with chronic conditions. Methods Participants at a camp for youths aged 6 to 17 years with chronic health conditions completed a survey measuring locus of control, readiness for transition to adult care, and medication adherence. Their parents completed a separate part of the survey about health care use and missed school days in the past year. Results A total of 163 youths completed the survey (78.5% white; 52.1% female; mean age, 12.3 y). Internal locus of control (β = 0.196; P = .013) and external Doctor locus of control with doctors controlling disease (β = 0.181; P = .025) were positively associated with transition readiness. External control by chance or with others controlling disease was negatively associated with transition readiness (β = -0.248; P = .002) and positively associated with emergency department visits (β = 0.225; P = .004) and with number of hospital inpatient nights at hospital (β = 0.166; P = .04). Conclusion Adolescents with external control of their health by chance or by other people are at increased risk for negative health outcomes and may fail to develop the self-management skills needed for successful transitioning to adult care. Future studies should examine effects of changes in locus of control on health outcomes among youths.
Anthropomorphic Test Devices and Injury Risk Assessments

Anthropomorphic test devices (ATDs), commonly referred to as dummies, are mechanical surrogates of the human that are used by the automotive industry to evaluate the occupant protection potential of various types of restraint systems in simulated collisions of new vehicle designs. Dummies are classified according to size, age, sex and impact direction. There are adult male and female dummies of different sizes, and child dummies that represent different ages. These dummies are used to assess occupant protection in frontal, side, rear and rollover collision simulations. The midsize adult male dummy is the most utilized size in automotive restraint testing. It approximates the median height and weight of the 50th percentile adult male population. The heights and weights of the small female and large male adult dummies are approximately those of the 5th percentile female and the 95th percentile male, respectively. The adult dummies are referred to as small female, midsize male and large male to avoid debates about whether the dimensions are consistent with the latest published percentile classifications. Child dummies have the median heights and weights of children of the specific age groups that they represent without regard to sex. They are referred to by age.
The Role of the Molecular Clock in Skeletal Muscle and What It Is Teaching Us About Muscle-Bone Crosstalk

Purpose of Review This review summarizes what has been learned about the interaction between skeletal muscle and bone from mouse models in which BMAL1, a core molecular clock protein has been deleted. Additionally, we highlight several genes which change following loss of BMAL1. The protein products from these genes are secreted from muscle and have a known effect on bone homeostasis.
Änderungen der regionalen Hirndurchblutung während einer willkürlichen, sequentiellen Fingerbewegung bei Patienten mit cerebellärer Degeneration

Das Cerebellum spielt uber offene und geschlossene Projektionsschleifen fur die Planung und Ausfuhrung von Bewegungen eine wichtige Rolle (Allen und Tsukahara 1974). Man kann deshalb annehmen, das verschiedene, insbesondere auch supratentorielle Hirnareale bei Patienten mit Kleinhirndegeneration infolge des cerebellaren Defizites eine veranderte Funktion aufweisen. Der Nachweis einer diffuseren und bilateralen topographischen Verteilung bewegungsbezogener langsamer Hirnpotentiale bei diesen Patienten weist in diese Richtung (Wessel et al. 1991; Tarkka et al. 1993). Wir haben deshalb mit der Methode der Positronenemissionstomographie (PET) Anderungen der regionalen Hirndurchblutung wahrend einer willkurlichen sequentiellen Fingerbewegung bei Patienten mit cerebellarer Degeneration im Vergleich zu einer altersentsprechenden normalen Kontrollgruppe untersucht.
Lost in transition? Sexuality and justice in post-conflict Northern Ireland

Northern Ireland has pioneered the delivery of transitional justice, largely as a result of its troubled past. Efforts to guide this long-divided society towards greater inclusion have been facilitated by a range of processes (judicial and otherwise) designed to deliver truth, justice and accountability. Legal requirements to consider a broader demographical representation in consultations means that lesbian, gay, bisexual and transgender voices are increasingly evident in this transition. Yet continued political resistance to sexual minority equality, set against a backdrop of wider social integration, indicates the piecemeal approach to progress which is being adopted. This article critically analyses the socio-legal positioning of sexual minorities in Northern Ireland’s ongoing processes of transitional justice. In addressing how sexual orientation fits with the driving factors underpinning a move towards a ‘post-conflict’ society, the analysis queries the heteronormative cultural dynamics informing this utopian future and the impact this may have on exacerbating rather than eradicating homophobic victimisation.
Grid adequacy and cooperation in central america: A data-driven analysis

Central America has the highest penetration of non-hydro renewable energy in the Western hemisphere. Grid adequacy evaluations are critical for such countries due to accelerating demand growth, constrained financial resources, and the inherent variability of renewables. A regional interconnection (SIEPAC) was constructed in the region to allow cooperation and coordination between national grids. This study calculates the Loss of Load Expectation (LOLE) and Effective Load Carrying Capacities (ELCC) for three countries connected to SIEPAC (Nicaragua, Costa Rica, and Panama) for years 2013–2015. The results show that Costa Rica and Panama have significant excess capacities deriving mostly from hydropower. Further, results show that regional excess capacity sharing would allow Nicaragua to reduce its thermal capacity while maintaining an acceptable LOLE. Specifically, at current capacity levels and expected demand growth, Nicaragua in 2015 only required 31% of its thermal capacity and would not require its full thermal capacity until 2025.
Thermolysis Parameters Measurements of Tetra Pak Waste Packages in High Temperatures

This article presents investigation of thermolysis called commonly as pyrolysis, of Tetra Pak waste packages containing paperboard, LDPE and aluminium. Thermolysis of Tetra Pak waste allows recovery of energy and range of resources including: aluminium, coke, and other chemical substances in form of liquids, waxes, and flammable gases. The work is focused on measurement and calculations of: effect of heating rate on the process, effect of target temperature on process duration, yields of products at each target temperature, and energy demand. Experiments were carried out on real used printed Tetra Pak waste packages. Thermolysis was applied without carrier gas in airtight sealed crucible, with absence of oxygen, in high temperatures: 600 °C, 700 °C, 800 °C. Collected data indicates that heating rate and target temperature does not affect yields of products. The process consumes small amount of heat, less than 600 MJ/Mg of waste, and does not require waste preparation.
Flux Balance Analysis Identifies Distinct NADPH Production Strategies Across NCI 60 Cancer Cell Lines

Flux Balance Analysis is a linear mathematical procedure which determines the set of reaction fluxes to produce a maximum flux of a reaction of interest. In this study, a core cancer model developed by Zielinski et al. 2017 is constrained by a set of 59 cancer cell type specific uptake and secretion rates. Optimizing for cell type specific biomass objective reactions and examining serine flux distributions reveals variability in production of NADPH. In many cell lines, production of NADPH is correlated to biosynthetic demand, however, outliers exist that produce excess NADPH beyond that of biomass demand. These outliers are first characterized by their NADPH production strategy (pentose phosphate pathway or a combination of One Folate Cycle and Malic Enzyme) and then the factors responsible for the different NADPH production strategies are identified. Results indicate that pentose phosphate pathway (PPP) producing NADPH cell lines had reprogrammed tricarboxylic acid cycle metabolism to meet the demand for decreased flux through glycolytic enzymes, while one folate cycle and malic enzyme (OFC + ME) producing NADPH cell lines had higher threonine, tyrosine and serine uptake.
Some Topics in Transmutation

A few of the principal themes from transmutation theory as developed over the past four years or so in [5-35] are formally indicated in this survey and some of the more recent results (mainly work carried out since the appearance of the book [19]) are sketched in more detail.
Attention scales according to inferred real-world object size.

Natural scenes consist of objects of varying shapes and sizes. The impact of object size on visual perception has been well-demonstrated, from classic mental imagery experiments1, to recent studies of object representations reporting topographic organization of object size in the occipito-temporal cortex2. While the role of real-world physical size in perception is clear, the effect of inferred size on attentional selection is ill-defined. Here, we investigate whether inferred real-world object size influences attentional allocation. Across five experiments, attentional allocation was measured in objects of equal retinal size, but varied in inferred real-world size (for example, domino, bulldozer). Following each experiment, participants rated the real-world size of each object. We hypothesized that, if inferred real-world size influences attention, selection in retinal size-matched objects should be less efficient in larger objects. This effect should increase with greater attentional demand. Predictions were supported by faster identified targets in objects inferred to be small than large, with costlier attentional shifting in large than small objects when attentional demand was high. Critically, there was a direct correlation between the rated size of individual objects and response times (and shifting costs). Finally, systematic degradation of size inference proportionally reduced object size effect. It is concluded that, along with retinal size, inferred real-world object size parametrically modulates attention. These findings have important implications for models of attentional control and invite sensitivity to object size for future studies that use real-world images in psychological research. Nearby small objects appear larger than distal large objects, reflecting a dissociation between perceived and actual object size. Collegio et al. show that inferences of true object size scale spatial attention to objects.
Affirmative Disclosure at the FTC: Strategic Dimensions:

This paper builds on previous work by the author on a framework for understanding affirmative action orders by the FTC. Specifically, this paper moves from the abstract level of goals, objectives, ...
VEGF/Neuropilin Signaling in Cancer Stem Cells

The function of vascular endothelial growth factor (VEGF) in cancer extends beyond angiogenesis and vascular permeability. Specifically, VEGF-mediated signaling occurs in tumor cells and this signaling contributes to key aspects of tumorigenesis including the self-renewal and survival of cancer stem cells (CSCs). In addition to VEGF receptor tyrosine kinases, the neuropilins (NRPs) are critical for mediating the effects of VEGF on CSCs, primarily because of their ability to impact the function of growth factor receptors and integrins. VEGF/NRP signaling can regulate the expression and function of key molecules that have been implicated in CSC function including Rho family guanosine triphosphatases (GTPases) and transcription factors. The VEGF/NRP signaling axis is a prime target for therapy because it can confer resistance to standard chemotherapy, which is ineffective against most CSCs. Indeed, several studies have shown that targeting either NRP1 or NRP2 can inhibit tumor initiation and decrease resistance to other therapies.
Second Chances: Does Allowing Homework Resubmissions Affect Student Learning?

In our quest to create conditions for greater and more powerful learning for our students, we have experimented with giving students a chance to resubmit programming assignments. The resubmission option would come after they receive a grade and feedback on their original submission. This paper describes a quantitative study of an introductory Java programming course at Brandeis University where we offered the resubmission option. We show a particular approach to collecting and analyzing the data and reach preliminary conclusions about the impact of resubmissions on learning outcomes.
“I Want to See Those Memories”: Social Affordances of Mobile Phone Cameras and Social Network Sites in Collegiate Drinking:

Alcohol use remains a prominent feature of American collegiate social life. Emerging technological developments, particularly the proliferation of mobile phone cameras and the easy sharing of digital images on social network sites, are now widely integrated into these drinking practices. This paper presents an exploratory study examining how 40 students on a mid-sized college campus in the interior Pacific Northwest incorporate these technologies into their drinking activities. Data from semi-structured interviews are considered within the theoretical framework of 'affordances', which classifies material technologies (camera phones, social network sites) as simultaneously inhabiting the role of artifact shaped by human action and of object that influences human conduct. Our data suggest that although contemporary college drinking reflects longstanding practices, cameras, digital images, and social media introduce new dimensions to college alcohol consumption and memory making processes. These technologies are used to chronicle and archive the festive, social aspects of drinking; commemorate the good times that make up the college experience, and capture proud or incautious displays of excessive drinking. Our examination of emergent college drinking practices seeks to extend understandings of contemporary trends in collegiate alcohol use beyond the discourse of risk and indiscretion to include other important social and cultural dimensions of these phenomena, including pro-social aspects of these practices and the social affordances provided by digital image sharing and reminiscing.
Glucocorticoid–immune response to acute stress in women and men living with HIV

Despite high risk for serious non-AIDS events (SNAEs) and accelerated age-related increases in inflammatory markers relative to HIV+ men, HIV+ women have been understudied, particularly in terms of stress impacts on immune parameters. The purpose of this study was to examine sex differences in glucocorticoid–immune stress response in mid-life HIV+ individuals, as poor glucocorticoid control of stress-induced inflammation may contribute to health risk in HIV+ women. Male and female participants completed a threat of shock laboratory stressor. Serum cortisol and cytokines [interleukin (IL)-6, IL-8, IL-10, IL-1β, C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interferon (IFN)-γ] were assessed at six timepoints prior to and in response to the stressor. Participants included 8 HIV− controls (n = 5 female) and 9 HIV+ (n = 5 female) who were virally suppressed. Repeated measures mixed models revealed a significant sex by HIV status by time interaction for IL-10, IL-1β, TNF-α, and cortisol. IL-10 response, an anti-inflammatory cytokine, was larger in males than females, regardless of HIV status. TNF-α response was blunted in HIV+ individuals compared with HIV−, and specifically in HIV+ women, IL-1β and cortisol response were blunted. Individuals living with HIV may have impaired coordination between the immune system and hypothalamic pituitary adrenal (HPA) axis. HIV+ women in particular exhibited dysregulated IL-1β and cortisol response to acute stress. Future work should focus on relationships among proinflammatory cytokines, stress, and SNAEs in HIV, with attention to sex as a biological variable.
The Origin of Anti-Hispanic Rhetoric - The Spanish Black Legend

This demonstration is meant to educate the community about a topic called The Spanish Black Legend. The demonstration will feature interactive components meant to engage the general public and pique their interest in learning more about the source and history of Anti-Hispanic Rhetoric. The demonstration will include interactive features through a timeline-based strategy where the user will visualize the events of the Spanish Black Legend as they move through their story. The timeline-based strategy will be used to clearly demonstrate the history of Anti-Hispanicism as it began and has manifested into the way society presently speaks about and treats Chicanx and Latinx peoples. This demonstration will be displayed on a tablet with the hopes that conference attendees interact with the story from beginning to end and walk away with a deeper understanding of a topic that is very pertinent in today's political climate. The goal of this platform is to educate about this topic while providing an opportunity for users to share their thoughts and experiences with each other both during and after the demonstration.
Surviving orthodontic graduate debt: Making correct career choices to manage debt re-payment, reduction or forgiveness .

ABSTRACT Monetary pitfalls and traps await unwary residents upon graduation. The path to a financially satisfying personal and professional life is obtainable despite high student loan debt and lim...
Identifying Aerosolized Cyanobacteria as an Environmental Risk Factor for ALS using Human Bronchoalveolar Lavage and Nasal Swab Specimens (P4.449)

Objective: To determine if aerosol is a potential route of cyanobacteria (CB) exposure in humans, and a possible risk factor for neurodegeneration in amyotrophic lateral sclerosis (ALS). Background: Exposure to the CB toxin β-N-Methylamino-L-alanine (BMAA) has been implicated as an environmental risk factor for ALS. Our earlier epidemiologic studies of waterbodies with CB blooms in Northern New England suggest that inhalation of CB toxins may be a possible mode for human exposure. Design/Methods: Seventeen non-ALS participants undergoing diagnostic bronchoscopy from Dartmouth-Hitchcock Medical Center consented to donate right upper lobe BALF and/or NS specimens. BALF samples were processed using standard cytocentrifuge methods and aliquots were reserved for nested 16s rDNA polymerase chain reaction (PCR). BALF and NS slides were analyzed using fluorescence microscopy (FM) to identify CB cells expressing phycocyanobilin pigments. “Fiji” software was used to analyze images for CB using a macro developed to measure fluorescent particles with ≥95% circularity for area and feret diameter. Purified CB was used as a positive control and analyzed following the same protocol as BALF and NS samples. Results: 70.5% of BALF samples tested positive for CB using PCR. 91.6% of the PCR-positive BALF samples had CB detectable by FM, compared to only 20% of the PCR-negative samples. Independent samples t-tests found no significant differences between feret diameter of NS CB cells (Mean=2.85μm, SD=0.760μm) versus controls (Mean=3.19μm, SD=0.767μm); p= 0.486; and area of NS CB cells (Mean=4.48μm2, SD=2.91μm2) versus control CB cells (Mean=5.82μm2, SD=2.71μm2); p= 0.245. Conclusions: These data suggest that humans may inhale aerosolized CB which can be harbored in the nostrils and, in some cases, the lungs. This is consistent with the hypothesis that aerosol may be a significant route of CB transmission. With chronic exposure, we postulate that this could represent an environmental risk factor for ALS. Study Supported by: Diamond Research Development Award - Neurology, Dartmouth-Hitchcock Medical Center Disclosure: Dr. Facciponte has nothing to disclose. Dr. Bough has nothing to disclose. Dr. Rauh has nothing to disclose. Dr. Carroll has nothing to disclose. Dr. Seidler has nothing to disclose. Dr. Dessaint has nothing to disclose. Dr. Vaickus has nothing to disclose. Dr. Henegan has nothing to disclose. Dr. Butt has nothing to disclose. Dr. Andrew has nothing to disclose. Dr. Stommel has nothing to disclose.
Acquired hypogammaglobulinemia and pathogen‐specific antibody depletion after solid organ transplantation in human immunodeficiency virus infection: A brief report

Hypogammaglobulinemia (HGG) frequently occurs in recipients after types of (SOT). The incidence and significance of HGG in HIV+ recipients of SOT are just being explored. We reported that 12% of the recipients in the SOT in multi-center HIV-TR (HIV-TR) Study developed moderate or severe HGG at 1 year. In LT recipients, this was associated with serious infections and death. We have now further characterized the decreased antibodies in HIV+ SOT recipients who developed HGG. We measured the levels of pathogen-specific antibodies and poly-specific self-reactive antibodies (PSA) in relation to total IgG levels from serial serum samples for 20 HIV+ SOT recipients who developed moderate to severe HGG following SOT. Serum antibody levels to measles, tetanus toxoid, and HIV-1 were determined by EIA. Levels of PSAs were determined by incubating control lymphocytes with patient serum, staining with anti-human IgG Fab-FITC, and analysis by flow cytometry. Levels of PSA were higher compared to healthy, HIV-uninfected controls at pre-transplant baseline and increased by weeks 12 and 26, but the changes were not significant. Likewise, anti-HIV antibody levels remained unchanged over time. In contrast, antibody levels against measles and tetanus were significantly reduced from baseline by week 12, and did not return to baseline, even after 2 years. For HIV patients who develop moderate to severe HGG after transplant, the reduction in IgG levels is associated with a significant decrease in pathogen-specific antibody titers, while PSA levels and anti-HIV antibodies are unchanged. This may contribute to infectious complications and other clinical endpoints.
4-Manifold Invariants From Hopf Algebras

The Kuperberg invariant is a topological invariant of closed 3-manifolds based on finite-dimensional Hopf algebras. In this paper, we initiate the program of constructing 4-manifold invariants in the spirit of Kuperberg's 3-manifold invariant. We utilize a structure called a Hopf triplet, which consists of three Hopf algebras and a bilinear form on each pair subject to certain compatibility conditions. In our construction, we present 4-manifolds by their trisection diagrams, a four-dimensional analog of Heegaard diagrams. The main result is that every Hopf triplet yields a diffeomorphism invariant of closed 4-manifolds. In special cases, our invariant reduces to Crane-Yetter invariants and generalized dichromatic invariants, and conjecturally Kashaev's invariant. As a starting point, we assume that the Hopf algebras involved in the Hopf triplets are semisimple. We speculate that relaxing semisimplicity will lead to even richer invariants.
The value of kinetic glomerular filtration rate estimation on medication dosing in acute kidney injury.

Author(s): Kwong, Yuenting D; Chen, Sheldon; Bouajram, Rima; Li, Fanny; Matthay, Michael A; Mehta, Kala M; Glidden, David V; Liu, Kathleen D | Abstract: BackgroundIn acute kidney injury (AKI), medication dosing based on Cockcroft-Gault creatinine clearance (CrCl) or Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rates (eGFR) are not valid when serum creatinine (SCr) is not in steady state. The aim of this study was to determine the impact of a kinetic estimating equation that incorporates fluctuations in SCrs on drug dosing in critically ill patients.MethodsWe used data from participants enrolled in the NIH Acute Respiratory Distress Syndrome Network Fluid and Catheters Treatment Trial to simulate drug dosing category changes with the application of the kinetic estimating equation developed by Chen. We evaluated whether kinetic estimation of renal function would change medication dosing categories (≥60, 30-59, 15-29, and l15mL/min) compared with the use of CrCl or CKD-EPI eGFR.ResultsThe use of kinetic CrCl and CKD-EPI eGFR resulted in a large enough change in estimated renal function to require medication dosing recategorization in 19.3% [95 CI 16.8%-21.9%] and 23.4% [95% CI 20.7%-26.1%] of participants, respectively. As expected, recategorization occurred more frequently in those with AKI. When we examined individual days for those with AKI, dosing discordance was observed in 8.5% of total days using the CG CrCl and 10.2% of total days using the CKD-EPI equation compared with the kinetic counterparts.ConclusionIn a critically ill population, use of kinetic estimates of renal function impacted medication dosing in a substantial proportion of AKI participants. Use of kinetic estimates in clinical practice should lower the incidence of medication toxicity as well as avoid subtherapeutic dosing during renal recovery.
Hospital complications and costs of spinal arteriovenous malformations in the United States from 2002-2014.

BACKGROUND Spinal arteriovenous malformations (AVMs) are rare disease entities with significant morbidity if untreated. Risk factors of complications, hospitalization and costs-of-care remain in need of characterization. METHODS Using the National Inpatient Sample years 2002-2014, adult subjects with spinal AVMs who underwent either laminectomy with lesion excision or endovascular embolization were extracted using ICD-9-CM diagnostic code 747.82. Predictors of inpatient complications, hospital length of stay (HLOS), and discharge home were evaluated using multivariable regression. Cost was evaluated using inflation-adjusted healthcare cost [charge*(cost/charge ratio)]. Mean differences (B), odds ratios (OR) and 95% CIs are reported. Significance was assessed at P<0.001. RESULTS In 2546 weighted admissions, age was 54.4±16.5-years (laminectomy: 70.0%, embolization: 30.0%). Fifteen percent suffered inpatient complications. Cost of hospitalization was $ 41216±38511 and was elevated for subjects with complications ($67571±2636, vs. no complications: $36562±723, P<0.001). Increased costs for categories of complications ranged from $ 16525 (renal/urinary) to $62246 (thromboembolism). In surgical subjects, complications were more costly ($ 69761±2896, vs. no complications: 36520±809, P<0.001). On multivariable analysis, major/extreme disease severity and major/extreme mortality risk were associated with increased complications and HLOS (P<0.001). Elective admissions had shorter HLOS (B=-4.3-days, [-4.8, -3.8], P<0.001) and higher odds of discharge home (OR=2.6 [2.1-3.2], P<0.001). Laminectomy (vs. embolization) was associated with complications (OR=2.6, 95% CI [1.7-3.8], P<0.001), HLOS (B=3.4-days [2.9-4.0], P<0.001), and decreased discharge home (OR=0.3 [0.2-0.4], P<0.001). CONCLUSIONS In spinal AVMs, high disease severity, non-elective admissions, and surgery are associated with complications, HLOS, and discharge to a non-home facility. Costs are elevated in patients suffering complications. Future studies are warranted.
How are SLPs managing services for people with mild aphasia

At present, there is limited information on the nature and extent of speech-language pathology services in the U.S. specific to people with mild aphasia (PWMA). The goal of the present study was to determine how speech-language pathologists (SLPs) perceive the assessment, treatment, and discharge of PWMA. According to anecdotal reports from SLPs and PWMA, current services may be inadequate and those with more severe aphasia types are being prioritized. To investigate factors potentially limiting SLP involvement and to determine gaps in service, a 26-question survey, consisting of both open-ended and closed-ended questions, was developed and distributed via email and social media to selected groups of SLPs. A total of 133 SLPs responded to the survey. In this brief report, we discuss only the primary findings. Reports of assessment, treatment, and discharge procedures were diverse; however, a number of central themes were observed. The majority of respondents had more than ten years of experience. They reported greater use of informal measures in assessing people with mild aphasia as compared to people with more severe forms of aphasia. Discharge procedures and recommendations were found to involve primarily referrals to the next level of care, recommendations for continued social interaction, and maintenance programs to preserve treatment progress. Responses tended to be appropriate, yet, not necessarily indicative of the actual standard of care. SLPs reported the need for additional assessment tools and resources in order to better serve people with mild aphasia. Perceived constraints included large caseloads, resource limitations, awareness of health professionals, and the prioritization of those with more severe deficits. Information gathered in this survey highlights the gap in services for this population and provides some tangible guidelines for how to proceed. Given that PWMA have the greatest chance of returning to work, we argue that any prioritization bias should lean toward favoring this population.
THE UTILITY OF POSITRON EMISSION TOMOGRAPHY (PET) MYOCARDIAL PERFUSION IMAGING (MPI) IN THE ASSESSMENT OF CORONARY ARTERY DISEASE IN PATIENTS WITH APICAL HYPERTROPHIC CARDIOMYOPATHY: FRIEND OR FOE?

Exertional chest pain with abnormal ECGs are not uncommon in patients with apical hypertrophic cardiomyopathy (aHCM). It is difficult to exclude the presence of flow limiting coronary artery disease A 73-year-old Female with history of aHCM, CAD who presented with severe exertional substernal chest
Human Immunodeficiency Virus Training Pathways in Residency: A National Survey of Curricula and Outcomes.

BACKGROUND The Ending the HIV Epidemic initiative, which aims to decrease the annual incidence of HIV infections in the United States (US) by 90% over the next decade, will require growth of a limited HIV provider workforce. Existing HIV training pathways within Family Medicine (FM) and Internal Medicine (IM) residency programs may address the shortage of HIV medical providers, but their curricula and outcomes have not previously been assessed. METHODS We identified HIV residency pathways via literature review, Internet search, and snowball sampling and designed a cross-sectional study of existing HIV pathways in the US. This survey of pathway directors included 33 quantitative items regarding pathway organization, curricular content, graduate outcomes, and challenges. We used descriptive statistics to summarize responses. RESULTS Twenty-five residency programs with dedicated HIV pathways in the US were identified (14 FM and 11 IM), with most located in the West and Northeast. All 25 (100%) pathway directors completed the survey. Since 2006, a total of 228 residents (77 FM and 151 IM) have graduated from these HIV pathways. Ninety (39%) of 228 pathway graduates provide primary care to persons with HIV (PWH). CONCLUSIONS HIV pathways are effective in graduating providers who can care for PWH, but generally are not located in nor do graduates practice in the geographic areas of highest need. Our findings can inform quality improvement for existing programs, development of new pathways, and workforce development strategies. Specifically, expanding pathways in regions of greatest need and incentivizing pathway graduates to work in these regions could augment the HIV workforce.
Trustworthy Human-Centered Automation Through Explainable AI and High-Fidelity Simulation.

As we become more competent developers of artificially intelligent systems, the level of deployment and associated implicit trust in these systems will increase in kind. While this is an attractive concept, with an already-demonstrated capability to positively disrupt industries around the world, it remains a dangerous premise that demands attention and intentional resource allocation to ensure that these systems’ behaviors match our expectations. Until we can develop explainable AI techniques or high-fidelity simulators to enable us to examine the models’ underlying logic for the situations we intend to utilize them in, it will be irresponsible to place our trust in their ability to act on our behalf. In this work we describe and provide guidelines for ongoing efforts in using novel explainable AI techniques and high-fidelity simulation to help establish shared expectations between autonomous systems and the humans who interact with them, discussing collaborative robotics and cybersecurity domains.
Material Adverse Effect Clauses and the COVID-19 Pandemic: How Sophisticated Parties Allocate Risk Contractually (preprint)

Currently pending in the Delaware Court of Chancery and other courts around the country are numerous cases in which the parties to a public-company merger agreement are disputing whether the target (the company being sold) has suffered a "material adverse effect" (an MAE) because of the COVID-19 pandemic. Tremendous amounts of money are at stake in such cases. In the LVHM-Tiffany transaction, for example, if Tiffany has suffered an MAE, LVHM may terminate the agreement and walk away from the deal; otherwise, it will likely have to close and pay the full $16.6 billion purchase price for a company that, it says, is no longer worth anywhere near that amount. Sophisticated commercial parties allocate between them risks that may materialize during the pendency of the merger through MAE clauses, extremely elaborate contractual provisions that have given rise to more litigation than any other standard provision in public-company merger agreements. This short essay considers how courts will construe MAE clauses in connection with the COVID-19 pandemic and, in so doing, explains more generally how sophisticated parties allocate risks efficiently in order to create value in business combination transactions.
Decoupling Capacitor Design for Multi-Inverter Based Grid Emulator System

CURENT's grid emulator contains multiple inverters to mimic the behaviors of several grid elements. The filtering inductor at the ac terminal of an inverter filters out the switching ripple current. However, the voltage on the point of common coupling (PCC) still contains switching harmonics. A decoupling capacitor at the PCC can effectively suppress the switching ripple voltage and improve voltage quality of the grid emulator. This paper provides a reduced order model of the multi-inverter system. With this reduced model, the PCC voltage harmonics can be derived. The decoupling capacitor of the PCC is designed to suppress the switching ripple based on the reduced model. Simulation and experimental results are provided to validate the proposed model and the decoupling capacitor design.
Fluid Transient Analysis During Priming of Evacuated Line

Water hammer analysis in pipe lines, in particularly during priming into evacuated lines is important for the design of spacecraft and other in-space application. In the current study, a finite volume network flow analysis code is used for modeling three different geometrical configurations: the first two being straight pipe, one with atmospheric air and other with evacuated line, and the third case is a representation of a complex flow network system. The numerical results show very good agreement qualitatively and quantitatively with measured data available in the literature. The peak pressure and impact time in case of straight pipe priming in evacuated line shows excellent agreement.
Pediatric patients with dog bites presenting to US children’s hospitals

Background To characterize pediatric dog bite injuries presenting to US children's hospitals and identify factors associated with clinically significant injuries. Methods We performed a multicenter observational study from 26 pediatric hospitals between July 1, 2010, and June 30, 2020, including patients ≤ 18 years with dog bites, consolidating together encounters from patients with multiple encounters within 30 days as a single episode of care. We characterized diagnoses and procedures performed in these patients. We used generalized linear mixed models to identify factors associated with a composite outcome that we term clinically significant injuries (defined as admission, operating room charge, sedation, fractures/dislocations, intracranial/eye injury, skin/soft tissue infection, or in-hospital mortality). Results 68,833 episodes were included (median age 6.6 years [interquartile range 3.5-10.4 years], 55.5% male) from 67,781 patients. We identified 16,502 patients (24.0%) with clinically significant injuries, including 6653 (9.7%) admitted, 5080 (7.4%) managed in the operating room, 11,685 (17.0%) requiring sedation, 493 (0.7%) with a skull fracture, 32 (0.0%) with a fracture in the neck or trunk, 389 (0.6%) with a fracture of the upper limb, 51 (0.1%) with a fracture in the lower limb, 15 (0.0%) with dislocations, 66 (0.1%) with an intracranial injury and 164 (0.2%) with an injury to the eyeball, 3708 (5.4%) with skin/soft tissue infections, and 5 (0.0%) with in-hospital mortality. In multivariable analysis, younger age (0-4 years, 5-9 years, and 10-14 years relative to 15-18 years), weekday injuries, and an income in the second and third quartiles (relative to the lowest quartile) had higher odds of clinically significant injuries. Black patients (relative to White), Hispanic/Latino ethnicity, and private insurance status (relative to public insurance) had lower odds of clinically important injuries. When evaluating individual components within the composite outcome, most followed broader trends. Conclusion Dog bites are an important mechanism of injury encountered in children's hospitals. Using a composite outcome measure, we identified younger, White, non-Hispanic children at higher risk of clinically significant injuries. Findings with respect to race and ethnicity and dog bite injuries warrant further investigation. Results can be used to identify populations for targeted prevention efforts to reduce severe dog bite injuries.
Impacts of prescription drug monitoring program policy changes and county opioid safety coalitions on prescribing and overdose outcomes in California, 2015-2018.

Abstract In 2015, California received funding to implement the Prescription Drug Overdose Prevention Initiative, a 4-year program to reduce deaths involving prescription opioids by 1) leveraging improvements to California's prescription drug monitoring program (PDMP) (i.e., mandatory PDMP registration for prescribers and pharmacists), and 2) supporting county opioid safety coalitions. We used statewide data from 2011 to 2018 to evaluate the Initiative's impact on opioid prescribing and overdose rates. Prescribing data were obtained from California's PDMP; fatal and non-fatal overdose data were obtained from the California Department of Public Health. Outcomes were monthly opioid prescribing rates and opioid overdose rates, modeled using generalized linear mixed models. Exposures were mandatory PDMP registration, presence of county coalitions, and Initiative support for county coalitions. Mandatory PDMP registration was associated with a 25% decrease (95%CI, 0.71–0.79) in opioid prescribing rates after 24 months. Having a county coalition was associated with a 2% decrease (95%CI, 0.96–0.99) in the opioid prescribing rate; receiving Initiative support was associated with an additional 2% decrease (95%CI, 0.97–0.98). Mandatory PDMP registration and county coalitions were associated with a 35% decrease (95%CI, 0.43–0.97) and a 21% decrease (95% CI, 0.70–0.90), respectively in prescription opioid overdose deaths. Both interventions were also associated with significantly fewer deaths involving any opioid but had no significant association with non-fatal overdose rates. Findings add to the knowledge available to guide policy to prevent high-risk prescribing and opioid overdoses. While further study is needed, coalitions and mandatory PDMP registration may be important components in such efforts.
Isolation of an Acidic Protein from Rat Brain

In aqueous extracts of rat brain, spinal cord, and sciatic nerve, a protein antigen has been detected which could not be shown in similarly prepared extracts of a variety of other rat tissues. The protein, designated antigen α, had a high mobility in zone electrophoresis at pH 7.4. Antigen α was isolated and was found to consist of a single type of subunit having a molecular weight of about 39,000. Evidence was obtained to suggest that the protein occurs in various aggregates stabilized by disulfide bonds. Antigen α is immunologically unrelated to another recently isolated acidic brain protein, the S-100 protein.
Drug binding by reservoirs in elastomeric infusion devices.

Drug binding by an elastomeric infusion device reservoir was assessed by measuring its ability to bind fifteen model solutes. Octanol/water (o/w) and hexane/water (h/w) partition coefficients were regressed against the reservoir’s solute equilibrium binding constant to generate a binding model. The reservoir’s drug binding ability was calculated with the model and drug partition coefficients, which were determined for seventeen commonly infused drugs including tobramycin, gentamicin, penicillin G, piperacillin, lidocaine, morphine, ceftriaxone, imipenem-cilastatin, amphotericin B, ticarcillin and clavulanate, pentamidine, vancomycin, foscarnet, desferoxamine, acyclovir, fluconazole and vinblastine. Formulations studied included 0.9% Saline and 5% Dextrose. With the exception of lidocaine, imipenem, vinblastine and fluconazole, octanol/ formulation and hexane/formulation partition coefficients were too low to be measured for these drugs. Thus, the majority of the drugs, when reconstituted in 0.9% Saline or 5% Dextrose, will not be bound by the reservoirs. The magnitude of drug loss for the most highly bound species, fluconazole, is less than 2%. Therefore the reservoirs used in this study are essentially inert with respect to binding of the drugs evaluated in this study.
Building ICU artifact detection models with more data in less time.

Abstract As many as 86% of intensive care unit (ICU) alarms are false. Multiple signal integration of temporal monitor data by decision tree induction may improve artifact detection. We explore the effect of data granularity on model-building by comparing models made from 1-second versus 1-minute data. Models developed from 1-minute data remained effective when tested on 1-second data. Model development using 1-minute data means that more hours of ICU monitoring (including more artifacts) can be processed in less time. Compression of temporal data by arithmetic mean, therefore, can be an effective method for decreasing knowledge discovery processing time without compromising learning.
Kaolinite, Opal-CT, and Clinoptilolite in Altered Tuffs Interbedded with Lignite in the Jackson Group, Texas

The mineralogy of partially kaolinized strata interbedded with lignite at the San Miguel mine, Atascosa County, Texas, was investigated by X-ray powder diffraction and optical and scanning electron microscopy. The San Miguel lignite occurs in the lower Jackson Group (late Eocene) of southern Texas. Based on mineralogical and micromorphological data, some of these clay partings are probably volcanic in origin and were exposed to variable degrees of in situ kaolinization in a swamp environment. Coexistence of kaolinite, clinoptilolite, and opal-CT in several of these strata suggests that the partially kaolinized volcanic layers were subjected to a subsequent resilication process following burial. Kaolinite is the dominant mineral in the oldest and most kaolinized volcanic layer (underclay) below the lowest lignite bed (seam D). The kaolinite exhibits a well-developed vermicular morphology. The youngest volcanic layer, which occurs stratigraphically above the uppermost lignite seam, is characterized by pseudomorphs of volcanic glass shards and consists mainly of clinoptilolite. Movement of siliceous ground water from this layer to the underlying strata apparently provided silica-rich solutions from which opal-CT and large (as long as 300 μm) euhedral crystals of clinoptilolite precipitated in the fossilized plant roots, veinlets, and fractures within the underlying strata. Micromorphological relationships between the Sirich (opal-CT and clinoptilolite) and sulfide (marcasite and pyrite) minerals in the fossil roots and fractures suggest that the marcasite formed before and pyrite after the resilication process.