cssi/SciSciGPT-SciSciNet huggingface dataset:
Economic Decision Model Suggests Total Shoulder Arthroplasty is Superior to Hemiarthroplasty in Young Patients with End-stage Shoulder Arthritis.

Young patients with severe glenohumeral arthritis pose a challenging management problem for shoulder surgeons. Two controversial treatment options are total shoulder arthroplasty (TSA) and hemiarthroplasty. This study aims to characterize costs, as expressed by reimbursements for episodes of acute care, and outcomes associated with each treatment. We asked: for patients 30 to 50 years old with severe end-stage glenohumeral arthritis refractory to conservative management, (1) are more years of patient-derived satisfactory outcome by the Neer criteria and quality-adjusted life-years (QALYs) achieved using a TSA or a hemiarthroplasty; (2) does a TSA or a hemiarthroplasty result in a greater number of revision procedures; and (3) does a TSA or a hemiarthroplasty result in greater associated costs to society? The incidence of glenohumeral arthritis among 30- to 50-year-old patients, outcomes, reoperation probabilities, and associated costs from TSA and hemiarthroplasty were derived from the literature. A Markov chain decision tree model was developed from these estimates with number of revisions, cost of management for patients to 70 years old as defined by reimbursement for acute-care episodes, years with “satisfactory” or “excellent” outcome by the modified Neer criteria, and QALYs gained as principle outcome measures. A Monte Carlo simulation was conducted with a cohort representing the at-risk population for shoulder arthritis between 30 and 50 years old in the United States. During the lifetime of a cohort of 5279 patients, hemiarthroplasty as the initial treatment resulted in 59,574 patient years of satisfactory or excellent results (11.29 per patient) and average QALYs gained of 6.55, whereas TSA as the initial treatment resulted in 85,969 patient years of satisfactory or excellent results (16.29 per patient) and average QALYs gained of 7.96. During the lifetime of a cohort of 5279 patients, a hemiarthroplasty as the initial treatment led to 2090 lifetime revisions (0.4 per patient), whereas a TSA as the initial treatment led to 1605 lifetime revisions (0.3 per patient). During the lifetime of a cohort of 5279 patients, a hemiarthroplasty as initial treatment resulted in USD 132,500,000 associated direct reimbursements (USD 25,000 per patient), whereas a TSA as initial treatment resulted in USD 125,500,000 associated direct reimbursements (USD 23,700 per patient). Treatment of end-stage glenohumeral arthritis refractory to conservative treatment in patients 30 to 50 years old in the United States with TSA, instead of hemiarthroplasty, would result in greater cost savings, avoid a substantial number of revision procedures, and result in greater years of satisfactory or excellent patient outcomes and greater QALYs gained. On a population level, TSA is the cost-effective treatment for glenohumeral arthritis in patients 30 to 50 years old. Level II, economic and decision analysis study.
Transapical versus transfemoral approach and risk of acute kidney injury following transcatheter aortic valve replacement: a propensity-adjusted analysis

AbstractBackground: The aim of this study was to compare the incidence of post-procedural acute kidney injury (AKI) and other renal outcomes in patients undergoing transapical (TA) and transfemoral (TF) approaches for transcatheter aortic valve replacement (TAVR).Methods: All consecutive adult patients undergoing TAVR for aortic stenosis from 1 January 2008 to 30 June 2014 at a tertiary referral hospital were included. AKI was defined based on Kidney Disease Improving Global Outcomes (KDIGO) criteria. Logistic regression adjustment, propensity score stratification, and propensity matching were performed to assess the independent association between procedural approach and AKI.Results: Of 366 included patients, 171 (47%) underwent TAVR via a TA approach. AKI occurrence in this group was significantly higher compared to the TF group (38% vs. 18%, p < .01). The TA approach remained significantly associated with increased risk of AKI after logistic regression (OR 3.20; CI 1.68–4.36) and propensity score adjus...
Embryonic origin of adult stem cells required for tissue homeostasis and regeneration

Planarian neoblasts are pluripotent, adult somatic stem cells and lineage-primed progenitors that are required for the production and maintenance of all differentiated cell types, including the germline. Neoblasts, originally defined as undifferentiated cells residing in the adult parenchyma, are frequently compared to embryonic stem cells yet their developmental origin remains obscure. We investigated the provenance of neoblasts during Schmidtea mediterranea embryogenesis, and report that neoblasts arise from an anarchic, cycling piwi-1+ population wholly responsible for production of all temporary and definitive organs during embryogenesis. Early embryonic piwi-1+ cells are molecularly and functionally distinct from neoblasts: they express unique cohorts of early embryo enriched transcripts and behave differently than neoblasts in cell transplantation assays. Neoblast lineages arise as organogenesis begins and are required for construction of all major organ systems during embryogenesis. These subpopulations are continuously generated during adulthood, where they act as agents of tissue homeostasis and regeneration.
Lattice Strain and Ligand Effects on the Formation of Cu2–xS/I-III-VI2 Nanorod Heterostructures through Partial Cation Exchange

In the synthesis of anisotropic colloidal nanocrystal heterostructures, the interplay between many complicating factors such as interfacial chemistry, lattice strain, and coordinating ligands can make precise control over spatial distribution of composition extremely challenging. However, understanding how each complicating factor contributes to the growth mechanism can lead to otherwise difficult-to-achieve or unique structures and the means to tune their electronic/optical properties. Here, we report on the effects of lattice strain and the choice of ligands on the formation of Cu2–xS/I-III-VI2 colloidal nanorod heterostructures through partial cation exchange starting from Cu2–xS nanorods. Lattice strain can induce alternating Cu2–xS/CuGaS2 segments along a colloidal nanorod if CuGaS2 can nucleate easily from the sides of the nanorods. The choice in coordinating ligands can alter this preference to favor tip nucleation, in which case the resulting heterostructure has CuGaS2/Cu2–xS/CuGaS2 rod/rod/rod ge...
Effect of atrial fibrillation duration on plasma von Willebrand factor level.

Aims von Willebrand factor (VWF) is an independent risk factor for adverse events in patients with non-valvular atrial fibrillation (NVAF). However, it is unclear if VWF level remains elevated and predictive of stroke during entire course of NVAF. Methods and Results In order to determine if VWF is a time-dependent blood variable, VWF antigen measured by latex immunoassay in 425 NVAF patients and 100 controls with normal sinus rhythm (NSR) was analyzed according to NVAF duration ( 12 months: n = 251). The mean VWF antigen level in NVAF patients with 12 months duration (156 ± 54%, P = .11) but higher compared to NSR controls (143 ± 48%, P = .003). Higher VWF level correlated with higher CHADS2 scores and with progressing intensity of blood stasis in the left atrium and thrombus formation in all three time periods of atrial fibrillation duration. Patients not treated with warfarin had VWF 30% higher in the first month compared to following months. Conclusions von Willebrand Factor is steadily elevated throughout the course of dysrhythmia in NVAF patients treated with warfarin and in those with higher intensity of left atrium blood stasis.
The Quiet Room.

After yet another mass shooting, we are told again that it is time for “a national conversation about guns.” From the vantage point of a trauma surgeon who has broken the news of a child’s death to far too many mothers, conversation seems a terribly feeble response.
The Self Organization of Liesegang Bands and Other Precipitate Patterns

Precipitation/dissolution kinetics coupled to transport can lead to a number of interesting pattern forming processes, the most well studied being the Liesegang bands. Here we review these phenomena and a number of models that have been set forth to explain them. Geological applications of the theory will be discussed.
Deduplication overlay network

Video content makes up more than half of the world's Internet traffic, and this figure is expected to grow rapidly. New techniques that remove traffic redundancy have been shown to significantly improve network performance since many concurrent streams deliver the same video. These techniques employ smart routers that recognize duplicated video streams and merge them to reduce traffic redundancy. Routers deployed over an ISP's network or Internet backbone capture the video traffic and convey it into the overlay. Overlapping streams are merged into each other in link-level by receiving the packet only for the first stream, and re-using it for the subsequent duplicated streams. In this paper, we significantly improve these techniques by introducing a merger-aware routing method. The conventional wisdom is that traffic congestion is bad and routing techniques should be designed to prevent congestion. Video access patterns, however, follow the 80:20 rule; i.e., many video requests are for the same videos. The proposed routing technique leverages this characteristic of streaming traffic. It plans strategic network congestion to increase the opportunity for traffic merging. Although it sounds counter-intuitive to improve network performance by introducing network congestion, we show that creating momentary congestion is indeed an effective solution to reduce network congestion. We introduce a new kind of overlay network, called the Deduplication Overlay Network (DON), to reduce traffic for the underlying network. In DON, redundancy is maximized in link-level by the new routing technique. In order to compute the optimal network path for a new stream, the overall delay of packet transfers in DON is modeled by taking merging streams into consideration. The cost minimization is reduced down to the shortest path problem for efficient computation. The proposed method is implemented on a network simulator and the redundancy elimination performance is compared with an alternative overlay solution based on a recent stream merging technique. Experiments under various workloads and overlay network densities show significantly less traffic over the alternative.
"It's Just a Lot of Work": Adolescents' Self-Presentation Norms and Practices on Facebook and Instagram.

We explored adolescents' (12- to 18-year-olds; n = 51) awareness of their audience and subsequent self-presentation practices on Facebook and Instagram through focus group discussions. Findings suggest that teens, who are developmentally able to perceive a situation from the third-person perspective and who value peer approval, purposefully share content to appear interesting, well liked, and attractive. Some teens invested great effort into posting by these norms, even asking their friends to help; however, this was more common among girls. Older teens especially discussed taking the perspective of their audience when deciding what to post, which is consistent with the finding that perspective taking continues to develop throughout adolescence. These findings suggest that perspective taking skills and need for peer approval influence self-presentation online.
The impact of spatial accessibility and perceived barriers on visitation to the US national park system

Abstract Visits to the US national park system continue to increase, but racial/ethnic minorities are consistently underrepresented among national park visitors compared to Whites. Research suggests several reasons for historic underrepresentation of racial/ethnic minorities, including limited spatial accessibility, marginality, subcultural differences, and discrimination. This study uses spatial analysis of survey data collected in a range of geographic locations across the US, to assess the spatial accessibility of three racial/ethnic groups to units of the national park system. The study also considers the relationships between spatial accessibility and measures of marginality, subculture, and discrimination. Results show that access to national parks varies greatly between geographic areas: residents of large metropolitan areas have better access to units of the national park system than residents of rural areas. The effect of spatial accessibility on visitation varies among racial/ethnic groups. The study also highlights the importance of culturally-oriented parks, provides information about park accessibility in order to enhance relevancy, and informs management strategies that can encourage visitation across different geographic areas and more diverse populations.
The prevalence of Dermatophilus congolensis in horses with pastern dermatitis using PCR to diagnose infection in a population of horses in southern USA.

Background Dermatophilus congolensis is a facultative anaerobic actinomycete that causes papular to exudative dermatitis with crusting in horses. This organism is frequently implicated as a cause of pastern dermatitis, but few data are available validating the organism's association with this disease. Hypothesis/objectives The aim of this study was to evaluate if D. congolensis is associated with pastern dermatitis in horses utilizing RT-qPCR. Animals Fifteen client-owned horses diagnosed with pastern dermatitis and eight client-owned unaffected control horses were utilized for this study. Methods A cross-sectional study was performed. History and physical examination findings were recorded, and samples were collected and tested for D. congolensis utilizing cytological evaluation and RT-qPCR. Dermatophyte culture and superficial skin scrapings were also performed. Results Ten of 15 horses with pastern dermatitis had feathered pasterns. Dermatophilus congolensis was identified by RT-qPCR from one nonfeathered horse but none with feathered pasterns. Cytological evaluation identified bacteria in all horses but failed to identify organisms resembling D. congolensis in any horse. Four of 15 horses, all feathered, were positive for Chorioptes mites. Fungal culture was negative for dermatophytes in all horses. All test results were negative for the eight control horses. Conclusions and clinical importance Dermatophilus congolensis was uncommonly associated with pastern dermatitis in horses in this population. However, chorioptic mange was commonly associated with pastern dermatitis in feathered horses and represented an important differential diagnosis for this clinical presentation.
Spectrally arbitrary patterns over rings with unity

Abstract A zero-nonzero pattern A is a matrix with entries from the set { 0 , ⁎ } . A square pattern A is spectrally arbitrary over R , a commutative ring with unity, if for each n-th degree monic polynomial f ( x ) ∈ R [ x ] , there exists a matrix A over R with pattern A such that the characteristic polynomial p A ( x ) = f ( x ) . A pattern A is relaxed spectrally arbitrary over R if for each n-th degree monic polynomial f ( x ) ∈ R [ x ] , there exists a matrix A over R with either pattern A or a subpattern of A such that the characteristic polynomial p A ( x ) = f ( x ) . We evaluate how the structure of rings affects how we determine if a pattern is spectrally arbitrary. We consider whether a pattern A that is spectrally arbitrary over R is spectrally arbitrary or relaxed spectrally arbitrary over another commutative ring S with unity. In particular, we establish that a pattern that is spectrally arbitrary over Z is relaxed spectrally arbitrary over Z m for all m ∈ Z + and spectrally arbitrary over Q . Similarly, a pattern that is spectrally arbitrary over the p-adic integers is spectrally arbitrary over the p-adic numbers.
Disability, cultural accessibility, and the radio archive

‘Archiving as activism’ is a beautifully paradoxical phrase: an archive is usually thought to be about preserving the past, while activism is about changing the future. But as a mission statement, ...
Separating host and microbiome contributions to drug pharmacokinetics and toxicity

The gut microbiota is implicated in the metabolism of many medical drugs, with consequences for interpersonal variation in drug efficacy and toxicity. However, quantifying microbial contributions to drug metabolism is challenging, particularly in cases where host and microbiome perform the same metabolic transformation. We combined gut commensal genetics with gnotobiotics to measure brivudine drug metabolism across tissues in mice that vary in a single microbiome-encoded enzyme. Informed by these measurements, we built a pharmacokinetic model that quantitatively predicts microbiome contributions to systemic drug and metabolite exposure, as a function of bioavailability, host and microbial drug-metabolizing activity, drug and metabolite absorption, and intestinal transit kinetics. Clonazepam studies illustrate how this approach disentangles microbiome contributions to metabolism of drugs subject to multiple metabolic routes and transformations.
CH Stretch Activation of CH3CHOO: Deep Tunneling to Hydroxyl Radical Products.

Alkene ozonolysis, an important source of hydroxyl (OH) radicals in the Earth’s troposphere, proceeds through unimolecular decay of Criegee intermediates. In this work, infrared activation of the methyl-substituted Criegee intermediate, syn-CH3CHOO, in the CH stretch fundamental region (2850–3150 cm–1) is shown to result in unimolecular decay to OH radical products. These excitation energies correspond to only half of the transition state barrier height, and thus the resultant 1,4 H atom transfer that leads to OH products occurs exclusively by quantum mechanical tunneling. Infrared action spectra recorded with UV laser-induced fluorescence detection of the OH products reveal the four CH stretch fundamentals and CO stretch overtone predicted to have strong transition strength. The vibrational band origins, relative intensities, and transition types derived from rotational band contour analyses are in good accord with theory. Distinctly different Lorentzian line broadening of the observed features is attrib...
Functionalized Porous Aromatic Frameworks as High-Performance Adsorbents for the Rapid Removal of Boric Acid from Water

This study demonstrates that functionalized, highly porous polymers are promising for the adsorptive capture of boric acid, a neutral contaminant that is difficult to remove from seawater using conventional reverse osmosis membranes. Appending N-methyl-d-glucamine (NMDG) to the pore walls of high-surface-area porous aromatic frameworks (PAFs) yields the adsorbents PAF-1-NMDG and P2-NMDG in a simple two-step synthesis. The boron-selective PAFs demonstrate adsorption capacities that are up to 70% higher than those of a commercial boron-selective resin, Amberlite IRA743, and markedly faster adsorption rates, owing to their higher NMDG loadings and greater porosities relative to the resin. Remarkably, PAF-1-NMDG is able to reduce the boron concentration in synthetic seawater from 2.91 to <0.5 ppm in less than 3 min at an adsorbent loading of only 0.3 mg mL-1 . The boron adsorption rate constants of both frameworks, determined via a pseudo-second-order rate model, represent the highest values reported in the literature-in most cases orders of magnitude higher than those of other boron-selective adsorbents. The frameworks can also be readily regenerated via mild acid/base treatment and maintain constant boron adsorption capacities for at least 10 regeneration cycles. These results highlight the numerous advantages of PAFs over traditional porous polymers in water treatment applications.
The Effect of Otoacoustic Emission Stimulus Level on the Strength and Detectability of the Medial Olivocochlear Reflex.

Objectives Previous work demonstrates the importance of a high signal to noise ratio (SNR) when using transient evoked otoacoustic emissions (TEOAEs) to assay the medial olivocochlear reflex (MOCR). Increasing stimulus level provides one means to increase TEOAE SNR. However, this may come at the expense of a smaller MOCR effect. It is not clear whether the gain in SNR associated with the use of higher stimulus levels outweighs the disadvantage of a potentially smaller MOCR effect. The present study investigated the strength and detectability of the MOCR when assayed using TEOAEs at different stimulus levels. The hypothesis was that although the strength of the MOCR decreases with increasing stimulus level, the occurrence of statistically significant MOCR effects increases due to an increase in TEOAE SNR. Design Twenty-five young adult females with normal hearing participated in the study. TEOAEs were measured in the right ear with and without broadband noise presented in the left ear. The strength of the MOCR was quantified as the percent difference in the TEOAE between the contralateral noise and quiet conditions. Statistical bootstrapping was used to detect significant MOCR effects in individual subjects across different frequency bands and stimulus levels. The relationship between a detectable MOCR (response variable) and frequency, stimulus level, TEOAE SNR, MOCR strength, and subject (predictor variables) was evaluated using generalized linear mixed-effect models. Results The number of statistically significant MOCR effects increased with stimulus level at all frequencies. Occurrence was highest for the 2-kHz TEOAE frequency band and lowest for the 4-kHz frequency band. The strength of the MOCR decreased with increasing click level. TEOAE SNR, MOCR strength, and stimulus level were significant predictors of a detectable MOCR: The likelihood of a detectable MOCR increased with TEOAE SNR, MOCR strength, and stimulus level. Conclusions Despite a reduction in the strength of the MOCR with increasing stimulus level, the detectability of the MOCR increased. This is due, in part, to an increase in TEOAE SNR with stimulus level. For clinical implementation of TEOAE-based MOCR assays, achieving a high SNR is necessary to permit the detection of the MOCR in individual patients.
Cost-effective care in eosinophilic esophagitis

Abstract Objective To examine costs related to eosinophilic esophagitis (EoE), understand the source of these costs, discuss a possible approach for cost-effective care in EoE, and identify areas for future research in this topic. Data Sources/Study Selections Narrative review of the literature from 1977 (first description of EoE) to March 2019, focusing on costs and cost-effectiveness analyses in EoE. Results High costs in EoE can be related to diagnostic delays, requirement for upper endoscopy with biopsy for diagnosis and monitoring of disease activity, expensive medications currently used off-label, increased food costs related to dietary elimination treatment, frequent doctor visits with subspecialists, and complications or disease exacerbations. Provision of cost-effective care in EoE is an understudied area, and a patient-centric approach is key. There are multiple areas in which future research can make an impact. These include determining predictors of treatment response, minimally or noninvasive methods to monitor disease activity, and validation of the use of multidisciplinary care. Conclusion Eosinophilic esophagitis (EoE) is considered to be a rare disease, but the costs of care and burden of disease attributed to EoE are substantial. However, few studies examine either the costs related to EoE or the approach to cost-effective care for the EoE patient. To provide cost-effective care, a patient-centric approach and shared decision-making model are optimal. In addition, a rational strategy for EoE diagnosis and initial treatment, effective maintenance therapy for disease control and ideally to prevent complications, and appropriate long-term monitoring are all required.
Effects of Current and Enhanced Tobacco Corrective Messages on Smokers' Intention to Quit Smoking and Intention to Purchase Cigarettes.

Introduction A federal court has ordered tobacco companies to issue corrective messages to address tobacco-related misperceptions. This study examined the effects of viewing current versus two enhanced versions of tobacco corrective messages on smokers' intention to quit smoking and intention to purchase cigarettes. Methods US adult smokers (N = 803) were randomly assigned to view (1) two current tobacco corrective messages (Current), (2) two corrective messages that include an industry deception statement (Industry Deception), or (3) two corrective messages with an industry deception statement and testimonials of people harmed by smoking (Industry Deception + Testimonial). Outcomes were pretest-posttest change in intentions to quit smoking and posttest intention to purchase cigarette measures. Results Intention to quit smoking increased significantly after viewing the Current corrective messages versus baseline. In addition, viewing the Industry Deception + Testimonial messages increased intention to quit smoking compared with the Current corrective condition and the Industry Deception condition. Hispanic smokers had increased intention to quit smoking and decreased intention to purchase cigarettes to a greater degree than non-Hispanic smokers in response to Industry Deception + Testimonial messages. There was no significant difference in intention to purchase cigarettes across conditions. Conclusions Enhancing the current corrective statements by including an industry deception statement and testimonials may strengthen effects and contribute to remedying the effects of tobacco misinformation. Implications Previous research has found that draft or proposed versions of tobacco industry corrective messages are effective in correcting beliefs and knowledge. However, studies have not examined how the current court-ordered corrective messages could change intention to quit smoking and intention to purchase cigarettes nor whether enhanced messages could perform better. Study findings suggest that the current corrective messages can increase smokers' intention to quit smoking beyond their baseline intention. More importantly, enhancing corrective messages by including an industry deception statement and testimonial was found to be more effective than current corrective messages. Findings can inform future iterations of tobacco correctives and strategies to reverse the effects of tobacco misinformation.
Protecting Children from Toxic Waste: Data-Usability Evaluation Can Deter Flawed Cleanup.

Nearly 25 percent of US children live within 2 km of toxic-waste sites, most of which are in urban areas. They face higher rates of cancer than adults, partly because the dominant contaminants at most US hazardous-waste sites include genotoxic carcinogens, like trichloroethylene, that are much more harmful to children. The purpose of this article is to help protect the public, especially children, from these threats and to improve toxics-remediation by beginning to test our hypothesis: If site-remediation assessments fail data-usability evaluation (DUE), they likely compromise later cleanups and public health, especially children’s health. To begin hypothesis-testing, we perform a focused DUE for an unremediated, Pasadena, California toxic site. Our DUE methods are (a) comparing project-specific, remediation-assessment data with the remediation-assessment conceptual site model (CSM), in order to identify data gaps, and (b) using data-gap directionality to assess possible determinate bias (whether reported toxics risks are lower/higher than true values). Our results reveal (1) major CSM data gaps, particularly regarding Pasadena-toxic-site risks to children; (2) determinate bias, namely, risk underestimation; thus (3) likely inadequate remediation. Our discussion shows that if these results are generalizable, requiring routine, independent, DUEs might deter flawed toxic-site assessment/cleanup and resulting health threats, especially to children.
Faces of Muhammad: Western Perceptions of the Prophet of Islam from the Middle Ages to Today

John Tolan’s new book, Faces of Muhammad, is an English translation of his French study, Mahomet l’Europeen (2018). Both titles accurately convey Tolan’s project. He focuses almost entirely on non-...
A woman’s worth: an access framework for integrating emergency medicine with maternal health to reduce the burden of maternal mortality in sub-Saharan Africa

Within each of the Sustainable Development Goals (SDGs), the World Health Organization (WHO) has identified key emergency care (EC) interventions that, if implemented effectively, could ensure that the SDG targets are met. The proposed EC intervention for reaching the maternal mortality benchmark calls for “timely access to emergency obstetric care.” This intervention, the WHO estimates, can avert up to 98% of maternal deaths across the African region. Access, however, is a complicated notion and is part of a larger framework of care delivery that constitutes the approachability of the proposed service, its acceptability by the target user, the perceived availability and accommodating nature of the service, its affordability, and its overall appropriateness. Without contextualizing each of these aspects of access to healthcare services within communities, utilization and sustainability of any EC intervention-be it ambulances or simple toll-free numbers to dial and activate EMS-will be futile. In this article, we propose an access framework that integrates the Three Delays Model in maternal health, with emergency care interventions. Within each of the three critical time points, we provide reasons why intended interventions should be contextualized to the needs of the community. We also propose measurable benchmarks in each of the phases, to evaluate the successes and failures of the proposed EC interventions within the framework. At the center of the framework is the pregnant woman, whose life hangs in a delicate balance in the hands of personal and health system factors that may or may not be within her control. The targeted SDGs for reducing maternal mortality in sub-Saharan Africa are unlikely to be met without a tailored integration of maternal health service delivery with emergency medicine. Our proposed framework integrates the fields of maternal health with emergency medicine by juxtaposing the three critical phases of emergency obstetric care with various aspects of healthcare access. The framework should be adopted in its entirety, with measureable benchmarks set to track the successes and failures of the various EC intervention programs being developed across the African continent.
Executive function predicts decline in mobility after a fall: The MYHAT study.

Abstract Background Evidence suggests that better cognitive functioning is associated with better mobility in older age. It is unknown whether older adults with better cognitive function are more resilient to mobility decline after a fall. Methods Participants from the Monongahela Youghiogheny Healthy Aging Team (MYHAT) study were followed annually for up to 9 years for incident falls. We examined one-year (mean 1.0 year, SD 0.1) change in mobility pre- to post-fall using the Timed Up and Go (TUG) in relation to pre-fall cognition (executive function, attention, memory, and visuospatial function) among incident fallers (n = 598, mean age 79.1, SD = 7.0). Linear regression models tested the association of cognition with change in TUG. Interaction terms were tested to explore if age, sex, body mass index, physical activity, depressive symptoms, or visual acuity modified the associations of cognition and mobility among fallers. The association between cognition and one-year change in TUG was also tested in a comparison sample of non-fallers (n = 442, mean age 76.3, SD = 7.2). Results Overall, mobility decline was greater in fallers compared to non-fallers. In fully-adjusted models, higher executive function, but not attention, memory, or visuospatial function, was associated with less decline in mobility among incident fallers. The effect was significantly stronger for those who were older, sedentary, and had lower body mass index. Higher scores in memory tests, but not in other domains, was associated with less mobility decline among non-fallers. Conclusions Higher executive function may offer resilience to mobility decline after a fall, especially among older adults with other risk factors for mobility decline. Future studies should assess whether executive function may be a helpful risk index of fall-related physical functional decline in geriatric settings.
Role of Attitudes in Transit and Auto Users’ Mode Choice of Ridesourcing:

This paper presents the results of a study that examines the factors that influence travelers’ mode choice between transit and ridesourcing, for two distinct market segments—transit users in a regu...
Photoacoustic and Magnetic Resonance Imaging of Hybrid Manganese Dioxide-Coated Ultra-Small NaGdF4 Nanoparticles for Spatiotemporal Modulation of Hypoxia in Head and Neck Cancer

There is widespread interest in developing agents to modify tumor hypoxia in head and neck squamous cell carcinomas (HNSCC). Here, we report on the synthesis, characterization, and potential utility of ultra-small NaYF4:Nd3+/NaGdF4 nanocrystals coated with manganese dioxide (usNP-MnO2) for spatiotemporal modulation of hypoxia in HNSCC. Using a dual modality imaging approach, we first visualized the release of Mn2+ using T1-weighted magnetic resonance imaging (MRI) and modulation of oxygen saturation (%sO2) using photoacoustic imaging (PAI) in vascular channel phantoms. Combined MRI and PAI performed in patient-derived HNSCC xenografts following local and systemic delivery of the hybrid nanoparticles enabled mapping of intratumoral nanoparticle accumulation (based on T1 contrast enhancement) and improvement in tumor oxygenation (increased %sO2) within the tumor microenvironment. Our results demonstrate the potential of hybrid nanoparticles for the modulation of tumor hypoxia in head and neck cancer. Our findings also highlight the potential of combined MRI-PAI for simultaneous mapping nanoparticle delivery and oxygenation changes in tumors. Such imaging methods could be valuable in the precise selection of patients that are likely to benefit from hypoxia-modifying nanotherapies.
Association between goal-striving stress and rapid kidney function decline among African Americans: the Jackson Heart Study.

African Americans (AAs) are disproportionately affected by kidney disease and also report higher psychosocial stressors than other racial groups. Goal-striving stress (GSS) is an understudied psychosocial stressor related to attempting to accomplish one's life goals. Given the numerous social determinants that contribute to health inequities among AAs, stress from goal striving may also disproportionately affect the health of AAs and in particular kidney disease outcomes. The objective of this study was to explore the association between GSS and rapid kidney function decline (RKFD) in an AA cohort. Using examination 1 (2000-2004) and examination 3 (2009-2013) data from the Jackson Heart Study (n=2630), we examined associations of baseline levels of GSS with RKFD among AAs using multivariable Poisson regression models, adjusting for sociodemographics, health behaviors, chronic disease and discrimination. We also explored baseline cortisol as a mediator. The incidence of RKFD in this sample was 7.34% (mean years of follow-up: 8.06±0.84 years). The mean GSS score was 3.80 (±4.88) and total GSS score ranged from 0 to 36. Those who reported high (vs low) GSS were 1.60 times more likely to experience RKFD after full adjustment (incidence rate ratio (IRR) 1.60; 95% CI 1.11 to 2.14, p=0.01). After confirming cortisol as a mediator and adding it to the model, those who reported high (vs low) GSS had 1.58 times the rate of RKFD (IRR 1.58; 95% CI 1.09 to 2.30, p=0.0153). Stress related to not achieving goals was associated with a greater risk of RKFD in this sample of AAs.
An Adversarial Domain Separation Framework for Septic Shock Early Prediction Across EHR Systems

Modeling patient disease progression using Electronic Health Records (EHRs) is critical to assist clinical decision making. While most of prior work has mainly focused on developing effective disease progression models using EHRs collected from an individual medical system, relatively little work has investigated building robust yet generalizable diagnosis models across different systems. In this work, we propose a general domain adaptation (DA) framework that tackles two categories of discrepancies in EHRs collected from different medical systems: one is caused by heterogeneous patient populations (covariate shift) and the other is caused by variations in data collection procedures (systematic bias). Prior research in DA has mainly focused on addressing covariate shift but not systematic bias. In this work, we propose an adversarial domain separation framework that addresses both categories of discrepancies by maintaining one globally-shared invariant latent representation across all systems through an adversarial learning process, while also allocating a domain-specific model for each system to extract local latent representations that cannot and should not be unified across systems. Moreover, our proposed framework is based on variational recurrent neural network (VRNN) because of its ability to capture complex temporal dependencies and handling missing values in time-series data. We evaluate our framework for early diagnosis of an extremely challenging condition, septic shock, using two real-world EHRs from distinct medical systems in the U.S. The results show that by separating globally-shared from domain-specific representations, our framework significantly improves septic shock early prediction performance in both EHRs and outperforms the current state-of-the-art DA models.
Patient Factors Limit Colon Cancer Survival at Safety-Net Hospitals: A National Analysis.

Abstract Background Safety-net hospitals serve a vital role in society by providing care for vulnerable populations. Existing data regarding oncologic outcomes of patients with colon cancer treated at safety-net hospitals are limited and variable. The objective of this study was to delineate disparities in treatment and outcomes for patients with colon cancer treated at safety-net hospitals. Methods This retrospective cohort study identified 802,304 adult patients with colon adenocarcinoma from the National Cancer Database between 2004-2016. Patients were stratified according to safety-net burden of the treating hospital as previously described. Patient, tumor, facility, and treatment characteristics were compared between groups as were operative and short-term outcomes. Cox proportional hazards regression was utilized to compare overall survival between patients treated at high, medium, and low burden hospitals. Results Patients treated at safety-net hospitals were demographically distinct and presented with more advanced disease. They were also less likely to receive surgery, adjuvant chemotherapy, negative resection margins, adequate lymphadenectomy, or a minimally invasive operative approach. On multivariate analysis adjusting for patient and tumor characteristics, survival was inferior for patients at safety-net hospitals, even for those with stage 0 (in situ) disease. Conclusion This analysis revealed inferior survival for patients with colon cancer treated at safety-net hospitals, including those without invasive cancer. These findings suggest that unmeasured population differences may confound analyses and affect survival more than provider or treatment disparities.
Formulating a Meaningful and Comprehensive Placental Phenotypic Classification.

IntroductionWhile many placental lesions have been identified and defined, the significance of multiple overlapping lesions has not been addressed. The purpose of our analysis was to evaluate overl...
Discussion Draft Prepared for the Greater Hartford Chamber of Commerce's Task Force on Tax Exempt Property

This Discussion Draft explains analyzes various approaches for municipalities to obtain revenue from tax-exempt property, and was prepared for the Hartford Chamber of Commerce’s Tax Force on Tax-Exempt Property. It begins by examining the implementation of service charges, such as charges for various municipal services, in lieu of a traditional property tax. Because measuring actual consumption of services like fire and police are impractical, alternative approaches to approximate a user charge are explored. The Discussion Draft then examines state payments to municipalities under a PILOT (payment in lieu of taxes) which Connecticut was using to offset municipal losses due to state-owned property, and evaluates the extension of that program to tax-exempt institutions. A program like this has the advantage of not infringing on the operations of these institutions, however, there are issues arising out of property valuation with this program, and an alternative valuation formula is presented. A third approach to balance the interests of tax-exempts with those of municipalities involves the use of ceilings or other limitations on exemptions. These ceilings or limitations on tax exemptions can be implemented on the total number of acres of land or the fair market value of property exempted from property tax. Another approach involves a time limit, after which the exemptions would phase out. Lastly, the Discussion Draft looks at an approach that would require a municipality’s permission before any taxable property could be acquired for tax-exempt purposes. Three sets of problems with this approach are identified. The Discussion Draft concludes by examining the statutory definition of tax-exempt property, the tension between municipalities and the valuation of tax-exempt property and the legislature’s indifference to whether the law developed by the courts comports with the current views on the policy underlying the granting of exemptions, and the constitutional issue of church and state.
Optical synchronization between a dissipative Kerr soliton and a chip-scale mode-locked laser

A 305 GHz dissipative Kerr soliton is synchronized to a chip-scale 10GHz mode-locked laser through regenerative harmonic injection locking, the repetition rate stability of the mode-locked laser after synchronization is shown to be 10−9 at 100 ms.
Physical-Knowledge Activities for the Development of Logico-mathematical Knowledge

This chapter describes six physical-knowledge activities based on Piaget’s theory. Physical-knowledge activities are those in which children act on objects physically and mentally to produce a desired effect. In Pick-Up Sticks, for example, children try to pick up as many sticks as possible without making any other stick move. The purpose of these activities is to encourage children to think, thereby developing logico-mathematical knowledge, which serves as the framework for organizing all knowledge. Pick-Up Sticks is not a new activity. However, I modified it to motivate children to think. For example, I reduced the number of sticks to about eight so that children can tell which stick is not touching any other stick, which one is on top of another, and which one is touching two sticks, etc. The effectiveness of physical-knowledge activities was evaluated by comparing two groups of first graders. Both groups came to first grade without any number concepts, but one group received traditional math instruction while the other group engaged in physical-knowledge activities during the math hour for half a year. The second group did much better in mental math as well as in solving word problems.
Analysis of Fastened Structural Connections

An approach for modeling the transfer of forces in fastener groups is described which takes nonlinearities into account. The method is used for analyzing two problems which involve design of repairs and damaged structures. The model predictions are found to be in a good agreement with available experimental results. The study demonstrates the importance of fastener stiffness and initial clearance on load distribution. R ELIABLE structural analysis of mechanically fastened connections is of major importance in modern design of aircraft structures where requirements for optimal design must be met. In current practice, extensive full-scale testing is used mainly because the reliability of mathematical models has not been established to the satisfaction of engineers who have to make or approve design decisions. Improved reliability of mathematical models will make it possible to reduce the scope of experimental programs and the time required for developing information on which design decisions can be based with confidence. Also, extensive testing programs can improve the safety of design (at a substantial cost) but cannot be used for optimizing design with respect to weight and durability. Only reliable mathematical models can do that. In this paper, the problem of simulating the elastostatic response of fastened structural connections, with guarantee of reliability, is discussed. Some aspects of this problem were presented in Ref. 1 where the interaction between the fasteners and the plates was simulated by distributed springs. Friction was treated by the addition of external tractions in an iterative process. Each fastener was represented by a nonlinear relation between the transferred force and the relative displacements. The accuracy of the method was verified through tight quality control of the numerical approximation errors and comparisons with experimental results. This paper is concerned with the accuracy and reliability of the mathematical model. Two kinds of error have to be considered2: 1) The differences between the exact solution of the mathematical problem formulated to represent a physical system and the actual response or behavior of the physical system are called errors of idealization. 2) The differences between the exact solution of the mathematical problem formulated to represent a physical system or process and its numerical approximation are called errors of discretization. In some cases the two errors, the errors of idealization, and discretization may partially cancel one another. Therefore it is important to verify by means other than the experiment itself that the numerical solution is close to the exact solution of the model. Only then is it possible to investigate whether the errors of idealization are large or small by making comparisons with experimental observations. The load distribution in bolted or riveted joints had been investigated both experimentally and theoretically, (e.g., Refs. 3-25). In these studies, a number of assumptions had been
Fluorescence microscopy and flow cytometric analysis of Peyer's patches and intestinal immune cells.

In recent years researchers have become more aware of the importance of the gut-associated immune system since it is in direct interaction with the entry site for virus, bacteria, and all type of food contaminants, including numerous toxins that can alter mucosal immunity. Peyer's patches (PP) are considered the inductive site for protein antigen presentation in the gut as well as the starting point for IgA B-cell differentiation. The IgA found in feces comes from IgA secreted by IgA lamina propria lymphocytes (LPL), and its presence is a sign of normal physiology, in that IgA plays a role in absorption and immune defense against gut-associated pathogens. Methods presented in this unit are intended to analyze PP and intestinal intraepithelial and LPL to determine whether the complexity of the mucosal-associated lymphoid tissue and its components have been altered by any form of external damage. The protocols explain how to isolate and culture isolated cells; how to stain and analyze; and also how to cryopreserve the gut. Curr. Protoc. Toxicol. 33:18.13.1-18.13.20. © 2007 by John Wiley & Sons, Inc. Keywords: Peyer's patches; intestinal intraepithelial lymphocytes; intestinal lamina propria lymphocytes; mucosal immunology; IgA; T lymphocytes; cytokines; flow cytometry; fluorescence microscopy