cssi/SciSciGPT-SciSciNet huggingface dataset:
HCAHPS Survey Results: Impact of Severity of Illness on Hospitals' Performance on HCAHPS Survey Results.

Background The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is used by the Centers of Medicare and Medicaid (CMS) to assess inpatient satisfaction. HCAHPS survey results are publicly reported, and performance began to affect CMS reimbursement to hospitals as of FY2013. However, the impact of severity of illness on patients' self-reported inpatient satisfaction as measured by HCAHPS survey scores remains unknown. Objective To determine the impact of severity of illness on patients' self-reported inpatient satisfaction. Design The All Patient-Refined, Diagnosis Related Group (APR-DRG) classifies every patient into one of four levels of severity of illness. We evaluated the impact of APR-DRG severity of illness on five HCAHPS domains, two reputation and two environmental questions, using linear regression analysis. Setting Adult inpatients discharged from a large, academic, tertiary care hospital. Patients 37,223 patients' HCAHPS survey data were combined with their APR-DRG severity of illness rating over a 39-month period between April 2008 and June 2011. Measurements HCAHPS scores. Results Higher severity of illness was consistently and inversely associated with lower patients' self-reported perception of inpatient hospital satisfaction as measured by HCAHPS scores. For each one-unit increase in severity of illness, the average HCHAPS scores across all five domains were approximately 3 percent lower. Conclusions Hospitals treating patients with a higher severity of illness will have lower HCAHPS scores, potentially leading these hospitals to receive lower reimbursement from CMS. Conversely, hospitals with lower severity of illness will receive greater reimbursement. Failure to adequately adjust for severity of illness is a serious flaw in the current HCAHPS reporting system that should be corrected.
Fibrin glue eliminates the need for packing after complex liver injuries.

Abstract Hemostasis after traumatic liver injury can be extremely difficult to obtain, particularly in coagulopathic patients who have suffered extensive liver damage. We determined the ability of a fibrin glue preparation (FG) to terminate ongoing bleeding using a new, clinically relevant porcine model of complex hepatic injury. Anesthetized swine (n = 6, 18 to 19 kg) received an external blast to the right upper abdomen and were immediately anticoagulated with intravenous heparin (200 u/kg). Uncontrolled hemorrhage from blast continued from time of injury (t = 0 minutes) to t = 15 minutes. Lactated Ringer's solution was infused to keep mean arterial pressure (MAP) > 80 mm Hg until the end of experiment (t = 90 minutes). Animals underwent routine surgical techniques to control bleeding, and FG was employed in the event these measures failed. Estimated blood loss and fluid resuscitation volume were measured. Serial MAP, arterial base excess, and temperature were recorded. Animals were severely injured with significant blood loss prior to laparotomy (26 +/- 6 cc/kg) and during routine surgical efforts to arrest hemorrhage (11 +/- 2 cc/kg). Bleeding could not be controlled with standard techniques in any animal. FG rapidly controlled hemorrhage and eliminated the need for packing. Re-bleeding was noted in only one animal (portal vein injury). FG can control severe hepatic hemorrhage when surgical techniques fail. Further work in the clinical arena is warranted to determine the potential benefits of FG in arresting hemorrhage in hemodynamically unstable coagulopathic patients with complex hepatic injuries.
The metabolic displacement of folic acid by aminopterin; studies in leukemia patients.

The amount of Aminopterin excreted during treatment with this antagonist has been measured in 9 leukemia patients. It was found that considerable although variable amounts were retained in the body and that the smallest amounts were excreted by patients with chronic granulocytic leukemia. Urinary excretion of Aminopterin continued at a significant level for a period of at least six days after a course of therapy. Following Aminopterin therapy, there was an increase in folic acid excretion as compared to the excretion of this vitamin prior to antagonist administration. These data suggest that there is a metabolic displacement of folic acid by Aminopterin.
Stroke Secondary to Trauma

Stroke secondary to trauma may be either hemorrhagic or ischemic. Traumatic subarachnoid hemorrhage may produce clinically significant vasospasm similar to that seen after aneurysmal SAH. It is suggested that the calcium channel blocker nimodipine that has been shown to improve outcome from aneurysmal subarachnoid hemorrhage, improves outcome from severe head injury only in those patients who have a large amount of subarachnoid blood. Injury to the cerebral venous sinuses may occasionally be encountered. The majority of these are hemorrhagic injuries produced by penetrating trauma or by depressed skull fractures. Damage to the intima may initiate thrombus formation that can occlude the entire artery, occlude the artery incompletely but still enough to reduce flow, or embolize small particles of thrombus into the cerebral circulation. Cerebral ischemia that has produced a completed stroke will probably not respond to any treatment. Surgery may be considered for patients with transient, fluctuating, or very recently manifest symptoms. It is found that potential surgical interventions include thrombectomy for cerebral lesions or thrombectomy, resection with grafting, gradual carotid occlusion, or carotid ligation for neck pathology.
The Atacama Desert: A Five Hundred Year Journey of Discovery

This article analyzes maps and written narratives to demonstrate how the Atacama Desert of South America was discovered, and then re-discovered, over nearly five centuries in a series of sequential phases. From about 1530 to 1700, “Atacama” designated a remote but strategic political province whose lack of population rather than desert climate was emphasized. After about 1700, however, the Atacama began to be identified as an arid region as a result of increasingly scientific mapping and exploration. In this transitional phase, the Atacama was part of a broader pattern in which the political mapping of empires was gradually supplemented by thematic physical or scientific mapmaking. In the third stage, which began in the mid-1830s, the Atacama Desert became linked to increasingly strong nationalist impulses and the rapidly growing power of international corporate developments in transportation and mineral extraction. In the fourth and current stage, which began about 1945, the Atacama began to be promoted ...
Can Unobserved House Quality Explain Price Premiums on Sales with Expected Losses

Previous literature has established that the first price of a repeat pair is a salient reference price. We show that local fundamentals at the date of the first sale (implicit rents divided by user costs of housing) are salient also. A salient market gap, the difference between change in market value and change in local fundamental value over the time between any two sales, redefines an important diagnostic tool for housing cycles, the ratio of house prices to fundamentals. The strong association we find between the mix of sellers with gains and losses, a mix that changes dramatically over the cycle, and the ratio of house prices to salient fundamentals challenges those developing structural models of excess volatility to include anchoring behavior.We find pro-cyclical selection of properties for sale based on unobserved quality as a function of gains and losses. This explains about 70% of the implausibly large discount for gains relative to losses documented in previous literature.Our unique data control major structural changes between sales and allow detailed spatial controls for unobserved heterogeneity; town-year fixed effects are strongly correlated with local public services and taxes. Average sales with gains are priced .17 (.06) below losses in log terms in the presence (absence) of a positive salient gap. Salience is supported when we compare to a counterfactual fixed seven-year gap. Results are robust to sub-periods around the global financial crisis, and to differences across towns in proxies for elasticity of housing supply and demand.
Magnetic signatures of ion cyclotron waves during Cassini's high-inclination orbits of Saturn

Abstract Based on magnetic field data from Cassini's high-inclination orbits of Saturn (radius R S = 60 , 268 km ), we analyze the latitudinal distribution of ion cyclotron waves in the giant planet's magnetosphere. Our survey takes into account magnetic field data from all high-inclination orbits between 2004 and 2015. We analyze the dependency of the occurrence rate and amplitude of the ion cyclotron waves on radial distance ρ to Saturn's rotation axis, vertical distance z to Saturn's equatorial plane, and magnetic latitude λ. The occurrence rate of ion cyclotron waves is approximately 100% in Saturn's equatorial plane between the orbits of Enceladus and Dione and decreases to 50% at altitudes of | z | ≈ 0.6 R S . Ion cyclotron waves were detected up to | z | = 2.0 R S . The occurrence rate displays strong, non-monotonic variations with respect to ρ, z, and λ. The vertical amplitude profile of the waves exhibits an M-like pattern with two distinct peaks near z = ± 0.3 R S and the central minimum at z=0. Compared to earlier observations, we find this M-like structure to be inflated in±z direction by a factor of three. The available magnetic field data provides only weak evidence for a local impact of Enceladus and Dione on the ion cyclotron wave field. Using the observed Doppler shift of the ion cyclotron wave frequency during Cassini's high-inclination orbits, we demonstrate the existence of a narrow band of bidirectional wave propagation. This band is centered around Saturn's equatorial plane and possesses a half-width of | z | = 0.15 R S , which agrees well with the vertical scale height of Saturn's neutral cloud. To the north of this band, all ion cyclotron waves propagate towards the north ( z > 0 ); and to the south, all waves propagate towards the south ( z 0 ). In companion with our previous study (Meeks et al., 2016), this survey provides the complete three-dimensional picture of the ion cyclotron wave field between the orbits of Enceladus and Rhea during the Cassini era.
FLAT VERSUS HEMISPHERICAL DOME PORTS IN UNDERWATER PHOTOGRAMMETRY

Abstract. Underwater photogrammetry, like its counterpart in 'air', has gained an increasing diffusion thanks to the availability of easy-to-use, fast and often quite inexpensive software applications. Moreover, underwater equipment that allows the use of digital cameras normally designed to work in air also in water are largely available. However, for assuring accurate and reliable 3D modelling results a profound knowledge of the employed devices as well as physical and geometric principle is even more crucial than in air. This study aims to take a step forward in understanding the effect of underwater ports in front of the photographic lens. In particular, the effect of dome or flat ports on image quality in 3D modelling applications is investigated. Experiments conducted in a semi submerged indust rial structure show that the tested flat port performs worse than the dome, providing higher image residuals and lower precision and accuracy in object space. A significant different quality per colour channel is also observed and its influence on achievable processing results is discussed.
Shelter from the Storm: Roles, responsibilities, and challenges in United States housing policy governance☆

Housing is a critical social determinant of health. Housing policy not only affects health by improving housing quality, affordability, and insecurity; housing policy affects health upstream through the politics that shape housing policy design, implementation, and management. These politics, or governance strategies, determine the successes or failures of housing policy programs. This paper is an overview of challenges in housing policy governance in the United States. I examine the important relationship between housing and health, and emphasize why studying housing policy governance matters. I then present three cases of housing governance challenges in the United States, from each pathway by which housing affects health - housing quality, affordability, and insecurity. Each case corresponds to an arm of the TAPIC framework for evaluating governance (Krieger and Higgins) [1], to assess mechanisms of housing governance in each case. While housing governance has come a long way over the past century, political decentralization and the expansion of the submerged state have increased the number of political actors and policy conflict in many areas. This creates inherent challenges for improving accountability, transparency, and policy capacity. In many instances, too, reduced government accountability and transparency increases the risk of harm to the public and lessens governmental integrity.
Teaching NeuroImages: Intracranial foreign body reaction after endovascular procedures

A 64-year-old woman with a family history of aneurysmal subarachnoid hemorrhage was diagnosed with an incidental aneurysm during screening. The aneurysm was treated with flow diversion (figure 1). Two months later, she complained of headache and intermittent word-finding difficulty. Brain MRI demonstrated multiple areas of nodular enhancement ipsilateral to the treated aneurysm (figure 2A). After a 6-week course of oral steroids, both the radiologic findings and her symptoms resolved (figure 2, C and D). This patient's clinical course and imaging findings are consistent with a foreign body reaction occasionally seen after endovascular treatment. This is related to an allergic reaction to microparticles sheared from catheters/devices during endovascular procedures.1,2
Investigating undergraduate business internships: Do supervisor and self-evaluations differ?

The authors analyze consistency between supervisors' and interns' self-evaluations based on interns' gender, time of completion (summer or academic year), and sponsor (on-campus department or off c...
KMeX: A Knowledge-Based Digital Library for Retrieving Scenario-Specific Medical Text Documents

Publisher Summary This chapter presents a new knowledge-based approach to mitigate problems related to scenario-specific information retrieval (IR). The use of metathesaurus and semantic structure in the UMLS to extract key concepts from the free text for indexing, phrase-based indexing for representing similar concepts, and query expansion to improve the probability of matching query terms with the terms in the document is preferred. A scenario typically refers to a specific health care task, such as searching for treatment methods for a specific disease. Although traditional systems are useful for general information retrieval, these systems cannot support scenario-specific IR because: the terms in the query posed by the user may not use a standardized medical vocabulary; there is no effective technique to represent synonyms, phrases, and similar concepts in free text; and the terms used in a query and those used in a document for representing the same topic may be mismatched. A new knowledge-based approach for retrieving scenario-specific free-text documents has been developed, which consists of three integrated components: IndexFinder, phrase-based VSM, and knowledge-based query expansion. IndexFinder extracts key terms from free text, generating conceptual terms by permuting words in a sentence rather than using the traditional techniques based on NLP. The phrase-based VSM has been developed for document retrieval. Knowledge-based query expansion techniques and the phrase-based VSM can be used in conjunction to significantly improve precision and recall.
Academic Merit versus Fair Representation

For a university to set as its goals the maintaining of “highest academic standards” and the continuing of a “tradition of service to the public” is highly laudable. It is also quite ambitious in an era in which these goals emerge in apparent opposition. For example, in California, as in some other parts of the country, the cultural diversity of the general public is increasing more rapidly than is the cultural diversity of the pool of what are, by traditional standards, high academic achievers (Figure 5.1). Confronted with different rates in the progress of these trends, authors of higher education admissions policy enter a territory where trade-offs, compro- mises, and redefined priorities are increasingly deemed essential.
Exemplary sound and hearing in sensory treatises from the early modern Spanish-speaking world

This essay considers sound in sensory treatises from the seventeenth-century Hispanic world: Jeronimo Becerra’s Estvdioso discvrso philosophica anathomia, y theatro ingenioso de los organos y sentidos interiores, y exteriores del hombre (Mexico, 1657); Tratado de los bienes del silencio y males de la lengua, attributed to rector of the Colegio de Manila Diego de S. I. Bobadilla (Manila, 1645) and Diego Calleja’s Talentos logrados, en el buen uso de los cinco sentidos (Madrid, 1700). My purpose is to draw out the authors’ engagement with aural discourses that intersect with other areas of early modern thought. Above all, I underscore the reconciliation of existing ideas about sound’s spiritual significance with developments in medicine and anatomy. The study is the first in-depth examination of each of the three treatises it considers. It advances our understanding of seventeenth-century sound culture and underscores the need for re-reading cultural production from this time period through an aural...
Contributions of Hydrology to Vesicular Stomatitis Virus Emergence in the Western USA

Relationships between environmental variables associated with the spread of vector-borne pathogens, such as RNA viruses transmitted to humans and animals, remain poorly understood. Vesicular stomatitis (VS) is caused by a vector-borne, zoonotic RNA virus (VSV) and is the most common vesicular disease affecting livestock (domestic horses, cattle, pigs) throughout the Americas. This investigation focused on explaining patterns of more than 1500 VS-infected livestock premises in the western USA from 2004 to 2016 related to the ecology of the host-vector-virus-environment system. We investigated the relationship between VS incidents and habitat characteristics expected to be important to insect vectors: stream location, streamflow conditions, climate, and vegetation. Results show that VS incidents were distributed near the stream network with 72% located within 1 km of lotic habitat. Monthly incidents were closest to lotic habitat in April (x = 525 m) and furthest from lotic habitat in November, December and January (1843, 2141 and 4807 m) indicating that initial infection near streams may spread away from these locations. All first incidents (n = 35) occurred following peak annual streamflow, with 89% (31 of 35) of these occurring after streams returned to baseflow. This finding indicated that surveillance for VS could be targeted spatially in locally relevant geographic areas (that is, near streams) and temporally relative to local streamflow conditions which can be remotely monitored via existing web-accessible information networks. Habitat modeling of 11 subwatersheds revealed somewhat different models for each watershed with several factors important in multiple watersheds. In nine of the 11 watersheds, the highest model PC (31–71%) represented either higher-than-average long-term mean temperature or lower-than-average long-term mean precipitation. Approaching habitat modeling on a watershed basis reveals information to support additional research. These spatial and temporal relationships showcase the importance of hydrologic contributions to the emergence and distribution of an arthropod-borne disease in the western USA.
Expanded definitions of the 'good death'? Race, ethnicity and medical aid in dying.

The range of end of life options is expanding across North America. Specifically, medical aid in dying, or the process by which a patient with a terminal illness may request medical assistance with hastening death, has recently become legal in eight jurisdictions in the U.S. and all of Canada. Debates about aid in dying often rely on cultural constructions that define some deaths as “good” and others as “bad.” While research has found commonalities in how patients, family members, and health care providers define good and bad deaths, these constructions likely vary across social groups. Because of this, the extent to which aid in dying is seen as a route to the good death also likely varies across social groups. In this article, we analyse qualitative data from six focus groups (n=39) across three racial and ethnic groups: African American, Latino, and white Californians, just after a medical aid in dying law was passed. We find that definitions of the “good death” are nuanced within and between groups, suggesting that different groups evaluate medical aid in dying in part through complex ideas about dying. These findings further conversations about racial and ethnic differences in choices about end of life options.
Studies on the Computational Modeling and Design of Financial Markets

Electronic marketplaces and the automation of trading have transformed the financial market from a human-decision ecosystem to an algorithmic one. Questions and challenges that arise from this new algorithmic ecosystem naturally lend themselves to computational approaches. My research builds computational models to understand trading behaviors, designs market mechanisms robust to manipulation, and proposes algorithms to facilitate order matchings.
Radiative Heating of an Ice-Free Arctic Ocean

Author(s): Pistone, K; Eisenman, I; Ramanathan, V | Abstract: During recent decades, there has been dramatic Arctic sea ice retreat. This has reduced the top-of-atmosphere albedo, adding more solar energy to the climate system. There is substantial uncertainty regarding how much ice retreat and associated solar heating will occur in the future. This is relevant to future climate projections, including the timescale for reaching global warming stabilization targets. Here we use satellite observations to estimate the amount of solar energy that would be added in the worst-case scenario of a complete disappearance of Arctic sea ice throughout the sunlit part of the year. Assuming constant cloudiness, we calculate a global radiative heating of 0.71nW/m2 relative to the 1979 baseline state. This is equivalent to the effect of one trillion tons of CO2 emissions. These results suggest that the additional heating due to complete Arctic sea ice loss would hasten global warming by an estimated 25nyears.
Developmental cascades of social competence, achievement in school, and achievement on standardized assessments during the transition to adolescence and secondary school

Abstract Introduction Social and academic functioning are cornerstones of positive youth development and important to later educational and health outcomes. Yet, little is known about how the timing and direction of relationships between social and academic functioning vary by the type of achievement assessed and how the transition to adolescence influences these relationships. Method This study employs longitudinal structural equation modeling to examine the interrelationships of children's social competence, teacher ratings of school achievement, and standardized assessments of cognitive achievement in a cohort of 1048 children in the United States. Results & Conclusions: Results identify 1) direct and indirect pathways from children's social competence in grades three and five to their school achievement in grades five and six; 2) significant pathways between school and cognitive achievement across all assessment points that decline in magnitude as students enter high school; 3) the magnitude of pathways between social competence and school achievement far exceed those between social competence and cognitive achievement; and 4) social and maturational factors account for variation in these functions but do not confound the timing and direction of the pathways from one to the other function. Given the importance of social competence and academic achievement to positive development, these findings demonstrate elementary school as an optimal and foundational period to implement universal interventions to optimize social functioning and prevent later academic difficulties in secondary school.
T Cell Activation Depends on Extracellular Alanine.

Summary T cell stimulation is metabolically demanding. To exit quiescence, T cells rely on environmental nutrients, including glucose and the amino acids glutamine, leucine, serine, and arginine. The expression of transporters for these nutrients is tightly regulated and required for T cell activation. In contrast to these amino acids, which are essential or require multi-step biosynthesis, alanine can be made from pyruvate by a single transamination. Here, we show that extracellular alanine is nevertheless required for efficient exit from quiescence during naive T cell activation and memory T cell restimulation. Alanine deprivation leads to metabolic and functional impairments. Mechanistically, this vulnerability reflects the low expression of alanine aminotransferase, the enzyme required for interconverting pyruvate and alanine, whereas activated T cells instead induce alanine transporters. Stable isotope tracing reveals that alanine is not catabolized but instead supports protein synthesis. Thus, T cells depend on exogenous alanine for protein synthesis and normal activation.
Relational verification using reinforcement learning

Relational verification aims to prove properties that relate a pair of programs or two different runs of the same program. While relational properties (e.g., equivalence, non-interference) can be verified by reducing them to standard safety, there are typically many possible reduction strategies, only some of which result in successful automated verification. Motivated by this problem, we propose a novel relational verification algorithm that learns useful reduction strategies using reinforcement learning. Specifically, we show how to formulate relational verification as a Markov Decision Process (MDP) and use reinforcement learning to synthesize an optimal policy for the underlying MDP. The learned policy is then used to guide the search for a successful verification strategy. We have implemented this approach in a tool called Coeus and evaluate it on two benchmark suites. Our evaluation shows that Coeus solves significantly more problems within a given time limit compared to multiple baselines, including two state-of-the-art relational verification tools.
Opioid Prescribing Trends in Women Following Mastectomy or Breast-Conserving Surgery Before and After the 2014 Federal Reclassification of Hydrocodone

Background Given concerns about suboptimal pain management for actively treated cancer patients following the 2014 federal reclassification of hydrocodone, we examined changes in patterns of opioid prescribing among surgical breast cancer patients. Materials and methods Data from a large nationally representative commercial health insurance program from 2009 to 2017 were used to identify women aged 18 years and older who were diagnosed with carcinoma in-situ or malignant breast cancer and received breast-conserving surgery or mastectomy from 2010 to 2016. Generalized linear mixed models were used to estimate the adjusted odds ratio (aOR) for receipt of ≥1-day, >30-day, or ≥ 90-day supply of opioids in the 12 months following surgery adjusting for demographics, cancer treatment-related characteristics, and preoperative opioid use. Results A total of 60,080 patients were included in the study. Surgically treated breast cancer patients in 2015 (aOR = 0.90, 0.84-0.97) and 2016 (aOR = 0.80, 0.74-0.86) were less likely to receive ≥1-day supply of opioid prescriptions when compared with patients in 2013. Patients who had surgery in 2015 (aOR = 0.89, 0.81-0.98) and 2016 (aOR = 0.80, 0.73-0.87) were also less likely to receive >30-day supply of prescription opioids in the 12 months following surgery. However, only surgical breast cancer patients in 2016 were less likely to receive ≥90-day supply (aOR = 0.86, 0.76-0.98). Conclusion Surgically treated breast cancer patients are less likely to receive short- and long-term opioid prescriptions following the implementation of hydrocodone rescheduling. Further studies on the potential impact of federal policy on cancer patient pain management are needed. Implications for practice Clinicians and researchers with diverse perspectives should be included as stakeholders during policy development for restricting opioid prescriptions. Stakeholders can identify potential unintended consequences early and help identify methods to mitigate concerns, specifically as it relates to policy that influences how providers manage pain for actively treated cancer patients. This work shows how federal policy may have led to declines in opioid prescribing for breast cancer patients who underwent mastectomy or breast-conserving surgery.
Characterizing the Human Heart Rate Circadian Pacemaker through Widely Available Wearable Devices

Real world passive measures of circadian timekeeping have the potential to improve the efficacy of medical treatments and improve human performance on a broad scale. Here, we present algorithms for extracting and quantifying the uncertainty of estimates of the underlying circadian rhythm in heart rate (CRHR) from several widely used wearables after removing the masking effects of sleep and activity on heart rate. Analysis of over 130,000 days of data from medical interns on rotating shifts shows how CRHR dynamics are distinct from those of sleep-wake timing. We determine a personalized phase response curve (PRC) of CRHR to activity for each individual, representing the first passive determination of personalized circadian parameters, and validate our methods against previous clinical data. We also validate a simplified algorithm that can be implemented on a smartphone and use this algorithm to test a hypothesis about the role of circadian timekeeping in timing sleep using data from individuals in 5 continents. These results collectively establish CRHR as a practical method to study circadian rhythms in the real world and to understand how circadian disruption affects human health and functioning.
pH and excipient profiles during formulation of highly concentrated biotherapeutics using bufferless media

Several models have been developed to describe the shifts in pH and excipient concentrations seen during diafiltration of monoclonal antibody (mAb) products accounting for both Donnan equilibrium and electroneutrality constraints. However, these models have assumed that the mAb charge is either constant or only a function of pH, assumptions that will not be valid when formulating highly concentrated mAbs using bufferless or low-buffered media due to the change in local H+ concentration at the protein surface. The objective of this study was to incorporate the effects of both pH and ionic strength on the mAb charge, through the use of a charge regulation model based on the amino acid sequence of the mAb, into an appropriate mass balance model to describe the pH and excipient profiles during diafiltration. The model involves no adjustable parameters, with the protein charge evaluated directly from the protonation/deprotonation of the ionizable amino acids accounting for the electrostatic interactions between the charged mAb and the H+ ions. Model predictions are in excellent agreement with experimental data for the pH and ion concentrations during diafiltration of a mAb and fusion protein with different isoelectric points and different formulation conditions. Model simulations are then used to obtain fundamental insights into the factors controlling the diafiltration behavior as well as guidelines for development of diafiltration processes to achieve target bufferless formulation conditions.
Audit Market Competition and Client Portfolio Risk

This study investigates whether audit market competition influences the risk profile of audit offices’ client portfolios and whether an audit office’s client risk profile affects the association between audit market competition and audit quality. Economic theory suggests that market competition can affect a company’s risk-taking, but there is limited evidence on how audit market competition affects audit offices’ client portfolio composition. Two streams of prior research have documented that auditors make portfolio management decisions based on risk avoidance, and that audit market competition affects audit quality, although the results are mixed. We suggest that audit market competition influences audit offices’ acceptance of risky clients by reducing the set of available acceptable clients. The increased riskiness of audit offices’ client portfolio, in turn, affects audit quality provided by the audit office. We find that audit market competition at both the MSA and MSA-industry levels increases the riskiness of audit offices’ client portfolios. Furthermore, results suggest that audit market competition through increases in the audit office’s client portfolio risk explains a significant amount of the total effect of audit market competition on audit quality. This study contributes to the prior literature examining how audit offices manage their client portfolio risk and how audit market competition affects that ability and ultimately affects audit quality.
An Algorithm for Detecting Coherence in Cyclone Global Navigation Satellite System Mission Level-1 Delay-Doppler Maps

An algorithm for detecting coherence in Cyclone Global Navigation Satellite System (CYGNSS) mission delay-Doppler maps (DDMs) is presented. Because CYGNSS DDMs report only the observed power without phase information, the algorithm uses estimates of power “spread” within the DDM to flag coherency. Since the estimate used is a ratio of the powers in differing portions of the DDM, it is less sensitive to absolute power calibration and to the GPS C/A code type observed, and is applied to CYGNSS Level-1 uncalibrated DDMs. The basic detector formulation is described along with modifications to improve performance in lower signal-to-noise ratio (SNR) situations. The required detection thresholds are determined using matchups with CYGNSS “Raw I/F” mode measurements for which the DDM phase can be computed and used to identify coherence more precisely. Application of the final detector over a large CYGNSS data set suggests that approximately 8.9% of all inland returns are coherent. Inland regions persistently identified as coherent were found largely to be associated with the presence of water bodies. A smaller set of desert locations apparently having very low surface roughness were also found to be associated with persistent coherence. The detector was also applied to a set of ocean measurements, with the results showing that persistent coherence is limited to areas with sheltered waters. Ocean tests avoiding such regions indicate that the detector’s false-alarm rate is approximately 0.0012% for the detection threshold used.
Anti-Anti-Evasion in Constitutional Law

In a previous paper, we identified “anti-evasion doctrines” (AEDs) that the U.S. Supreme Court develops in various areas of constitutional law to prevent the circumvention of constitutional principles the Court has sought to enforce. Typically, the Court employs an AED – crafted as an ex post standard – to bolster or backstop a previously-designed decision rule – crafted as an ex ante rule – so as to prevent government officials from complying with the form of the prior rule while evading the constitutional substance the rule was designed to implement. Although AEDs present benefits and tradeoffs in constitutional doctrine, their function in optimizing constitutional enforcement is likely worth the costs they impose.But the Court’s use of AEDs is not foreordained. In notable areas of constitutional doctrine, the Court has declined to create AEDs in situations that seemingly invite it to do so. This paper addresses this phenomenon, which we term “anti-anti-evasion,” and seeks to understand why the Court employs AEDs in some contexts but not in others. After furnishing a number of examples of anti-anti-evasion, we identify and evaluate the reasons the Court gives for declining to create AEDs. Because these reasons do not tell the whole story, we also pose a working hypothesis – i.e., the Court will not create AEDs where it believes that the constitutional principle is adequately protected by robust political safeguards, and this occurs primarily in cases involving taxing or spending decisions, including the provision of government-subsidized goods and services. Support for this hypothesis is found in a number of the Court’s AED and anti-anti-evasion decisions, including the much-awaited decision in National Federation of Independent Business v. Sebelius.Apart from academic curiosity, the hypothesis (if correct) has broader implications. First, it helps to demonstrate that the formulation of constitutional doctrine is a type of risk regulation where the Court employs decision rules in an effort to achieve optimal (as opposed to maximal) protections. Second, it expands on earlier work by other scholars that considered possible reasons for why the Court might choose one set of decision rules over another, thereby contributing to the ongoing effort to describe accurately what courts actually do when they decide cases. Third, our hypothesis hopefully will encourage the Justices to be more intentional in selecting among available decision rules, and perhaps more transparent in the reasoning behind the adoption of one set over others. Finally, our hypothesis should prove useful to practicing lawyers in crafting constitutional arguments.
The Outsourcing of R&D Through Acquisition in the Pharmaceutical Industry

We examine the performance of 160 pharmaceutical acquisitions from 1994 to 2001 and find evidence that on average acquirers realize significant positive returns. These returns are positively correlated with prior acquirer access to information about the research and development activities at target firms and a superior negotiating position. A unique Desperation Index is employed to determine the current status of a firm's internal productivity. We find that firms experiencing declines in internal productivity or which are more desperate are more likely to engage in an outsourcing-type acquisition in an effort to replenish their research pipelines.
Supplier Partnerships and the Small, High-Growth Firm: Selecting for Success

How changes in strategic direction brought about by firm growth affect a firm's relationships with suppliers is investigated. Two hypotheses were tested: (1) that firm growth is positively related to maintaining or expanding relationships with suppliers, and (2) that the relationship between firm growth and amount purchased from suppliers is moderated by the perceived effectiveness of the partnership. Two models of organizational change are utilized: the model of structural inertia, and the model that firms change and adapt quickly during periods of high growth. Data on purchases by pharmaceutical firms were obtained through questionnaires from 91 firms and subjected to regression analysis. Data were collected on relationships among sales growth, the amount purchased, and the effectiveness of the supplier in high-growth firms. Analysis of the results showed that sales growth is related positively to the percentage purchased from the supplier. Although it was found that firms do buy a greater percentage when the relationship is effective, the greater impact of sales growth on percentage purchased occurs when effectiveness is low. (TNM)
Mechanism of Action of Radiofrequency Ablation

Understanding the mechanism of radiofrequency (RF) can optimize pain management and patient selection, prevent complications, and help design clinical trials in pain medicine. This chapter reviews the principles of nerve damage, physics of RF types, various mechanisms of action proposed for the RF, and areas of need for future studies.
Spiriting urban educational justice: The leadership of African American mothers organizing for school equity and local control

Inner-city school systems serving marginalized populations around the world are hindered by undemocratic and anti-public, political forces given global neoliberalism. This paper highlights a three-year case study of community organizers’ efforts to resist such forces and increase school access, equity, and local control in Detroit, MI (USA). Authors emphasize how the leadership of African American mother organizers was particularly instrumental to positive change. Literature on educational activism, leadership, and community organizing help frame the organizational and political value of the organizers’ efforts. In-depth interview, observation, and artifact data further reveal how the activist-mother-organizers, motivated by their spiritual beliefs and liberatory aims, guided effective educational reform campaigns to oppose school closure and cultivated critical hope among their fellow organizers through a process the authors name as “spiriting urban educational justice.” Spiriting urban educational justice involves enacting border crossing and boundary spanning activities to navigate placed-based politics and seek educational equity with spiritual clarity and drive. Authors discuss how school and district leaders can learn from this process and collaborate with activist-organizers who serve as spiriters of justice to improve urban schools.
The REDI-Parent Program: Enhancing the School Success of Children from Low-Income Families

This chapter describes the Research-based, Developmentally Informed Parent (REDI-P) home visiting program that was designed to support families of 4-year-old children attending Head Start through the transition into kindergarten. In REDI-P parents are provided with learning materials to use at home and coached in strategies to support child skill development in the dual domains of language-emergent literacy skills and social-emotional learning. A randomized trial documented significant benefits for children in kindergarten in areas of academic performance and social competence, and these benefits were sustained through third grade. Parents increased positive interactions and conversations with their children and reported higher academic expectations. By third grade, parents reported fewer child problems at home and less parenting stress. In addition to describing the program and its outcomes, this chapter describes links between initial program response (program engagement and intervention-related improvements in targeted competencies in kindergarten) and sustained benefits evident 2–4 years later, revealing the potential mechanisms of action and key factors that may account for the long-term benefits of parent engagement efforts at school entry. Implications of this research for the scaling of REDI-P and future design of similar family engagement programs are described, along with recommendations for next steps in this important area of research.
Clinical problem solving and diagnostic decision making: selective review of the cognitive literature

This is the fourth in a series of five articles This article reviews our current understanding of the cognitive processes involved in diagnostic reasoning in clinical medicine. It describes and analyses the psychological processes employed in identifying and solving diagnostic problems and reviews errors and pitfalls in diagnostic reasoning in the light of two particularly influential approaches: problem solving1, 2, 3 and decision making.4, 5, 6, 7, 8 Problem solving research was initially aimed at describing reasoning by expert physicians, to improve instruction of medical students and house officers. Psychological decision research has been influenced from the start by statistical models of reasoning under uncertainty, and has concentrated on identifying departures from these standards. #### Summary points Problem solving and decision making are two paradigms for psychological research on clinical reasoning, each with its own assumptions and methods The choice of strategy for diagnostic problem solving depends on the perceived difficulty of the case and on knowledge of content as well as strategy Final conclusions should depend both on prior belief and strength of the evidence Conclusions reached by Bayes's theorem and clinical intuition may conflict Because of cognitive limitations, systematic biases and errors result from employing simpler rather than more complex cognitive strategies Evidence based medicine applies decision theory to clinical diagnosis ### Diagnosis as selecting a hypothesis The earliest psychological formulation viewed diagnostic reasoning as a process of testing hypotheses. Solutions to difficult diagnostic problems were found by generating a limited number of hypotheses early in the diagnostic process and using them to guide subsequent collection of data.1 Each hypothesis can be used to predict what additional findings ought to be present if it were true, and the diagnostic process is a guided search for these findings. Experienced physicians form hypotheses and their diagnostic plan rapidly, and the …
Breast masses in women treated for childhood cancer: incidence and screening guidelines.

BACKGROUND The authors' aims were to define the frequency, characteristics, and methods of detection of breast masses in young women treated for childhood cancer and to develop screening guidelines for the growing population of long term survivors. METHODS The authors reviewed medical records of all female patients treated for malignancy at a childhood cancer center over a 34-year period to identify those who developed a breast mass and to determine the cumulative incidence of breast cancer as a second primary cancer. RESULTS A breast mass was identified in 66 patients who had been diagnosed with a malignancy at a median age of 13.8 years (range, 0.4-24.4 years). Masses were initially detected by breast self-detection in 32 and clinical examination in 28; the method of detection was unknown in 6 cases. Breast lesions were benign in 41 patients and malignant in 26; 1 patient had both a benign and a malignant lesion. Of the 26 malignant masses, 14 represented metastases of the primary malignancy and 12 were primary breast cancers as second primary cancers. The median interval to a primary breast cancer as a second primary cancer was 13.6 years (range, 9.2-24.4 years), and the median age at detection was 27.7 years (range, 12.5-43.1 years). The 25-year cumulative incidence of primary breast cancer as a second primary cancer in this cohort was 1.7% (95% CI, 0.4%-2.9%). This represented a 20-fold increase (95% CI, 10-36) over the expected incidence in age-matched and race-matched controls. CONCLUSIONS Young women treated for childhood cancer have a significantly increased risk of breast cancer compared with age-matched controls. For this group of patients, the authors recommend patient education regarding this risk and the importance of properly conducted self-examination as the foundation of breast cancer screening. In addition, clinical and mammographic screening should be instituted at a younger age and performed more frequently than recommended for the general population of women. Cancer 1998;82:784-92. ©; 1998 American Cancer Society.