cssi/SciSciGPT-SciSciNet huggingface dataset:
Thyroid fine‐needle aspiration with atypia of undetermined significance

BACKGROUND: Atypia of undetermined significance is a controversial category in thyroid fine-needle aspiration (FNA), not only for its questioned clinical utility, but also for its very existence as an expression of uncertainty. The current study was performed to investigate the potential impact of eliminating this category on the sensitivity and specificity for detecting thyroid neoplasms by FNA. METHODS: Forty cases originally diagnosed as atypia of undetermined significance with histologic follow-up were selected for the present study. These cases were reinterpreted blindly by 2 experienced reviewers, who eliminated atypia of undetermined significance as a diagnostic possibility and reclassified these cases as either benign, follicular neoplasm, suspicious for malignancy, or malignant. Twenty-six cases of atypia of undetermined significance were randomly selected and reevaluated 6 months later to study intraobserver variation. RESULTS: After eliminating the atypia of undetermined significance category, the sensitivity for detecting papillary thyroid carcinoma (PTC) was reduced from 100% to 27% (P = .04). In those atypia of undetermined significance cases that were reclassified as benign, 37% had PTC. In those reclassified as follicular neoplasm or suspicious for malignancy, 38% were histologically proven to be benign lesions. Unanimous interobserver and intraobserver agreement was observed in only 60% of cases. CONCLUSIONS: Eliminating the diagnosis of atypia of undetermined significance substantially decreases the sensitivity of thyroid FNAs and increases both false-positive and false-negative rates. In addition, it increases interobserver and intraobserver variability. Therefore, the atypia of undetermined significance category should not be eliminated; but we advocate minimizing its use. Cancer (Cancer Cytopathol) 2009. © 2009 American Cancer Society.
Union Activism: Do Union Pension Funds Act Solely in the Interest of Beneficiaries?

Union pension funds manage approximately $3.5 trillion in retirement assets on behalf of public and private sector employees covered by collective bargaining agreement. They are also very active in the proxy process, sponsoring approximately one-third of the shareholder proposals that are included in corporate proxies each year. Federal and state laws (including ERISA) require that the trustees and administrative bodies that oversee these funds manage their plans “solely in the interest of participants and beneficiaries.” Furthermore, the U.S. Department of Labor is clear that pension funds are not to use plan assets and their voting rights “to further legislative, regulatory or public policy issues through the proxy process.”We examine this issue is greater detail, including the types of proposals put forward but union pension funds, the support these proposals receive, and the companies they target. We ask: Are union-sponsored proposals made solely in the interest of their pension beneficiaries? How can the public or a pension beneficiary assess the motives of funds that sponsor proxy proposals? How do union pension funds determine which positions to advocate and which companies to target? Are unions violating their ERISA duties by sponsoring these proposals?Includes: Response from Brandon Rees, Acting Director, AFL-CIO Office of Investment.Topics, Issues and Controversies in Corporate Governance and Leadership: The Closer Look series is a collection of short case studies through which we explore topics, issues, and controversies in corporate governance. In each study, we take a targeted look at a specific issue that is relevant to the current debate on governance and explain why it is so important. Larcker and Tayan are co-authors of the book Corporate Governance Matters, and A Real Look at Real World Corporate Governance.
Direct assessment of platelet adhesion to glass: a study of the forces of interaction and the effects of plasma and serum factors, platelet function, and modification of the glass surface.

Platelet adhesion to glass has been directly determined with a cover slip chamber. These studies have separated the functions of platelet adhesion to a foreign surface from platelet cohesion (aggregation). The forces of the platelet-glass interaction have been studied, and the qualitative variables affecting this interaction have been defined. Fibrinogen and calcium or magnesium are required for adhesion of either unwashed or washed platelets in plasma. Platelet adhesion in fresh serum requires thrombin and probably the fibrinogen of the platelet surface, since washed platelets are not adherent in fresh serum. Platelets incubated at 37°C for 48 hr can neither spread nor adhere to glass, a defect that may reflect decreased platelet surface area and membrane deformability. Platelets are equally as adherent to siliconized glass as to untreated glass surfaces. However, platelets cannot adhere to glass treated with the hydrogen-bonding polymer, poly(ethylene oxide). In contrast to silicone, poly(ethylene oxide)-treated glass surfaces do not impede blood coagulation. These surface properties further distinguish the two major factors involved in thrombogenesis: platelet adhesion and plasma coagulation.
Delaunay Refinement by Corner Lopping

An algorithm for quality Delaunay meshing of 2D domains with curved boundaries is presented. The algorithm uses Ruppert’s “corner lopping” heuristic [MR96b:65137]. In addition to admitting a simple termination proof, the algorithm can accept curved input without any bound on the tangent angle between adjoining curves. In the limit case, where all curves are straight line segments, the algorithm returns a mesh with a minimum angle of arcsin (\({1 \mathord{\left/ {\vphantom {1 2}} \right. \kern-\nulldelimiterspace} 2}\sqrt 2 \)), except “near” input corners. Some loss of output quality is experienced with the use of curved input, but this loss is diminished for smaller input curvature.
Absorption of Protein and Protein Fragments in the Developing Intestine: Role in Immunologic/Allergic Reactions

An important adaptation of the gastrointestinal tract to the extrauterine environment is its development of a mucosal barrier against the penetration of proteins and protein fragments. To combat the potential danger of invasion across the mucosal barrier the newborn infant must develop within the lumen and on the luminal mucosal surface an elaborate system of defense mechanisms which act to control and maintain the epithelium as an impermeable barrier to the uptake of macromolecular antigens. As a result of a delay in the maturation of the mucosal barrier, newborn infants are particularly vulnerable to pathologic penetration by harmful intraluminal substances. The consequences of altered defense are susceptibility to infection and the potential for hypersensitivity reactions and the formation of immune complexes. With these reactions comes the potential for developing life-threatening diseases such as necrotizing enterocolitis, sepsis, and hepatitis. Fortunately, "nature" has provided a means for passively protecting the "vulnerable" newborn against the dangers of a deficient intestinal defense system, namely human milk. It is now increasingly apparent that human milk contains not only antibodies and viable leukocytes but many other substances that can interfere with bacterial colonization and prevent antigen penetration.
Generation of political priority for global surgery: a qualitative policy analysis.

Summary Background Despite the high burden of surgical conditions, the provision of surgical services has been a low global health priority. We examined factors that have shaped priority for global surgical care. Methods We undertook semi-structured interviews by telephone with members of global surgical networks and ministries of health to explore the challenges and opportunities surgeons, anaesthesiologists, and other proponents face in increasing global priority for surgery. We did a literature review and collected information from reports from organisations involved in surgery. We used a policy framework consisting of four categories—actor power, ideas, political contexts, and characteristics of the issue itself—to analyse factors that have shaped global political priority for surgery. We did a thematic analysis on the collected information. Findings Several factors hinder the acquisition of attention and resources for global surgery. With respect to actor power, the global surgery community is fragmented, does not have unifying leadership, and is missing guiding institutions. Regarding ideas, community members disagree on how to address and publicly position the problem. With respect to political contexts, the community has made insufficient efforts to capitalise on political opportunities such as the Millennium Development Goals. Regarding issue characteristics, data on the burden of surgical diseases are limited and public misperceptions surrounding the cost and complexity of surgery are widespread. However, the community has several strengths that portend well for the acquisition of political support. These include the existence of networks deeply committed to the cause, the potential to link with global health priorities, and emerging research on the cost-effectiveness of some procedures. Interpretation To improve global priority for surgery, proponents will need to create an effective governance structure that facilitates achievement of collective goals, generate consensus on solutions, and find an effective public positioning of the issue that attracts political support. Funding None.
Potential neuroprotective effects of cinnamon

Summary. The pathogenesis of neurodegenerative diseases involves complex interactions between multiple mechanisms, including but not limited to oxidative stress, inflammation, and proteotoxicity, which have yet to be ameliorated by pharmaceutical drugs with single targets. Natural products have been recognized for their health promoting effects for thousands of years. Plants produce a vast collection of secondary products, such as alkaloids, phenolic compounds, and terpenes that have shown health benefits in a variety of conditions including cancer, cardiovascular disease, and neurodegenerative diseases. In the search for more effective and safe treatment options for neurodegenerative diseases, several dietary sources of phytochemicals have been investigated. Historical usage in traditional medicine, along with modern research has identified several key products with potential benefits in neurodegenerative diseases. Among the dietary sources, cinnamon shows particular merit as a therapeutic potential for neurodegenerative diseases. Accumulating evidence suggesting neuroprotective effects via modulation of various risk factors relevant to neurodegeneration has been reviewed here. Industrial relevance. Cinnamon has been cherished for its health-promoting effects for thousands of years. Today, while modern medicine provides critical pharmaceutical agents that have assisted in ameliorating many diseases and extended the average lifespan significantly in the past century, these agents are associated with many side effects and expenses. As such, the search for efficient therapies with limited side effects is a significant target of research. Cinnamon, as a rich source of phytochemicals and long history in traditional medicine, has been a popular spice in recent decades for investigations elucidating its health-promoting effects. This review evaluates the therapeutic potential of cinnamon in ameliorating the risk factors responsible for the development of neurodegenerative diseases and associated pathologies. Keywords. Cinnamon; Neuroprotection; Alzheimer’s disease; Parkinson’s disease
Effects of Hydrophobic Macromolecular Crowders on Amyloid β (16–22) Aggregation

In Alzheimer’s disease (AD), the amyloid β (Aβ) peptide aggregates in the brain to form progressively larger oligomers, fibrils, and plaques. The aggregation process is strongly influenced by the presence of other macromolecular species, called crowders, that can exert forces on the proteins. One very common attribute of macromolecular crowders is their hydrophobicity. We examined the effect of hydrophobic crowders on protein aggregation by using discontinuous molecular dynamics (DMD) simulations in combination with an intermediate resolution protein model, PRIME20. The systems considered contained 48 Aβ (16–22) peptides and crowders with diameters of 5 A, 20 A, and 40 A, represented by hard spheres or spheres with square-well/square-shoulder interactions, at a crowder volume fraction of ϕ = 0.10. Results show that low levels of crowder hydrophobicity are capable of increasing the fibrillation lag time and high levels of crowder hydrophobicity can fully prevent the formation of fibrils. The types of structures that remain during the final stages of the simulations are summarized in a global phase diagram that shows fibril, disordered oligomer, or β-sheet phases in the space spanned by crowder size and crowder hydrophobicity. In particular, at high levels of hydrophobicity, simulations with 5 A crowders result in only disordered oligomers and simulations with 40 A crowders result in only β-sheets. The presence of hydrophobic crowders reduces the antiparallel β-sheet content of fibrils, whereas hard sphere crowders increase it. Finally, strong hydrophobic crowders alter the secondary structure of the Aβ (16–22) monomers, bending them into a shape that is incapable of forming ordered β-sheets or fibrils. These results qualitatively agree with previous theoretical and experimental work.
Physical and functional analyses of the syrA and syrB genes involved in syringomycin production by Pseudomonas syringae pv. syringae.

The syrA and syrB genes involved in syringomycin production in Pseudomonas syringae pv. syringae B301D were identified from an EcoRI-pLAFR3 cosmid library and then physically and functionally analyzed in relation to plant pathogenicity. Homologous recombination of the genes required for syringomycin production from cosmids pGX183 (syrA) and pGX56 (syrB), respectively, introduced into nontoxigenic (Tox-) Tn5 mutants W4S2545 and W4S770 resulted in the concomitant restoration of toxin production and full virulence. The disease indices of the Tox+ strains obtained by recombination of the cloned, homologous DNA into the corresponding Tn5 mutant were essentially equivalent to that of strain B301D-R and significantly higher than those of W4S2545 and W4S770. A 12-kilobase (kb) EcoRI fragment from pGX183 was subcloned (i.e., pGX15) and found to contain the sequences necessary for syringomycin production. A map of pGX15 prepared by a combination of restriction endonuclease digestions and Tn5 mutagenesis showed that the syrA sequence was 2.3 to 2.8 kb. Marker exchange of syrA::Tn5 from pGX15 into B301D-R yielded nonpathogenic phenotypes, indicating that syrA is a regulatory gene since it is necessary for both syringomycin production and pathogenicity. The 4.9-kb EcoRI fragment from pGX56 was subcloned (i.e., pGX4) and shown to carry the syrB sequence which was 2.4 to 3.3 kb. Sodium dodecyl sulfate-polyacrylamide gel electrophoretic analysis of protein extracts from B301D-R associated five proteins, ranging from approximately 130,000 to approximately 470,000 in molecular weight, with syringomycin production. The syrA and syrB genes were required for the formation of proteins SR4 (approximately 350,000) and SR5 (approximately 130,000), which are believed to be components of the syringomycin synthetase complex.
Integrating central and peripheral information during object categorization

The integration of visual information across saccades when processing a complex scene is affected by many factors. A large amount of high resolution information at the center of fixation is sequentially added to the stored results of recent fixat ions. In addition, contextual knowledge of the coherent image as well as peripheral visual information influences this process. We began to investigate this integration of visual information by reducing the complexity of the task in three ways. First, we eliminated contextual information by showing random pairs of object images. Second, we restricted eye movements with short presentation times. Third, we restricted the access to peripheral information away from fixation by sequential presentation of information.
Lorentz Mixing of Co-Flowing Reactant Streams

Abstract A new method has been developed for enhancing bulk mixing in a planar diffusion flame. The fuel stream is seeded with cesium to raise the electrical conductivity at the reactant interface. A current is passed through the flame, and by applying an orthogonal magnetic field a Lorentz body force is induced perpendicular to the flame sheet. Sinusoidal oscillation of the current is used to wiggle the flame sheet at the imposed frequency and promote bulk mixing of the reactants through a disruption of the laminar behavior of the flow. High-speed video images have been analyzed to estimate induced lateral flame sheet velocities. Experimental results compare well with velocities predicted from a simple theoretical analysis.
Self-consistent integral equation theory for the equilibrium properties of polymer solutions

Self-consistent RISM integral equation theory of polymeric liquids is used to investigate the equilibrium properties of polymer solutions and melts. Density functional formalism is employed to derive the effective medium-induced potential between two sites on a polymer chain. The resulting expression leads to a coupling between the interchain and intrachain pair correlation functions. An approximate method for the calculation of the effective intrachain pair correlations is examined. The method employs Monte Carlo computer simulations of a single polymer chain interacting via local chemical interactions, long-range excluded volume, and the self-consistently determined medium-induced potential in the condensed phase to compute the intrachain pair correlations which are consistent with the interchain packing. Results for solutions of tangent hard-sphere chains are compared to recent off-lattice Monte Carlo simulations for various chain lengths and densities. In particular, it was found that the theory slightly overestimates the average size of the polymers in solution, while the density dependence of the average size of the chains is in good agreement with the Monte Carlo simulations. The inclusion of the self-consistent determination of the intrachain correlations is found to significantly alter the interchain pair correlation function at low and intermediate densities.
The Application of a Generativity Model for Older Adults.

Generativity is a concept first introduced by Erik Erikson as a part of his psychosocial theory which outlines eight stages of development in the human life. Generativity versus stagnation is the main developmental concern of middle adulthood; however, generativity is also recognized as an important theme in the lives of older adults. Building on the work of Erikson, McAdams and de St. Aubin (1992) developed a model explaining the generative process. The aims of this article are: (a) to explore the relationship between generativity and older adults as it appears in research literature; and (b) to examine McAdam's model and use it to explain the role of generativity in older adults who share life stories with gerontology students through an oral history project.
Diagnostic Evaluation of Elderly Patients with Mild Memory Problems

This case-based discussion focuses on the clinical presentation and diagnostic assessment of a uniquely challenging group of elderly patients: those with symptoms of mild memory problems. Such patients present a challenge to clinicians because of flux in our understandings of normal, age-related cognitive changes; of cognitive changes due to neurodegenerative illnesses; and of the relationships between depression and cognitive impairment. In addition, symptoms of memory problems may be reported by an observer rather than by the patient. These challenges warrant stepwise evaluation of elderly patients who present with symptoms of memory loss.
Budget decision making in large public school systems

Abstract This paper reviews and discusses results of a study of the budget process in fourteen large city school districts. Topics covered include incremental decision making, the use of “ratios” and “norms” in school budgeting, public participation in budgeting, relevant structural arrangements of local government, and the influence of boards of education on the allocation of resources. Finally, implications for the improvement of school management practices in large school districts are discussed.
Resolution in column chromatography of polymer latexes. II. A comparison of porous and nonporous packing systems

Data are presented to compare the size separation capabilities of several porous packing systems for latex particle chromatography. Material balance problems as well as nonequilibrium behavior encountered with small-pore systems (pores less than 1 μm) lead to the conclusion that larger pore systems (diameter 2 μm or greater) are superior from an operational viewpoint. The separation mechanism for a large-pore Fractosil system is shown to be predominantly hydrodynamic in nature with flow separation occurring in both the pores and packing interstices. The name Hydrodynamic Permeation Chromatography, or HDPC, is used to describe the process. The effects of calibration slope and band broadening on peak resolution are compared for an HDC system and the Fractosil system indicating the superior resolving power of the HDC system. Qualitative and semiquantitative considerations are made with regard to improved porous packing characteristics for an ideal HDPC system which would improve separation efficiency and resolution.
In vitro cell-based assay for activity analysis of staphylococcal enterotoxin A in food.

Staphylococcal enterotoxins (SEs) are a leading cause of food poisoning and have two separate biological activities; it causes gastroenteritis and functions as a superantigen that activates large numbers of T cells. In vivo monkey or kitten bioassays were developed for analysis of SEs emetic activity. To overcome the inherent limitations of such bioassays, this study describes an in vitro splenocyte proliferation assay based on SEs superantigen activity as an alternative method for measuring the activity of staphylococcal enterotoxin A (SEA). After incubation of splenocytes with SEA, cell proliferation was measured by labeling the proliferating cells' DNA with bromodeoxyuridine (5-bromo-2-deoxyuridine, BrdU) and quantifying the incorporated BrdU by immunohistochemistry. BrdU labeling is shown to be highly correlated with SEA concentration (R2=0.99) and can detect 20 pg mL−1 of SEA, which is far more sensitive than most enzyme-linked immunosorbent assays. Our assay can also distinguish between active toxin and inactive forms of the toxin in milk. By applying immunomagnetic beads that capture and concentrate the toxin, our assay was able to overcome matrix interference. These results suggest that our in vitro cell-based assay is an advantageous practical alternative to the in vivo monkey or kitten bioassays for measuring SEA and possibly other SEs activity in food.
Vertical-cavity surface-emitting lasers: the applications

In this paper, we focus on how vertical-cavity surface- emitting lasers (VCSELs) and arrays have led to many feasible advanced technological applications. Their intrinsic characteristics, performance, and producibility offer substantial advantages over alternative sources. Demonstrated performance of `commercial-grade' VCSELs include low operating powers ( 15 GHz), and high temperature operating ranges (10 K to 400 K and -55 degree(s)C to 125 degree(s)C, and T > 200 degree(s)C). Moreover, their robustness is manifest by high reliability in excess of 107 hours mean time between failures at room temperature and tenfold improvement over existing rad-hard LEDs. Hence, even these `commercial-grade' VCSELs offer potential within cryogenic and avionics/military or space environments. We have also demonstrated submilliamp ITH, stable, single-mode VCSELs utilized within bias-free 1-Gbit/s data links. These low- power VCSELs may also serve in applications from printers to low-cost atomic clocks. The greatest near-term VCSEL applications are upgrades to low-cost LEDs and high-grade copper wire in data links and sensors. Exploiting their surface-emitting geometry, VCSELs are also compatible with established multichip module packaging. Hence VCSELs and VCSEL arrays are ideal components for interconnect-intensive processing applications between and within computing systems.© (1997) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.
Mechanism of efficacy of 2-amino oleic acid for inhibition of calcification of glutaraldehyde-pretreated porcine bioprosthetic heart valves.

BACKGROUNDCalcification is a frequent cause of the clinical failures of glutaraldehyde-pretreated bioprosthetic heart valves (BPHV) fabricated from glutaraldehyde-cross-linked porcine aortic valves. 2-Amino oleic acid (AOA) has been shown in previous in vivo studies to be a promising anticalcification agent. Our objective was to investigate the mechanism of calcification inhibition mediated by AOA pretreatment of porcine aortic valve bioprostheses.METHODS AND RESULTSBPHV tissues were treated with an AOA solution for 72 hours before experimentation. The diffusion of AOA across both cusp and aortic wall was evaluated. The lag time for AOA to diffuse across the aortic wall was prolonged compared with that of the cusp. An extraction study was performed to determine the stability of AOA binding; the results indicated that the binding was relatively stable regardless of solvent extraction conditions. The interaction between ionic calcium and AOA on treated tissue also was investigated by evaluating the patterns...
Vibrations of Laminated Beams

This paper is a continuation of Ref. 1 and its extension to dynamic problems. As in Ref. 1 the underlying assumptions about the kinematics of the beam deformation are: a) deformations are elastic and small such that the linear elasticity theory is applicable; b) perfect bond is realized between adjacent laminae; c) Bernoulli's hypothesis of planar cross sections is valid for each lamina independently such that after the deformation each cross section consists of a number of planes interconnected at interface lines; d) deformation is symmetric with respect to vertical plane (no torsion). As shown in Ref. 1 on the basis of these assumptions it is possible to develop a simple and consistent theory without the introduction of additional simplifications (such as neglecting the bending rigidity of the core, etc.). Consider a laminated beam with x axis being the loci of all cross-sectional centroids and denote axial displacement by u(x9 z) and transverse displacement by w(x, z). As a consequence of assumptions about the deformation kinematics, set forth above, both displacement components u(x,z) and w(x, z) are defined as a polygonal graph with vertices at extreme fibers of all three laminae. It is, for example, obvious that to determine the displacement component u(x, z) we ought to know the values of the axial displacement at four vertices at each cross section. Hence, we write
Neuromodulatory Approaches for Chronic Pain Management: Research Findings and Clinical Implications

ABSTRACT Two lines of evidence provide preliminary support for the role that brain state, measured via electroencephalogram (EEG), may play in chronic pain. First, research has identified a link between brain EEG activity and the experience of pain. Second, there are a number of published studies documenting the beneficial effects of interventions that impact the cortical activity associated with chronic pain. These interventions include neurobehavioral treatments such as neurofeedback and hypnosis as well as invasive and non-invasive brain stimulation. Preliminary data showing the efficacy of neuromodulatory strategies for treating pain provides compelling reason to examine how cortical activity (as measured by EEG) may underlie the experience of pain. Existing data already suggest specific approaches that neurofeedback clinicians might consider when treating patients with chronic pain. Reciprocally, observations by neurofeedback practitioners could provide important case data that could foster the desig...
Partially Adaptive Estimation of Regression Models via the Generalized T Distribution

This paper considers M-estimators of regression parameters that make use of a generalized functional form for the disturbance distribution. The family of distributions considered is the generalized t (GT), which includes the power exponential or Box-Tiao, normal, Laplace, and t distributions as special cases. The corresponding influence function is bounded and redescending for finite “degrees of freedom.” The regression estimators considered are those that maximize the GT quasi-likelihood, as well as one-step versions. Estimators of the parameters of the GT distribution and the effect of such estimates on the asymptotic efficiency of the regression estimates are discussed. We give a minimum-distance interpretation of the choice of GT parameter estimate that minimizes the asymptotic variance of the regression parameters.
Electronic health records in outpatient clinics: Perspectives of third year medical students

United States academic medical centers are increasingly incorporating electronic health records (EHR) into teaching settings. We report third year medical students' attitudes towards clinical learning using the electronic health record in ambulatory primary care clinics. In academic year 2005–06, 60 third year students were invited to complete a questionnaire after finishing the required Ambulatory Medicine/Family Medicine clerkship. The authors elicited themes for the questionnaire by asking a focus group of third year students how using the EHR had impacted their learning. Five themes emerged: organization of information, access to online resources, prompts from the EHR, personal performance (charting and presenting), and communication with patients and preceptors. The authors added a sixth theme: impact on student and patient follow-up. The authors created a 21-item questionnaire, based on these themes that used a 5-point Likert scale from "Strongly Agree" to "Strongly Disagree". The authors emailed an electronic survey link to each consenting student immediately following their clerkship experience in Ambulatory Medicine/Family Medicine. 33 of 53 consenting students (62%) returned completed questionnaires. Most students liked the EHR's ability to organize information, with 70% of students responding that essential information was easier to find electronically. Only 36% and 33% of students reported accessing online patient information or clinical guidelines more often when using the EHR than when using paper charts. Most students (72%) reported asking more history questions due to EHR prompts, and 39% ordered more clinical preventive services. Most students (69%) reported that the EHR improved their documentation. 39% of students responded that they received more feedback on their EHR notes compared to paper chart notes. Only 64% of students were satisfied with the doctor-patient communication with the EHR, and 48% stated they spent less time looking at the patient. Third year medical students reported generally positive attitudes towards using the EHR in the ambulatory setting. They reported receiving more feedback on their electronic charts than on paper charts. However, students reported significant concerns about the potential impact of the EHR on their ability to conduct the doctor-patient encounter.
Responsiveness of the Numeric Pain Rating Scale in Patients with Low Back Pain

Study design Cohort study of patients with low back pain (LBP) receiving physical therapy. Objective To examine the responsiveness characteristics of the numerical pain rating scale (NPRS) in patients with LBP using a variety of methods. Summary of background data Although several studies have assessed the reliability and validity of the NPRS, few studies have characterized its responsiveness in patients with LBP. Methods Determination of change on the NPRS during 1 and 4 weeks was examined by calculating mean change, standardized effect size, Guyatt Responsiveness Index, area under a receiver operating characteristic curve, minimum clinically important difference, and minimum detectable change. Change in the NPRS from baseline to the 1 and 4-week follow-up was compared to the average of the patient and therapist's perceived improvement using the 15-point Global Rating of Change scale. Results The majority of patients had clinically meaningful improvement after both 1 and 4 weeks of rehabilitation. The standard error of measure was equal to 1.02, corresponding to a minimum detectable change of 2 points. The area under the curve at the 1 and 4-week follow-up was 0.72 (0.62, 0.81) and 0.92 (0.86, 0.97), respectively. The minimum clinically important difference at the 1 and 4-week follow-up corresponded to a change of 2.2 and 1.5 points, respectively. Conclusions Clinicians can be confident that a 2-point change on the NPRS represents clinically meaningful change that exceeds the bounds of measurement error.
Nanogele als pharmazeutische Trägersysteme: winzige Netzwerke mit großen Möglichkeiten

Als Nanogele bezeichnet man gequollene Netzwerke aus hydrophilen oder amphiphilen Polymeren in der Grosenordnung von einigen Dutzend bis Hundert Nanometern. Sie wurden als Tragersysteme fur den Transport von Wirkstoffen entwickelt. Durch gezieltes Design konnen biologisch aktive Molekule spontan eingebunden werden, sei es mithilfe von Salzbrucken, Wasserstoffbrucken oder hydrophoben Wechselwirkungen. Polyelektrolyt-Nanogele sind in der Lage, gegensatzlich geladene niedermolekulare Wirkstoffe und Biomakromolekule wie Oligo- und Polynucleotide (siRNA, DNS) sowie Proteine aufzunehmen. Die Gastmolekule wechselwirken elektrostatisch mit den ionischen Polymerketten des Gels und werden dadurch in den winzigen Nanogelen gebunden. Zahlreiche chemische Funktionalitaten stehen zur Verfugung, um Gruppen fur Bildgebungsverfahren und den gezielten Wirkstofftransport im Nanogel einzufuhren. Letzteres kann z. B. durch abbaubare oder schaltbare Vernetzungen erreicht werden. Aktuelle Arbeiten zeichnen eine aussichtsreiche Zukunft fur biomedizinische Anwendungen von Nanogelen.
Gestagens and endometrial carcinoma.

Abstract The current state of knowledge of the clinical and cellular effects of progestational agents in endometrial carcinoma is reviewed. High dose gestagens have an overall response rate of 32%, with most response in well-differentiated tumors. Nevertheless, 15% of poorly differentiated tumors do respond. Tumor differentiation rather than patient age is the discriminating factor in response. The effect of the hormone is a direct one on the cell but the precise mechanism of action at the cellular level awaits elucidation. Data are presented for a more rational approach to hormone administration.
Examination of Problem Solving in Learning Disabled Adolescents through Verbalized Self-Instructions

Problem solving is receiving increased attention from professionals working with learning disabled adolescents because of its obvious relation to success within the secondary school curriculum and life adjustment in the post-school environment. This study examines the problem-solving characteristics of learning disabled adolescents through a paradigm that uses verbalized self-instructions. Havertape and Kass delineate specific characteristics of learning disabled adolescents which differentiate their problem-solving skills from those of their normal peers. Implications for intervention are discussed.
Behavioral and cortisol responses to repeated capture and venipuncture in Cebus apella.

Eight capuchins were trained in a capture and venipuncture procedure. Samples taken immediately following capture indicated that subjects experienced rising cortisol levels over the first 5 weeks of training followed by a return to baseline (equivalent to day 1 levels) in the sixth and seventh weeks. After 7 weeks, samples taken 60 min after initial capture revealed that behaviorally habituated animals exhibited significantly lower cortisol levels in response to venipuncture as opposed to naive and experienced but nonbehaviorally habituated subjects. © 1996 Wiley-Liss, Inc.
“Deeper Than Rap” Gifted Males and Their Relationship With Hip Hop Culture

One would be hard-pressed to deny the impact that hip hop is having on gifted students. More specifically, because hip hop is a creative and exciting male-dominated culture, gifted males gravitate ...
FK506 alters sarcoplasmic reticulum calcium release in neonatal piglet cardiac myocytes.

Tacrolimus (FK506) is a potent immunosuppressive drug that, when complexed to a family of immunophilin proteins known as FK binding proteins, inhibits calcineurin in T lymphocytes. Although i.v. use of FK506 in pediatric transplant recipients has been linked to development of cardiomyopathies, its mechanism of cardiotoxicity has not been examined in a neonatal animal model. In our study the effects of FK506 were investigated in cardiac myocytes isolated from newborn piglets. The peak amplitude of electrically triggered fura-2 Ca2+ transients was increased in FK506-treated myocytes, but Ca2+ transient duration and baseline fura-2 Ca2+ ratios were not altered. 45Ca2+ uptake by digitonin-lysed piglet cells decreased at pCa ≤ 6.0, indicating that sarcoplasmic reticulum efflux channels were leaky. The results suggest that elevated release of sarcoplasmic reticulum Ca2+ during systole contributes to cardiotoxic effects observed in children.
Inhibition of pulmonary cytochrome P-450 and benzo(a)pyrene hydroxylase in rabbits by polychlorinated biphenyls (PCBs).

Summary In rats pretreated with the PCBs mixture, Aroclor 1254, or with 3-methylcholanthrene, pulmonary cytochrome P-450 content was increased and benzo(a)-pyrene hydroxylase activity was markedly enhanced. In rabbits, 3-methyl-cholanthrene caused no significant increase in pulmonary cytochrome P-450 content but did cause a 2-fold induction of the hydroxylase activity. In contrast, PCBs caused a 45% decrease in rabbit lung cytochrome P-450 content, and a 31% decrease in the hydroxylase activity. Although PCBs are generally considered as powerful inducers of microsomal monooxygenases, the present studies provide evidence for species and tissue specific action of the PCBs.
The bystander effect in the HSVtk/ganciclovir system and its relationship to gap junctional communication

The bystander effect (BSE) is an interesting and important property of the herpes thymidine kinase/ganciclovir (hTK/GCV) system of gene therapy for cancer. With the BSE, not only are the hTK expressing cells killed upon ganciclovir (GCV) exposure but also neighboring wild-type tumor cells. On testing a large number of tumor cell lines in vitro, a wide range of sensitivity to bystander killing was found. Since transfer of toxic GCV metabolites from hTK-modified to wild-type tumor cells via gap junctions (GJ) seemed to be a likely mechanism of the BSE, we tested GJ function in these various tumors with a dye transfer technique and pharmacological agents known to affect GJ communication. We confirmed that mixtures of tumor cell resistant to the BSE did not show dye transfer from cell to cell while bystander-sensitive tumor cells did. Dieldrin, a drug known to decrease GJ communication, diminished dye transfer and also inhibited the BSE. Forskolin, an upregulator of cAMP did increase GJ, but directly inhibited hTK and therefore its effect on BSE could not be determined. We conclude that these observations further support port the concept that functional GJ play an important role in the BSE and further suggest that pharmacological manipulation of GJ may influence the outcome of cancer therapy with hTK/GCV.
Franchisor use of influence and conflict in a business format franchise system

– This study aims to examine the relationship between a franchisor's use of different types of persuasive communication to influence its franchisees and franchisee perceptions of conflict in the franchise relationship., – Multiple regression analysis of survey data collected from franchisees of a US‐based franchise system., – Data analysis indicates that a franchisor's use of requests, threats, and legalistic pleas is positively related to conflict in the franchisor‐franchisee relationship. These relationships are not moderated by franchisee dependence. Franchisee dependence, does however, negatively moderate the relationship between the franchisor's use of recommendations and conflict. The franchisor's use of information exchange and promises and conflict are not related. The results suggest that business format franchisors should use information exchange and promises and restrain from using requests, threats, and legalistic pleas to influence their franchisees. Recommendations should be used to influence franchisees who are highly dependent on the franchisor., – Future research should validate the findings of this study using data collected from business format franchisees in different cultural environments., – This is the first empirical study to examine the relationship between a franchisor's use of different types of persuasive communication and conflict in the business format franchise setting.
Molecular electronics of the Dionaea muscipula trap.

Transmission of electrical charge between a lobe and the midrib causes closure of the trap and induces an electrical signal propagating between a lobe and a midrib. The Venus flytrap can accumulate small subthreshold charges, and when the threshold value is reached, the trap closes. The cumulative character of electrical stimuli points to the existence of short-term electrical memory in the Venus flytrap. We investigated the electrical properties of the upper leaf of the Venus flytrap and proposed the equivalent electrical circuit in agreement with the experimental data.
Report of the Clinical Protocol Committee: Development of Randomized Trials for Malignant Bowel Obstruction

Malignant bowel obstruction (MBO) is a commonly encountered palliative care problem. There have been very few comparative trials in this area, and consequently there is very little clinical evidence upon which therapy can be rationally based. The purpose of this paper is to highlight the discussion and decision-making process that was undertaken by the Clinical Protocol Subcommittee during the development of a proposed clinical trial of best medical care versus surgical or endoscopic treatment for MBO. The development of the proposed clinical trials followed an orderly process. The first step taken was a discussion of a specific definition for MBO. Once agreed upon, this definition helped identify inclusion and exclusion criteria for the proposed trial. This was followed by an extensive literature review, which helped define both surgical and endoscopic approaches to MBO as well as what constituted best medical care. An extensive discussion was then undertaken concerning the best outcome measure of success for medical, surgical, and endoscopic interventions. All of the above steps culminated in two proposed protocols, one for MBO of the small intestine distal to the ligament of Treitz and a second for colonic obstructions. The small intestinal trial is designed to compare surgical intervention versus best medical care, whereas the colonic trial seeks to compare surgery with endoscopically-placed intraluminal stents coupled with best medical care.
Nutritional therapy based on positive caloric balance in burn patients.

• Oxygen consumption and caloric expenditure was 1½ to 2 times normal in 15 major burn patients from the time of burn to the time of surface coverage. This hypermetabolic state was quite consistent hour-to-hour and day-to-day, and correlated best with the extent of full-thickness burn. Nutritional management and caloric intake can be intelligently planned using simple spirometry and indirect calorimetry to measure caloric requirements. Weight gain and prompt healing can be achieved by positive caloric balance. Based on daily metabolic studies, a positive caloric balance feeding protocol has been used in the treatment of 556 patients. This regimen, in combination with many other factors in physiologic and surface care, has resulted in high survival rates, short hospitalization, and rapid rehabilitation. ( Arch Surg 112:974-980, 1977)
Laparoscopic Risk-Reducing Salpingo-Oophorectomy: The Brigham and Women's Experience

Objective. To establish short-term surgical outcomes of three-port laparoscopic risk-reducing salpingo-oophorectomy (RRSO) in women with hereditary breast-ovarian cancer syndrome (HBOC). Methods. The medical records of all HBOC women that underwent laparoscopic RRSO between January 2001 and December 2010 were retrospectively reviewed. Demographic data, operative details, and short-term surgical outcomes were obtained and subjected to SAS. Statistical univariate and multivariate analyses were performed. Results. 358 patients met study criteria with 277 (77.4%) carrying a documented BRCA mutation. The predominant technique utilized three ports (two 5 mm and one 10/12 mm), a 5 mm laparoscope and a 5 mm Ligasure pulsatile bipolar device. Mean operative time was 58.3 minutes (SD 22.6, 26.0–197.0), significantly affected by BMI greater than 30 ( 𝑃 0 . 0 0 0 1 ) and status of adhesions ( 𝑃 = 0 . 0 0 1 ). Estimated blood loss (EBL) was negligible in 96.9% of cases. Seven patients required conversion to laparotomy. No major intraoperative complications were recorded. One-night hospital admission rate was less than 2.0% while postoperative complication rate was 3.1%. Malignancy was revealed in 14 patients (3.9%). Conclusion. In HBOC population, three-port laparoscopic RRSO is a simple, reproducible, and safe procedure with low conversion rate, short operative time, minimal EBL, low surgical morbidity, and rapid postoperative recovery.
Using the Minnesota Multiphasic Inventory 2, EEGs, and Clinical Data to Predict Nonepileptic Events

Abstract Minnesota Multiphasic Inventory 2 (MMPI-2) scale 3, duration of illness, and routine EEGs have been used to predict nonepileptic events (NEEs) with a high degree of accuracy in patients referred for video/EEG (vEEG) monitoring. This study tested the Storzbach logistic regression equation in our patients with definitive epileptic seizures ( n = 57) or NEEs without evidence of epileptiform activity ( n = 51) during vEEG monitoring, yielding an overall classification accuracy of 81%, sensitivity of 80%, and specificity of 81%. This study also replicated previous findings of significant group differences in duration (years) of spells, number of elevations on the MMPI-2, MMPI-2 elevations on scales 1, 2, 3, and 8, and incidence of the conversion valley on the MMPI-2. Our findings indicated that combined use of the MMPI-2 and clinical variables was most predictive of patients with NEEs.
Getting Ready for School: An Examination of Early Childhood Educators’ Belief Systems

This study examines early childhood educators’ beliefs about what children need prior to before entering kindergarten. Focus group interviews were conducted with early childhood educators from three learning settings: public center-based programs, private center-based programs, and family child care centers. Qualitative methods were used to analyze the data. Across program types, educators said that three levels should be addressed to help prepare a child for school: child, home, and teacher. The child must be physically and emotionally ready to engage with others and participate in learning opportunities, acquire basic skills, such as letter recognition, and have reasoning skills that enable the child to problem-solve. At the home level, emotionally preparing the child for the transition and creating a home environment that promotes learning were reported as key to getting children for school. Teacher relationships with parents also emerged as important school readiness factor. Differences across program types are discussed.