cssi/SciSciGPT-SciSciNet huggingface dataset:
Natural and surgical history of Chiari malformation Type I in the pediatric population

OBJECT The natural and surgical history of Chiari malformation Type I (CM-I) in pediatric patients is currently not well described. In this study the authors discuss the clinical and radiological presentation and outcomes in a large cohort of pediatric CM-I patients treated with either conservative or surgical management. METHODS The authors retrospectively reviewed 95 cases involving pediatric patients with CM-I who presented between 2004 and 2013. The patients ranged in age from 9 months to 18 years (mean 8 years) at presentation. The cohort was evenly split between the sexes. Twenty-five patients underwent posterior fossa decompression (PFD) with either dural splitting or duraplasty. Seventy patients were managed without surgery. Patients were followed radiologically (mean 44.8 months, range 1.2-196.6 months) and clinically (mean 66.3 months, range 1.2-106.5 months). RESULTS Seventy patients were treated conservatively and followed with serial outpatient neurological and radiological examinations, whereas 25 patients were treated with PFD. Of these 25 surgical patients, 11 were treated with duraplasty (complete dural opening) and 14 were treated with a dura-splitting technique (incomplete dural opening). Surgical intervention was associated with better clinical resolution of symptoms and radiological resolution of tonsillar ectopia and syringomyelia (p = 0.0392). Over the course of follow-up, 20 (41.7%) of 48 nonsurgical patients who were symptomatic at presentation experienced improvement in symptoms and 18 (75%) of 24 symptomatic surgical patients showed clinical improvement (p = 0.0117). There was no statistically significant difference in resolution of symptoms between duraplasty and dura-splitting techniques (p = 0.3572) or between patients who underwent tonsillectomy and tonsillopexy (p = 0.1667). Neither of the 2 patients in the conservative group with syrinx at presentation showed radiological evidence of resolution of the syrinx, whereas 14 (87.5%) of 16 patients treated with surgery showed improvement or complete resolution of syringomyelia (p = 0.0392). In the nonsurgical cohort, 3 patients (4.3%) developed new or increased syrinx. CONCLUSIONS The overwhelming majority of CM-I patients (92.9%) managed conservatively do not experience clinical or radiological progression, and a sizeable minority (41.7%) of those who present with symptoms improve. However, appropriately selected symptomatic patients (sleep apnea and dysphagia) and those presenting with syringomyelia should be considered surgical candidates because of the high rates of clinical (75%) and radiological improvement (87.5%).
Percutaneous spinal cord puncture and myelocystography. Its role in the diagnosis and treatment of intramedullary neoplasms

Three patients with cystic tumors of the cervical spinal cord were evaluated with percutaneous cord puncture and myelocystography. This procedure gives relief of symptoms and permits delineation of the extent and character of the cystic mass.
Types of Brain Waves

(1965). Types of Brain Waves. American Journal of EEG Technology: Vol. 5, No. 2, pp. 31-35.
The Role of Astrocytic Aquaporin-4 in Synaptic Plasticity and Learning and Memory

Aquaporin-4 (AQP4) is the predominant water channel expressed by astrocytes in the central nervous system (CNS). AQP4 is widely expressed throughout the brain, especially at the blood-brain barrier where AQP4 is highly polarized to astrocytic foot processes in contact with blood vessels. The bidirectional water transport function of AQP4 suggests its role in cerebral water balance in the CNS. The regulation of AQP4 has been extensively investigated in various neuropathological conditions such as cerebral edema, epilepsy, and ischemia, however, the functional role of AQP4 in synaptic plasticity, learning, and memory is only beginning to be elucidated. In this review, we explore the current literature on AQP4 and its influence on long term potentiation (LTP) and long term depression (LTD) in the hippocampus as well as the potential relationship between AQP4 and in learning and memory. We begin by discussing recent in vitro and in vivo studies using AQP4-null and wild-type mice, in particular, the impairment of LTP and LTD observed in the hippocampus. Early evidence using AQP4-null mice have suggested that impaired LTP and LTD is brain-derived neurotrophic factor dependent. Others have indicated a possible link between defective LTP and the downregulation of glutamate transporter-1 which is rescued by chronic treatment of β-lactam antibiotic ceftriaxone. Furthermore, behavioral studies may shed some light into the functional role of AQP4 in learning and memory. AQP4-null mice performances utilizing Morris water maze, object placement tests, and contextual fear conditioning proposed a specific role of AQP4 in memory consolidation. All together, these studies highlight the potential influence AQP4 may have on long term synaptic plasticity and memory.
BVA position on bovine TB and badger culls

Sean Wensley, the BVA President, comments : BVA continues to support a comprehensive strategy to control and eradicate bovine TB, which recognises the need to control the wildlife reservoir of disease. It remains our position that failure to tackle wildlife sources of infection has prolonged the presence of the disease …
Design of a REBCO thin film superconducting undulator

Recent developments have shown that superconducting undulators, mainly NbTi- based, outperform the existing devices. However, cooling these undulators is a challenge. REBCO (RE = rare earth, barium copper oxide) coated conductors (CCs) have been found to be a promising alternative to these materials due to their larger temperature stability margin and high engineering current densities. Here, we have investigated the feasibility of building an undulator magnetic structure using REBCO coated conductors and conducted experiments to evaluate their performance. The undulator coil has been wound with no inter-layer insulation. The critical current measurements at 77K showed that the winding of the undulator does not noticeably deteriorate the performance of the tape. Transient behaviour of the undulator has also been investigated and found to be characterized by long magnetic field decay times that result from current sharing between the windings. Steady-state operation was found to be very suitable for most undulator applications.
Trichinellosis Masquerading as a Soft-Tissue Mass: A Case Report.

Trichinellosis, also known as trichinosis and trichiniasis, is a rare infection caused by the ingestion of raw or undercooked meat containing viable encysted larvae of the parasitic roundworm Trichinella species1-3. Previously quite common, the Centers for Disease Control and Prevention currently report only a few trichinellosis cases annually in the United States2,4. The scarcity of present-day cases is largely attributed to increased federal legislation over the past several decades that led to many public health measures to educate people regarding techniques for safe food preparation2,4-6. Trichinellosis usually presents acutely with circumorbital edema, fever, myalgia, and abdominal discomfort. We report a case in a fifty-seven-year-old woman who presented atypically with a soft-tissue mass in the forearm. Clinical presentation, diagnosis, prevention, and treatment of this rare infection are discussed. The patient was informed that data concerning her case would be submitted for publication, and she provided consent. A fifty-seven-year-old woman presented to the orthopaedic oncology service for evaluation of a painless mass in the left forearm, which had been slowly enlarging over several years. The patient's rheumatoid arthritis had caused finger deformities and diffuse rheumatoid nodules. At the time of presentation, the rheumatoid arthritis was being treated with abatacept, a T-cell costimulation modulator, but in the past it had been treated with other disease-modifying antirheumatic drugs. Additionally, she had a twenty-year history of anterior interosseous nerve syndrome of the right forearm, and a one-year history of anterior interosseous nerve syndrome of the left forearm, although the cause of these bilateral syndromes was unknown. Physical examination demonstrated a firm, fixed, painless mass on the volar side of the left forearm, proximal to the wrist crease. The patient had an absence of flexor pollicus longus and flexor digitorium profundus function …
Choose Your Own Adventure: Leading Effective Case-Based Learning Sessions Using Evidence-Based Strategies.

Introduction Learning how to lead engaging teaching sessions is critical for faculty development and for optimizing teaching opportunities. We developed an interactive workshop to provide an eviden...
Adversarial Deep Structural Networks for Mammographic Mass Segmentation

Mass segmentation is an important task in mammogram analysis, providing effective morphological features and regions of interest (ROI) for mass detection and classification. Inspired by the success of using deep convolutional features for natural image analysis and conditional random fields (CRF) for structural learning, we propose an end-to-end network for mammographic mass segmentation. The network employs a fully convolutional network (FCN) to model potential function, followed by a CRF to perform structural learning. Because the mass distribution varies greatly with pixel position, the FCN is combined with position priori for the task. Due to the small size of mammogram datasets, we use adversarial training to control over-fitting. Four models with different convolutional kernels are further fused to improve the segmentation results. Experimental results on two public datasets, INbreast and DDSM-BCRP, show that our end-to-end network combined with adversarial training achieves the-state-of-the-art results.
Kinetic Methods for Studying DNA Glycosylases Functioning in Base Excision Repair

Base excision repair (BER) is a conserved and ubiquitous pathway that is initiated by DNA glycosylases, which recognize and remove damaged or mismatched nucleobases, setting the stage for restoration of the correct DNA sequence by follow-on BER enzymes. DNA glycosylases employ a nucleotide-flipping step prior to cleavage of the N-glycosyl bond, and most exhibit slow release of the abasic DNA product and/or strong product inhibition. As such, studying the catalytic mechanism of these enzymes requires care in the design, execution, and interpretation of single- and multiple-turnover kinetics experiments, which is the topic of this chapter.
Mattering: feminism, science, and materialism

Mattering: Feminism, Science, and Materialism (2016) is the edited volume that resulted from a conference of the same name at the City University of New York (CUNY) in 2013 (vii). The purpose of th...
Projecting Performance Data Over Simulation Geometry Using SOSflow and ALPINE

The performance of HPC simulation codes is often tied to their simulated domains; e.g., properties of the input decks, boundaries of the underlying meshes, and parallel decomposition of the simulation space. A variety of research efforts have demonstrated the utility of projecting performance data onto the simulation geometry to enable analysis of these kinds of performance problems. However, current methods to do so are largely ad-hoc and limited in terms of extensibility and scalability. Furthermore, few methods enable this projection online, resulting in large storage and processing requirements for offline analysis. We present a general, extensible, and scalable solution for in-situ (online) visualization of performance data projected onto the underlying geometry of simulation codes. Our solution employs the scalable observation system SOSflow with the in-situ visualization framework ALPINE to automatically extract simulation geometry and stream aggregated performance metrics to respective locations within the geometry at runtime. Our system decouples the resources and mechanisms to collect, aggregate, project, and visualize the resulting data, thus mitigating overhead and enabling online analysis at large scales. Furthermore, our method requires minimal user input and modification of existing code, enabling general and widespread adoption.
High dose insulin for beta-blocker and calcium channel-blocker poisoning

Abstract Background/objectives High dose insulin (HDI) is a standard therapy for beta-blocker (BB) and calcium channel-blocker (CCB) poisoning, however human case experience is rare. Our poison center routinely recommends HDI for shock from BBs or CCBs started at 1 U/kg/h and titrated to 10 U/kg/h. The study objective was to describe clinical characteristics and adverse events associated with HDI. Methods This was a structured chart review of patients receiving HDI for BB or CCB poisoning with HDI defined as insulin infusion of ≥0.5 U/kg/h. Results In total 199 patients met final inclusion criteria. Median age was 48 years (range 14–89); 50% were male. Eighty-eight patients (44%) were poisoned by BBs, 66 (33%) by CCBs, and 45 (23%) by both. Median nadir pulse was 54 beats/min (range 12–121); median nadir systolic blood pressure was 70 mm Hg (range, 30–167). Forty-one patients (21%) experienced cardiac arrest; 31 (16%) died. Median insulin bolus was 1 U/kg (range, 0.5–10). Median starting insulin infusion was 1 U/kg/h (range 0.22–10); median peak infusion was 8 U/kg/h (range 0.5–18). Hypokalemia occurred in 29% of patients. Hypoglycemia occurred in 31% of patients; 50% (29/50) experienced hypoglycemia when dextrose infusion concentration ≤10%, and 30% (31/105) experienced hypoglycemia when dextrose infusion concentration ≥20%. Conclusions HDI, initiated by emergency physicians in consultation with a poison center, was feasible and safe in this large series. Metabolic abnormalities were common, highlighting the need for close monitoring. Hypoglycemia was more common when less concentrated dextrose maintenance infusions were utilized.
Coloniality of knowledge, hybridisation, and indigenous survival: exploring transnational higher education development in Africa from the 1920s to the 1960s

This historical multi-case study uses the concepts of coloniality of knowledge, critical hybridity, and indigeneity in examining higher education development in Africa through the efforts of Nnamdi...
A qualitative study of nuisance bleeding and medication-related beliefs with dual antiplatelet drug therapy.

Abstract Objectives The purpose of this qualitative study was to explore perceptions of nuisance bleeding and medication-related beliefs among adults taking dual antiplatelet drug therapy. Methods We conducted qualitative telephone interviews with 34 community-dwelling adults with cardiovascular disease. Results Using qualitative content analysis, we identified 4 dominant themes: nuisance bruising, nuisance bleeding, importance of medication adherence, and duration of therapy. Participants' bruising was frequently more severe than expected given the force of the bump that caused it. Concerns focused on whether increased bleeding tendencies would lead to hemorrhage in the event of a major traumatic injury, confusion about the duration of therapy, and the rationale for when and why therapy should be discontinued. Conclusion Excessive bruising and medication-related concerns about hemorrhage and duration of treatment were salient issues for participants. Effective clinician-patient communication should be used to assist individuals in managing concerns to help assure positive health outcomes with antiplatelet drugs.
Husserl’s world of infinite transcendence

Husserl is true to form as a totalist. He prefers an alternate phenomenological world to the ordinary natural world in which we all live. To be sure, this alternate world is a theoretical and rational enterprise. But he prefers this world of total reason to the natural world we inhabit. The alternate world gives him a new ‘foundation for knowledge,’ the freedom to live in the sphere of transcendental subjectivity, as well as absolute truth (with apodictic certainty). The world Husserl leaves behind him is not just doubtable; it is suspendable. One can bracket such a world, put it out of action, and make it completely inconsequential in the world of the mind. Husserl presents an elaborate methodology for making a ‘break’ with this world in order to achieve extraordinary knowledge. The world of total reason is made possible by infinite transcendence, which mediates the journey from our world to an alternate one. This anonymous infinite transcendence is also central to the operations of the alternate world of total reason.
Masses from Inhomogeneous Partial Difference Equations; A Shell-Model Approach for Light and Medium-Heavy Nuclei

Any mass equation M(N,Z) may be expressed as a special solution of an inhomogeneous partial difference equation. One only has to introduce an appropriate difference operator D and calculate κ(N,Z) = D M(N,Z). The inhomogeneous partial difference equation $${\text{D M}}\left( {{\text{N}},{\text{Z}}} \right){\text{ }} = {\text{ }}\kappa \left( {{\text{N}},{\text{Z}}} \right)$$ (1) contains the original mass equation as a special solution. The most general solution of eq. (1) will include solutions of the homogeneous equation which can, for example, be used to generate shell correction terms.
The Impact of Disability and Chronic Illness

Older adults both inside and outside of nursing homes cope with chronic illnesses. More than one in three community-living older adults report that a chronic illness poses some limitation in their otherwise normal activities (Dorgan, 1995).
BIOLOGICAL ACTIVITIES OF A MACROPHAGE CHEMOTAXIS INHIBITOR (MCI) PRODUCED BY NEOPLASMS

Publisher Summary This chapter describes a study to investigate the biological activities of a macrophage chemotaxis inhibitor (MCI) produced by neoplasms. In the study, the MCI was prepared by washing and then sonicating Hepatoma 129 cells. The cell-free supernatant obtained by centrifugation was passed through an Amicon CF25 cone, a membrane designed to exclude molecules above approximately 25,000 daltons. The material that passed through the cones was diluted and injected subcutaneously into the thighs of groups of four mice. Twenty-four hours following the MCI injection, the mice were given intraperitoneal injections of one of the three inflammatory stimulants: (1) phytohemagglutinin (PHA), (2) concanavalin A (Con A), or proteose peptone. Both PHA and Con A are not chemotactic in vitro but activate lymphocytes and generate chemotactic lymphokines. Proteose peptone, on the other hand, is itself chemotactic in vitro. Forty-eight or 72 hours later, the mice were sacrificed, the peritoneal cavities were lavaged, and the total and differential cell counts for the individual peritoneal exudates were determined. The findings demonstrated that the MCI from even small numbers of tumor cells can depress macrophage accumulation to inflammatory agents regardless of whether they are directly chemotactic or stimulate lymphokine production.
Action Spectra and Their Key Role in Assessing Biological Consequences of Solar UV-B Radiation Change

Action spectra of UV damage to plants must be used as weighting functions to (1) evaluate the relative increase of solar UV radiation that would result from a decreased atmospheric ozone layer, the radiation amplification factor—RAF, (2) evaluate the existing natural gradients of solar UV irradiance on the earth, and (3) compare UV radiation from lamp systems in experiments with solar UV radiation in nature. Only if the relevant biological action spectra have certain characteristics is there a potential biological problem that would result from ozone reduction. Similarly the existence of a natural latitudinal solar UV gradient is dependent on action spectrum characteristics.
Case 24: An Airway Surprise

You are called to the ICU for an airway problem. You arrive and find an 86 year old man who does not seem to want to stop coughing. The nurse said she had been encouraging him to take large breaths, when he suddenly started to cough. His oxygen saturation is 86% and he does not want the oxygen mask on his face. He is sitting up and looks like he is fighting for his life. He is holding onto his neck but cannot tell you what the problem is. He won’t open his mouth.
Characterizing Lithological Effects on Large Scale Borehole Heat Exchangers during Cyclic Heating of the Subsurface

Abstract This paper presents the results of a study where subsurface temperatures were monitored adjacent to the u-tube of a central borehole of a large scale 144 borehole heat exchanger (BHE) at multiple depths. This was an effort to develop a method to characterize the variability of thermal properties of the various lithological units surrounding the BHEs of large scale ground coupled heat pump systems during the operation of the system. Saturation of the units and lithology was shown to affect the performance of the BHE resulting variable temperature fluctuations and heat flux at different depths within the borehole. Median heat flux tended to increase with decreasing temperature ranges measured by the sensors. The lowest median heat flux was in the location nearest to the surface in the least saturated zone. In the more saturated zone, the highest median heat flux were at locations where the lithological units were composed of 75 percent or greater dolomite while the lowest median heat flux where in lithological units composed of 30 percent or greater chert.
The voyage of thought: navigating knowledge across the sixteenth-century world

The Voyage of Thought is a multi-layered and complex study of Jean Parmentier’s voyage to Sumatra that deploys a range of disciplinary methods and bodies of knowledge to tell a dramatic story of Eu...
Identification of Rabies Virus from Chinese Ferret-Badger and Analysis of Its P and M Genes

Infection of rabies virus (RV) was inspected in 23 captured wild Chinese Ferret-badgers by direct fluorescence immunoassay. One of the Ferret-badger was identified to be RV antigen positive. Existence of the RV was confirmed by the RT-PCR. The P and M genes of the RV from the badger (CZJF01) was amplified and the genetic variability on functional positions were studied on molecular level. The homology comparison and evolution analysis of the P and M genes among the rabies virus isolated from Chinese Ferret-Badger, human, dog, vaccine strains were performed. As the results, the CZJF01 strain shared with the RV from other sources in nucleotide sequences a homology of 80.6 ％ ~ 98.7 ％ and 84.2 ％ ~97.2 ％ for the P and M gene, respectively, and a homology of 86.2 ％ ~ 96.6 ％ and 89.2 ％ ~ 96.6 ％ in the relevant amino acid sequences, respectively. Phylogenic analysis of the P and M gene nucleotide sequence revealed that the CZJF01 strain was closely related with the genotype 1 RV strains. The CZJF01 has the closest evolution relation with a vaccine strain, HEP-Flury. The functional area of P and M gene is highly conserved among all the genotype 1 RV strains. There were no variations on functional positions of P and M proteins that affect its biological functions. The vaccine developed from HEP-Flury may have better protective effect in Zhejiang, China.
Depressive symptoms and immune transcriptional profiles in late adolescents

Abstract Background Rates of depression increase and peak during late adolescence and alterations in immune processes are thought to be both a risk factor and outcome of depression. However, few studies have examined depression-immune dynamics among adolescents. Using a functional genomics approach, the current study examined whether depressive symptoms were associated with activation of a gene expression profile, characterized by upregulated expression of pro-inflammatory-related genes and downregulated expression of antiviral-related genes in a sample of older adolescents (Mage = 18.37, SD = 0.51). Method Participants (n = 87) reported on their depressive symptoms during the past week using the CES-D, and provided blood samples for genome-wide transcriptional profiling of mRNA. Results Adolescents with clinically-significant levels of depressive symptoms (CES-D ≥ 16) exhibited upregulated expression of inflammation-related genes and downregulated expression of antiviral-related genes compared to their peers with lower levels of depressive symptoms (CES-D Conclusion Results are consistent with past work demonstrating links between depression and altered immunity. They provide a molecular basis for these associations and suggest that the underlying molecular signature may emerge as early as late adolescence when rates of depression tend to increase.
Overcoming barriers to effective management of tardive dyskinesia

Tardive dyskinesia (TD) is a heterogeneous syndrome of involuntary hyperkinetic movements that is often persistent and occurs belatedly during treatment with antipsychotics. Recent approval of two dopamine-depleting analogs of tetrabenazine based on randomized controlled trials offers an evidence-based therapeutic approach to TD for the first time. These agents are optimally used within the context of a comprehensive approach to patient management that includes a practical screening and monitoring program, sensitive and specific criteria for the diagnosis of TD, awareness of the severity and impact of the disorder, informed discussions with patients and caregivers, and a rational basis for prescribing decisions about continued antipsychotic and adjunctive agents. Areas of limited or inconclusive data, bias and misunderstandings about key aspects, and neglect of training about TD in recent years contribute to barriers in providing effective care and promoting patient safety.
Lean Design for the Developing World: Making Design Decisions Through the Use of Validated Learning Techniques in the Developing World

Current methods for design in the developing world rely on many tools that are used in standard product and system design. Design for the developing world methods, such as Human Centered Design or co-design, often use a user-centered method yet advise the use of design tools developed for use in a market-centered approach. Recent advances in market-centered design from lean startup methodologies and decision-based design hold promise for the development of new methods that allow effective product design for consumers in the developing world. The Lean Design for the Developing World method (LDW) is an iterative method that is based upon three fundamental hypotheses including the growth hypothesis, the value hypothesis, and the impact hypothesis. LDW seeks to provide products for under-served markets of the developing world that are economically viable, have strong market growth potential, and have a net positive impact on the customers and their communities. This paper contributes a novel detailed method to collect and analyze qualitative and quantitative data for the LDW. To enable effective decision making and design tradeoff decision-making in the LDW, effective accounting and gathering of feedback data is vital.Copyright © 2014 by ASME
Indigenous Nations in Postracial America: Rethinking Social Inclusion:

This article presents the concept of social inclusion as a means of addressing problems of poverty and social welfare and reviews the place of social inclusion in U.S. policies toward Indigenous pe...
Women Mother Daughters: The Reproduction of Mothering After Forty Years

The Reproduction of Mothering comes from a period in second wave feminism when the personal was political, but feminists with rare exception were hostile to psychoanalysis and suspicious in general of any account that seemed to begin from the psyche rather than from political and economic forces. This book, by contrast, argues that the personal is personal, even as the personal connects to the sociocultural and political-economic. A universal male dominance, I argue in articles that precede the book and in the book itself, is rooted in a defensive and aggressive psychodynamics of masculinity that grows from the son’s relationship to his mother. This territory had been explored, but what seemed missing in social theory, as in most of psychoanalysis, was attention to daughters and to the mother-daughter relationship, as well as an account of how girls grew up to be mothers. The book ties the intrapsychic and interpsychic dynamics of individual gender-sexuality and the family to the sociology, political economy, and culture of gender. My own response to these insights, that moved many people and seemed true to me, was to undertake psychoanalytic training: I could not go deeper without clinical experience. My contribution here brings this experience back to The Reproduction of Mothering. I notice the tacit argument, expressed in its title, that in thinking about psychologies of gender, we are in the realm of generation. I look at how the inner mother-daughter world helps and hinders mothering and how it changes over the life cycle. In so doing, I also honour some of the women psychoanalysts—the psychoanalytic mothers—who preceded me and the sisters whom I now count upon. I am grateful to have had some effect on clinician and theorist daughters as well.
Differences in trunk range of motion for various flexibility protocol types, particularly in quarterbacks wearing rib protectors

Summary Background It is unclear how rib protectors may affect trunk mobility in American football players. The purposes of the study were: 1) to determine which flexibility protocol (active-assisted, maximal-speed, self-selected) exhibits the highest range of motion for trunk lateral flexion and axial rotation and 2) to determine the effect of rib protectors (hard-rib and soft-rib protectors and control: compression shirt only) on trunk range of motion. Methods Eleven male participants with competitive quarterback experience were recruited. Participants were instructed to rotate the trunk in the lateral flexion and axial rotation directions during each flexibility protocol and rib protector condition. The lower-thoracic range of motion were measured. Results Two-way repeated measures ANOVA (flexibility protocol by rib protector) demonstrated significant main effect of flexibility protocol for lateral flexion, but not axial rotation. The range of motion during self-selected protocol was significantly greater than maximal-speed protocol by approximately 7° (p = .009). Conclusions Self-selected and maximal-speed protocol produced the highest lateral flexion and axial rotation range of motion, respectively, and can be used to test the influence of rib protectors and potentially other sports equipment on thoraco-lumbar range of motion. Additionally, rib protectors likely do not affect trunk range of motion needed to throw long-distance passes or other movements as performed by football quarterbacks.
Variability of COPD inhaler coverage in Medicare Part D.

OBJECTIVES Stand-alone prescription drug plans (S-PDPs) and Medicare Advantage prescription drug (MA-PD) plans are incentivized to cover outpatient medications differently. This could affect the coverage of inhalers that prevent costly exacerbations of chronic obstructive pulmonary disease (COPD), with impacts for the Medicare program and its beneficiaries. This study compared the coverage of guideline-recommended COPD inhalers between S-PDPs and MA-PD plans. STUDY DESIGN A cross-sectional analysis of the formularies for all 689 S-PDPs and 2578 MA-PD plans offered in 2017. METHODS We assessed each prescription drug plan's coverage of inhalers in 6 therapeutic categories recommended by the 2017 Global Initiative for Chronic Obstructive Lung Disease (GOLD) report and compared the use of prior authorization, step therapy, and coinsurance between S-PDPs and MA-PD plans. RESULTS In 2017, all S-PDPs and MA-PD plans covered at least 1 inhaler from each GOLD therapeutic category, except for long-acting β agonist/long-acting muscarinic antagonist combination inhalers. S-PDPs were more likely to require coinsurance for inhalers across all therapeutic categories, whereas MA-PD plans required prior authorization more frequently for 3 of the 6 therapeutic categories. S-PDPs required coinsurance more frequently than MA-PD plans for inhalers that treat mild (20.8% vs 11.4%; P < .001), moderate (40.0 vs 13.2%; P < .001), and severe (45.4% vs 11.0%; P < .001) disease. CONCLUSIONS Medicare Part D S-PDPs are more likely than MA-PD plans to require coinsurance for outpatient COPD inhalers, especially for severe disease. This likely reflects their different financial incentives and is an important consideration for providers and policy makers aiming to improve outpatient COPD management.
Do people with opioid use disorder and posttraumatic stress disorder benefit from dding Individual opioid Drug Counseling to buprenorphine

Abstract Background and Purpose Large randomized trials have found that behavioral therapy for opioid use disorder (e.g., Individual Drug Counseling, Cognitive Behavioral Therapy for Opioid Use Disorder) does not improve buprenorphine maintenance outcomes, on average, for individuals with opioid use disorder. However, recent studies indicate that certain subgroups of patients may benefit from the addition of behavioral therapy to buprenorphine. In particular, people with more complex and severe psychosocial needs may benefit from the addition of behavioral therapy for opioid use disorder. Methods In this study, we conducted a secondary analysis of a large, multi-site randomized trial (N = 357) of buprenorphine maintenance with and without individual Opioid Drug Counseling (ODC) for the treatment of opioid use disorder. We hypothesized that participants with posttraumatic stress disorder (PTSD) would benefit from the addition of ODC. Results Logistic regression models indicated a significant PTSD by treatment condition interaction. Specifically, 67% of those with PTSD had a successful opioid use disorder treatment outcome when they were assigned to receive both ODC and buprenorphine, compared to a 36% response rate among those who received buprenorphine alone. Conclusions Although these results require replication, our findings provide initial indication that ODC is an important complement to buprenorphine maintenance treatment for people with co-occurring PTSD and opioid use disorder.
Which Markets (DonAT) Drive Pharmaceutical Innovation? Evidence from U.S. Medicaid Expansions

Pharmaceutical innovation policy involves managing a tradeoff between high prices for new products in the short-term and stronger incentives to develop products for the future. Prior research has documented a causal relationship between market size and pharmaceutical research and development (R&D) activities. The existing literature, however, provides no evidence of how this relationship varies across markets. We investigate whether recent expansions in state Medicaid programs caused an increase in R&D. We find no evidence of a response, potentially a result of Medicaid’s low reimbursement for pharmaceuticals, suggesting low(er) price markets may have different dynamics with respect to innovation policy. Institutional subscribers to the NBER working paper series, and residents of developing countries may download this paper without additional charge at www.nber.org.
Antihypertensive therapy causes erectile dysfunction.

Purpose of review Erectile dysfunction is a common sexual disorder affecting 40% of men in the United States. However, the pathophysiologic mechanism involved in the causation of erectile dysfunction is multifactorial and not well delineated. Recent findings Several recent studies disclose that erectile dysfunction is the result of multiple interrelated comorbid conditions that include hypertension, coronary artery disease (CAD), heart failure, and diabetes mellitus among them. In addition to comorbid conditions, certain cardiovascular and antihypertensive drugs are also involved in the development of erectile dysfunction, with the most prominent being the thiazide type diuretics, the aldosterone receptor blockers, and the β-adrenergic receptor blockers. Also, knowledge by the patient of the drug and its action on erectile dysfunction may increase the incidence of erectile dysfunction (Hawthorn effect). Before treatment is initiated, patients should be screened for the presence of erectile dysfunction, because this condition is associated with hypertension, CAD, heart failure, diabetes mellitus, and their treatment and an appropriate treatment regimen should be selected. If that fails, the addition of phosphodiesterase 5 inhibitors to the treatment regimen is recommended. The only exception is a patient with CAD treated with organic nitrates, in which the coadministration of phosphodiesterase 5 inhibitors is strictly prohibited. Summary Knowledge of the various comorbid conditions and their treatment associated with the development of erectile dysfunction will help the caring physician to treat his patients appropriately and safely. All these aspects will be discussed in this review.
Complement dependent immune phagocytosis. I. Requirements for C'1, C'4, C'2, C'3.

Abstract In vitro phagocytosis using as a model sheep E, guinea pig polymorphonuclear cells, partially purified rabbit anti sheep E and guinea pig C′, indicated a sequential requirement for Ab, and the four components of C′: C′1, C′4, C′2 and C′3, to generate a site which induced maximal reactivity of susceptibility to ingestion, in quantitative assays for phagocytosis. A remarkable finding, however, has been the fact that both C′1 and C′2 were presumably removed from the site without changing reactivity of the sensitized cell either in immune adherence or in immune phagocytosis. Nine serum proteins from guinea pig have been isolated in a highly purified form. They appear to represent the factors necessary to bring about the lysis of sensitized sheep E. Some details on the purification of C′1, C′4, C′2 and C′3 were outlined in brief. The four components required for phagocytosis and immune adherence seem to be identical to the first four serum proteins reacting in the hemolytic system. A normally-occurring inactivator of the C′3 site which is capable of inhibiting lysis and immune adherence of EAb C′1, 4, 2, 3 also was found to block phagocytosis. The biological implication of C′ as a mediator in body defense and tissue injury was discussed.
VLSI functional testing using critical path traces at hardware description language level

A new approach for testing VLSI circuits is presented. Through backward critical path tracing, a test and all faults detectable by the test are generated simultaneously. Therefore, the expensive fault simulation is completely eliminated. We present a critical path test generation procedure for digital systems described by hardware description language (HDL). A multiplication circuit described by a HDL is utilized for demonstrating the test generation method.
Bionanoparticles and their Biomedical Applications

The sections in this article are Introduction BNPs Genetic and Chemical Alterations of BNPs Chemical Modifications Conventional Bioconjugation Methods for Selective Modifications “Click Chemistry” for Bioconjugation of BNPs New Developments in Tyrosine Modification Genetic Alterations Heterologous Peptide Insertions NAA Substitutions Protein Expression Systems BNPs in Therapeutics Cell Targeting Gene Delivery Bioimaging Drug Encapsulation and Release Immune Response Vaccine Development Immune Modulation Future Directions Acknowledgments
The OODB Ownership Relationship

The notion of “ownership” is prevalent in many social, economic, and political activities. In this paper, we show that an “ownership” semantic relationship can be a powerful addition to the repertoire of object-oriented database (OODB) modeling primitives. The motivation for such a relationship is provided by example OODB schemata. Using these schemata and some (informal) legal definitions, the varied semantics of ownership are identified A formal ownership relationship is presented as an extension to an OODB data model.
Effect of blueberry juice on clearance of buspirone and flurbiprofen in human volunteers.

Aim The present study evaluated the possibility of drug interactions involving blueberry juice (BBJ) and substrate drugs whose clearance is dependent on cytochromes P4503A (CYP3A) and P4502C9 (CYP2C9). Methods A 50:50 mixture of lowbush and highbush BBJ was evaluated in vitro as an inhibitor of CYP3A activity (hydroxylation of triazolam and dealkylation of buspirone) and of CYP2C9 activity (flurbiprofen hydroxylation) using human liver microsomes. In clinical studies, clearance of oral buspirone and oral flurbiprofen was studied in healthy volunteers with and without co-treatment with BBJ. Results BBJ inhibited CYP3A and CYP2C9 activity in vitro, with 50% inhibitory concentrations (IC50) of less than 2%, but without evidence of mechanism-based (irreversible) inhibition. Grapefruit juice (GFJ) also inhibited CYP3A activity, but inhibitory potency was increased by pre-incubation, consistent with mechanism-based inhibition. In clinical studies, GFJ significantly increased area under the plasma concentration−time curve (AUC) for the CYP3A substrate buspirone. The geometric mean ratio (GMR = AUC with GFJ divided by AUC with water) was 2.12. In contrast, the effect of BBJ (GMR = 1.39) was not significant. In the study of flurbiprofen (CYP2C9 substrate), the positive control inhibitor fluconazole significantly increased flurbiprofen AUC (GMR = 1.71), but BBJ had no significant effect (GMR = 1.03). Conclusion The increased buspirone AUC associated with BBJ is quantitatively small and could have occurred by chance. BBJ has no effect on flurbiprofen AUC. The studies provide no evidence for concern about clinically important pharmacokinetic drug interactions of BBJ with substrate drugs metabolized by CYP3A or CYP2C9.
Review and Evaluation of Hand–Arm Coordinate Systems for Measuring Vibration Exposure, Biodynamic Responses, and Hand Forces

The hand coordinate systems for measuring vibration exposures and biodynamic responses have been standardized, but they are not actually used in many studies. This contradicts the purpose of the standardization. The objectives of this study were to identify the major sources of this problem, and to help define or identify better coordinate systems for the standardization. This study systematically reviewed the principles and definition methods, and evaluated typical hand coordinate systems. This study confirms that, as accelerometers remain the major technology for vibration measurement, it is reasonable to standardize two types of coordinate systems: a tool-based basicentric (BC) system and an anatomically based biodynamic (BD) system. However, these coordinate systems are not well defined in the current standard. Definition of the standard BC system is confusing, and it can be interpreted differently; as a result, it has been inconsistently applied in various standards and studies. The standard hand BD system is defined using the orientation of the third metacarpal bone. It is neither convenient nor defined based on important biological or biodynamic features. This explains why it is rarely used in practice. To resolve these inconsistencies and deficiencies, we proposed a revised method for defining the realistic handle BC system and an alternative method for defining the hand BD system. A fingertip-based BD system for measuring the principal grip force is also proposed based on an important feature of the grip force confirmed in this study.
Managing Challenges to Inclusive Growth

Inclusive growth is a universal problem, not just a problem of emerging economies. While the scale and scope of the inequality in growth may be different in developed and emerging economies, the structure and solutions are likely to be similar. For example, the problem of malnutrition on the one hand and the obverse problem of childhood obesity are present in both developing and developed countries. Malnutrition is more dominant in the developing countries and childhood obesity in the developed countries. Inclusive growth in health entails reducing both in both developing and developed countries. A comprehensive framework which encapsulates the natural language and logic of the problem is needed to address the problem systemically and systematically. Developing a coherent strategy would be difficult without such a framework. We propose an ontological framework to catalyze the systemic and systematic formulation of the problem. The framework has been derived by parsing the title of the paper into three dimensions: (a) Challenges, (b) Inclusivity, and (c) Growth. The Challenges dimension is deconstructed into two sub-dimensions: (a) Resources, and (b) Forces. Each dimension is articulated by a taxonomy of categories and subcategories. Each concatenation of categories subcategories across the dimensions sub-dimensions is an aspect of the problem. The set of all possible concatenations is a comprehensive description of the problem. A selection of relevant concatenations can form the foundation of a coherent strategy.
Myopathy with anti-HMGCR antibodies Perimysium and myofiber pathology

Objective: To analyze clinical features and myopathology changes in muscle fibers, connective tissue, and vessels in 3-hydroxy-3-methylglutaryl-coenzyme A reductase (HMGCR) antibody–associated myopathies. Methods: Retrospective review of records and myopathologic features of 49 consecutive patients with myopathies and serum HMGCR antibodies. Results: Clinical features included onset age from 12 to 83 years, female predominance (67%), proximal, symmetric weakness (84%), muscle discomfort (78%), dysphagia (35%), systemic features, including skin rash and interstitial lung disease (37%), statin use (38%), and a high serum creatine kinase (83%). Myopathology included muscle fiber necrosis or regeneration (66%), myonuclear pathology (43%), perimysial connective tissue damage (61%), and lymphocytic foci (27%). Conclusions: Patients with HMGCR antibody–associated myopathies present with weakness and muscle discomfort and often have damage to both perimysial connective tissue and muscle fibers, with necrosis and myonuclear pathology. Only a minority of patients with HMGCR antibody–associated myopathies have a history of statin exposure.
Charge trapping in HfO2 and HfSiO4 MOS gate dielectrics

Abstract In this work the effect of hafnium content on charge trapping characteristics of Hf-based MOS gate dielectrics is investigated. Direct comparison of charge trapping phenomena in HfO 2 and HfSiO 4 formed on the Si surface by mist deposition is carried out. Results obtained demonstrate that the amount of trapping increases as the Si content in Hf–Si–O network increases, and hence, in advanced MOS gate applications HfO 2 is expected to display more stable electrical characteristics than HfSiO 4 .
The angle of repose of bulk corn stover particles

Abstract Lignocellulosic biomass feedstock such as corn stover, the residues left on the field after corn grain harvest, has been studied as one of the renewable feedstocks to be used for fuel ethanol conversion in the near future. The primary objective of this work was to determine the angle of repose (AoR) of bulk corn stover particles prepared to four particle sizes (chopped and particles screened through 6.4, 3.2 and 1.6 mm) at two moisture contents (dry, 20%). The results show that particles size and feedstock moisture content were important variables that affected the angle of repose for all three angle of repose methods (piling AoR loose-base, piling AoR fixed-base and sliding AoR) investigated. In general, increasing moisture content and particle size increased the piling AoR (loose-base), piling AoR (fixed-base) and sliding angle of repose. Characterization of the flow behavior of bulk corn stover particles using the piling AoR (loose-base) and comparison with three granular bulk solids of biological origin (corn, soybean and distillers dried grains with solubles, DDGS) indicated that dry and wet stover particles of the particle size ranges tested in this study have a poor flow behavior.