cssi/SciSciGPT-SciSciNet huggingface dataset:
Acute Exacerbations of Chronic Obstructive Pulmonary Disease and the Effect of Existing Psychiatric Comorbidity on Subsequent Mortality

Objectives Studies investigating associations between chronic obstructive pulmonary disease (COPD) outcomes and psychiatric comorbidity have yielded mixed findings. We examined a national sample of hospitalized COPD patients to evaluate the impact of three psychiatric conditions on mortality and readmission. Methods Department of Veterans Affairs (VA) administrative and laboratory data were used to identify 26,591 consecutive patients admitted for COPD during October 2006 to September 2008. Associations between psychiatric comorbidity and both 30-day mortality and readmission were examined using generalized estimating equations and Cox proportional hazards regression, respectively, with adjustments for patient demographics, medical comorbidities, illness severity, and clustering within hospitals. Results Unadjusted 30-day mortality was higher in patients with anxiety (5.3% vs. 3.8% [P Conclusion Comorbid anxiety and depression may have an adverse impact on COPD hospital prognosis or may be indicative of more severe illness.
Strain Release in Organic Photonic Nanoparticles for Protease Sensing

Proteases are overexpressed in most cancers and proteolytic activity has been shown to be a viable marker for cancer imaging in vivo. Herein, we describe the synthesis of luminescence-quenched shell cross-linked nanoparticles as photonic nanoprobes for protease sensing. Protease sensing scheme is based on a “turn-on” mechanism where the protease cleaves peptide cross-linkers of the fluorescence-quenched shell cross-linked NP (OFF state) leading to a highly emissive non-cross linked NP (ON state). The cross-linked particles can be strained by exposure to a good solvent and proteolysis allows for particle expansion (swelling) and a recovery of the luminescence.
Career Satisfaction and Role Harmony in a Sample of Young Women Physicians.

Abstract In a sample of young women physicians, self-ratings of Career Satisfaction and Role Harmony were correlated with a group of situational, achievement, and personality variables. Career Satisfaction was extremely high with about 88% reporting they are satisfied or very satisfied. However, over half experienced at least a moderate amount of strain in integrating professional and sex roles. In addition women who were high on both Career Satisfaction and Role Harmony were compared with the others in the sample and individual differences were apparent: These women were exceptionally confident, intellectually resourceful, and tolerant; they tended to have clear priorities with either family or work coming first. Overall their current level of personality adjustment was superior to the others who, as a group, were very well-functioning women.
A self-scaling, distributed information architecture for public health, research, and clinical care.

Objective: This study sought to define a scalable architecture to support the National Health Information Network (NHIN). This architecture must concurrently support a wide range of public health, research, and clinical care activities. Study Design: The architecture fulfils five desiderata: (1) adopt a distributed approach to data storage to protect privacy, (2) enable strong institutional autonomy to engender participation, (3) provide oversight and transparency to ensure patient trust, (4) allow variable levels of access according to investigator needs and institutional policies, (5) define a self-scaling architecture that encourages voluntary regional collaborations that coalesce to form a nationwide network. Results: Our model has been validated by a large-scale, multi-institution study involving seven medical centers for cancer research. It is the basis of one of four open architectures developed under funding from the Office of the National Coordinator of Health Information Technology, fulfilling the biosurveillance use case defined by the American Health Information Community. The model supports broad applicability for regional and national clinical information exchanges. Conclusions: This model shows the feasibility of an architecture wherein the requirements of care providers, investigators, and public health authorities are served by a distributed model that grants autonomy, protects privacy, and promotes participation.
Convex Meshfree Solutions for Arbitrary Waveguide Analysis in Electromagnetic Problems

This paper presents a convex meshfree framework for solving the scalar Helmholtz equation in the waveguide analysis of electromagnetic problems. The generalized meshfree approximation (GMF) method using inverse tangent basis functions and cubic spline weight functions is employed to construct the flrst-order convex approximation which exhibits a weak Kronecker-delta property at the waveguide boundary and allows a direct enforcement of homogenous Dirichlet boundary conditions for the transverse magnetic (TM) mode analyses. Four arbitrary waveguide examples are analyzed to demonstrate the accuracy of the presented formulation, and comparison is made with the analytical, flnite element and meshfree solutions.
Knuth's complex number arithmetic revisited

Complex number arithmetic occurs frequently in Digital Signal Processing. A Butterfly usually constitutes at least of one complex product and one complex sum. The standard binary implementation of a product requires at best three real multiplations and five real additions. Besides, the two components of a complex number must be tracked down at every stage. In the past, many authors have proposed different digital representations, in order to cirmcumvent these problems. The choice of any particular one must be based on three factors: completeness, complexity of implementation, and ease of conversion from and to binary. In this paper, the Knuth's representation or "Qua-ter-Imaginary" is revisited and its practical merits evaluated. We then propose the design of some arithmetics and describe in details their hardware implementation. The additional conversion arithmetic is also described. The existence of this overhead is highly justifiable in some systems.
Saving Biological Diversity: An Overview

The conservation movement in North America emerged in part due to the shock of the extinction of the passenger pigeon and the near extinction of the American bison, species that had once been considered too numerous to be depleted. By the 1960s, a broad consensus emerged in the United States that species should not be driven to extinction by human activity. Since then, however, the Endangered Species Act and major programs to restore endangered and threatened species have become controversial. Private property rights advocates claim that endangered species protection hampers economic activity and land development to an unreasonable extent. At the same time some conservationists are concerned that too much money and effort are devoted to endangered species, diverting efforts from protection of entire ecosystems that support numerous species. They argue that given the limited resources available, preventing common species from becoming rare is the most effective long-term strategy. Defenders of endangered species programs claim that protecting endangered species usually entails protecting entire ecosystems, and endangered species can serve as effective symbols to rally support for ecosystem protection. Saving Biological Diversity: Balancing the Protection of Endangered Species and Ecosystems seeks to emphasize the interplay between the science and policy of species protection. We have chosen to take a broadly interdisciplinary approach by focusing on such important topics as the effectiveness and economics of endangered species protection, efforts to sustain biological diversity in entire ecosystems or across regional landscapes, and the need to protect species diversity on a global scale. Our book is a synthesis of the views of economists, political scientists, resource managers and conservation biologists on a wide array of species protection issues. In a single book we could not hope to address the myriad species, habitats, ecosystems, conservation issues and political systems worldwide that a truly comprehensive treatment would require. Instead we present chapters illustrating a wide range of problems and solutions as they are seen by people who work in an array of disciplines and professions. Since our authors come from different academic traditions, the editors have chosen to tread lightly on preferred writing and referencing styles. While this results in some distinct stylistic differences between those authors with a legal background and those with scientific training, it does not detract from the communication of important ideas. Our goal for this book is to engage a wide audience that includes researchers, concerned citizens, regulators, conservation managers and policy analysts. Saving Biological Diversity may also serve as a book of readings for courses in conservation biology, environmental studies, or environmental policy. We believe that the juxtaposition of
The oribatid mite Scheloribates moestus (Acari: Oribatida) alters litter chemistry and nutrient cycling during decomposition

It is widely accepted that microarthropods influence decomposition dynamics but we know relatively little about their effects on litter chemistry, extracellular enzyme activities, and other finer-scale decomposition processes. Further, few studies have investigated the role of individual microarthropod species in litter decomposition. The oribatid mite Scheloribates moestus Banks (Acari: Oribatida) is abundant in many U.S. ecosystems. We examined the potential effects of S. moestus on litter decomposition dynamics and chemical transformations, and whether these effects are influenced by variation in initial litter quality. We collected corn and oak litter from habitats with large populations of S. moestus and in microcosms with and without mites measured respiration rates, nitrogen availability, enzyme activities, and molecular-scale changes in litter chemistry. Mites stimulated extracellular enzyme activities, enhanced microbial respiration rates by 19% in corn litter and 17% in oak litter over 62 days, and increased water-extractable organic C and N. Mites decreased the relative abundance of polysaccharides in decomposing corn litter but had no effect on oak litter chemistry, suggesting that the effects of S. moestus on litter chemistry are constrained by initial litter quality. We also compared the chemistry of mite feces to unprocessed corn litter and found that feces had a higher relative abundance of polysaccharides and phenols and a lower relative abundance of lignin. Our study establishes that S. moestus substantially changes litter chemistry during decomposition, but specific effects vary with initial litter quality. These chemical transformations, coupled with other observed changes in decomposition rates and nutrient cycling, indicate that S. moestus could play a key role in soil C cycling dynamics.
Site-searching strategies of searchers referred from search engines

In this research, we analyze the referral queries and associated site-search queries at the session level from searchers coming from web search engines. Findings are based on a random sample of 10,000 from a total of 327,261 searching sessions of an online Spanish entertainment business collected over the course of a five month period from March 23, 2012 to August 26, 2012. We find six searching strategies that are correlated with the type of referral keywords (i.e., search terms) used at the major search engine. Of the six, the three major searching strategies are (1) the explorers who submit a broad query on the major search engine and then submit multiple broad queries on the site-search engine, (2) the navigators who submit a query to the major search engine that is part of a URL and then submit specific queries to the site-search engine, and (3) the persisters who submit the exact type of query on both the search engine and the site search. Implications for this research include developing better internal searching features, sponsored search keyword generation, and personalization of website content.
Childhood sexual abuse and early substance use in adolescent girls: the role of familial influences.

Aim To assess the extent to which the association between childhood sexual abuse (CSA) and early use of alcohol, cigarettes and cannabis in adolescent girls is mediated by risk factors that tend to cluster in families where CSA occurs. Design An abridged version of the Semi-Structured Assessment for the Genetics of Alcoholism (SSAGA) was administered by telephone. Participants A total of 3761 female twins aged 18–29 (14.6% African American, 85.4% European American). Measurements CSA experiences and history of substance use were queried in the SSAGA-based interviews. Findings After controlling for familial influences on early substance use by including co-twin early use status in models, separate Cox proportional hazards regression analyses predicting onset of alcohol, cigarette and cannabis use revealed a significant association with CSA. The effect was observed to age 19 years for cigarettes and to age 21 years for cannabis, but was limited to age 14 years or younger for alcohol, with the most pronounced risk before age 10 [hazard ratio (HR) = 4.59; confidence interval (CI): 1.96–10.74]. CSA-associated risk for initiation of cigarette and cannabis use was also highest in the youngest age range, but the decline with age was much more gradual and the hazard ratios significantly lower (HR: 1.70; CI: 1.13–2.56 for cigarettes and HR: 2.34, CI: 1.57–3.48 for cannabis). Conclusions Childhood sexual abuse history is a distinct risk factor for use of cigarettes and cannabis, and a very strong predictor of early age at first drink.
Men's Tears: Football Players' Evaluations of Crying Behavior

Guided by social constructionist and social norms perspectives on masculinity, this study examined male college football players’ evaluations of crying behavior. Using an experimental design, 150 college football players were randomly assigned to four conditions in which they read different vignettes about Jack, a football player who cries after a football game. Participants who read vignettes of Jack tearing up (vs. sobbing) tended to report higher levels of perceived appropriateness, typicality, and conformity with regard to Jack’s crying behavior. Participants who read vignettes of Jack sobbing after losing (vs. winning) a football game perceived his behavior to be more typical of football players. In addition, the findings are consistent with a model in which perceived appropriateness and typicality of Jack’s crying behavior mediated the association between intensity of tears (tearing up vs. sobbing) and perceived conformity to Jack’s crying behavior. Adherence to the masculine norm of emotional control, perceived appropriateness of Jack’s crying behavior, and perceived conformity to Jack’s crying behavior were significantly associated with participants’ self-esteem. Further, a combination of low perceived appropriateness and high conformity to Jack’s crying behavior was related to lower levels of self-esteem.
Characteristics of Quantitative Nursing Research from 1990 to 2010

Purpose To assess author credentials of quantitative research in nursing, the composition of the research teams, and the disciplinary focus of the theories tested. Design Nursing Research, Western Journal of Nursing Research, and Journal of Advanced Nursing were selected for this descriptive study; 1990, 1995, 2000, 2005, and 2010 were included. The final sample consisted of 484 quantitative research articles. Findings From 1990 to 2010, there was an increase in first authors holding doctoral degrees, research from other countries, and funding. Solo authorship decreased; multi-authorship and multidisciplinary teams increased. Theories tested were mostly from psychology; the testing of nursing theory was modest. Multidisciplinary research far outdistanced interdisciplinary research. Conclusions Quantitative nursing research can be characterized as multidisciplinary (distinct theories from different disciplines) rather than discipline-specific to nursing. Interdisciplinary (theories synthesized from different disciplines) research has been conducted minimally. Clinical Relevance This study provides information about the growth of the scientific knowledge base of nursing, which has implications for practice.
New generation enrichment monitoring technology for gas centrifuge enrichment plants

We report our progress toward development of new generation on-line enrichment monitoring technology for UF 6 gas centrifuge plants based on a transmission source and a NaI spectrometer. We use an X-ray tube with transmission filters instead of a decaying isotopic transmission source to eliminate the costly replacement of this source. The UF 6 gas density measurement is based on the energy dependency of the mass attenuation for two characteristic X-ray lines generated by the transmission filters. An analytical expression for the UF 6 density is derived and criteria for the selection of transmission energies are discussed. Because of the differential method of measurement, the UF 6 gas density does not depend on the intensity of the X-ray source. We describe a design of a sealed UF 6 gas test stand for development testing and calibration of various on-line enrichment monitoring instruments. The sealed source is intended to replace a UF 6 gaseous loop currently used for calibration.
Unexplained fetal death has a biological signature of maternal anti-fetal rejection: chronic chorioamnionitis and alloimmune anti-human leucocyte antigen antibodies.

Aims Chronic chorioamnionitis is a histological manifestation of maternal anti-fetal cellular rejection. Failure of graft survival being the most catastrophic event in organ transplantation, we hypothesized that fetal death could be a consequence of rejection of the mother against the fetus. This study was conducted to assess evidence of cellular and antibody-mediated rejection in fetal death cases.
Tongue and hyoid movements in feeding and speech

Feeding and speech depend on integrated movements of the jaws, tongue surface and tongue base–hyoid complex. Phylogenetically and ontogenetically, the movements of feeding antedate those required for speech. The hypothesis that speech movements would fall within the range used in feeding was tested. Lateral projection videofluorographic records were made for 10 subjects eating 8 g samples of three foods and reading a standard diagnostic speech text (Grandfather Passage). Radiopaque markers were glued to the upper and lower canines and tongue. Marker positions (Cartesian coordinates) for each video frame were plotted relative to the upper occlusal plane (X axis) and to a perpendicular dropped from that plane at the upper canine (Y axis). A plot of all coordinates per record gives the spatial domain (in the sagittal plane) within which a given marker moved. Tongue marker domains showed an extraordinary range of movement in feeding with extensive palatal contact. In speech, there was little palatal contact, and markers moved within a smaller sagittal domain. Although speech domains fell within the range for feeding, their centroids were highly statistically different, P < 0·001 (Hald test for differences in bivariate populations). In contrast, the hyoid domain for speech was anterior to that used in feeding and had almost no overlap with it (P < 0·0001). Our hypothesis is confirmed for the tongue surface markers but not for the hyoid. We conclude that patterns of hyoid movement in speech are a specific adaptation for speech. This research was supported by USPHS NIDCD Award 02123.
Applications of importance sampling to polarization mode dispersion

We describe the application of importance sampling to Monte-Carlo simulations of polarization-mode dispersion (PMD) in optical fibers. The method allows rare PMD events to be simulated much more efficiently than with standard Monte- Carlo methods, thus making it possible to assess the effect of PMD on system outage probabilities at realistic bit error ratios.
A Distributed Cooperative Target Tracking with Binary Sensor Networks

Target tracking is a typical and important cooperative sensing application of wireless sensor networks. We study it in its most basic form, assuming the binary sensing model in which each sensor can return only 1-bit information regarding target's presence or absence within its sensing range. A novel, real-time and distributed target tracking algorithm is proposed. The algorithm reduces the uncertainty of the target location from a two-dimensional area into a one-dimensional arc and estimates the target velocity and trajectory in a distributed and asynchronous manner. Extensive simulations show that our algorithm achieves good performance by yielding highly accurate estimates of the target's location, velocity and trajectory.
Millimeter-wave Electrooptic Polymer-based Ring Resonator Modulation

Modulation is demonstrated throughout the W-band and at the 139 GHz and 165 GHz resonances of an electro-optic polymer ring resonator-based modulator. The experimentally validated analysis indicates superior high-frequency performance over a similar Vpi Mach-Zehnder modulator. copy 2007 Optical Society of America.
High Tail-Cuff Blood Pressure in Mice 1 Week After Shipping: The Need For Longer Acclimation

Many investigators involved in hypertension research routinely measure blood pressure in mice.1 Usually mice from in-house colonies are used, but occasionally the logistics of experiments require ordering mice from vendors. A general rule of thumb is to let these mice acclimate for 1 week after shipping, and this is also the advice of most institutional animal care committees.2 For rats, one study even suggested that 3 days of acclimation would be sufficient, as heart rate, body weight, and activity had returned to normal by this time.3 Here, however, we report our observation of finding higher blood pressures in wild-type mice that were acclimated for 1 week compared to mice that were acclimated for longer periods of time.
Origin, Evolution, and Finescale Structure of the St. Valentine's Day Mesoscale Gravity Wave Observed during STORM-FEST. Part III: Gravity Wave Genesis and the Role of Evaporation

Abstract On 14 February 1992, a long-lived moderate-amplitude mesoscale gravity wave formed in Kansas during the Storm-scale Operational and Research Meteorology-Fronts Experiment Systems Test (STORM-FEST). Wave formation was evident in correlated surface pressure and wind fields. The wave of depression, accompanied by a weak rainband, tracked across the state. A wealth of data was collected on the mature wave as it passed over the STORM-FEST dual-Doppler domain. However, the mechanism of genesis remained difficult to ascertain, since wave formation occurred in a region of less comprehensive observations. The genesis of the STORM-FEST gravity wave is successfully simulated using the fifth-generation Pennsylvania State University–National Center for Atmospheric Research (Penn State–NCAR) Mesoscale Model (MM5), which was run at 6-km grid spacing in the innermost domain. The lee cyclone movement, dry airmass development, and gravity wave formation over Kansas were successfully captured by the model. Results ...
A Theory of Stationary Long Waves. Part I: A Simple Theory of Blocking

Abstract A theory is presented that attempts to explain the tropospheric blocking phenomenon caused by the resonant amplification of large-scale planetary waves forced by topography and surface heating. It is shown that a wave becomes resonant with the stationary forcings when the wind condition in the lower atmosphere is such that the phase speed of the wave is reduced to zero. The resonant behavior of the wave in the presence of Ekman pumping and other damping mechanisms is used to account for the time amplification of the pressure ridges that is an essential part of the blocking phenomenon. This same time behavior also allows the waves to interact with the mean flow in the stratosphere, possibly initiating major sudden warmings. Such a situation was, in fact, assumed by Matsuno (1971) in the lower boundary of his stratospheric model of sudden warming. The basis for reviving the classical normal-mode theory (when faced with the difficulties associated with the zero-wind line) is presented in Part II. Th...
Erythrocyte deformability and lung segmental vascular resistance: effect of hematocrit.

We have investigated the role of erythrocyte (RBC) deformability and perfusate viscosity on lung segmental vascular resistance in 12 isolated perfused lungs of 3- to 5-wk-old rabbits. Each lung was perfused alternately with control and formaldehyde-fixed rabbit RBCs at a flow rate of 80 ml.kg-1.min-1, left atrial and airway pressures being 8 and 6 cmH2O, respectively (zone 3). Perfusate RBC concentration was kept constant at 3.2 x 10(6)/mm3 for group I lungs (n = 6) and 7.2 x 10(6)/mm3 for group II lungs (n = 6). In all lungs, we measured pressures in the pulmonary artery and in 20- to 50-microns-diam arterioles and venules with the micropipette servo-null method during both perfusion periods. Compared with control, fixed cells had a 60% decrease in deformability index (i.e., the volume of a dilute solution of RBCs filtered through a 5-microns Nuclepore filter in 1 min). In groups I and II, perfusate viscosity of fixed cells was 15 and 55% greater, respectively, than that of control cells. We found that perfusion with fixed cells in group I lungs did not alter total or segmental vascular pressure drops. However, in group II lungs, perfusion with fixed cells at twice the cell concentration resulted in an increase in total vascular pressure drop, mainly due to an increase in pressure drop in veins (50% of total) and arteries (33%). The relatively small (17%) increase in pressure drop in microvessels was probably due to distension and/or recruitment of capillaries resulting from increased venular pressures.(ABSTRACT TRUNCATED AT 250 WORDS)
Intelligence Demands in a Democratic State: Congressional Intelligence Oversight

The recent revelations regarding a domestic surveillance program exposed an exceptionally divisive issue: to what extent can the Executive conduct intelligence operations absent congressional oversight? This Article seeks to address this question through an examination of the historical and constitutional foundations for congressional intelligence oversight. Despite a strong historical and constitutional basis for demanding a significant role for Congress in the conduct of intelligence operations, the nature and breadth of this role remain unclear. Intuitively, one sees Congress’s role in guaranteeing the conduct of intelligence operations in accordance with majoritarian views on mores, civil liberties, and human rights. Less intuitive is Congress’s role in facilitating efficient and aggressive intelligence operations. For a multitude of reasons, Congress has often failed to accomplish either function. The instant historical period finds the Intelligence Community under increased congressional scrutiny. This presents a unique opportunity for Congress to reassert itself and fulfill its constitutional mandate. To this end, the Article provides appropriate recommendations.
The Instability of Minimum Winning Coalitions

This paper examines William Riker's thesis that only minimum winning coalitions form in n-person zero-sum symmetric games. It demonstrates that Riker's conclusion is false by identifying the conditions under which larger than minimum winning coalitions can form. Since these conditions are quite general it indicates that Riker's conclusion is valid only for a highly restricted class of games. This class of games is identified as those in which players not in a minimum winning coalition have no incentive to form any coalitions among themselves. These games are characterized as games inessential over coalitions of losers. Only in these games can minimum winning coalitions be expected to form exclusively. In all other games, larger than minimum winning coalitions are possible.
Numerical Studies of Mixing and Flame-Turbulence Interactions in Shear Coaxial Injector Flows under Trans-Critical Conditions

In order to gain a better understanding of the physical processes inside a liquid rocket combustion engine, validation of numerical tools is essential. A series of single-element injector experiments conducted at Pennsylvania State University is used here to investigate the predictive capabilities of Large-Eddy Simulation (LES) for such flows. These studies include both non-reacting and reacting cases with trans-critical injection of liquid oxygen (LOX), where the injection temperature of oxygen is below its critical value but where the operating pressure is above the critical pressure of both reactants. The current solver uses a hybrid upwind-central scheme alongside a full real gas thermodynamics framework to deal with this liquid-like injection. The current solver is shown to predict the nonreacting cases with good accuracy and allows the investigation of coaxial injector behavior when operating conditions are scaled up closer to a real engine. Reproducing the reacting experiments is more challenging and the influence of parameters such as upstream heat transfer, co-flow modeling and influence of oxygen post tip temperature is investigated.
Abstract 3379: Overexpression of CTGF is associated with chemoresistance in esophageal adenocarcinoma.

Esophageal adenocarcinoma is the most rapidly increasing solid malignancy with an overall 5-year survival of only 19%. Neoadjuvant chemoradiation is standard practice in most large centers but results in a complete pathologic response in only 21%, although this subset has an improved 5-year survival. In this study, connective tissue growth factor (CTGF), which is associated with increased cell migration, tissue invasion, and angiogenesis, was evaluated for its role in chemoresistance in esophageal adenocarcinoma. CTGF was found to be overexpressed in 33.3% (5 of 15; mean 3.1-fold) of esophageal adenocarcinomas on oligonucleotide microarray relative to Barrett9s metaplasia. Elevated expression of CTGF was also found in 5/5 advanced stage IV esophageal adenocarcinomas on Western blot. Overexpression of CTGF was observed in 70.6% of chemoresistant esophageal adenocarcinomas (n=17) as determined using qRT-PCR and was significantly higher compared to chemo-naive esophageal adenocarcinomas (n=102; p Citation Format: Zhuwen Wang, Lin Lin, Dafydd G. Thomas, Mark B. Orringer, Andrew C. Chang, David G. Beer, Jules Lin. Overexpression of CTGF is associated with chemoresistance in esophageal adenocarcinoma. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 3379. doi:10.1158/1538-7445.AM2013-3379
Ductal Carcinoma In Situ: To Irradiate or Not to Irradiate?

Ductal carcinoma in situ (DCIS) is a heterogeneous entity that has continued to perplex clinicians and patients despite extensive efforts to characterize its behavior andbesttreatmentstrategies.Asastand-alone diagnosis, it poses no mortality risk, yet the local therapyoptions range frommastectomy to limited excision, with or without radiation therapy (RT). The majority of current DCIS cases are amenable to wide excision to negative margins. Mastectomy (with or without reconstruction) typically is reserved for multicentric DCIS, lesions too extensive to encompass within a cosmetically acceptable excision,situationsinwhichriskreductionisa goal (ie, patients with a known BRCA1/2 mutation), or patients with a strong personal preference for mastectomy. The accompanying article by Wood outlines the dilemma of how best to treat patients with DCIS in the modern era, who often present with small, localized disease. It bears mentioning that the technology of mammography has improved such that it is not uncommon todiagnose small lesions and that the natural history of these lesions is uncertain.
Estimating direct climate impacts of end-of-life solar photovoltaic recovery

Abstract Resource recovery of end-of-life photovoltaics has been the focus of much recent research and development investment. Understanding the environmental impacts of collecting and processing these solar materials is imperative to informing the roll out of recycling infrastructure. This work combines traditional life-cycle assessment, geospatial statistical modeling, and processing optimization to quantify direct human and ecological impacts of PV resource recovery under a broad range of scenarios. For a baseline scenario, the most environmentally benign path is to landfill all of the end-of-life photovoltaics; this is due both to the sheer number and thereby close proximity of available landfill sites as well as the environmental burdens associated with current state-of-the-art recycling technologies. Such a disposal structure was found to be highly decentralized. Under a case where all materials are required to be recycled, emissions range from 7 to 252 g CO2 eq/kW h depending on the region; highly distributed regions have equivalently larger environmental impacts. Credits for recycling decrease these impacts and make recycling more favorable for certain scenarios. Future processing facilities co-located near utility scale photovoltaic installations may make environmental sense assuming optimistic advancements in prospective resource recovery technologies.
Are we maintaining the ratio of private practicing pediatric dentists to the number of children

Using recent ADA and Bureau of the Census reports, national, region and state ratios of pediatric dentists per 100,000 children are provided for the mid-1990s. While national averages continue to improve, there are wide variations at more local levels.
Approaches to the treatment of patients with hormone-sensitive prostate cancer.

Androgen ablation therapy provides effective palliation for patients with advanced cancer of the prostate for only a short duration because the tumor eventually develops resistance. Among the many potential molecular mechanisms involved in the development of tumor resistance to both androgen ablation therapy and chemotherapy, mutations in the p53 tumor suppressor gene, overexpression of the antiapoptotic protein bcl-2, and overexpression of the multidrug resistance protein probably play a role. Because hormone-resistant tumors demonstrate greater expression of bcl-2 and because transfection of the bcl-2 gene into hormone-sensitive tumor cells confers resistance to both hormone therapy and chemotherapy, efforts to abrogate bcl-2 in prostate tumors represent one approach to improve clinical results. Of several agents recently shown to reduce prostate-specific antigen levels in phase II studies, 13-cis-retinoic acid and interferon-alpha can reduce the expression of bcl-2 and overcome bcl-2-mediated resistance to paclitaxel in resistant cell lines. For these reasons, our current studies test the hypothesis that reducing the expression of bcl-2 with 13-cis-retinoic acid and interferon-alpha in combination with taxanes will improve clinical results. Additionally, other studies test the hypothesis that treatment early, before the development of resistance mechanisms, in hormone-sensitive disease will improve results. Studies with docetaxel (Taxotere; Rhone-Poulenc Rorer, Collegeville, PA) and with estramustine combination therapy are also ongoing.
Does therapeutic plasma exchange have a role in the treatment of prosthetic hip-associated cobalt toxicity? A case report and literature review.

BACKGROUND Prosthetic hip–associated cobalt toxicity (PHACT) is an uncommon, but potentially devastating, complication for patients with metal-on-metal hip implants (MoMs). Clinical management of PHACT is poorly defined, with primary intervention being MoM explant followed by chelation therapy. Therapeutic plasma exchange (TPE) in cobalt toxicity has not been previously described. Given that cobalt is predominantly albumin bound, it should theoretically be removed by TPE. Here we report a case of PHACT and our experience using TPE to lower plasma cobalt levels. CASE REPORT A 61-year-old woman developed deafness, blindness, ambulatory dysfunction, and endocrinopathies after MoM implant. Cobalt levels on admission were greater than 1500 µg/L. In an attempt to rapidly lower cobalt levels before MoM explant, hemodialysis and TPE were performed. Hemodialysis removed negligible amounts of cobalt. One session of TPE temporarily removed approximately two-thirds of measurable cobalt, but levels rebounded to pre-TPE values after 8 hours. It was only after MoM removal that cobalt levels plateaued below 300 µg/L and clinical symptoms improved. DISCUSSION TPE removed cobalt from a PHACT patient, but a durable decrease in cobalt was only achieved after MoM explant. These findings are comparable to reports where chelation was employed in PHACT patients before MoM explant. The observed rebound phenomenon is likely from rapid equilibration between the immense extravascular tissue source (the MoM) and the intravascular compartment. CONCLUSION TPE may serve as adjunctive therapy for PHACT patients whose cobalt levels remain high after explant, especially in patients with renal failure, in whom chelation is contraindicated.
New Encounters in U.S.-Africa Democracy Relations: Less of the Same?

Rita Abrahamsen and Paul Williams have argued that contemporary democracy promotion emerges as a product of a hard-won Cold War struggle fought in the name of democracy and freedom. These values, they say, reemerged in the post-Cold War era at a time of capitalism’s historic triumph over communism. As a result, the promotion of democracy became an intrinsic part of Western-led globalization in the millennium and the focus of a new liberal development ideology.1
Ensuring safe reuse of residential wastewater: Reduction of microbes and genes using peat biofilter and batch chlorination in an on-site treatment system.

Aims A batch chlorination system was optimized for on-site wastewater treatment and reuse system (OWRS) and its efficiency was evaluated for reducing viruses, protozoa, bacteria and antimicrobial resistance in cold and warm seasons. Methods and Results The OWRS performance in reducing microbial contaminants was determined by assessing three different faecal indicators (Escherichia coli, F-specific coliphages and Clostridium perfringens for measuring the disinfection efficiency of bacteria, viruses and spore-formers and surrogate for protozoa, respectively) using culture-based methods. Quantitative PCR was used to quantify pathogenic bacteria (Shiga-toxin-producing E. coli (STEC), Campylobacter spp., and Arcobacter spp.), a human-associated faecal marker (gyrB), and tetracycline resistant bacteria (tetQ). The levels of E. coli, coliphages and Cl. perfringens showed 5·4, 2·3, 2·5 log reduction, respectively, upon disinfection. In the final effluents, coliphages (1·7 × 102 PFU 100 ml−1) and Cl. perfringens (3·4 CFU 100 ml−1) were detected in 80 and 100% of the samples, but E. coli was not found. The removal and inactivation of E. coli and Cl. perfringens were not significantly different across the seasons, however, efficacy of removal and inactivation of F-specific coliphage was significantly reduced during the winter/spring season compared to the summer/autumn season (P = 0·009). The reduction of Arcobacter, gyrB and tetQ by 3·1, 2·3 and 2·3 log, respectively, was mostly due to peat biofiltration under the study conditions. Conclusions This study demonstrated that peat biofiltration was the most important step of the OWRS to remove microbes and genes from wastewater before spray irrigation of the effluents. The irrigation system is not suitable for edible crops because of the potential presence of residual pathogens. Significance and Impact of the Study On-site wastewater treatment systems are a practical option for reusing the wastewater for landscape, especially for those areas where geological and seasonal limitations impact the removal of microbial contaminants by soil infiltration.
Mechanistic insights into the manganese-dependent phosphodiesterase activity of yeast Dbr1 with bis-p-nitrophenylphosphate and branched RNA substrates

Saccharomyces cerevisiae Dbr1 is a manganese-dependent RNA debranching enzyme that cleaves the 2'-5' phosphodiester bond of the lariat introns formed during pre-mRNA splicing. Dbr1 is a member of the binuclear metallophosphoesterase enzyme superfamily. We showed previously via alanine scanning that RNA debranching in vivo and in vitro depends on conserved active site residues His13, Asp40, Asn85, His86, His179, His231, and His233. Here, by extending the alanine scan, we added Cys11 to the ensemble of essential active site components. We report that Dbr1 has a vigorous manganese-dependent phosphodiesterase activity with the non-RNA substrate bis-p-nitrophenylphosphate. Whereas RNA debranching requires His86, bis-p-nitrophenylphosphatase activity does not. We interpret these and other structure-activity relations reported here in light of the crystal structures of Entamoeba Dbr1 and other homologous binuclear metallophosphodiesterases. Our results suggest that (i) Dbr1 adheres to the two-metal mechanism of the enzyme superfamily, but is distinguished by its reliance on a Cys11-Xaa-His13 motif to engage one of the catalytic metals instead of the Asp-Xaa-His element typical of other clades within the superfamily; (ii) His86 is a general acid catalyst that protonates the O2' leaving group of the RNA 2'-5' phosphodiester; and (iii) the favorable pKa of p-nitrophenol elides the strict need for a general acid during hydrolysis of bis-p-nitrophenylphosphate. The Dbr1 bis-p-nitrophenylphosphatase activity is well suited for high-throughput screening for inhibitors of debranching.
Hodgkin Lymphoma Type Post-Transplant Lymphoproliferative Disorder (HL-PTLD) after Solid Organ Transplant (SOT): A Comprehensive and Comparative Analysis of Disease Characteristics, Prognosis, and Survival

Abstract Background: HL-PTLD is a rare subtype of PTLD that carries an unknown prognosis as minimal clinical data are available. Furthermore, little is known regarding differences in clinical features between HL-PTLD and HL and the optimal treatment of HL-PTLD is not well defined. Methods: Patients (pts) diagnosed with HL-PTLD from 1/1999 - 4/2011 were identified in the Scientific Registry of Transplant Recipients, a prospective database of SOT recipients. Additionally, non-PTLD HL pts (n=13,847) were identified in the Surveillance, Epidemiology and End Results (SEER) Program. Baseline characteristics were compared using Wilcoxon and Chi square testing. Further, we compared cohorts of HL-PTLD and HL-SEER pts exactly matched on age, sex, and year (yr) of diagnosis. Overall survival (OS) rates were estimated using Kaplan-Meier and compared with log rank test. Cox proportional hazards models estimated hazard ratios (HR) and adjusted HR (aHR). Results: We identified 192 HL-PTLD pts. Compared with HL-SEER pts, HL-PTLD pts were older (median age 38 vs 51 yrs, respectively, P Conclusions: To the best of our knowledge, this is the largest cohort of HL-PTLD reported to date. When compared with HL-SEER pts, HL-PTLD pts were older, more likely male, and had higher frequency of extranodal disease. Furthermore, HL-PTLD pts had significantly inferior OS. Among HL-PTLD pts, clinical factors at diagnosis identified pts with markedly divergent outcomes. In addition, treatment without Ctx (including RIS alone) appeared insufficient, and moreover, treatment with HL-specific Ctx (and possibly CHOP) resulted in the most optimal outcomes. Download : Download high-res image (111KB) Download : Download full-size image Figure 1 . Disclosures No relevant conflicts of interest to declare.
Pharmacological Considerations in Ophthalmic Drug Delivery

The eye is housed in a bony orbit, anchored by extraocular muscles and multiple layers of soft tissue. The globe is comprised of several layers including the sclera, uvea, and retina. The refractive elements of the eye include the lens and cornea, which provide refractive power necessary to focus light on the retina.
“Let Me Tell You About My…” Provider Self-Disclosure in the Emergency Department Builds Patient Rapport

ABSTRACT Background As patients become increasingly involved in their medical care, physician-patient communication gains importance. A previous study showed that physician self-disclosure (SD) of personal information by primary care providers decreased patient rating of the provider communication skills. Objective The objective of this study is to explore the incidence and impact of Emergency Department (ED) provider self-disclosure on patients’ rating of provider communication skills. Methods A survey was administered to 520 adult patients or parents of pediatric patients in a large tertiary care ED during the summer of 2014. The instrument asked patients whether the provider self-disclosed and subsequently asked patients to rate providers’ communication skills. We compared patients’ ratings of communication measurements between encounters where self-disclosure occurred to those where it did not. Results Patients reported provider SD in 18.9% of interactions. Provider SD was associated with more positive patient perception of provider communication skills (p<0.005), more positive ratings of provider rapport (p<0.05) and higher satisfaction with provider communication (p<0.05). Patients who noted SD scored their providers’ communication skills as “excellent” (63.4%) compared to patients without self-disclosure (47.1%). Patients reported that they would like to hear about their providers’ experiences with a similar chief complaint (64.4% of patients), their providers’ education (49%), family (33%), personal life (21%) or an injury/ailment unlike their own (18%). Patients responded that providers self-disclose to make patients comfortable/at ease and to build rapport. Conclusion Provider self-disclosure in the ED is common and is associated with higher ratings of provider communication, rapport, and patient satisfaction. Keywords Patient, resident, provider communication, education
Deep Venous Thromboses Associated with Peripherally Inserted Central Catheters in Patients with Hematological Malignancies.

Deep venous thromboses (DVTs) complicating peripherally inserted central catheters (PICCs) placed for antibiotic administration were observed in 1.4% of patients in the largest study to date that included more than 2000 patients (Clinical Infectious Diseases, 34:1179–1183). The incidence of DVTs associated with PICCs in patients with hematological malignancies is unknown. We designed this retrospective analysis to better determine the incidence, characteristics, and outcomes of PICC-related DVTs on a Leukemia Unit at a large academic institution. Between April 2001 and February 2006, a total of 899 PICCs were placed in 568 patients with hematological malignancies. Ultrasound documented deep venous thromboses occurred in 38 patients (6.69%), a median of 26 days (2–172) after PICC placement. Patient’s characteristics were as follows: median age at the time of PICC insertion 45.5 yrs; 61% male; 37% black and 58% white. At the time of PICC placement 22 (58%) patients had newly diagnosed AML (46%), ALL (36%), lymphoma (13%), or CML (5%). Median platelet count at the time of DVT diagnosis was 106 ×10E3/μL. DVT management included removal of the PICC (71%), thrombectomies/thrombolysis/PTCA (13%), and anticoagulation with heparin (76%), or warfarin (24%). Anticoagulation was subsequently intermittently discontinued due to chemotherapy-induced thrombocytopenias. With a median follow up of 601 days, there were no documented pulmonary emboli or hemorrhages; 50% were in remission, 8% had relapsed disease, and 39% were deceased. In summary, patients with hematological malignancies appear to have a higher incidence of PICC-associated DVTs compared to patients without malignant hematological disorders with PICCs inserted for antibiotic administration. Risk factor analysis is in progress.