cssi/SciSciGPT-SciSciNet huggingface dataset:
Echocardiographic predictors of an adverse response to a nifedipine trial in primary pulmonary hypertension: diminished left ventricular size and leftward ventricular septal bowing.

Background The clinical course in primary pulmonary hypertension (PPH) is improved by calcium channel blocker therapy in those with a favorable hemodynamic response during a trial of high-dose oral nifedipine. Although trials of nifedipine are performed only in patients who demonstrate pulmonary vasodilator reserve to short-acting agents, this response does not predict the safety of nifedipine treatment, which can result in severe first-dose hypotension and death. Study objectives To identify echocardiographic parameters that predict first-dose nifedipine-induced hypotension in patients with PPH. Methods The pretrial echocardiograms of 23 consecutive PPH patients (mean age, 42.3 ± 13 years; 77% female) undergoing evaluation of pulmonary vasodilator reserve with nifedipine were analyzed. Patients were classified as those who suffered first-dose nifedipine hypotension (group 1) and those who did not (group 2). Echocardiographic measures of chamber size and septal geometry in the two groups were compared. Results Five measures reflecting diminished left ventricular (LV) size and leftward ventricular septal bowing were found to be associated with nifedipine hypotension: LV transverse diameter in systole (LVDs; p = 0.007), LV transverse diameter in diastole (LVDd; p = 0.05), LV area in systole (LVAs; p = 0.009), LV area in diastole (LVAd; p = 0.03), the ratio of RV to LVAs (p = 0.02), and leftward ventricular septal bowing (p = 0.01). The LV dimensions found to best predict nifedipine-induced hypotension were LVDs 2 , and LVAd 2 . Conclusions Readily available echocardiographic parameters in patients with PPH are predictive of nifedipine-induced hypotension, and can be used to select patients in whom a trial of nifedipine should be avoided.
Composite TaSi 2 /n + poly-Si formation by rapid thermal annealing

Composite TaSi 2 /n+ poly-Si structures have been formed by rapid thermal annealing (RTA). Polysilicon films 0.2 µm thick were deposited on oxidized Si wafers by LPCVD and heavily doped with phosphorus by diffusion. A layer of TaSi x 0.22 µm thick was then cosputtered on polysilicon from separate targets. The as-deposited samples were annealed by RTA using high-intensity tungsten lamps. Uniform stoichiometric low-resistivity tantalum disilicide was formed by RTA in 1 s at 1000°C. The sheet resistance and grain size of the silicide layers are comparable to those formed by conventional furnace anneals. The surface morphology of the RTA samples is superior to that obtained by furnace annealing. These results show that RTA technique has a great potential for low-resistivity tantalum silicide formation in VLSI circuits.
The International Legal Right to Individual Compensation in Nepal and the Transitional Justice Context

Some consider Nepal to be Shangri-la — or earthly utopia — but its current situation is far from that. Having only emerged in 2006 from a ten-year internal conflict that left over 13,000 people dead, Nepal is seeking its own Shangri-la: peace, democracy, and development. This journey, however, is complicated by the numerous human rights violations committed by the state during the internal conflict. Not only do those whose human rights were violated want redress from the state, but international law encourages — and sometimes mandates — justice for victims. Providing that justice can be problematic for states like Nepal that are attempting to transition away from war and authoritarian rule toward peace and democracy, yet are underdeveloped and impoverished. Transitional justice is premised on the notion that a society cannot have closure — and subsequently progress — unless it addresses the problems of its past. To achieve these goals, transitional justice offers a range of mechanisms through which a state can provide truth and justice to victims of human rights violations. One such mechanism is individual compensation. This Note explores the intersection of transitional justice and international human rights law concerning the right to individual compensation. It examines the human rights violations for which individual compensation is legally required and discusses the alternative paradigm of compensation - as - development as a potentially better solution to achieve the goals of transitional justice. Part I of this Note provides a brief political history of Nepal since the mid-eighteenth century; defines the concept of transitional justice; and explores the international law of remedy, reparations, and compensation. Part II focuses on the right to individual compensation in order to determine which human rights violations trigger a state’s legal obligation to compensate victims, and then applies that right to the transitional justice context. Finally, Part III proposes the design of an individual compensation program in which Nepal, and other transitional states, can fulfill legal obligations while simultaneously working toward peace, democracy, and development.
Effect of ascorbic acid and its synthetic lipophilic derivative ascorbyl palmitate on phorbol ester-induced skin-tumor promotion in mice.

The effect of topical application of ascorbic acid (AA) and ascorbyl palmitate (AP) on l2-O-tetradecanoyl- phorbol-l3-acetate (TPA)-induced tumor promotion in mouse skin was investigated. A single application of TPA decreased epidermal AA by 45%. Repetitive application of 6 and 28 �mol AA with 2 nmol TPA inhibited tumor multiplicity by 39% and 76%. Repetitive application of0.l6, 0.8, and 4.0 �zmol AA with 5 nmol TPA inhibited tumor multiplicity by 16%, 46%, and 9 1%. Because AA may be poorly absorbed cutaneously, we eval- uated the effect ofdietary AA. Supplementation ofdrinking water with AA increased epidermal ascorbic acid levels by 50%. Dietary intake of AA did not inhibit TPA-induced tumor promotion. Preliminary data suggest that the mice not receiving AA devel- oped increased epidermal AA levels in response to the tumor promoting regimen. Recently we have found that dietary AP inhibited TPA-induced biochemical parameters associated with tumor promotion. Am J C/in Nutr 199l;54: 12665-735.
Diabetes Attenuates the Alterations in Both Venous Endothelial and Smooth Muscle Cell Function Induced by Prolonged Hypercholesterolemia in an Experimental Model

The systemic effects of the combination of diabetes and hypercholesterolemia on venous vasomotor function are poorly understood. This study examines in vitro vasomotorresponses of New Zealand White rabbit jugular veins from control, diabetic, hypercholesterolemic, and hypercholesterolemic with diabetes groups. Hypercholesterolemia was induced with a diet supplemented with 1% cholesterol, while diabetes was induced by alloxan.Cumulative dose response curves to norepinephrine, bradykinin, and histamine were performed. After precontraction with norepinephrine to give 80% maximal contraction, relaxation in response to acetylcholine and sodium nitroprusside was determined. Potency of the agonist responses were compared. The contractile responses to all agonists were significantly increased in hypercholesterolemia. Only the response to norepinephrine was increased in diabetes. However, when diabetes and hypercholesterolemia were combined the contractile response to bradykinin was increased, the response to hist...
The Role of the Visual Image: What Are Students Really Learning from Pictorial Representations?

AbstractYoung learners must be better prepared to interpret and utilize the visual information presented to them in elementary science books. The findings of this study suggest that illustrations may not promote student understanding, but may. in fact, encourage misconceptions about science. Further, the elementary students in this study demonstrated a propensity for constructing their own interpretations to describe the visual representation, rather than posing questions about their observations, or reading the caption or explanatory text. Only two students, out of sixty, chose to read any part of the accompanying text. Other research on visual representations should concentrate on investigating learner understanding and interpretation to determine what changes, if any, are necessary to make illustrations more meaningful.
Between Metaphysics and Methodology

Metaphysics constitutes sets of statements or principles; methodology constitutes sets of rules. Metaphysics is constitutive; methodology is regulative. That, metaphysics gives birth to rules of research — scientific or pseudoscientific — was obvious for long; Wittgenstein and Popper, following a lead of Bertrand Russell, went further and tried to do away with the constitutive while retaining the regulative which might be necessary for scientific research. In Wittgenstein’s case things obviously don’t work. I shall venture to argue that Popper’s case is also objectionable. (In the case of Wittgenstein, as well as in that of Popper, incidentally, I refer exclusively to the author’s first and classic book.)
Glass Transition of Elastomers Using Thermal Analysis Techniques

Abstract The paper defines the glass transition temperature (Tg) of elastomers using various thermal analysis techniques (differential scanning calorimetry, DSC; derivative DSC; thermomechanical an...
Effects of Dietary Aluminum from an Aluminum Water Treatment Residual on Bone Density and Bone Mineral Content of Feeder Lambs1

Abstract A 111-d experiment was conducted to determine if dietary Al provided by AlCl 3 or water treatment residuals (WTR) at various levels (910 to 8,000 ppm) affected bone mineral content and bone density of growing sheep. Using a completely randomized design, 42 lambs (12 ewes and 30 wethers; 5 to 8 mo of age) were assigned to 1 of 6 treatments. Treatments were 1) 10% sand (control), 2) 9.7% sand and 0.3% AlCl 3 , 3) 7.5% sand and 2.5% WTR, 4) 5% sand and 5% WTR, 5) 0% sand and 10% WTR, and 6) 0% sand, 0% WTR, 2 times the quantities of the mineral and vitamin premix, and 1.29% dicalcium phosphate. Basal diets met all requirements and contained 0.25% P. The resulting concentrations of Al in the 6 treatment diets were 910, 2,000, 2,000, 4,000, 8,000, and 8,000 ppm, respectively. Radiographs of the left third metacarpal (MCIII) were obtained on d 28, 69, and 109 for estimation of bone density. Lambs were killed on d 111 and bone density of the left third metacarpal was determined by specific gravity procedures. Radiographic density was not affected by treatment. No differences in bone density were observed among treatments. Overall, results indicated that Al in various forms and levels fed to growing sheep provided adequate amounts of P (0.25%,) and that other required dietary nutrients had no effect on bone mineral content over a period of 79 d or on specific gravity calculations of bone density over 111 d.
Gravitational Waves in the Linearised Theory of General Relativity

The theory of general relativity (GR) states that gravity can be considered as curvature of spacetime [1].
Animal Visions: Rethinking the History of the Human Future

AbstractWild animal abundance and scarcity have been key to religious and secular visions of the American future for centuries, and changes in their meanings reflect radical shifts in understanding...
40 MAGNETIC RESONANCE IMAGING FEATURES OF LIMB-LOCALIZED POLYARTERITIS NODOSA.

Purpose The purpose of this study is to describe a case of localized polyarteritis nodosa (PAN). Materials and Methods Case study including medical history, physical examination, laboratory and radiographic reports of a 51-year-old black male who presented to the Veterans Affairs Medical Center, Memphis, TN, with lower limb myalgias. Results The patient9s history was significant for 2 months of intermittent bilateral lower extremity pain and swelling associated with subjective fevers. Admission physical examination was notable for tenderness to calf muscles bilaterally, with no dermatologic lesions. Laboratory studies revealed elevated acute-phase reactants (CRP 344.2 mg/L (normal 0-4.9), ESR 112 mm/h (normal Conclusion Calf muscle myalgias may rarely be the presenting feature of PAN, and this does not have a benign course. MRI may be useful in the diagnosis of limb-localized PAN.
Influence of dexmedetomidine preconditioning on inflammatory response in pediatric patients under cardiopulmonary bypass

Objective To explore the influence and imlications of dexmedetomidine preconditioning on inflammatory response in pediatric patients under cardiopulmonary bypass(CPB). Methods Eighty pediatric patients with ventricular septal defect were divided into two groups. The patients of control(C group) received equal saline and the patients of treatment group(D group) received an initial bolus dose of dexmedetomidine(0.5μg/kg) over 10 min after tracheal intubation,followed immediately by a continuous infusion of 0.5μg/kg-1·h-1until the start of CPB. Blood samples were obtained for determination of serum concentration of TNF-α,IL-6,IL-8,MDA,CK-MB,c Tn I and activity of SOD after induction of anesthesia(T0),at the end of CPB(T1),and 4 hours(T2), 12 hours(T3) after CPB termination. Results The plasma level of IL-6,IL-8,TNF-α,MDA,CK-MB,c Tn I in group D were significantly lower and the serum SOD activity was significantly higher than that in group C at the end of CPB(T1),and 4 hours(T2),12 hours(T3) after CPB termination.(P0.05);and the plasma level of IL-6,IL-8,TNF-α,MDA,CK-MB,c Tn I in two groups were significantly lower and the serum SOD activity was significantly higher at T1,T2,T3 than that at T0. Conclusion Dexmedetomidine preconditioning can inhibit inflammatory response during CPB,So it can exert protective effects on acute ischemia/reperfusion heart.
Research on Reliability of Composite Insulators Used in EHV and UHV DC Transmission Lines

The authors present some research items and results on DC composite insulators by China Electric Power Research Institute(CEPRI),including the anti-erosion performance of silicon rubber under DC voltage,the effect of ion migration on mechanical strength of rods,the corrosion of end-fitting caused by leakage current and DC pollution flashover characteristic of composite insulators,etc.The results from on-site investigation and the tests in laboratory show that it is feasible to apply composite insulators in DC transmisison lines and the reliability of transmission line operation can be improved.It is also pointed out that composite insulators can also be used in UHV DC transmission lines reliably.
An electron microscopic and functional study of very low density lipoproteins in intestinal lymph.

Previous studies with fasting rats showed that the intestine produces endogenous very low density lipoproteins (VLDL) which resemble those in the plasma. Intestinal VLDL also were found to be important in lipid transport during absorption of saturated but not of unsaturated fat. These findings depended upon separations of a chylomicron-rich fraction (Sf > 400) from VLDL (Sf 20-400) by preparative ultracentrifugation methods based on particle flotation rates. The present studies correlate this method with electron microscopic measurement of lipoprotein particle size. Almost all intestinal lymph lipoprotein particles from fasting rats were less than 750 A in diameter, and could not be distinguished morphologically from plasma VLDL. Cholestyramine administration or bile diversion led to decreased lymph lipid output, correlating with marked reduction in VLDL. This supports the concept that lymph VLDL contain endogenous lipid which is reabsorbed from the intestinal lumen. During exogenous fatty acid absorption, lymph lipoprotein particle sizes were significantly smaller after administration of palmitate than after administration of linoleate, a finding consistent with ultracentrifugal evidence of the importance of VLDL in lipid transport during palmitate absorption. These studies fully confirm and extend earlier observations. Together, they show that the intestine is a source of endogenous VLDL in the fasting animal. In addition, significant quantities of exogenous lipid are transported in VLDL during palmitate absorption, whereas with linoleate absorption nearly all lipid is in chylomicrons. These findings indicate that the small intestine plays a role in lipoprotein metabolism which extends beyond the absorption of dietary fat.
Hand-assisted laparoscopic nephrectomy: Technical considerations

PURPOSE Laparoscopic nephrectomy can be technically difficult and associated with lengthy operative times because of the limitations imposed by working with long instruments rotating about a fixed site on the abdominal wall, and without direct manual contact with the tissue. Hand-assisted laparoscopy is an option that addresses these problems. Herein we report our initial technique for hand-assisted laparoscopic nephrectomy. TECHNIQUE After obtaining pneumoperitoneum and placing a 12-mm cannula lateral to the rectus muscle, a 7- to 8-cm incision is made in the upper midline. A commercially available wound protector and occlusive sleeve are inserted. Once an arm strap has been secured, the surgeon can operate with one hand in the abdomen while maintaining pneumoperitoneum. Using instruments placed through one or two additional laparoscopic ports, the nephrectomy is completed and the specimen is removed through the upper midline incision. Our continued experience with 10 hand-assisted laparoscopic nephrectomies to date has been favorable. CONCLUSION Hand-assisted laparoscopic nephrectomy may facilitate the laparoscopic management of demanding pathologies, such as severely inflamed kidneys and larger tumors. It is particularly advantageous when intact specimens are required. Although more experience is required to define the role of hand-assisted urologic laparoscopy, we are encouraged by our initial technique and results.
A meridional dipole in premonsoon Bay of Bengal tropical cyclone activity induced by ENSO

Analysis of Bay of Bengal tropical cyclone (TC) track data for the months of May–June during 1979–2014 reveals a meridional dipole in TC intensification: TC intensification rates increased significantly in the northern region and decreased in the southern region. The dipole is consistent with changes in the large-scale TC environment estimated using the Genesis Potential Index (GPI) for the same period. While an increase in lower troposphere cyclonic vorticity and midtroposphere humidity in the northern Bay of Bengal made the environment more favorable for TC intensification, enhanced vertical wind shear in the southern Bay of Bengal tended to reduce TC development. These environmental changes were associated with a strengthening of the monsoon circulation for the months of May–June, driven by a La Nina-like shift in tropical Pacific SSTs and associated tropical wave dynamics. Finally, analysis of a suite of climate models from the Coupled Model Intercomparison Project Phase 5 archive shows that most models correctly reproduce the link between ENSO and premonsoon Bay of Bengal TC activity at interannual timescales, demonstrating the robustness of our main conclusions.
Chapter VII – INTELLIGENCE IN THE PRESCHOOL CHILD

This chapter discusses intelligence in the preschool child. The child's mental expression is more similar to the structure of an adult's dream than to the structure of his thinking, because children's thought is characterized by symbolization, condensation, transposition, and omission of associative links. The child's emotional expression is not necessarily directed toward an object, but frequently is a mere discharge of energies. Intelligence is a product of an inborn brain structure. The most decisive factor influencing any evaluation of intelligence is the emotional response that underlies or even substitutes for a reaction that is supposed to indicate intelligence. Memory is not a static function that works with any kind of material; it is a dynamic process, effective with material that interests the child, and ineffective with other material. The child sees relationships between things the adult does not see, and vice versa. While the adult's intelligence is mostly based upon a large series of experiences that condition certain reactions, the child's intelligence is in a statu nascendi, a state of development.
Relating Reaction Rate Constant to Structures of Reactants and Solvent Using a Hybrid GA-DT Approach

Abstract In recent years, Computer-Aided Molecular Design (CAMD) has been extensively used for defining and designing reactions at their maximal potential. In all these contributions, either the reactants/products were considered constant or the solvents. Developing a QSPR model which not only captures the influence of reactant structures but also the solvent effect on reaction rate, is essential. Since the structures of reactants and products are related, such QSPR models will serve as a prerequisite for the simultaneous CAMD of reactants, products and solvents. They will also provide a useful tool for predicting the rate constant without relying on experiments. To develop such a QSPR, in our work, the Diels-Alder reaction with different sets of reactants and solvents was investigated. Connectivity indices were used to represent the structures of the members of each set. Principal Component Analysis (PCA) was applied to identify the principal components (PCs) of each set for further use in model development. These PCs were then used to develop a linear model that best predicts the reaction rates in our study. In this paper, Genetic Algorithm (GA) has been modified using the Decision Tree (DT) algorithm for increased efficiency. Inclusion of DT in GA ensures an initial generation of meaningful combination of descriptors. This set gets further improved in every step of crossover and mutation with applied constraints. Only improvement of generations is accepted due to these constraints. Finally, Multiple Linear Regression (MLR) relates the chosen descriptors with the property under study. The model undergoes thorough internal and external validation to ensure that a best fit model can be found in minimum steps possible.
MODELS OF FLOW AND PRESSURE MODULATED ISOOSMOTIC REABSORPTION IN MAMMALIAN PROXIMAL TUBULES

Publisher Summary This chapter discusses models of flow and pressure modulated iso-osmotic reabsorption in mammalian proximal tubules. Two phenomena are thought to underlie glomerulotubular balance: (1) cotransport of Na+ across apical cell membranes and (2) adjustments of interstitial hydrostatic pressure secondary to changes in hydrostatic or colloid osmotic pressure in peritubular capillaries. This chapter presents the derivation of model of the tight junction–intercellular channel–basement membrane pathway. The chapter further discusses the behavior of the system as interstitial hydrostatic pressure varies. The results of a study presented in the chapter suggest that pressure modulation of iso-osmotic reabsorption is an effective mechanism for controlling proximal tubule reabsorption. When a change in glomerular filtration rate changes filtration fraction, this mechanism becomes effective for achieving glomerulotubular balance. When the filtration rate changes without affecting peritubular capillary variables, cotransport-dependent phenomena are not likely to provide much adaptability.
High-Dose Acyclovir for Cytomegalovirus Prophylaxis in Seropositive Abdominal Transplant Recipients.

Background: Following abdominal solid organ transplant (aSOT), valganciclovir (VGC) is recommended for cytomegalovirus (CMV) prophylaxis. This agent is associated with efficacy concerns, toxicity, ...
Making Patients and Doctors Happier — The Potential of Patient-Reported Outcomes

Interviews with providers suggest that incorporating collection of patient-reported outcomes into routine care can improve physician satisfaction, enhance physician–patient relationships, increase workflow efficiency, and enable crucial conversations.
Collaborative (CPU + GPU) algorithms for triangle counting and truss decomposition on the Minsky architecture: Static graph challenge: Subgraph isomorphism

In this paper, we present collaborative CPU + GPU algorithms for triangle counting and truss decomposition, the two fundamental problems in graph analytics. We describe the implementation details and present experimental evaluation on the IBM Minsky platform. The main contribution of this paper is a thorough benchmarking and comparison of the different memory management schemes offered by CUDA 8 and NVLink, which can be harnessed for tackling large problems where the limited GPU memory capacity is the primary bottleneck in traditional computing platform. We find that the collaborative algorithms achieve 28× speedup on average (180× max) for triangle counting, and 165× speedup on average (498× max) for truss decomposition, when compared with the baseline Python implementation provided by the Graph Challenge organizers.
Postmodernism and Millennials

The chapter compares postmodernism to modernism and suggests that postmodernism represents a “widespread cultural mutation” that has shaped human relations and modern societies. This occurred in the United States around 1960. It discusses the theory of “intertextuality,” which asserts that all texts are based, to varying degrees, on texts that preceded them, which weakens the modernist emphasis on originality. It is suggested that there is a strong connection between postmodernity and consumerism and that postmodernism’s delegitimation of authority, rationality and “grand theories” has had an impact on the thinking and behavior of Millennials. The chapter discusses Fredric Jameson’s notion that postmodernism is really a new form of capitalism and then suggests that Millennials are the quintessential postmodern generation and Millennials are very different from their parents. The chapter offers a chart showing the differences between modernism and postmodernism in many different areas and discusses the fact that many Millennials were not raised with two parents, which may have had an impact on their psyches and behavior. The chapter then discusses the ideas found inJack Solomon’s The Signs of Our Times and in my mystery novel Mistake in Identity , both of which are relevant to our understanding of postmodernism’s impact on Millennials. It concludes with a discussion of the role smartphones play in the lives of Millennials.
Magnetically Responsive Elastomer–Silicon Hybrid Surfaces for Fluid and Light Manipulation

Stimuli-responsive surfaces with tunable fluidic and optical properties utilizing switchable surface topography are of significant interest for both scientific and engineering research. This work presents a surface involving silicon scales on a magnetically responsive elastomer micropillar array, which enables fluid and light manipulation. To integrate microfabricated silicon scales with ferromagnetic elastomer micropillars, transfer printing-based deterministic assembly is adopted. The functional properties of the surface are completely dictated by the scales with optimized lithographic patterns while the micropillar array is magnetically actuated with large-range, instantaneous, and reversible deformation. Multiple functions, such as tunable wetting, droplet manipulation, tunable optical transmission, and structural coloration, are designed, characterized, and analyzed by incorporating a wide range of scales (e.g., bare silicon, black silicon, photonic crystal scales) in both in-plane and out-of-plane configurations.
Store owners as potential agents of change: energy drinks in the interior of Alaska.

ABSTRACTChildhood obesity disproportionately impacts disadvantaged communities, including Alaska Native children. In part, lack of access to fresh fruits and vegetables and over consumption of sugar sweetened beverages including energy drinks contribute to excessive weight gain in Alaska Native youth. This commentary reports the possibility of storeowners and workers partnering with community members to limit sales of nutrient-poor energy drinks through point-of-sale counselling in rural communities in the interior of Alaska. This model of intervention may be useful to implement in areas where there are limited health workers or others that can serve as health educators. This study reports preliminary evidence from rural Alaska and from other Arctic communities that store workers may effectively improve community health status by limiting or promoting specific products. Storeowners or workers may be helpful partners in the fight against childhood obesity as they are present at the point of sale of high-ri...
The convergence analysis of bat-inspired consensus protocols with nonlinear dynamics

This paper proposes a new class of cooperative bat-inspired consensus protocols including a collection of nonlinear dynamics for multi-agent coordination. The proposed consensus protocols embed a suggested convergence direction which can improve the performance of convergence time. This suggested convergence direction can be used to design a distributed algorithm for controlling multi-agent systems while simultaneously solving a large-scale optimization problem. By virtue of a Lyapunov-based method, we show that the proposed bat-inspired consensus protocols can reach the global consensus asymptotically. Meanwhile, the bat-inspired consensus protocols subjected to external disturbance are also considered. We give the theoretical proof of a sufficient condition for guaranteeing the convergence of the extended consensus protocols with disturbances.
The Cost of Self-Reported Penicillin Allergy: A Systematic Review

Background Patients who report a penicillin (PCN) allergy receive suboptimal antibiotic therapy compared with patients not reporting an allergy. However, a majority of patients who report PCN allergy are not truly allergic on confirmatory testing. Ruling out PCN allergy by testing may improve clinical and economic outcomes for patients with reported allergies requiring antibiotic therapy. Objective The objective of this study was to summarize clinical and economic outcomes associated with PCN allergy and provide recommendations for future cost-effectiveness analyses for PCN allergy testing. Methods A literature search was conducted using SCOPUS, EMBASE, and PubMed, including all articles published any date through April 25, 2017 (PROSPERO Registration number 42017064112). A total of 1518 abstracts were found during the initial search with 96 duplicates, for a total of 1422 articles for screening. Thirty articles were included for qualitative synthesis and full data extraction. Results The majority of the studies included had an observational design focusing on inpatient admissions. The most frequently measured outcome in the context of PCN allergy was optimizing antibiotic therapy. Patients with PCN allergy were found to have direct drug costs during inpatient admission ranging from no difference to an additional $609/patient compared with patients without PCN allergy. Outpatient prescription costs were estimated from $14 to $193/patient higher for PCN allergic patients. Total inpatient costs were less for patients without PCN allergy with average savings from $1145 to $4254/patient. Conclusions Evaluations of clinical and economic outcomes of PCN allergy are primarily observational and focus on inpatient populations. Long-term relationships between PCN allergy and clinical and economic outcomes are unknown.
Sympatho-excitatory response to pulmonary chemosensitive spinal afferent activation in anesthetized, vagotomized rats.

The sensory innervation of the lung is well known to be innervated by nerve fibers of both vagal and sympathetic origin. Although the vagal afferent innervation of the lung has been well characterized, less is known about physiological effects mediated by spinal sympathetic afferent fibers. We hypothesized that activation of sympathetic spinal afferent nerve fibers of the lung would result in an excitatory pressor reflex, similar to that previously characterized in the heart. In this study, we evaluated changes in renal sympathetic nerve activity (RSNA) and hemodynamics in response to activation of TRPV1-sensitive pulmonary spinal sensory fibers by agonist application to the visceral pleura of the lung and by administration into the primary bronchus in anesthetized, bilaterally vagotomized, adult Sprague-Dawley rats. Application of bradykinin (BK) to the visceral pleura of the lung produced an increase in mean arterial pressure (MAP), heart rate (HR), and RSNA. This response was significantly greater when BK was applied to the ventral surface of the left lung compared to the dorsal surface. Conversely, topical application of capsaicin (Cap) onto the visceral pleura of the lung, produced a biphasic reflex change in MAP, coupled with increases in HR and RSNA which was very similar to the hemodynamic response to epicardial application of Cap. This reflex was also evoked in animals with intact pulmonary vagal innervation and when BK was applied to the distal airways of the lung via the left primary bronchus. In order to further confirm the origin of this reflex, epidural application of a selective afferent neurotoxin (resiniferatoxin, RTX) was used to chronically ablate thoracic TRPV1-expressing afferent soma at the level of T1-T4 dorsal root ganglia pleura. This treatment abolished all sympatho-excitatory responses to both cardiac and pulmonary application of BK and Cap in vagotomized rats 9-10 weeks post-RTX. These data suggest the presence of an excitatory pulmonary chemosensitive sympathetic afferent reflex. This finding may have important clinical implications in pulmonary conditions inducing sensory nerve activation such as pulmonary inflammation and inhalation of chemical stimuli.
Inhibition of BKCa negatively alters cardiovascular function

Large conductance calcium and voltage‐activated potassium channels (BKC a) are transmembrane proteins, ubiquitously expressed in the majority of organs, and play an active role in regulating cellular physiology. In the heart, BKC a channels are known to play a role in regulating the heart rate and protect it from ischemia–reperfusion injury. In vascular smooth muscle cells, the opening of BKC a channels results in membrane hyperpolarization which eventually results in vasodilation mediated by a reduction in Ca2+ influx due to the closure of voltage‐dependent Ca2+ channels. Ex vivo studies have shown that BKC a channels play an active role in the regulation of the function of the majority of blood vessels. However, in vivo role of BKC a channels in cardiovascular function is not completely deciphered. Here, we have evaluated the rapid in vivo role of BKC a channels in regulating the cardiovascular function by using two well‐established, rapid‐acting, potent blockers, paxilline and iberiotoxin. Our results show that BKC a channels are actively involved in regulating the heart rate, the function of the left and right heart as well as major vessels. We also found that the effect on BKC a channels by blockers is completely reversible, and hence, BKC a channels can be exploited as potential targets for clinical applications for modulating heart rate and cardiac contractility.
Surfactant-protein interactions.

To retain biological activity, proteins generally must be maintained in a specific, three-dimensional conformation. This conformation is only marginally stable, and thus relatively minor perturbing forces can disrupt protein structure, causing loss of biological activity, as well as formation of non-native protein aggregates. Such perturbations are commonly encountered as proteins are produced, stored, transported, and delivered to patients. For example, it is well known that during common industrial processes such as filtering (Maa and Hsu, 1998), storage (Mcleod et al., 2000), agitation (Thurow and Geisen, 1984; Maa and Hsu, 1997) freeze/thawing (Eckhardt, Oeswein et al., 1991; Nema and Avis, 1993; Izutsu et al., 1994), lyophilization (Carpenter and Chang, 1996; Carpenter et al., 1997), nebulization (Ip et al., 1995) and spray-drying (Broadhead et al., 1994; Mumenthaler et al., 1994; Maa et al., 1998; Adler and Lee, 1999; Millqvist-Fureby, Malmsten et al., 1999; Tzannis and Prestrelski, 1999) proteins can suffer damage to their native conformation. Further, delivery of protein pharmaceuticals to patients may also provoke losses of conformational integrity via unfavorable interactions of proteins with surfaces (e.g., inner walls of catheter tubing or syringes (Tzannis et al., 1996)).
Data-Driven Lack-of-Fit Tests for General Parametric Models

In this chapter we consider testing the fit of parametric models of a more general nature than the constant mean model of Chapter 7. We begin with the case of a linear model, i.e., the case where r is hypothesized to be a linear combination of known functions. The fit of such models can be tested by applying the methods of Chapter 7 to residuals. It will be argued that test statistics generally have the same distributions they had in Chapter 7 if least squares is used to estimate model parameters.
Delivery of Preventive Oral Health Services by Rurality: A Cross-Sectional Analysis

Purpose Integrating oral health care into primary care has been promoted as a strategy to increase delivery of preventive oral health services (POHS) to young children, particularly in rural areas where few dentists practice. Using a multistate sample of Medicaid claims, we examined a child's odds of receiving POHS in a medical office by county rurality. Methods We used 2012-2014 Medicaid Analytic extract claims data for 6,275,456 children younger than 6 years in 39 states that allowed Medicaid payment for POHS in medical offices. We used county-level characteristics from the Area Health Resources Files, including a 3-level measure of county rurality. We used logistic regression to estimate a child's odds of receiving POHS in a medical office by county rurality, while controlling for other patient and county characteristics. Findings POHS in medical offices were received by 7.8% of children. Rates of POHS in medical offices were higher in metropolitan (metro) counties (8.4%) than nonmetro adjacent to metro (5.8%) and nonmetro not adjacent to metro (4.3%). In adjusted analysis, children living in nonmetro not adjacent to metro (OR = 0.79, 95% CI: 0.64-0.99) and adjacent to metro counties (OR = 0.70, 95% CI: 0.59-0.82) were significantly less likely to receive POHS in medical offices than children living in metro counties. Conclusions In this study of POHS in medical offices among young Medicaid-enrolled children, we found POHS rates were lowest in nonmetro counties. Given barriers to dental care in rural areas, states should take additional steps beyond allowing Medicaid reimbursement to increase delivery of POHS in medical offices.
Development of an Analytical Method for Quantitation of Deoxynivalenol by UPLC-MS-MS: A Preliminary Assessment of Gestational and Lactational Transfer in Rats.

Deoxynivalenol (DON) is the most widely distributed trichothecene mycotoxin in grain-based foods and animal feed. Exposure to DON is widespread as it has been detected in food sources from around the world. The objective of this work was to develop a method to quantitate DON in biological matrices and apply it in a preliminary assessment of gestational and lactational transfer of DON following exposure of pregnant rats. The method used protein precipitation followed by ultra-performance liquid chromatography-tandem mass spectrometry. The method was evaluated in male Sprague Dawley rat plasma over the concentration range ∼2-1,000 ng/mL. The method was linear (r ≥ 0.99), accurate (mean relative error ≤ ±4.9%) and precise (relative standard deviation ≤ 5.5%). The mean absolute recovery was 85.9%. The limit of detection was 0.35 ng/mL. The method was also evaluated in gestational day (GD) 18 Hsd:Sprague Dawley®SD® dam plasma and fetal homogenate (mean % relative error ≤ ±16.9; % relative standard deviation ≤ 9.5). Concentrations of DON in dam plasma stored at -80°C for at least 29 days and in fetal homogenate for at least 43 days were within 97.9 to 120% of Day 0 concentrations, demonstrating that DON is stable in these matrices. The method was used to quantitate DON in rat maternal plasma, amniotic fluid, GD 18 fetuses and postnatal day (PND) 4 pups following exposure of dams to 0 (control) and 1 mg/kg DON beginning on GD 6 and continuing through gestation and lactation for a preliminary assessment of maternal transfer. In animals exposed to 1 mg/kg/day, similar concentration of DON was found in GD 18 dam plasma and fetuses, demonstrating significant gestational transfer. The concentration of DON in PND 4 dam plasma was similar to that in GD 18 dam plasma. However, DON was not detected in PND 4 pup plasma above the limit of detection of the assay, demonstrating absence of transfer of DON to pups via lactation.
Transforming Health Care through Digital Revolutions

The Internet, which has spanned several networks in a broad range of domains, is having a significant impact on every aspect of our lives. The next generation of networks will utilize a wide variety of resources with significant sensing capabilities. Such networks will extend beyond physically linked computers to include multimodal-information from biological, cognitive, semantic, and social networks. This paradigm shift will involve symbiotic networks of smart medical devices, and smart phones or mobile personal computing and communication devices. These devices-and the network-will be constantly sensing, monitoring, and interpreting the environment; this is sometimes referred to as the Internet of Things (IoT). We are also witnessing considerable interest in the "Omics" paradigm, which can be viewed as the study of a domain in a massive scale, at different levels of abstraction, in an integrative manner. The IoT revolution, combined with the Omics revolution (genomics and socio-omics or social networks) and artificial intelligence resurgence, will have significant implications for the way health care is delivered in the United States. After discussing a vision for health care in the future, we introduce the P9 health care concept, followed by a discussion of a framework for smart health care. Then, we present a case study and research directions, followed by examples of ongoing work at the National Institute of Standards and Technology (NIST).
Increased ease of access to genetic counseling for low-income women with breast cancer using a point of care screening tool.

Increased access to genetic counseling services is of prime importance in minority and underserved populations where genetic testing is currently underutilized. Our study tested a point of care screening tool to identify high-risk low-income patients for genetic counseling in a busy county hospital oncology clinic. Eligible breast patients treated at a “safety-net” hospital, were scored into ‘high-risk’ (> or = 6) or ‘low-risk’ (< 6) groups using a screening tool on personal and family history of cancer. Genetic counseling and testing were provided at the Vanderbilt Hereditary Cancer Program (VHCP) to all ‘high-risk’ and some ‘low-risk’ participants considered to need genetic counseling by their oncologist. Ninety-nine women with a history of breast cancer were enrolled onto the study over a period of 26 months. 53.5% (53/99) had a ‘high-risk’ score and ethnic predominance of African-American (60.4%). Of these, 67.9% (36/53) were counseled, and 91.6% (33/36) tested with a 9% (3/33) mutation positive rate. In the ‘low-risk’ group, 28.2% (13/46) still met current NCCN guidelines and were referred by their oncologist. 69.2% (9/13) were counseled and tested. The ‘low-risk’ group of predominantly Caucasian (41.3%) participants carried a 20% (2/10) mutation positive rate; which was later adjusted to 10% to exclude a mutation not conferring a strong breast cancer risk. The screening tool was well accepted by patients; and increased access to genetic counseling. There was a subset of breast cancer affected women under 45 with no reported family history that failed to be identified. Minor alterations to the tool would enhance concordance with current NCCN guidelines.
When selfish is socially optimal

In this paper, we consider cooperative multi-agent systems, where independent agents need to minimize a collective social cost. Given the coupling in the cost, the optimal strategy requires interaction and communications among all the agents in general. In this paper, we unveil important classes of social costs which are optimized by decentralized and selfish solutions, hence eliminating the need for an inter-agent communication network. In particular, we focus on a set of n independent agents coupled only through an overall cost that penalizes the divergence of each agent from the average collective behavior. Adopting input-output methods, we show that optimal decentralized and selfish solutions are possible in a variety of standard input-output cost criteria. These include the cases of l_1, l_2, l_infty induced, and H2 norms for any finite n. Moreover, if the cost includes nondeviation from average variables, the above results hold true as well for l_1, l_2, l_infty induced norms and any n, while they hold true for the normalized, per-agent square H2 norm, cost as n ! 1. The results of the paper demonstrate that selfish behavior can be socially optimal in nontr
Tc-99m Sestamibi parathyroid SPECT-CT scans is the only diagnostic study required in most patients with primary hyperparathyroidism.

200 Objectives Currently, multiple imaging modalities are used to evaluate patients with primary hyperparathyroidism (HP). Tc-99m Sestamibi parathyroid scan (SPS) with SPECT-CT can become the only required study for localization of abnormal parathyroid glands in PH. This can reduce time and cost of management of these patients. This study aims to evaluate the accuracy of SPS with SPECT-CT in patients with PH as the sole diagnostic study using a systematic method of interpretation. Methods Consecutive patients, who underwent SPS followed by surgical intervention between April, 2011 and April, 2014 were evaluated. Data were collected retrospectively including patients’ demographics, serum calcium and PTH levels, SPS findings, surgical and pathology findings. Our systematic method of interpretation of SPS starts by reviewing initial and 3 hours delayed planar images; subsequently we reviewed coronal and axial SPECT-CT images. Results There were 3 male and 24 females with an average age of 65. The average serum calcium and PTH levels were 10.6 mg/dl and 157.4 pg/ml, respectively. The median interval between the scan and operative resection was 50 days. SPS interpretation correlated perfectly with surgical finding in 24/27 patients (88.8%). In two patients (7.4%); SPS interpretation was on the correct side of the surgical finding but not exact location and only one SPS (3.7%) was non-localizing. The average intra-operative PTH after resection of the abnormal gland was 39.7 pg/ml. Conclusions Systematic interpretation of SPS has high accuracy with good surgical outcomes in most patients with PH. Thus, SPS can serve as the first and only required diagnostic test in most PH patients.