cssi/SciSciGPT-SciSciNet huggingface dataset:
Pituitary hypoplasia in patients with a mutation in the growth hormone- releasing hormone receptor gene

BACKGROUND AND PURPOSE: Several anatomic abnormalities of the pituitary gland have been described as occurring in association with congenital growth hormone deficiency, including hypoplasia of the adenohypophysis, truncation of the pituitary stalk, and ectopia of the neurohypophysis. Their pathogenesis, however, is obscure. Normal pituitary development is dependent on the sequential expression of a series of ontogenetic factors. Growth hormone–releasing hormone (GHRH) is known to stimulate somatotroph proliferation, and a dwarf mouse model with a mutant GHRH receptor, the “little mouse,” has a small anterior pituitary due to hypoplasia of the somatotrophs. We recently described the human homolog of the little mouse (dwarfism of Sindh), caused by a homozygous nonsense mutation in the GHRH receptor gene in a Pakistani kindred. We investigated MR imaging characteristics to gain information regarding the potential role of GHRH in human pituitary organogenesis. METHODS: MR images of the head were obtained of four affected male patients (age range, 22–29 years). Maximal anterior pituitary dimensions were determined from sagittal and coronal images, and pituitary volumes were estimated from cubic and ellipsoid formulae. The measurements were compared with normative values matched for age and sex. RESULTS: The adenohypophysis was small in each of the four patients. The maximal height for the anterior pituitary was 3 mm in three patients and 2 mm in one (mean ± SD, 2.75 ± 0.5 mm), which is significantly (P CONCLUSION: We describe significant hypoplasia of the adenohypophysis occurring in four dwarfs with a nonsense mutation in the GHRH receptor. In addition to isolated growth hormone deficiency and severe dwarfism, affected patients have anterior pituitary hypoplasia, presumably due to somatotroph maldevelopment. Resistance to GHRH explains the hypoplasia of the adenohypophysis—a feature that contributes to growth hormone deficiency in this syndrome. This is one of the few instances in which the molecular basis of pituitary dysmorphogenesis has been identified.
The Irreversible Output Effects of Severance Taxes on Oil

This article explains why the output effect of a severance tax on oil is not generally reversed when the tax is removed. It is shown that this severance-tax-induced irreversibility in supply has important implications for both the interpretation and estimation of the supply of oil. Specifically, severance taxes cause a path dependence in supply that makes the concept of a supply curve for oil ambiguous. The authors provide estimates for the case of Kansas that indicate that the magnitude of the irreversible effects of severance taxes is large.
Can virus infections trigger autoimmune disease

This review will examine various infectious parameters that could lead to enhancement or exacerbation of autoimmune disease. Multiple sclerosis (MS) will be the prototype human autoimmune disease detailed and experiments relating to the pathogenesis of MS will use data derived from an experimental animal model, experimental allergic encephalomyelitis (EAE). Other autoimmune diseases will be included for comparison. MS is the most common human demyelinating disease with a prevalence rate between 50–100 per 100,000 Caucasians [1]. Other ethnic groups have lower but significant prevalence rates. Women are more afflicted than men by more that a 2:1 ratio. The inflammatory demyelinating lesions are limited to the central nervous system (CNS) [2]. In most cases, oligoclonal IgG bands are present in the cerebral spinal fluid and a mild mononuclear pleocytosis may be present. Clinical features include vision loss due to optic neuritis, weakness of the limbs and sensory disturbances with some memory and cognitive impairment. The clinical course can include relapses and remissions and/or a progressive course. MS is immune mediated and, while not conclusively shown, thought to be caused by autoreactive myelin-specific Th1 CD4 T cells [3].
College Students’ Storytelling of Ethnicity-Related Events in the Academic Domain

The purpose of the present study was to examine storytelling of ethnicity-related events among college-going, emerging adults. A total of 280 ethnically diverse participants recounted a memory about a time in which they told a previously reported, ethnicity-related story to others. Analysis centered on the function of the telling and on to whom the story was told. The findings indicated that stories were most often told to share experiences with others, followed by for emotion regulation and validation, and that friends were the most frequent audience. The pattern of story content, telling function, and audience suggests that stories are differentially channeled to various audiences for different purposes. Furthermore, 40% of all stories had never been told to others, suggesting continued barriers in the ability to talk to others about ethnicity-related experiences in the United States.
Performance of Instantaneous Microwave Analysis by Parametric Channelized Receiver Through Time Domain Monitoring

For many applications, ranging from commercial, surveillance, or defense, it is essential to analyze the frequency components of a captured microwave signal over a wide bandwidth in real time and with high resolution. Various photonic approaches have been proposed for the processing of wideband microwave signals in order to overcome limitations imposed by conventional electronic frequency measurements. Here, we present the performance analysis and characterization of a parametric channelized receiver with 275 MHz resolution defined by the Fabry-Perot 3 dB bandwidth and 1 GHz step. Our approach relies on the generation of high quality copies of the RF input by self-seeding wavelength multicasting in a two-pump parametric mixer. Periodic filtering using off-the-shelf elements is then performed on the multicast beam. Ease of filtering is thus achieved by relying on frequency nondegeneracy of the newly generated copies. In this paper, instantaneous analysis of the incoming microwave signal is demonstrated by simultaneous monitoring five of the generated parametric copies while transmitting a frequency-hopping pattern. Operating margins in terms of optical and microwave powers are studied using the five-channel data simultaneously collected on a real-time oscilloscope. Dynamic range adjustments through optical power tuning of the input signal seed are demonstrated. Finally, the effects of frequency mapping detuning are observed to determine optimal operating conditions.
A NONLINEAR AUTONOMOUS ROLL MODEL FOR HEAVY TRUCKS' DIRECTIONAL STABILITY.

This paper gives a possibility to use a nonlinear nonautonomous roll model for studying an autonomous constant speed heavy truck with a nonlinear controlled suspension system. The roll model parametric analysis provides the influence of various geometric truck parameters that are important to the designer in stability viewpoint. The directional stability analysis of the truck, with the presence of a sudden impact on any truck-trailer wheels, is carried out by using the linear and the nonlinear modelling techniques. The directional stability of the truck due to linear and nonlinear parameter variations is also discussed in detail. This study shows that the nonlinear directional stability predictions are significant and provide more useful information than linear results that may enhance the selection of proper actuators and sensors for automation. The dynamic stability of the system is illustrated using parameters depended phase portraits. These phase portraits provide the impulsive force effect on truck's qualitative stability change.
A new function for an old organelle: microtubule nucleation at the Golgi apparatus

The microtubule cytoskeleton of a mammalian cell originates from the perinuclear region and controls membrane trafficking, organelle positioning, and cell polarisation. Although the centrosome is viewed as the major microtubule organising centre, there is emerging evidence that the Golgi apparatus also has a role in the nucleation of perinuclear microtubules during the interphase. In a recent paper in The EMBO Journal, Rivero and colleagues reported the identification of a microtubule nucleation machinery at the Golgi and provided clues about functional differences between Golgi‐ and centrosome‐nucleated microtubules.
A simple method for extraction of multiple quantum well absorption coefficient from reflectance and transmittance measurements

A simple model is presented which takes into account interference effects in the common three-layer p-i-n diode epitaxial structure used for measurement of electroabsorption effects in multiple quantum well material. Antireflection coatings or surface roughening are not required to extinguish Fabry-Perot oscillations in the reflectance and transmittance spectra which improves the accuracy of the extracted absorption coefficient. Sources of error in the extracted absorption coefficient are examined. The absorption spectra of bulk GaAs and a 10-nm GaAs/10-nm AlGaAs multiple quantum well obtained using this method are compared with other measured results. >
Anatomy of the Middle Cerebral Artery: The Temporal Branches

Nineteen out of 23 middle cerebral arterial specimens had as the first major branch of the middle cerebral artery a sizable anterior temporal artery; a trunk forming the anterior and middle temporal branches; a trunk forming the anterior, middle, and posterior temporal arteries; or a trunk forming temporal and angular arterial branches. Patients harboring middle cerebral stenoses or occlusions who have correlating cerebral ischemic symptoms may be considered as candidates for microsurgical cerebral revascularization. However, if such patients undergo intracranial surgery, the superficial temporal artery should probably be joined to a supra-Sylvian arterial branch, rather than to a temporal arterial branch, in order to avoid delivering the new blood supply proximal to the stenotic or occluded segment.
Composable Language Extensions for Computational Geometry: A Case Study

This paper demonstrates how two different sets of powerful domain specific language features can be specified and deployed as composable language extensions. These extensions incorporate analyses and transformations that simplify the process of writing efficient and robust computational geometry programs and can be automatically added to a host language and used simultaneously. This is not possible in domain-specific language and library-based implementations of these features. One extension relies on characteristics of geometric algorithms to implement efficient exact-precision integers; the other employs a technique that symbolically perturbs geometric coordinates to safely and automatically handle degeneracies in the input data. These language extensions are implemented in an extensible language framework based on higher-order attribute grammars and forwarding. Attribute evaluation on the new language extension constructs is used to implement the static analysis and code transformations that enable the generation of efficient code.
Pharmacokinetics and pharmacodynamics of aztreonam and tobramycin in hospitalized patients

Abstract Background: Pharmacokinetic/pharmacodynamic (PK/PD) optimization of antibiotic therapy has been shown to improve outcomes in several antibiotic classes. Despite the frequent use of beta-lactams, clinical data in humans remain limited. Objective: This study evaluated the relationship between serum pharmacokinetics, pharmacodynamics, pathogen susceptibility, and clinical outcomes in patients receiving aztreonam or tobramycin monotherapy. Methods: The case-report forms of hospitalized patients who received either aztreonam or tobramycin for a bacterial infection in 3 clinical trials conducted between 1982 and 1984 were reviewed for the present study. A pathogen was identified for all included patients, and susceptibility testing was performed to determine the minimum inhibitory concentration (MIC) for each agent. Pharmacokinetic parameters for each antibiotic were determined using population modeling, and variables potentially related to outcomes were evaluated using tree-based modeling, logistic regression, and nonlinear regression methods. Results: Data from 91 patients were analyzed, 68 treated with aztreonam monotherapy and 23 treated with tobramycin monotherapy. Of the types of infections treated, 39 were intra-abdominal, 42 involved the lower respiratory tract, and 10 involved the skin and skin structures. The pharmacodynamic ratio of the 24-hour area under the curve (AUC 24 ) to the MIC was associated with clinical outcome for both antibiotics: aztreonam and tobramycin patients with ratios meeting or exceeding the respective 24-hour inverse serum inhibitory titer breakpoints of 184 and 110 were significantly more likely to achieve a successful outcome than were those with ratios not meeting these values ( P 24 /MIC break-points were a respective 85% and 53% for aztreonam and 80% and 47% for tobramycin (both, P P Conclusion: PK/PD optimization of both aztreonam and tobramycin is associated with improved patient outcomes.
Classification in sensor networks

We consider the problem of classifying among a set of M hypothesis with N distributed noisy sensors. The N sensors can collaborate over a finite link-capacity network. The task is to arrive at a consensus about the event after exchanging such messages. In contrast to the conventional decentralized detection approach, wherein the bit rates for each link is explicitly constrained, our approach is based on high-rate limit perspective. We apply a variant of belief propagation as a strategy for collaboration to arrive at a solution to the distributed classification problem. We show that the message evolution can be reformulated as the evolution of a linear dynamical system, which is primarily characterized by network connectivity. It turns out that consensus is almost always reached by the sensors for any arbitrary network. We then derive conditions under which the consensus is the centralized MAP estimate and show that this is achieved with O(M log/sub 2/ N) bits.
Confidence interval estimation under the presence of non-Gaussian random errors: Applications to uncertainty analysis of chemical processes and simulation

Confidence intervals (CIs) are common methods to characterize the uncertain output of experimental measurements, process design calculations and simulations. Usually, probability distributions (pdfs) such as Gaussian and t-Student are used to quantify them. There are situations where the pdfs have anomalous behavior such as heavy tails, which can arise in uncertainty analysis of nonlinear computer models with input parameters subject to different sources of errors. We present a method for the estimation of CIs by analyzing the tails of the pdfs regardless of their nature. We present case studies in which heavy tail behavior appears due to the systematic errors in the input variables of the model. Taking into account the probability distributions behavior to estimate appropriate CIs is a more realistic approach to characterize and analyze the effect of random and systematic errors for uncertainty analysis of computer models.
Social support, life events, and psychological distress among the Puerto Rican population in the Boston area of the United States.

Objectives: The aim of this article is to investigate the role of social network support in ameliorating the psychological impact of life stressors that are prevalent for the older Puerto Rican population. Method: Social support was measured through the Norbeck Social Support Questionnaire, and psychological distress through the Center for Epidemiological Studies Depression Scale and the Perceived Stress Scale. We describe the life stressors (Norbeck Life Events) faced by Puerto Ricans and their implications for psychological distress. We present associations between depression, perceived stress, social support, and socio-demographic indicators. The role of social network support–emotional and instrumental–in buffering the effect of negative events is examined. Attention is given to the interacting effect of gender and the type of support. Results: The analysis shows that dimensions of social support, particularly emotional support, are generally protective of psychological health. However, when delineati...
DIFFERENCE AND THE ESTABLISHMENT: AN ASIAN CANADIAN SENIOR PASTOR’S EVANGELICAL SPATIALITY AT TENTH AVENUE ALLIANCE CHURCH IN VANCOUVER, BC

This paper explores how the evangelical spatiality of an Asian Canadian senior pastor at a historically Anglo-Saxon congregation has transformed it from an ethnically homogeneous, aging church to a heterogeneously-constituted gathering in an evangelical Protestant tradition. This piece challenges the conventional wisdom of the church growth movement and the new religious economics in the sociology of religion, both of which advise religious groups to construct homogeneity and consensus in efforts for numerical growth over against secularizing forces. The paper argues instead that Pastor Ken Shigematsu’s evangelical spatiality from the mid-1990s to the present must be understood as a theological embrace of difference in a church gifted to him by God over which he prayerfully pastors along with his staff. This paper understands Shigematsu’s evangelical spatiality through his own New Testament exegesis, his denominational affiliation with the Christian and Missionary Alliance, his ancient spiritual practices of indiscriminate hospitality, and his mystical reception of Tenth as a welcoming space toward a multiplicity of ethnic, class, and religious backgrounds. This article contributes to Asian Canadian Christian studies by discouraging a future where pan-Asian churches in Canada are homogeneously constructed and by exploring the concrete possibility of non-strategies in which heterogeneous, complex spaces that include Asian Canadians are received by pastors and studied by academics as a divine gift.
RNA Polymerase I, the Nucleolus and Synthesis of 35S rRNA in the Yeast Saccharomyces Cerevisiae

The synthesis of ribosomes is regulated in response to environmental changes, and this regulation is important in connection with the regulation of growth. This is true for both prokaryotic and eukaryotic organisms. In E. coil, the cellular concentration of ribosomes is roughly proportional to the growth rate except under slow growth conditions; this regulatory feature is called growth-rate-dependent control of ribosome synthesis. Extensive studies of this regulation in E. coli have shown that the regulation acts primarily on the synthesis of rRNA, and that growth-rate-dependent control of ribosomal protein (r-protein) synthesis is achieved indirectly through various autogenous (feedback) repression systems. In eukaryotes, although the synthesis of r-proteins may be regulated directly, and independently of rRNA synthesis, there is no doubt that the synthesis of rRNAs in the nucleolus is of primary importance in overall regulation of ribosome biosynthesis (see reviews, Warner, 1982; Sollner-Webb and Tower, 1986; Sollner-Webb and Mougey, 1991). A few years ago, our laboratory initiated studies on the synthesis of rRNA in the yeast Saccharomyces cerevislae as a model eukaryotic organism, with the eventual goal of understanding molecular events involved in the regulation of ribosome biosynthesis.
Policy-Related Communications and Agenda Setting: Twitter, New York Times, and the Widening Soapbox

Agenda setting efforts by our elected officials have been studied thus far under the assumptions that symbols and the like propagate an understanding of the problem, and that this happens through the traditional media (e.g., newspapers, television news). The rise of social media, and Twitter in particular, enhances opportunities for agenda setters to share information with others. Indeed, the volume of communications from our elected officials in Congress is enormous – hundreds of thousands of Twitter postings each year – and there has been scant research on what all this social media activity means for the policy making process. We examine Twitter data for all of 2013, focusing on areas relating to the environment, health care, the economy, among others. We match up these communications to those presented in the traditional media in order to gauge how these Congress-based Twitter posts and New York Times articles co-occur. There is overlap, and it is striking. The patterns for discussions about the budget and the Affordable Care Act are nearly identical for both information sources, but patterns are less correlated for issues relating to immigration, the environment, and energy. While eschewing causal claims, we do believe that this is mounting evidence that members of Congress are attempting to use social media to impact the public agenda. Competing with media outlets, politicians seek first mover status in identifying a problem.
Experimental study on penny-shaped fluid-driven cracks in an elastic matrix

When a pressurized fluid is injected into an elastic matrix, the fluid generates a fracture that grows along a plane and forms a fluid-filled disc-like shape. We report a laboratory study of such a...
Cardiac Computed Tomography: Problem-Based Learning

Cardiac Computed Tomography: Problem-Based Learning - Libros de Medicina - Diagnostico por la Imagen - 122,00
Parsimony in PSF engineering using patterned illumination

The present work examines a greedy approach to minimizing the number of temporal observations in
Does devolution crowd out development? A spatial analysis of US local government fiscal effort:

Devolution to the subnational state and local level has increased reliance on locally raised revenue to provide basic social, infrastructural, and economic development services. We conduct multilev...
Uncommon Types of Thyroid Cancer

Anaplastic carcinoma of the thyroid is rare, making up 5% to 14% of primary malignant thyroid neoplasms. Lymphoma of the thyroid is even rarer, accounting for only 1% to 2% of thyroid malignancies. Other even rarer tumors of the thyroid, such as liposarcoma and angiosarcoma, have also been described. Although these thyroid tumors are rare, it is very important to recognize them because they may present as medical emergencies and constitute a challenge for endocrinologists, surgeons, radiotherapists, and oncologists. Anaplastic carcinoma grows rapidly and has a dismal prognosis. A significant number of patients with anaplastic carcinoma have areas of well differentiated thyroid carcinoma, which supports the hypothesis that anaplastic thyroid carcinoma arises from a pre-existing well differentiated thyroid carcinoma. Younger patients do better than older patients, and those diagnosed at an earlier stage do better than those with metastases at presentation. Multimodality therapy with surgery, radiotherapy, and chemotherapy appears to be of value. Lymphoma of the thyroid may be a primary disease or may involve the gland as part of a systemic disease. It is not usually suspected before surgery or fine-needle aspiration biopsy. Radiotherapy alone, if the disease is limited to the neck, produces good results; however, in patients with mediastinal extension, chemotherapy is indicated.
Insights into the epidemiology and management of lupus nephritis from the US rheumatologist's perspective

Lupus nephritis is a common and severe manifestation of systemic lupus erythematosus that disproportionately affects nonwhites and those in lower socioeconomic groups. This review discusses recent data on the incidence, prevalence, and outcomes of patients with lupus nephritis with a focus on low-income US Medicaid patients. We also review recent guidelines on diagnosis, treatment, and screening for new onset and relapses of lupus nephritis. Finally, we discuss the management of lupus nephritis from a rheumatologist's perspective, including vigilance for the common adverse events related to disease and treatment, and we review prevention and new treatment strategies.
Dynamic Kinesthetic Perception and Adjustment

(1953). Dynamic Kinesthetic Perception and Adjustment. Research Quarterly. American Association for Health, Physical Education and Recreation: Vol. 24, No. 2, pp. 176-187.
Decade-bandwidth low cross-polarization UWB array

The proposed Sliced Notch Antenna (SNA) array fixes the longstanding problem of high cross-polarization radiation in Vivaldi arrays while maintaining their excellent wideband wide-scan impedance performance with a simple reconfiguration of the Vivaldi fins. The enabling technical innovation is the introduction of discontinuities at the upper region of the flared fins that control the ratio of vertical-to-horizontal current density, without introducing sizable reflections. Measurements and simulations suggest a 10:1 (1.2–12 GHz) SNA array operation with good scanning VSWR out to 45°, and about 15 dB polarization purity improvement over a well-designed Vivaldi counterpart.
Academic Achievement in Adults with a History of Childhood Attention-Deficit/Hyperactivity Disorder: A Population-Based Prospective Study.

ABSTRACTObjective:Previous research on the developmental course of attention-deficit/hyperactivity disorder (ADHD) is limited by biased clinic-referred samples and other methodological problems. Thus, questions about adult academic outcomes associated with childhood ADHD remain unanswered. Thus, the
Building a National Seismic Monitoring Center: NEIC from 2000 to the Present

Operating a seismic data center is like being in the army. Most of the time it is “hurry up and wait,” but it can quickly change to “the plan goes out the window once the first bullet is fired.” So it goes at the U.S. Geological Survey (USGS)’s National Earthquake Information Center (NEIC), home to one of the world’s foremost seismic monitoring systems. Located in Golden, Colorado, just west of Denver, NEIC staff provides the latest, most accurate earthquake information available within minutes of the occurrence of a global event. That means NEIC is ready to respond at a moment’s notice. NEIC determines, as rapidly and as accurately as possible, the location and size of all significant earthquakes worldwide, including estimates of economic loss and casualties, and swiftly disseminates that information to emergency responders, governments, the public, and the news media. NEIC maintains an extensive seismic database as well—it is the nation’s data center and archive for earthquake information. It also pursues an active research program to improve its ability to characterize earthquake sources and their likely impact. NEIC’s job and its tools have evolved substantially over the years, and especially since the turn of the century. This is the tale of the evolution between 2000–2016, when NEIC dealt with 21 M 8 or larger earthquakes (including two M 9.1 events) and a number of other devastating earthquakes (see Fig. 1). This took place against the backdrop of an explosion of available real‐time seismic data, instantaneous global communication and societal awareness, and, consequently, higher expectations for information services. Figure 1. Map of global seismicity from 1973 to present for all magnitude 5.5 and larger earthquakes (white circles). All magnitude 7.0 and larger earthquakes (yellow circles), magnitude 7.5 and larger earthquakes (orange circles), and the 21 magnitude 8 or larger earthquakes since 2000 …
Leveraging burst buffer coordination to prevent I/O interference

Concurrent accesses to the shared storage resources in current HPC machines lead to severe performance degradation caused by I/O contention. In this study, we identify some key challenges to efficiently handling interleaved data accesses, and we propose a system-wide solution to optimize global performance. We implemented and tested several I/O scheduling policies, including prioritizing specific applications by leveraging burst buffers to defer the conflicting accesses from another application and/or directing the requests to different storage servers inside the parallel file system infrastructure. The results show that we mitigate the negative effects of interference and optimize the performance up to 2x depending on the selected I/O policy.
Operative Management of Renal Injuries

This chapter will cover the operative management of renal injuries encountered during the care of combat trauma casualties. Renal injuries may seem daunting to the elective general surgeon not accustomed to operating in the retroperitoneum or on the genitourinary system. However, a basic understanding of management of renal injuries is essential for the combat surgeon as the kidney may be injured by any mechanism, particularly in the setting of penetrating or blast injury. You are highly unlikely to have a Urologist or Transplant Surgeon immediately available to assist you, but you can expertly manage renal trauma without them. This chapter will review indications for operation and renal exploration, operative exposure and injury evaluation, repair and resection (partial and nephrectomy) of the injured kidney, and postoperative complications.
The calcium-ytterbium system

Abstract Specimens of calcium, ytterbium, and seven calcium-ytterbium alloys have been examined over the temperature range 900 °–400 °C by differential thermal analysis. The results indicate the existence of a minimum in the melting point near 75 at. % ytterbium. Equilibrium in the solid state is characterized by continuous body-centered cubic and face-centered cubic solid solutions at high and low temperatures, respectively. Metallographic examination of several of the alloys confirmed the existence of a solid solution at room temperature. The form of the electrical resistivity vs. composition curve obtained at 27 °C is typical of a solid solution.
Microtubule Polymerization and Cross-Link Dynamics Explain Axonal Stiffness and Damage

Axonal damage is a critical indicator for traumatic effects of physical impact to the brain. However, the precise mechanisms of axonal damage are still unclear. Here, we establish a mechanistic and highly dynamic model of the axon to explore the evolution of damage in response to physical forces. Our axon model consists of a bundle of dynamically polymerizing and depolymerizing microtubules connected by dynamically detaching and reattaching cross-links. Although the probability of cross-link attachment depends exclusively on thermal fluctuations, the probability of detachment increases in the presence of physical forces. We systematically probe the landscape of axonal stretch and stretch rate and characterize the overall axonal force, stiffness, and damage as a direct result of the interplay between microtubule and cross-link dynamics. Our simulations reveal that slow loading is dominated by cross-link dynamics, a net reduction of cross-links, and a gradual accumulation of damage, whereas fast loading is dominated by cross-link deformations, a rapid increase in stretch, and an immediate risk of rupture. Microtubule polymerization and depolymerization decrease the overall axonal stiffness, but do not affect the evolution of damage at timescales relevant to axonal failure. Our study explains different failure mechanisms in the axon as emergent properties of microtubule polymerization, cross-link dynamics, and physical forces. We anticipate that our model will provide insight into causal relations by which molecular mechanisms determine the timeline and severity of axon damage after a physical impact to the brain.
Impact of Implementing Antibiotic Stewardship Programs in 15 Small Hospitals: A Cluster-Randomized Intervention

Background Studies on the implementation of antibiotic stewardship programs (ASPs) in small hospitals are limited. Accreditation organizations now require all hospitals to have ASPs. Methods The objective of this cluster-randomized intervention was to assess the effectiveness of implementing ASPs in Intermountain Healthcare's 15 small hospitals. Each hospital was randomized to 1 of 3 ASPs of escalating intensity. Program 1 hospitals were provided basic antibiotic stewardship education and tools, access to an infectious disease hotline, and antibiotic utilization data. Program 2 hospitals received those interventions plus advanced education, audit and feedback for select antibiotics, and locally controlled antibiotic restrictions. Program 3 hospitals received program 2 interventions plus audit and feedback on the majority of antibiotics, and an infectious diseases-trained clinician approved restricted antibiotics and reviewed microbiology results. Changes in total and broad-spectrum antibiotic use within programs (intervention versus baseline) and the difference between programs in the magnitude of change in antibiotic use (eg, program 3 vs 1) were evaluated with mixed models. Results Program 3 hospitals showed reductions in total (rate ratio, 0.89; confidence interval, .80-.99) and broad-spectrum (0.76; .63-.91) antibiotic use when the intervention period was compared with the baseline period. Program 1 and 2 hospitals did not experience a reduction in antibiotic use. Comparison of the magnitude of effects between programs showed a similar trend favoring program 3, but this was not statistically significant. Conclusions Only the most intensive ASP intervention was associated with reduction in total and broad-spectrum antibiotic use when compared with baseline. Clinical trials registration NCT03245879.
Age and sex of surgeons and mortality of older surgical patients: observational study.

Abstract Objective To investigate whether patients’ mortality differs according to the age and sex of surgeons. Design Observational study. Setting US acute care hospitals. Participants 100% of Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries between 2011 and 2014. Main outcome measure Operative mortality rate of patients, defined as death during hospital admission or within 30 days of the operative procedure, after adjustment for patients’ and surgeons’ characteristics and indicator variables for hospitals. Results 892 187 patients who were treated by 45 826 surgeons were included. Patients’ mortality was lower for older surgeons than for younger surgeons: the adjusted operative mortality rates were 6.6% (95% confidence interval 6.5% to 6.7%), 6.5% (6.4% to 6.6%), 6.4% (6.3% to 6.5%), and 6.3% (6.2% to 6.5%) for surgeons aged under 40 years, 40-49 years, 50-59 years, and 60 years or over, respectively (P for trend=0.001). There was no evidence that adjusted operative mortality differed between patients treated by female versus male surgeons (adjusted mortality 6.3% for female surgeons versus 6.5% for male surgeons; adjusted odds ratio 0.97, 95% confidence interval 0.93 to 1.01). After stratification by sex of surgeon, patients’ mortality declined with age of surgeon for both male and female surgeons (except for female surgeons aged 60 or older); female surgeons in their 50s had the lowest operative mortality. Conclusion Using national data on Medicare beneficiaries in the US, this study found that patients treated by older surgeons had lower mortality than patients treated by younger surgeons. There was no evidence that operative mortality differed between male and female surgeons.
Some Special Cases and Some Numerical Examples

In the preceding section a model was proposed which essentially involved the following three equations in T(t), I(t) and S(t) for large t,
Ivor Lewis esophagectomy.

Ivor Lewis esophagectomy remains a durable procedure for the resection of mid to distal esophageal carcinoma. This chapter discusses the indications and contraindications for Ivor Lewis esophagectomy and details a step by step guide for open Ivor Lewis esophagectomy operative technique as well as management strategies for common complications.
SIGNIFICANCE LEVELS, CONFIDENCE LEVELS, CLOSED REGIONS, CLOSED MODELS, AND DISCRETE DISTRIBUTIONS

Publisher Summary This chapter discusses significance levels, confidence levels, closed regions, closed models, and discrete distributions. Rank and other randomization procedures, based on closed acceptance regions and confidence intervals, are conservative for discrete models. In nonparametric tests, one theoretical approach to ties is to break them at random. For a rank test, the values of the test statistic occurring without ties in every neighborhood of the observed point are those obtainable by tie-breaking. If the transformed confidence interval is closed, then its confidence level is at least that of the continuous case.
Chapter 5 Modeling of Circulation and Dispersion in Coastal Lagoons

A review of strategies to model the circulation and pollutant transport in inletcoastal lagoon systems is presented. Simplified procedures based on correlation analysis, analytic solutions to the ordinary linearized differential equation describing the system, and a numerical model that solves the governing equation for multi-inlet, multi-basin systems are described. The models predict the inlet flow characteristics, basin surface elevation response, and pollutant concentrations for cases where the basin responds in a simple pumping or Helmholtz mode. To describe circulation and pollutant movement when the pumping mode assumption is inappropriate two-dimensional, vertically-averaged models based either on finite element or finite difference solution methodologies are presented. This approach is also employed when the specific interest is circulation or pollutant transport within the basin. A unique hybrid model, coupling a one dimensional inlet model with a two-dimensional, vertically-averaged model for the basin, is described. The use of boundary fitted coordinate models is explored exploiting their ability to accurately describe areas with disparate spatial scales. A procedure is presented to assist in model selection for inlet-lagoon systems. To demonstrate model application for management decision making a simplified approach is applied to predict the impacts of inlet channel modification on the circulation, flushing dynamics, and salinity in the Charlestown, R.I. pond system.
Arts Participation: Counterbalancing Forces to the Social Stigma of a Dementia Diagnosis

A diagnosis of dementia profoundly impacts a person in terms of both the functional progression of the disease and the social stigma associated with the diagnosis. A growing body of research demonstrates the effectiveness of innovative programs such as the Alzheimer's Poetry Project, Meet Me at MoMA, and TimeSlips™ in counterbalancing social stigma by building a social and emotional framework for strength-based living for people diagnosed with dementia through arts participation. These programs focus on supporting autonomy and generativity through creative expression to help sustain the social, emotional, and community fabric of people's lives in the face of significant counterbalancing forces (e.g., the disease itself, stigma, and institution-centered approaches to care).
Excitation Wavelength-Dependent Photoluminescence Decay of Hybrid Gold/Quantum Dot Nanostructures.

Hybrid nanostructures comprised of metal nanoparticles (MNPs) and quantum dots (QDs) have been found to exhibit unique, new optical properties due to the interaction that occurs between the MNPs and QDs. The aim of this work is to understand how the exciton–plasmon interaction in these systems is dependent on the excitation wavelength. The nanoassemblies consisted of gold (Au) NPs coated in a silica (SiO2) shell of a controlled thickness and core/shell CdSe/CdS QDs adsorbed onto the SiO2 shells. Our findings show that the photoluminescence lifetimes of the hybrid constructs are dependent on the excitation wavelength relative to the localized surface plasmon resonance (LSPR) of the Au NPs. When the excitation wavelength is closer to the LSPR, the photoluminescence decay of the hybrid structures is faster. We demonstrate that by tuning the excitation wavelength close to the resonance, there is an enhancement in the exciton–plasmon coupling between the Au NPs and QDs resulting in a shortening in the QD photo...
Leaching behavior of palladium in thiourea/acid solutions

The dissolution behavior of palladium powder in thiourea solutions was investigated. The variables studied were temperature, stirring speed and the concentrations of thiourea, acid and ferric ion. Palladium was found to be soluble in thiourea solutions in the presence of an oxidant such as ferric ion. The dissolution of palladium in thiourea solutions was believed to be chemical-reaction controlled, with an apparent activation energy of about 25.3 kJ/mol.
An up-to-date predictive model for rectal cancer survivorship reflecting tumor biology and clinical factors.

Introduction Our aim was to develop a nomogram taking into account factors such as tumor biology to predict overall and disease-free survival for patients with primary rectal adenocarcinoma undergoing curative intent surgical resection. Methods Patients undergoing resection for primary rectal adenocarcinoma (2007-2017) were included. Factors reflecting tumor biology and important clinical prognosticators were included in nomogram development. Prognostic factors were assessed with multivariable analysis using Cox regression. The impact of each was assessed using Kaplan Meier survival curves. Results Overall, 1688 patients (male, 61%) with a mean age of 59.8 years (±13.5) and a median follow-up of 34.8 months (range, 12-132) were included. The only significant factors affecting the overall and disease-free survival were age at diagnosis, pathological staging, regression grade, resection margin, and tumor deposits. Conclusion The current model incorporates histopathological and clinical factors. It emphasizes the importance of tumor biological factors like tumor deposits in predicting overall and disease-free survival in rectal cancer. Summary Rectal cancer outcomes are associated with certain clinical and pathological factors that can be evaluated. Tumor deposits are one such factor that can affect overall and disease-free survival.
Penile Length and Its Preservation in Men After Radical Prostatectomy

Penile changes (most prominently shortening) after radical prostatectomy (RP) can negatively influence body image and quality of life. Here, we review the relevance of penile length to sexual satisfaction, the etiology of penile shortening after RP, and interventions that may preserve penile length. Most studies measure flaccid stretched penile length from the penopubic skin junction to the glans tip; however, the technique reportedly underestimates erect length by 23%. There is evidence that oral pharmacotherapy and mechanical devices may provide some benefit for length preservation, but the evidence basis remains marginal. Surgical augmentation in the setting of penile shortening may be efficacious but carries risks including potential for failure and/or worsening deformity. Penile length loss (perceived or objective) can have a major impact on quality of life after radical prostatectomy. Additional research is required to understand optimal means to help men preserve penile length after RP.
Differing trajectories of adversity over the life course: implications for adult health and well-being

Abstract Background Adverse childhood experiences (ACE), can give rise to long-term mental and physical health consequences as well as additional stressors later in the life course. This study aims to examine differing profiles of trajectories of adversity over the life course and investigate their association with socioeconomic and health outcomes. Methods We used population representative data from the Washington State 2011 Behavioral Risk Factor Surveillance System BRFSS survey n = 7953. Six ACE items were paired with six Adverse Adulthood Experience AAE items in respondents’ adulthood that parallel the ACE e.g. physical abuse in childhood and physical victimization in adulthood. We applied latent class analysis to identify distinct trajectories of adversity; then tested for differences across trajectories in terms of demographic, socioeconomic, and health measures. Results Six latent classes were identified: individuals with high AAE: (1. Consistently High, 2. Substance Abuse and Incarceration, 3. Adult Interpersonal Victimization) and individuals with low AAE (4. Repeat Sexual Victimization, 5. High to Low, and 6. Consistently Low). The Consistently High group had the highest prevalence of ACE and AAE and fared poorly across wide ranging outcomes. Other groups displayed specific patterns of ACE and AAE exposures (including salient subgroups such as those with incarceration exposure) as well as differences in demographic characteristics, illustrating disparities. Conclusions Subgroup analyses such as this are complementary to population generalized findings. Understanding differences in life course patterns of adversity can shed light on interventions in earlier life and better target service provision to promote health and well-being.
'Green Product' Procurement Policy in the European Union: Treatment of Lifecycle Carbon Analysis and Environmental PPM Restrictions

The European Union has adopted policies to “green” its public purchasing to promote environmental sustainability. With over nineteen percent of GDP in the EU spent on government procurement, the European Commission (EC) recognizes the potential impact of sustainable public procurement on the environment and the economy. This paper discusses EC central policy directives policy on government procurement of eco-friendly products through its “Green Product Program” (GPP), which seeks to foster a market for sustainable products through government buying power. Despite these efforts, green procurement in the EU has had limited success, perhaps given that the EC’s procurement directives are primarily voluntary and due to differing priorities among EU countries, which can lead to wide variations in uptake of sustainable procurement policies. Further, even for countries that favor green procurement, the existing procurement directives leave unanswered the question of to what extent agencies may make purchasing decisions based on full lifecycle analysis or other environment-friendly preferences for low-carbon production methods.Changes are underway, however, that will likely give EU Member States greater latitude to take these environmental factors into account. First, the EU’s emerging voluntary ‘lifecycle product footprint’ methodology, although not yet required in procurement, may help agencies assess the GHG impact of the products they procure, at least where vendors voluntarily disclose product ‘carbon footprints.’ Second, the European Commission’s efforts too overhaul its general procurement directives will give EU countries more leeway to account for upstream environmental impacts and “process and production methods” (PPMs). These steps will enable the EU to influence the market for green products by encouraging a shift towards upstream, supply chain carbon accounting.