cssi/SciSciGPT-SciSciNet huggingface dataset:
Initial Experience With Commercial Transcatheter Mitral Valve Repair in the United States

Abstract Background Transcatheter mitral valve (MV) repair with the MitraClip received approval in 2013 for the treatment of prohibitive-risk patients with primary mitral regurgitation (MR). Objectives The aim of this study was to report the initial U.S. commercial experience with transcatheter MV repair. Methods Data from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry on patients commercially treated with this percutaneous mitral valve repair device were analyzed. Results Of 564 patients (56% men, median age 83 years), severe symptoms were present in 473 (86.0%). The median Society of Thoracic Surgeons Predicted Risk of Mortality scores for MV repair and replacement were 7.9% (interquartile range: 4.7% to 12.2%) and 10.0% (interquartile range: 6.3% to 14.5%), respectively. Frailty was noted in 323 patients (57.3%). Transcatheter MV repair was performed for degenerative disease, present in 90.8% of patients. Overall, MR was reduced to grade ≤2 in 93.0%. In-hospital mortality was 2.3%; 30-day mortality was 5.8%. Other 30-day events were stroke (1.8%), bleeding (2.6%), and device-related complications (1.4%). The median length of stay was 3 days (interquartile range: 1 to 6 days), with 84.0% patients discharged home. Overall, procedure success occurred in 90.6%. Variables associated with reduction in MR were end-diastolic dimension, MR severity, clip location, and case volume. Conclusions In this study of the initial commercial U.S. experience, it was found that procedural success was achieved in approximately 91% of patients, and the majority of patients were discharged home with moderate or less MR. These data support the effectiveness of this therapy in appropriately selected high-risk patients in a commercial setting. Further study is required to determine the long-term impact of transcatheter MV repair in this patient population.
The Most Sustainable Car

The purpose of this paper is simple. It aims to find the most sustainable car company. This study explores the relationships between and among lists of most sustainable automakers based upon their sustainable values, CAFE, CDP & Bloomberg scores, and PSI grades. As a first step, this analysis determines whether there is a meaningful correlation among the measures as to which automakers are the most sustainable. As a second step, non-parametric methods for paired tests are applied to ascertain whether the results provide evidence to support which car company is truly most sustainable.
Experimental infection of rhesus with simian virus 40 (SV40).

SummaryNonimmune rhesus were readily infected by administration of SV40 by intranasal (i.n.), subcutaneous (s.c.), or intragastric (i.g.) route. Viremia, demonstrable in animals of all three groups, occurred earlier and with higher titers in the s.c. group. Neutralizing and viral CF antibodies appeared in all inoculated rhesus and T antibodies in 14 of 16. Viruria was detected in three of six of the s.c. group, most commonly in the third week after inoculation. Virus neutralizing activity occurred in the urine at or after 9 weeks postinoculation and was not confined to previously viruric animals. Virus was isolated from kidney of one rhesus from biopsy cultures performed 29–31 weeks after inoculation. Three rhesus fetuses which were given SV40 intracerebrally and subcutaneously at about 90 days of gestation had, at or soon after birth, high titers of antibodies and no tumors. In the single surviving infant, antibody titers did not fall in the first 11 weeks of life.
Effects of Engine Aging on Aircraft NOx Emissions

The impact of representative paths of engine degradation on aircraft cruise NOx emissions was investigated. Engine cycles corresponding to older, current, and future subsonic and supersonic technologies were developed and used to determine the sensitivities of combustor conditions to various changes in component efficiencies and flow capacities due to aging. Estimates of relative changes in NOx emissions levels were made using established empirical correlations that relate emissions to combustor flow parameters. The analysis methodology was validated through comparisons to test data where available.It was found that the sensitivity of specific fuel consumption (SFC) and combustor flow parameters to component aging is enhanced by increases in cycle temperatures and pressures. This ultimately results in a higher sensitivity of NOx emissions to engine degradation for cycles representative of more advanced technology. At constant thrust, turbine degradation typically acts to decrease NOx emissions while compressor aging results in an increase in NOx emissions; both occurring at the expense of SFC. Sample degradation scenarios were used to highlight the balance between turbine and compressor aging effects. Changes in NOx emissions in the −1% to +4% range were predicted for typical aging scenarios. The applicability of these results to the formulation of aircraft emissions inventories is considered.Copyright © 1997 by ASME
Quantifying the rambunctious journey of the anesthesia provider's hands during simulated, routine care

Background The role of anesthesia providers in dispersing potentially pathogenic material from one patient to another during intraoperative care needs further study. In this study we aimed (1) to quantify the dispersion of a surrogate pathogen from a simulated patient's mouth to the anesthesia workstation during routine anesthetic induction, (2) to test the hypothesis that there would be fewer contamination sites by providers who used a double-gloving technique, and (3) to examine the effectiveness of between-case anesthesia apparatus disinfection. Methods Twenty subjects were randomized to a single pair of gloves group (group 1) or a double-gloved group (group 2) and completed a simulated general anesthesia induction, completing a standardized set of interventions. Dispersion of a surrogate pathogen dye placed in the oral cavity of the simulated patient was tracked by a blinded observer and photography. Standard cleaning of the workstation was performed, and residual dye was quantified. Group performance was plotted using regression analysis and rate of contamination compared using parametric statistics. Results Group 1 contaminated an average of 16.0 (SEM = 0.89) sites compared with group 2, who contaminated an average of 7.6 (SEM = 0.85). The cart drawers, gas flow dials, medication vials, and ventilator controls were significantly contaminated by group 1, but not by group 2 ( P Conclusions A double-gloving technique was associated with less spread of an oral inoculum to the workstation but was not uniformly protective. Between-case cleaning was ineffective in removing the contaminant, indicating that biologic material from one patient may be present when subsequent patients are cared for. This suggests risks for the current patient (eg, skin or oral site transfer to an intravenous site) and also may place future patients at risk. Importantly, using models that simulate actual clinical events can inform clinical practice and decipher challenging areas of ergonomics.
Effects of genotype and mating weight on ovulation rate, litter size, and uterine efficiency of Coopworth, Polypay, and crossbred ewes

Six genotypes were produced by mating Coopworth (C), Polypay (P), and Suffolk (S) rams to Coopworth-type and Polypay ewes. In 1989, BW and ovulation rate (OR) were recorded for 188 naturally ovulating 5- and 6-yr-old ewes representing all six genotypes, and litter size (LS) was recorded for 174 ewes (93%) lambing to the ovulation observed by laparoscopy. Overall OR and LS averaged 1.85 and 1.71, respectively. Mean OR and LS did not differ (P greater than .40) among daughters of the various sire breeds; however, daughters of Polypay dams exhibited both higher OR (P less than .05) and LS (P less than .01) than daughters of Coopworth-type ewes. Heterosis estimates for OR and LS were 6 and 7%, respectively. Overall uterine efficiency (UE) of ewes conceiving to twin ovulations was .83. Polypay-derived ewes exhibited higher UE than other genotypes (P less than .05). Premating BW had significant but small effects on both OR and LS. Overall estimates of OR and LS response to a 10% increase in BW were 5 and 3%, respectively. Only Polypay-sired ewes showed a significant relationship between BW and reproductive performance; the estimated responses to a 10% BW increase were 9% for OR and 6% for LS. Variation in BW had no effect on UE of ewes conceiving to twin ovulations (P greater than .50).
The Influential Factor Analysis of Three-phase Flow Condensation Gas Well AOF potential

In the exploitation of condensation gas well,single well's absolutely AOF potential and rational deliverability are relative parameters which directly affect the feasibility of gas well exploitation and the exploitation scale of the whole gas field.In this paper,based on researching of three-phase flow condensation gas well AOF potential deliverability equation and aimed at the phenomenon of retrograde condensation and formation producing water which often appeared in the exploitation of condensation gas well,we first analyse the influential factor of three-phase flow condensation gas well AOF potential theoretically.Then we verify the primary influential factor of three-phase flow condensation gas well AOF potential.
Freedom of Expression

Freedom of expression or speech is widely held to be both a moral right and a legal right. John Milton (1608–74) defended it in Britain in the seventeenth century, and the U.S. Constitution’s Bill of Rights (1791) made it part of the First Amendment. Almost every modern constitution and international protocol regarding human rights recognizes freedom of expression. However, the justifications for and the contours of freedom of speech are much mooted. Moreover, there are some, even in liberal democracies, who deny this freedom special importance, whereas others deny its coherence as a concept.
Acquiring High Quality Customer Data with Low Cost

This work concerns optimal customer data acquisition and selection problem. We first propose using a divide-and-conquer technique to find empirical distribution of the customer data. We then formulate a data acquisition problem as an optimization problem that maximizes the quality of the acquired data while keeping the cost of acquisition as low as possible. We propose using generalized second-price (GSP) auction to acquire customer data and show that when the number of bidders is large, GSP is a truth-telling mechanism. We derive the analytical solution for the optimization problem, which finds a set of data that best represents the probability distribution of the target population relative to the acquisition cost. An experimental study is conducted to demonstrate the effectiveness of the proposed approach.
FITTING A CONTINUOUS TIME AUTOREGRESSION TO DISCRETE DATA

A brief review of time series analysis with missing observations and unequally spaced data in both time and frequency domain is presented. The exact likelihood for Gaussian ARMA processes can be calculated using Kalman recursive estimation, and non-linear optimization programs used to calculate the maximum likelihood estimates of the parameters including the observational error variance. This algorithm readily handles missing observations. For unequally spaced data it is necessary to consider continuous time models. This paper considers the problem of fitting a continuous time autoregression (all pole spectrum) with observational error. If sampled at equally spaced time points this process would be ARMA (p, p) so for p > 1 this gives the possibility of a more parsimonious representation. Using a state space representation, the exact likelihood function can be calculated by first performing an orthogonal rotation on the state vector producing an uncoupled equation of state with a diagonal state transition matrix. This greatly simplifies the recursive calculation of the likelihood for equally or unequally spaced data. Non-linear optimization involving constraints to ensure a stationary solution produces maximum likelihood estimates of the parameters and observational error variance. Numerical examples are presented of fitting continuous time models to yearly sunspot numbers and producing forecasts and of fitting models to unequally spaced respiration data.
Why Complex Signals Matter, Sometimes

Animal signals commonly consist of multiple components—say a sound and a display—and students of signaling have offered many perceptual and cognitive explanations for why compound signals should be more effective. Yet, the economic benefits that receivers obtain by following multiple signal components remain unclear. Superficially, it would seem that a single discriminable difference should be sufficient to discriminate between underlying states, such as high-quality versus low-quality mates. This chapter asks when receivers can benefit by responding to combinations of signals. While there are many situations in which it is best to follow the single most reliable signal and ignore others, our model suggests that it can pay to follow signal combinations when these combinations indicate the occurrence of a rare event. This chapter develops the logic of this confirmation of rare events hypothesis of multiple signal use and discusses the implications of this idea for future studies of signaling.
Neisseria arctica sp. nov., isolated from nonviable eggs of greater white-fronted geese (Anser albifrons) in Arctic Alaska.

During the summers of 2013 and 2014, isolates of a novel Gram-stain-negative coccus in the genus Neisseria were obtained from the contents of nonviable greater white-fronted goose (Anseralbifrons) eggs on the Arctic Coastal Plain of Alaska. We used a polyphasic approach to determine whether these isolates represent a novel species. 16S rRNA gene sequences, 23S rRNA gene sequences, and chaperonin 60 gene sequences suggested that these Alaskan isolates are members of a distinct species that is most closely related to Neisseria canis , N eisseria animaloris and N eisseria shayeganii . Analysis of the rplF gene additionally showed that the isolates are unique and most closely related to N eisseria weaveri . Average nucleotide identity of the whole genome sequence of the type strain was between 71.5 and 74.6 % compared to close relatives, further supporting designation as a novel species. Fatty acid methyl ester analysis showed a predominance of C14 : 0, C16 : 0 and C16 : 1ω7c fatty acids. Finally, biochemical characteristics distinguished the isolates from other species of the genus Neisseria . On the basis of these combined data, the isolates are proposed to represent a novel species of the genus Neisseria , with the name Neisseria arctica sp. nov. The type strain is KH1503T (=ATCC TSD-57T=DSM 103136T).
Rise of the API Copyright Dead? an Updated Epitaph for Copyright Protection of Network and Functional Features of Computer Software

After a decade of bruising legal battles, the courts and software industry norms largely resolved the costly war over the scope of copyright protection for computer software. By the mid 1990s, freedom to develop interoperable devices, systems, and software triumphed over broad copyright protection for network features of computer software. Copyright peace prevailed throughout the software industry for the next 15 years. But in 2010, Oracle reignited the smoldering embers of that war when it brought suit alleging that Google infringed copyright in the Java application program interface packages (APIs)... This article updates and expands upon an earlier “epitaph” for copyright protection of network features of computer software to address the second API copyright wave. As background, Part I reviews the first wave of API copyright legislation and litigation. Part II examines the Oracle v. Google litigation, tracing the development of Java and Android and the subsequent (and still ongoing) battle over the scope of copyright protection for APIs. Part III critically analyzes the Oracle v. Google decisions. It explains that copyright law’s fundamental exclusion of protection for functional features dictates that the labeling conventions and packaging of functions within interface specifications generally fall outside of the scope of copyright protection even as implementing code garners thin copyright protection. This interpretation of copyright law comports with fundamental principles channeling protection among the modes of intellectual property. It also serves the larger goals of intellectual property law and competition policy.
Identification of novel MRP3 inhibitors based on computational models and validation using an in vitro membrane vesicle assay

Abstract Introduction Multidrug resistance-associated protein 3 (MRP3), an efflux transporter on the hepatic basolateral membrane, may function as a compensatory mechanism to prevent the accumulation of anionic substrates (e.g., bile acids) in hepatocytes. Inhibition of MRP3 may disrupt bile acid homeostasis and is one hypothesized risk factor for the development of drug-induced liver injury (DILI). Therefore, identifying potential MRP3 inhibitors could help mitigate the occurrence of DILI. Methods Bayesian models were developed using MRP3 transporter inhibition data for 86 structurally diverse drugs. The compounds were split into training and test sets of 57 and 29 compounds, respectively, and six models were generated based on distinct inhibition thresholds and molecular fingerprint methods. The six Bayesian models were validated against the test set and the model with the highest accuracy was utilized for a virtual screen of 1470 FDA-approved drugs from DrugBank. Compounds that were predicted to be inhibitors were selected for in vitro validation. The ability of these compounds to inhibit MRP3 transport at a concentration of 100 μM was measured in membrane vesicles derived from stably transfected MRP3-over-expressing HEK-293 cells with [3H]-estradiol-17β- d -glucuronide (E217G; 10 μM; 5 min uptake) as the probe substrate. Results A predictive Bayesian model was developed with a sensitivity of 73% and specificity of 71% against the test set used to evaluate the six models. The area under the Receiver Operating Characteristic (ROC) curve was 0.710 against the test set. The final selected model was based on compounds that inhibited substrate transport by at least 50% compared to the negative control, and functional-class fingerprints (FCFP) with a circular diameter of six atoms, in addition to one-dimensional physicochemical properties. The in vitro screening of predicted inhibitors and non-inhibitors resulted in similar model performance with a sensitivity of 64% and specificity of 70%. The strongest inhibitors of MRP3-mediated E217G transport were fidaxomicin, suramin, and dronedarone. Kinetic assessment revealed that fidaxomicin was the most potent of these inhibitors (IC50 = 1.83 ± 0.46 μM). Suramin and dronedarone exhibited IC50 values of 3.33 ± 0.41 and 47.44 ± 4.41 μM, respectively. Conclusion Bayesian models are a useful screening approach to identify potential inhibitors of transport proteins. Novel MRP3 inhibitors were identified by virtual screening using the selected Bayesian model, and MRP3 inhibition was confirmed by an in vitro transporter inhibition assay. Information generated using this modeling approach may be valuable in predicting the potential for DILI and/or MRP3-mediated drug-drug interactions.
Advances in Raman Spectroscopy for the Geoenvironment

Raman spectroscopy has long offered potential for analytical specificity, sensitivity, and versatility in the study of a broad array of environmentally relevant compounds. As with other optical analytical methods, the use of the technique has been hampered by challenges in optimizing the sensor-sample interface, managing turbidity for quantitative analysis, limiting fluorescence interference, preventing biofouling (particularly for long-term monitoring), and achieving low cost. As outlined herein, research over the last several years has systematically addressed each of these factors so that Raman spectroscopy is arguably ready to be revisited as a robust and flexible field measurement technique and may now warrant targeted development effort so that it may become a more routinely employed field analysis method. In addition, the developments outlined herein are believed to be applicable to material analyses in complex, turbid, and/or fluorescence-prone settings in a broad array of fields.
Using ion implantation for figure correction in glass and silicon mirror substrates for x-ray telescopes

Ion implantation is a method of correcting figure errors in thin silicon or glass substrates. For future high-resolution, highthroughput x-ray observatories, such figure correction may be critical for thin mirror substrates. Ion implantation into both glass and silicon results in surface stress, which bends the substrate. We demonstrate that this stress may be used to improve the surface figure of flat glass wafers. We then describe three effects of ion implantation in glass and silicon. The first effect is the stress resulting from the implanted ions, and the implications for figure correction with each material. Second, each material studied also shows some relaxation after the ion beam is removed; we report on the magnitude of this relaxation and its implications. Finally, the surface stress may affect the strength of implanted materials. We report on ring-on-ring strength tests conducted on implanted glass samples.
My Father Works with Carpet, My Mother Works with Emotion: Understanding the Lived Experiences of Children of Student Affairs Professionals

This interpretative phenomenological analysis study focused on the way that children of student affairs professionals make meaning of their parents’ work. A purposive sample of 11 children at two i...
Creating Developmentally-Appropriate Measures of Media Literacy for Adolescents

The current generation of children and adolescents has yet to know a time when digital networks and social media were unavailable. However, it remains unclear how youth develop the skills necessary to critically evaluate the content they find via these media forms. These skills are thought to underlie what has been referred to as media literacy. To date, there is limited consensus on how best to define, measure, or teach media literacy skills, particularly in the US where media literacy instruction remains noticeably absent within most state curricula. Here, we constructed and validated a 14-item media literacy scale for adolescents, a demographic shown to be extensive digital media users. We used the scale to 1) assess adolescents' grasp of media literacy as defined in extant research, and 2) explore relationships between media literacy and social media use, media multitasking, and academic achievement. Findings from 78 adolescents (mean age 13 years; range 11-15) indicated that the internal consistency for the 14-item scale approached an acceptable range (Cronbach's α = .68). Media literacy scores correlated positively with self-reported grades and negatively with self-reported social media use and media multitasking. Thus, experience with social media use, in particular, may not promote media literacy skills. Further, youth may need targeted media literacy skill instruction to reduce their vulnerability to misinformation via digital media and enhance their critical evaluation of content found through these sources.
Bidirectional control of goal-oriented action selection by distinct prefrontal cortex circuits

The immense behavioral repertoire of animals necessitates mechanisms that select and suppress specific actions depending on current goals. The prefrontal cortex (PFC) has been suggested to orchestrate these processes by biasing activity in its target structures, but how its vastly converging inputs and diverging outputs are coordinated to control goal-oriented actions remains unclear. Here we use a bilateral task in which mice select between symmetric but opposing actions to show that distinct outputs from a subdivision of the PFC, the anterior cingulate cortex (ACC), promote correct and suppress incorrect actions. Surprisingly, ACC outputs to the superior colliculus principally inhibit incorrect actions. Optogenetic analyses and a projection-based activity model make the unexpected prediction that feedback from the ACC to the visual cortex promotes correct actions, which we confirm. Our results show that anatomically non-overlapping but functionally complementary PFC outputs bidirectionally control actions, and suggest a candidate organizing principle for PFC circuits.
Systematic analysis of outcomes evaluations applied to drug management programs.

Objective To evaluate prior analyses that quantify how drug management programs impact health plans and patients with respect to those analyses' effectiveness in measuring program quality. Methods We examined 77 US studies from 1996 to 2007 that evaluated the respective drug management programs of managed care, indemnity insurance, Veterans Health Administration, and Medicaid health plans. Our review included those studies that assessed the ways in which specific drug management tools and the drug management program overall impacted economic, clinical, and/or humanistic outcomes. Results The 77 studies included in our review used 11 types of outcome end points. A total of 52 studies (68%) incorporated an economic end point; of these, 35 (68%) reported economic data only and did not address clinical or humanistic outcomes. Overall, 33 (43%) evaluated clinical or humanistic end points; of these, 17 (52%) also reported on an economic end point. Conclusions Although the number of studies evaluating drug management programs has trended upward, only a handful have integrated economic, clinical, and/or humanistic outcomes when assessing the effects these programs have on health plans and patients. The efforts of these researchers to assess the overall quality of drug management programs have fallen short. To ensure that drug management tools have a desired effect on outcomes and medical costs, measures used to evaluate drug management programs must be improved.
From Superconductivity to Ferromagnetism in Amorphous Gd-La-Au Alloys

Splat cooled alloys of composition (La100−xGdx)80Au20 have been obtained by complete substitution of gadolinium for lanthanum in amorphous La80Au20 matrix. Results of high field magnetization (up to 70 kOe), ac and dc low field susceptibility, and resistivity measurements over temperature range of 1.7 to 300°K for these alloys are reported. The La80Au20 alloys are superconducting at 3.5°K. For x ≲ 1, a suppression of Tc described by the relation dTc/dx ≈ — 4.0°K per atomic per cent gadolinium is observed. For alloys within the concentration range 1 ≲x ≲ 70, maxima in low field susceptibility measurements are observed. The “ordering” temperatures TM are proportional to x for 1 ≤ x ≤ 16, similar to those observed in crystalline spin-glass alloys. For 1.6 ≲ x ≲ 70, TM is increasing at a faster rate than in the low concentration region, and this intermediate type of ordering corresponds to a mictomagnetic regime. As x ≳ 70, a ferromagnetic regime emerges. The maximum Curie temperature is observed for Gd80Au20 at ~ 150°K. The moment per gadolinium atom is found to be constant and close to that of the crystalline value throughout the concentration range investigated. Results of resistivity measurements are correlated with the magnetic properties of different regimes in the magnetic phase diagram.
Unusual Stability of a Bacteriochlorin Electrocatalyst under Reductive Conditions. A Case Study on CO2 Conversion to CO

Photosynthetic CO2 fixation is mediated by the enzyme RuBisCo, which employs a nonredox-active metal (Mg2+) to bind CO2 adjacent to an organic ligand that provides reducing equivalents for CO2 fixa...
Patient plus partner trial: A randomized controlled trial of 2 interventions to improve outcomes after an initial implantable cardioverter-defibrillator

Background Interventions to improve physical and psychological outcomes in recipients with an initial implantable cardioverter-defibrillator (ICD) and their intimate partners are largely unstudied, though likely to have a major impact on adjustment to the ICD and general well-being. Objective The purpose of this study was to report the primary outcomes of the patient plus partner randomized controlled trial. Methods In a 2-group (N = 301) prospective randomized controlled trial, we compared 2 social-cognitive–based intervention programs—patient plus partner (P+P) and patient only (P only)—implemented after initial ICD implantation. The patient intervention, consisting of educational materials, nurse-delivered telephone coaching, videotape demonstrations, and access to a nurse via a 24/7 pager, was implemented in both groups. P+P also incorporated partner participation. The primary patient outcomes were symptoms and anxiety at 3 months. Other outcomes were physical function (SF-36 [Short Form 36] and ICD shocks—patient), psychological adjustment (PHQ-9 [Patient Health Questionaire-9]), relationship impact (Dyadic Adjustment Scale and Oberst Caregiving Burden Scale (DAS and OCBS) partner), self-efficacy and knowledge (Sudden Cardiac Arrest-Self Efficacy [SCA-SE], Sudden Cardiac Arrest-Outcomes Expectation [SCA-OE], and Knowledge Self-Assessment [KSA]), and health care utilization (outpatient visits and hospitalizations) at hospital discharge and 1, 3, 6, and 12 months post-ICD implantation. Results For patients, P+P compared with P only was more effective in improving symptoms (P = .02), depression (P = .006), self-efficacy (P = .02), outcome expectations (P = .03), and knowledge (P = .07). For partners, P+P was more effective in improving partner caregiver burden (P = .002), self-efficacy (P = .001), and ICD knowledge (P = .04). Conclusion An intervention that integrated the partner into the patient's recovery after an ICD improved outcomes for both. Beyond survival benefits of the ICD, intervention programs designed to address both the patient and their partner living successfully with an ICD are needed and promising.
End-of-Life Care

The chapter on end-of-life care focuses on important aspects of caring for families of dying ICU patients. Mainly, this chapter discusses the symptom burden experienced by ICU families as they transition from intervention to end-of-life care, along with practical interventions to help alleviate families’ symptom burden. It provides suggestions on how best to support families who are in conflict during end-of-life decision-making. It discusses strategies that help families prepare for and cope during the transition where the patient is actively dying. Finally, issues affecting end-of-life care of families of underrepresented and LGBTQ populations are examined.
Formation of a recent hybrid zone offers insight into the geographic puzzle and maintenance of species boundaries in musk turtles

Speciation is the result of an accumulation of reproductive barriers between populations, but pinpointing the factors involved is often difficult. However, hybrid zones can form when these barriers are not complete, especially when lineages come into contact in intermediate or modified habitats. We examine a hybrid zone between two closely related riverine turtle species, Sternotherus depressus and S. peltifer, and use dual-digest RAD sequencing to understand how this hybrid zone formed and elucidate genomic patterns of reproductive isolation. First, the geographical extent and timing of formation of the hybrid zone is established to provide context for understanding the role of extrinsic and intrinsic reproductive isolating mechanisms in this system. The strength of selection on taxon-specific contributions to maintenance of the hybrid zone is then inferred using a Bayesian genomic cline model. These analyses identify a role for selection inhibiting introgression in some genomic regions at one end of the hybrid zone and promoting introgression in many loci at the other. When selective pressures necessary to generate outliers to the genomic cline are considered with the geographical and temporal context of this hybrid zone, we conclude that habitat-specific selection probably limits introgression from S. depressus to S. peltifer in the direction of river flow. However, selection is mediating rapid, unidirectional introgression from S. peltifer to S. depressus, which is probably facilitated by anthropogenic habitat alteration. These findings indicate a potentially imminent threat of population-level genomic extinction for an already imperiled species due to ongoing human-caused habitat alteration.
Soft Tissue Reconstruction of the Middle Third of the Tibia

Wounds in the middle third of the tibia can occur after trauma. Coverage of exposed bone and hardware is paramount for extremity salvage. Skin and subcutaneous fat overlying the anterior tibial surface is very thin, and wounds presenting in this area can be challenging for primary closure due to paucity of soft tissue. Soleus and tibialis anterior pedicled muscle flaps provide the bulk of local reconstructive options for durable autologous soft tissue coverage in this area [1–4] (Fig. 21.1).
Do “interdisciplinary” disciplines have an interdisciplinary impact?: Examining citations between educational technology and library and information science journals

This study examines the exchange of citations between two disciplines – Educational Technology (ET) and Library and Information Science (LIS) – as an indication of their interdisciplinary impact. The study was conducted in three phases. The first phase consists of an analysis of citations from ET journals to 15 top LIS journals; the second phase examined citations from LIS journals to 15 top ET journals; the third phase studied the five LIS journals – not on the original list of 15 – to cite ET journals and the relationship of citations from ET journals to them. The findings of this study reveal that about 1/10 LIS articles and 1/30 ET articles in the study sample were cited at least once in an article from the other discipline. This suggests that LIS has slightly stronger impact on ET research than vice versa. Among specific journals, the Journal of Education for Library and Information Science and the Journal of Documentation in LIS and Educational Technology Research and Development and the Journal of Educational Technology and Society in ET were most cited in the other discipline. Overall, the findings indicate a fair amount of exchange of ideas between the disciplines of LIS and ET. These findings are significant for interdisciplinary researchers in both ET and LIS as an indication of the links between and impact of these disciplines.
Corruption and formal-sector entrepreneurship in a middle-income country: spatial analysis of firm births in the Mexican states

We evaluate the impact of corruption on firm births in the formal sector in the 32 Mexican states. In addition to controlling for socioeconomic factors previously linked to entrepreneurship, we also evaluate the impact of corruption and corruption squared in each of the Mexican states with both spatial and non-spatial models. Our results show that corruption is positively correlated with the formation of new formal-sector firms, but corruption squared is negatively correlated with firm formation. We believe this implies that some corruption helps entrepreneurs navigate complex rules and bureaucracy but too much corruption hinders entrepreneurship. We find a strong spatial component to new firm formation.
Did Rural Resentment of Government Employees Elect Donald Trump

A recent “rural resentment” hypothesis holds that the rise of conservative politicians in the state of Wisconsin is explained by rural residents’ resentment of beneficiaries of economic advantages,...
G -algebras and their applications

In this chapter we provide a number of general properties of G-algebras together with some applications to modular representations and block theory. After introducing the trace map, we examine in detail permutation G-algebras. We then introduce defect groups in G-algebras and demonstrate that vertex theory can be subsumed under the theory of G-algebras.
Defining the iliac wing osseous fixation pathways: anatomy and implant constriction points

Insertion of iliac wing implants requires understanding of the curvilinear shape of the ilium. This study serves to quantitatively identify the area of iliac inner–outer table convergence (IOTC), characterize the iliac wing osseous corridor, and define the gluteal pillar osseous corridor. Computed tomography scans of 100 male and 100 female hemipelves were evaluated. The iliac wing was studied using manual best-fit analysis of the bounds of the inner and outer cortices. The IOTC was defined as the location of the iliac wing with an intercortical width less than 5 mm. The shortest distance from the apex of the iliac crest to the superior border of the IOTC was defined as the iliac wing osseous corridor. Finally, the width of the gluteal pillar corridor from the gluteus medius tubercle to the ischial tuberosity was measured. The IOTC is an elliptical area measuring 22.3 cm2. All ilia had an area where the inner and outer cortices converged to an intercortical width of less than 5 mm; 48% converged to a single cortex. The shortest mean distance from the superior edge of the iliac crest to the beginning of the IOTC was 20.3 mm in men and 13.8 mm in women (p < 0.001). The gluteal pillar diameter averaged 5.3 mm in men and 4.3 mm in women (p < 0.001). All ilia converge to a thin and frequently unicortical central region. A 4.5 mm iliac wing lag screw will not breach the cortex if it remains within 20 mm or 14 mm distal to the cranial aspect of the iliac crest in males and females, respectively. Not only is the gluteal pillar smaller than previously thought, in 41% of males and 73% of females, it is not be large enough for 5 mm implants. This study quantitatively assesses the dimensions of the IOTC, the iliac crest osseous corridor, and the gluteal pillar. Overall, our findings provide improved understanding of the limits for implant use in the iliac wing as well as better appreciation of the complex osteology of the ilium. This will help surgeons to identify safe areas for implant placement and avoid inadvertent cortical penetration.
Competency assessment of an undergraduate program using a third-party, objective pre-post examination

Assessing competencies or program learning outcomes in educational programs is often a leadership challenge. This case study reports medical education program’s efforts to document undergraduate competency attainment using a pre-post, third-party, objective testing service that allows for inter-university comparison, a testing service that is being adopted by some certification and accrediting bodies. Students completed a pre-test after program acceptance and a post-test at the end of the last didactic semester (1.5 years later) just prior to their required internships. Scores and subscores were evaluated using t-tests (Holm-adjusted p-values). MANOVA models of sub-competency difference scores were also evaluated. Results indicate competency improvement for each of the 12 areas based on the n = 55 student sample, (p < .001 for all scores). These improvements were independent of ethnicity, age, gender, and grades. The average student improved by 12.85 points (95% CI of 10.52 to 15.18) with the largest improvements in strategic planning and leadership competency areas (21.30 and 18.33 percentage points, respectively). The third-party pre-post has some face validity given that student performance improved after completing a related curriculum as would be expected. Congruent with earlier studies, we find that repeated testing helps document competency attainment and that a single method for assessment is insufficient. We further document limitations of this 3d-party exam.
Investigation of Narrow Band-Gap Semiconductors for Tunnetts

The potential of abrupt junction TUNNETT diodes made from narrow band gap semiconductor for millimeter wave frequency are explored theoretically. The alloy compound Hg 1-x Cd x Te which has a tunable band gap is chosen in this study. Neglecting impact ionization, an efficiency of 2.5% is obtained at 94 GHz in the simulation with a band-gap of 0.41 eV. We suggest that narrow band gap semiconductors have good potential for fabricating diodes operating in the TUNNETT or MITATT modes for millimeter wave applications.
From Tyranny to Totalitarianism in the Twentieth Century: Communism—Utopian Dreams and Totalitarianism Reality

Karl Marx created a utopian vision of a perfect society: democratic and egalitarian. But, in Russia, Marxism-Leninism became a model for rapid industrialization in an underdeveloped country. Although women were liberated and an excellent educational and scientific system was created, the Soviet Union became a totalitarian nightmare when Stalin took charge. Murder, terror and totalitarian control characterized Stalinist Russia. And, the industrialization succeeded in building heavy industry, but failed to create consumer goods. After World War II, China followed Stalinist Russia in economics and totalitarian politics. When the consumer economy failed to develop, and Mao Tse Tung died, China embarked on “the capitalist road.” With the successful capitalist economy, observers hoped that China would evolve towards democracy. But Xi Jinping has taken China towards a technological totalitarianism such as that imagined in George Orwell’s 1984.
Increasing Breast, Cervical, and Colorectal Cancer Screenings: A Qualitative Assessment of Barriers and Promoters in Safety-Net Practices.

Purpose Breast, cervical, and colorectal cancer screening rates are suboptimal in underserved populations. A 7-year quality improvement (QI) project implemented academic detailing and practice facilitation in safety-net primary care practices to increase cancer screening rates. This manuscript assesses barriers and promoters. Methods Primary care practices providing care to underserved patients were recruited in New York cities Buffalo, Rochester, and Syracuse. Enrollment totaled 31 practices, with 12 practices participating throughout. Annually, each practice received 6 months of practice facilitation support for development and implementation of evidence-based interventions to increase screening rates for the three cancer types. At the end of each practice facilitation period, focus groups and key informant interviews were conducted with participating personnel. Content analysis was performed annually to identify barriers and promoters. A comprehensive final analysis was performed at project end. Results Barriers included system-level (inconsistent communication with specialists, electronic health record system transitions, ownership changes) and practice-level challenges (staff turnover, inconsistent data entry, QI fatigue) that compound patient-level challenges of transportation, cost, and health literacy. Cyclical barriers like staff turnover returned despite attempts to resolve them, while successful implementation was promoted by reducing patients' structural barriers, adapting interventions to existing practice priorities, and enacting officewide policies. During the QI project, practices became aware of the impact of social determinants of health on patients' screening decisions. Conclusions The project's longitudinal design enabled identification of key barriers that reduced accuracy of practices' screening rates and increased risk of patients falling through the cracks. Identified promoters can help sustain interventions to increase screenings.
Knowledge is Happiness: is The End—An Inquiry Concerning Stoic Philosophy

I argue that the validity of the Stoic conception of the singular soul, empirically and psychologically, creates a view that is paradoxical: if being happy is the end for the sake of which everything is done, and if this consists in living according to virtue, using only right reasoning, one cannot obtain happiness. Why? Because selecting using right reasoning is the only virtue leading to the end, obtaining things that right reasoning is aimed at is ethically insignificant. I reconstruct fragments of text written by the outlaw Stoic philosopher, Posidonius, and interpret them to show how one can obtain the end while preserving Stoic ethics, through a radical connection between the soul consisting as parts and the passions. In this paper, I quote and try to interpret passages drawn from Plato’s Republic IV and connect them to the Stoics.
The certification process for tritium operators at TFTR

The TFTR project, in concert with the PPPL Office of Certification and Training (OC&T), has established a program by which tritium operations personnel are certified for their respective positions in accordance with DOE Order 5480.20A "Personnel Selection, Qualification, and Training at DOE Nuclear Facilities" and DOE Order 5480.19 "Conduct of Operations Requirements for DOE Facilities". The certification process commences during the candidate's interview for the position of TFTR Tritium Operator. Prior to accepting a candidate into the tritium operation program, a detailed educational and work experience record is constructed for the candidate, including an interview by OC&T personnel to assess the candidates credentials and ability to successfully complete the program. The typical successful candidate for the position of TFTR Tritium Operator has worked in the nuclear or chemical industry for several years, and in many cases possess a college degree. A US Nuclear Navy background is quite common for many of the applicants. Candidates complete the program in 4 to 6 months, and typically move into supervisory positions (Tritium Shift Supervisors) within 2 to 3 years.
Effects of Different Temper and Aging Temperature on the Precipitation Behavior of Al 5xxx Alloy

Al 5xxx alloys can become sensitized to intergranular corrosion (IGC) and stress corrosion cracking (SCC) because of the precipitation of intergranular β phase (Al3Mg2) when exposed to elevated temperature for sufficient time. In this study, ASTM G67 mass loss tests of Al 5083 H131, H116 and Al 5456 H116 aged at 323 K and 343 K for different times were conducted. The average grain size and grain boundary thickness of the three alloys were obtained from Electron Backscattered Diffraction (EBSD) images, and the classical nucleation theory was used to predict the precipitation behavior. Transmission Electron Microscopy (TEM) and Energy Dispersive X-ray Spectroscopy (EDS) were used to characterize Al 5083 H116 aged at different temperature for different times. Scanning Electron Microscopy (SEM) images of Al 5083 H131 etched for different times were used to evaluate the corrosion behavior of different grain boundaries.
LONG-TERM CULTURE AND TRANSPLANTATION OF MURINE TESTICULAR GERM CELLS

The objectives of this study were to develop an in vitro culture system to optimize germ cell proliferation and to measure the potential of the cultured germ cells to produce mature spermatozoa after transplantation into a recipient. Donor germ cells isolated from ROSA26 male mice were cultured with a STO feeder cell layer in Dulbecco's minimal essential medium (DMEM) supplemented with fetal bovine serum (FBS), stem cell factor, leukemia inhibitory factor, basic fibroblast growth factor, insulin-like growth factor 1, interleukin-11, L-glutamine, sodium pyruvate, 2-mercaptoethanol, murine oncostatin M, and platelet-derived growth factor. Donor germ cells formed colonies in the primary cultures after 8-21 days. These cultured colonies were maintained for 4 weeks or longer without subculture and proliferated for up to 8 passages over a period of 3 months. These colonies had alkaline phosphatase activity and incorporated 5-bromo-2'-deoxyuridine. These colonies were positive partially when screened with antibody for germ cell nuclear antigen and c-kit. Germ cells cultured with this supplemented medium showed enhanced colonization vs controls cultured with DMEM and FBS. Cultured germ cells from Rosa26 donors were transplanted into testes and were identified by X-gal staining and histological screening. The cells cultured in the supplemented medium colonized the tubules and initiated spermatogenesis in the recipient mice. This is an improved method for culturing germ cells and may be useful in gene therapy and the production of transgenic animals.