cssi/SciSciGPT-SciSciNet huggingface dataset:
Exact mutual impedance between sinusoidal electric and magnetic dipoles

Analytic expressions are presented for the exact mutual impedance of sinusoidal electric and magnetic monopoles in a homogeneous medium. Numerical computations are carried out and presented. It is shown that computed values of mutual impedances for both linear monopoles and surface-patch monopoles in the near-overlapping case exhibit an excellent convergence to the theoretical values when monopoles are physically overlapped. This demonstrates the robust accuracy of the presented expressions in the near-singular integration kernel for the mutual impedance computation. The expressions are also compatible with existing techniques. Minor modifications are needed to enable existing programs to compute such mutual impedances. >
Suggesting causes of faults in data-driven rule-based systems

As part of developing the CLIPS-based debugging tool MIRO, and because there has been relatively little exploration of the debugging process for such programs, the problems of debugging data-driven rule-based programs in general are defined and analyzed. How explanation can be used as a tool to ease the debugging process is discussed, and how it can suggest causes of faults in answer to questions asking why a particular fault occurred is examined. An algorithm that provides part of the explanation for a rule's failure to fire is discussed. >
Retroperitoneal hand-assisted laparoscopic nephrectomy and partial nephrectomy

The purpose of the present paper is to describe our technique and experience with retroperitoneal hand-assisted laparoscopic (HAL) nephrectomies as an alternative to the transperitoneal approach. Eight retroperitoneal HAL nephrectomies and one partial nephrectomy were performed. Several excisional techniques were employed incorporating the Harmonic scalpel or Ligasure device. Hemostatic agents were used to cover the renal defect. Surgical bolsters were sutured to the renal capsule with pleget reinforcements to aid in hemostasis. The average operative time was 210 min and estimated blood loss 110 mL. Mean change in hematocrit was 3 units and creatinine was 1 point. No patient required a transfusion. There were no major complications, with a mean follow-up of fourteen months. On average, patients resumed oral intake in 2 days, and were discharged in 3 days. Pathological examination revealed that two lesions were benign and seven malignant. Tumor diameter averaged 3 cm. There were no positive surgical margins. In conclusion, we have demonstrated the feasibility of retroperitoneal laparoscopic hand-assisted nephrectomy and partial nephrectomy surgery for solid renal masses.
The Implications of Religious Identity for Teaching Ethics.

Some debate exists about the degree to which one should merge one’s identities, particularly those with important normative content, with one’s teaching practices. This issue becomes particularly important for those with a religious identity who purposefully merge their identity with classroom practices. This article examines the qualitative answers of 328 Christian professors to a question addressing how they merge their Christian theological tradition with their ethical teaching in the classroom. We find that the answers demonstrate the identity merging takes place in multiple ways. For these professors, teaching consists of multiple sub-practices (e.g. discussion, lecturing, grading, etc.) that need to be guided by certain virtues and theological perspectives and justifications in order to develop the requisite goods. Indeed, both good teaching and their conception of the good cannot be separated from their identity.
Governance Form and Organizational Adaptation: Lessons from the Savings and Loan Industry in the 1980s

This paper explores how governance form affects the organizational capacity for adaptation. We make a general case about the importance of governance in adaptation, and we identify three mechanisms through which governance form may affect organizations' ability to manage the competency and failure traps that often frustrate the process. We look for evidence of these mechanisms through a study of the U.S. Savings and Loan (S&L) industry in the 1980s. This is an apt context because S&Ls were confronted by severe environmental changes that suggested a need for change of a relatively radical sort during this decade and because the industry contains a mix of governance forms (stock form firms and mutual associations). We examine whether mutuals and stocks differed in their propensity to move away from their traditional business and mission of residential mortgage lending in response to the challenges of the 1980s. We also consider whether stocks and mutuals differed in their performance outcomes during this decade. Results indicate that mutuals were slightly less prone toward change but were in no sense inertial. They also show that mutuals performed better overall and appeared to change more successfully than did stock firms. The overall pattern of results suggests that mutual governance was a resource that allowed S&Ls to better balance exploration and exploitation in the face of a changing and ambiguous environment. We consider the broader implications of these findings for research on organizational adaptation, governance form, and governance more generally.
Concomitant occurrence of canine malposition and tooth agenesis: evidence of orofacial genetic fields.

Certain discrete malpositions of the human canine tooth and agenesis of at least 1 tooth (hypodontia) are abnormalities known to occur together frequently. This study examines the specificity of tooth-agenesis sites associated with the occurrence of 3 unambiguous canine malpositions: palatally displaced canine (PDC; n = 58), mandibular lateral incisor-canine transposition (Mn.I2.C; n = 60), and maxillary canine-first premolar transposition (Mx.C.P1; n = 43). A fourth sample was formed from 4 cases of combined occurrence of PDC and Mn.I2.C, the only combination-phenotype noted among the 161 subjects. Oral panoramic radiographs were used to identify agenesis of at least 1 third molar (M3), mandibular second premolar (MnP2), and maxillary lateral incisor (MxI2)-the 3 most frequently absent tooth types among people of European descent. PDC and Mn.I2.C transposition appear to be associated with significantly increased M3 agenesis (P <.01), representing the posterior orofacial field, and Mx.C.P1 transposition appears to be associated with conspicuously elevated MxI2 agenesis (P <.001), representing the anterior orofacial field. MnP2 agenesis appears to represent an intermediate field, found in significantly elevated frequencies with all 3 canine positional anomalies. Coupling these new clinical findings with results from recent molecular studies, we suggest that transcription factors such as MSX1 and PAX9, which have been associated with agenesis of molars, might be involved in the genetic control of Mn.I2.C transposition and PDC, tooth malpositions connected here with the specific expression of posterior-field (M3) hypodontia.
Is the device working properly

Normal pacemaker and defibrillator function can occasionally mimic device malfunction. A thorough understanding of timing cycles and familiarity with company-specific pacing algorithms can often avoid unnecessary confusion.
Active Support Vector Machine Classification

An active set strategy is applied to the dual of a simple reformulation of the standard quadratic program of a linear support vector machine. This application generates a fast new dual algorithm that consists of solving a finite number of linear equations, with a typically large dimensionality equal to the number of points to be classified. However, by making novel use of the Sherman-Morrison-Woodbury formula, a much smaller matrix of the order of the original input space is inverted at each step. Thus, a problem with a 32-dimensional input space and 7 million points required inverting positive definite symmetric matrices of size 33 × 33 with a total running time of 96 minutes on a 400 MHz Pentium II. The algorithm requires no specialized quadratic or linear programming code, but merely a linear equation solver which is publicly available.
POTENTIAL DIFFERENCES INFLUENCE AMINO ACID/Na + SYMPORT RATES IN LARVAL MANDUCA SEXTA MIDGUT BRUSH-BORDER MEMBRANE VESICLES

The time-dependent fluorescence intensity of an intravesicular potential-sensitive dye was used to probe the real-time kinetics of potential difference (PD)-dependent amino acid/Na+ symport at pH9 into brush-border membrane vesicles obtained from larval Manduca sexta midgut. Neutral amino acids (alanine, proline) are symported at higher rates as the vesicles are hyperpolarized. The symport rates of acidic (glutamate) and basic (arginine) amino acids are almost PD-independent. The half-saturation constant of alanine is PD-independent between -108 and -78 mV, although the maximal symport velocity increases by half as the voltage is increased. Amino acid throughput is evidently enhanced as the relatively high transmembrane PDs (> 150 mV, lumen positive) measured in vivo are approached. The half-saturation concentrations of Na+ were in the range 15-40 mmol l-1 for most of the amino acids examined and increased with voltage for alanine. The Vmax observed as a function of cation or amino acid concentration increased as the vesicle was hyperpolarized in the case of leucine and alanine. The data support the hypothesis that carrier and substrates are at equilibrium inasmuch as substrate translocation seems to be the rate-determining step of symport.
Deconvolution and Adaptive Optics Imaging

Adaptive Optics imaging is unique in that it provides real-time compensation of scenes distorted by turbulent media. However, the compensation is never 100% and residual optical aberrations are present in the images. In general, the compensated Strehl ratios are significantly less averaging in the 20-50% regime for most systems. Image post-processing is further complicated by the temporal variability of the AO compensated PSFs.
Poor HPV vaccine-related awareness and knowledge among Utah Latinas overdue for recommended cancer screenings

Individuals overdue for recommended cancer screenings may not be receiving adequate cancer prevention education. Since Latinas have the highest incidence of cervical cancer among all racial/ethnic groups, human papillomavirus (HPV) vaccination education is especially important for this population. The correlates of HPV vaccine-related awareness and knowledge were assessed among Latinas who were overdue for recommended cancer screenings. N = 206 Latinas who were overdue for recommended cancer screenings were recruited by health educators from local community groups. Bivariate analyses and multivariable regression models were used to investigate factors associated with HPV vaccine-related awareness and knowledge among participants as well as to assess correlates of HPV vaccine receipt for eligible children of participants. In multivariable regression analyses, years living in the U.S. (p = 0.05) and health insurance status (p = 0.03) were significantly related to HPV vaccine-related knowledge measures. Age (p < 0.01), birthplace (p = 0.02), years living in the U.S. (p = 0.05), annual household income (p = 0.05), cervical cancer screening status (p = 0.03), and HPV vaccine-related knowledge measures (p < 0.01) were significantly associated with HPV vaccination outcomes for eligible daughters of participants. Cervical cancer screening status (p = 0.02) and HPV vaccine-related knowledge measures (p = 0.01) were significantly associated with HPV vaccination outcomes for eligible sons of participants. Results indicate poor HPV vaccine-related awareness and knowledge among Latinas. Interventions to improve HPV vaccine-related awareness and knowledge in Utah's growing Latino population should target vulnerable individuals (e.g., not employed outside the home, less educated, less acculturated, poor, uninsured, overdue for cervical cancer screening) by using materials that are culturally sensitive, linguistically appropriate, and easily accessible.
Scanning RHEED Studies of Silicide Formation in a UHV-SEM

A variety of techniques for studying surfaces have been developed or adapted to UHV recently, including TEM, REM, SEM and STM. The scanning or probe forming techniques offer a great advantage in flexibility over parallel imaging techniques since many different signals may be used to form the image. A familiar example is Auger electron yield, used in scanning Auger microprobe instruments. RHEED provides a particularly strong and surface sensitive signal, yet it is seldom used or exploited in UHV microprobe instruments, primarily due to the conflicting requirements of a well colli-mated beam and a small spot size. Use of a field emission gun (FEG) with its superior brightness makes possible a combined scanning diffraction and microanalysis instrument[1]. We describe here such a custom built UHV-SEM-FEG+diffraction instrument and discuss is application to a study of epitaxial growth of nickel overlayers on silicon.
Managing Human Capital in Government Organizations

Managing human capital in government organizations has become more important given the global financial and economic crisis. This is a challenge for government agencies across the world. Many organizations are facing reductions in force, while others are restructuring their programs and services or merging with other agencies. Jobs today require employees to possess wider skillsets as they assume more challenging responsibilities. Research by the Partnership for Public Service and Deloitte Consulting identified ten workplace categories critical to engaging government employees. They are: effective leadership; teamwork; employee skills–mission match; work–life balance; training and development opportunities; satisfaction with pay; strategic management; support for diversity; performance-based rewards and advancement; and alternative work and employee support programs. Keywords: industrial relations; organization and management theory; sociology of organizations; sociology of work and occupations; work, management, occupations, and organizations
The Current Actuality and Expctation of Home Medical Equipment

Home medical equipment primarily for home use,as opposed to medical devices used in hospitals,its simple,compact,portable and other characteristics,market potential,is a sunrise industry.In this paper,the basic situation of home medical equipment,in-depth study of the current home medical equipment industry in China the problems and future trends.
Food borne acute gastroenteritis among community residents in Haining

Objective To know about the prevalence of food borne acute gastroenteritis among community residents in Haining.Methods After random sampling,a face-to-face questionnaire survey on food borne acute gastroenteritis was carried out among 2400 residents in Haining from August 2011 to July 2012.Results The monthly prevalence rate of diarrhea in communities of Haining district was 0.92%,with an incidence of approximately 0.19/person-year.The diarrhea patients were mainly among the age group of 21-50.63.64% acute diarrhea cases had suspected causes which were mainly intake of contaminated food.31.82%cases had treatment seeking behavior.Conclusions Great attention should be paid to the food borne acute gastroenteritis.Comprehensive prevention and treatment is also necessary.
Presidential address--1980. Psychosomatic and psychoimmunologic research.

Much of what I have to say, I have said before. As a matter of fact, much of what I have to say many of you have said before. I have been persuaded, however, that it bears repeating. WhiJe I am talking to you, I am really addressing my remarks to those who are not here; those who are not committed t
Learning curve for the transsphenoidal endoscopic endonasal approach to pituitary tumors.

AbstractIntroduction: The transsphenoidal endoscopic approach is a relatively new procedure compared to the microscopic approach in pituitary adenoma resection. The endoscopic approach has shown to significantly decrease the rate of complications, time in the operating room and hospital, and patient post-op discomfort. However, this procedure requires the surgeon to make use of different visual and tactile clues that must be developed with experience. Therefore, it is important to understand the learning curve that the surgeon must overcome to become proficient with the endoscopic approach.Methods: Retrospective review of a single-surgeon consecutive series of 78 patients undergoing endoscopic pituitary tumor surgery from 2006 to 2012 at Rush University Medical Center has been used in this study. Patients were grouped according to an early (n = 9) and late group (n = 68) determined by a significant difference in outcomes. Our primary outcome measures were: duration of operation, CSF leak, hospital length ...
P092 Algorithmic approach to injured workers: designed for dairy and pork, applicable across industries

Background Agriculture has again been listed as the most dangerous U.S. industry in 2015. Like other large animal production, dairy and pork operations consistently account for serious, restrictive, non-fatal injuries. This project was designed to develop a return to work software application to produce applicable light duty job assemblies based on worker limitations and available tasks on the farm. Methods Farm task data were collected by physical and occupational therapists at dairy and pork farms in Minnesota and „Wisconsin. The collection included heights, weights, and environmental considerations such as slippery surfaces. Narrative data from therapist collection had to be converted to a structured format to make most use of algorithmic functionality. Results The system, in prototype form, has been tested with workers, employers and clinicians. The application outputs suggested job tasks based on the limitations entered. Rather than a typical proscriptive output from physician to patient and employer, this application provides a prescriptive recommendation allowing the injured worker to get back to work sooner and safer. Farmers/employers still have the discretion to adjust the recommended tasks so long as they stay within the physical limitations outlined by the physician (e.g. cannot lift more than 10 lbs.). Conclusions The tool in prototype appears to be appealing to Insurance companies that offer Workers’ Compensation coverage and Farmers/employers who appreciate the guidance it offers in navigating a safe return to work of injured employees. Though few farmers realise the financial ramifications of keeping someone on time-loss, they quickly discern the value of the system, and often request more information about farm safety and injury prevention.
Diamond-Shaped Mesh Network Routing with Cross-Layer Design to Explore the Benefits of Multi-Beam Smart Antennas

Conventional wireless mesh network (WMN)routing protocols are designed for the nodes that use the omni-directional or single-beam directional antennas. This research presents a throughput-efficient routing scheme for WMN, by taking advantage of the nodes equipped with the multi-beam directional antennas (MBDAs). Our routing design has the following two novel features: First, it is a cross-layer design by integrating the routing scheme with multi-beam oriented medium access control (MAC) scheme. Second, the routing topology has a diamond-like shape and uses the multi-path routes (i.e., one main path and a few side paths). The diamond shape makes the traffic converge and diverge periodically in the routing paths, which exploits the simultaneous data delivery capability of multi-beam antennas, and enhances the network throughput. Our simulation results demonstrate the high throughput efficiency of the proposed multi-beam routing scheme.
E-035 Superior Outcomes in Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke among Late MR-Selected Candidates Compared with Early Candidates Not Screened with MR

Purpose With thrombectomy for anterior circulation large vessel occlusion (ACLVO) stroke time is considered important, but collateral status may be a greater driver of outcome than time. MR screening can identify good candidates for thrombectomy regardless of time from onset. Here we tested the hypothesis that MR-selected patients would show superior outcomes regardless of time compared with early patients screened by CTA alone. Methods A cohort of 56 ACLVO patients treated with thrombectomy between 11/1/2012 and 5/15/2015 was retrospectively studied. Seven early-presenting patients with contraindication to MRI proceeded immediately to thrombectomy upon CTA confirmation of LVO. Forty-nine patients with CTA-proven LVO but no MR contraindication went next to MRI and were selected for thrombectomy based on low diffusion-restricted infarct volume (non-intervention threshold: core volume > (100 minus patient age) mL). Final infarct volume was measured on post-treatment imaging. Comparisons were made between early CTA-only-screened and MR-screened groups. Additional comparisons were made with the late MR-screened (decision-to-treat >6 hours from symptom onset) subset. Results Compared to the MR-screened group, the early CTA-only group had a higher median age (81 [IQR 76–83] vs. 71 [57–77]) and NIHSS score (25 [22–26] v. 15 [11–19]) was more likely to have received IV tPA (71.4% vs. 36.7%) and yielded a lower TICI ≥ 2 B recanalization rate (57.1% vs. 79.6%, p = 0.36). Despite significantly earlier treatment decision times (3.0 h [2.5–3.6] vs. 6.4 h [2.9–8.7]), median final infarct volume was larger in the early CTA-only group compared with the MR-selected group (134 mL vs. 20 mL, estimated median final infarct difference of 100 mL [95 CI: 1.00–134], p = 0.043). A similar difference in median final infarct volume was observed between CTA-only and the late MR-screened groups (134 mL v. 27 mL [95 CI: –6 – 132], p = 0.069) (Figure 1). The odds of a final core infarct greater than 70 mL, a poor prognostic factor, were significantly lower in the MR-screened group OR 0.013 ([95 CI: 0.022–0.757], p = 0.022). Conclusion Despite a median 3.4 hour-shorter interval from symptom onset to treatment decision, ACLVO patients not screened with MRI had larger median final infarct volumes after thrombectomy compared with MR-screened patients. Importantly, late MR-selected patients also tended to have lower final infarct volumes. Consideration should be given to patient selection strategies incorporating MRI with diffusion weighted sequences rather than time from symptom onset alone. Disclosures B. Cristiano: None. M. Pond: None. U. Oyoyo: None. S. Basu: None. J. Jacobson: 4; C; GeneLux.
Comparing Surgical Clerkship Performance of Medical and Physician Assistant Students.

Objective Third-year medical students (MS-III) and second-year physician assistant students (PA-S) have similar core clinical rotations during their education. Uniquely at our institution, both groups rotate together and are assessed by the same evaluation and grading standards. This study compares the performance of MS-III and PA-S during their combined surgical clerkship rotation. Design A retrospective analysis on students' final clerkship grades, individual grades for clinical performance evaluation, objective structured clinical examination, faculty tutorials, and National Board of Medical Education (NBME) general surgery examination for academic years 2013 and 2014. Statistical analysis using the Statistical Package for Social Sciences (SPSS) was used. A p Setting The study took place in the Department of Surgery at the University of Oklahoma School of Community Medicine, Tulsa, Oklahoma. Participants All MS-III and PA-S that performed a clinical rotation in the Department of Surgery at the University of Oklahoma School of Community Medicine, Tulsa were included in the study. Fourth-year medical students on elective rotations were excluded. A total of 95 students were included, 51 MS-III and 44 PA-S. Results The results indicated that MS-III had statistically significant higher clinical performance evaluation (p = 0.005), NBME (p Conclusion MS-III performed better in tests evaluating medical knowledge, possibly a reflection of more in-depth different organ systems physiology and pathophysiology education that MS-III receive. No significant difference in clerkship performance was found. This could be attributed to similar clinical education both receiving as well as PA-S often having a history of prior professional health care experience. Over time of the study, PA-S performance seems to have improved. These observations might help to improve future curricula for MS-III as well as for PA-S.
CLINICAL EVALUATION OF COST EFFICACY OF DRUGS FOR TREATMENT OF OSTEOPOROSIS: A META-ANALYSIS.

ABSTRACT Objective: To assess the cost efficacy of available regimens for therapy of osteoporosis as defined as the cost time's number need to treat to prevent one fracture. Methods: Existing meta-analyses were supplemented through electronic databases SCOPUS and PubMed between 2013 (a date overlapping the latest meta-analyses) and March 2016. Primary references included all randomized controlled trials of anti-osteoporotic drugs versus comparators using search terms “osteoporosis,” “random,” and “trial.” Results: There were 43 evaluable randomized, double-blind, placebo-controlled trials in 71,809 postmenopausal women comparing fracture frequency. Trials were similar in recruitment age (mean ± SD, 67.3 ± 8.1 years) and follow-up duration (25.5 ± 12.6 months). Cost comparisons were evaluated for a treatment strategy assuming generic alendronate as first-line therapy. Denosumab and teriparatide showed benefits in vertebral fracture reduction over alendronate at incremental costs respectively of $46,000 and $455,000 per fracture prevented. Zoledronate, recently released as a generic, would be either less expensive or comparable in cost. None of the alternate medicines were statistically better in preventing hip fractures. Teriparatide was more effective in preventing nonvertebral fractures at an incremental cost of $1,555,000. Conclusion: The most cost-effective initial therapy of postmenopausal osteoporosis is generic oral alendronate or generic parenteral zoledronate. There is no statistically significant difference in efficacy of available drugs to prevent hip fractures. There are limited data to suggest switching drugs after sustaining an osteoporotic fracture while on oral alendronate therapy, although generic zoledronate may be considered on the basis of side effects or questions of medication adherence. Abbreviations: ALN = alendronate; DEN = denosumab; IBN = ibandronate; NNT = number needed to treat; OR = odds ratio; RCT = randomized controlled trial; RIS = risedronate; RLN = raloxifene; TER = teriparatide; ZOL = zoledronate
Harassment of adults by immatures in bonobos (Pan paniscus): testing the Exploratory Aggression and Rank Improvement hypotheses

The immatures of many primate species frequently pester adult group members with aggressive behaviors referred to as a type of harassment. Although these behaviors are characteristic of immatures as they develop from infancy through adolescence, there have been few studies that specifically address the adaptive significance of harassment. Two functional hypotheses have been generated from observations of the behavior in chimpanzees. The Exploratory Aggression hypothesis describes harassment as a mechanism used by immatures to learn about the parameters of aggression and dominance behavior and to acquire information about novel, complex, or unpredictable relationships. The Rank Improvement hypothesis describes harassment as a mechanism of dominance acquisition used by immatures to outrank adults. This study investigated harassment of adults by immatures in a group of bonobos housed at the Columbus Zoo and compared the results to the predictions outlined by the Exploratory Aggression and Rank Improvement hypotheses. Although all immature bonobos in this group harassed adults, adolescents performed the behavior more frequently than did infants or juveniles and low-ranking adults were targeted more frequently than high-ranking. Targets responded more with agonistic behaviors than with neutral behaviors and the amount of harassment an individual received was significantly correlated with the amount of agonistic responses given. Furthermore, bouts of harassment were found to continue significantly more frequently when responses were agonistic than when they were neutral. Adolescents elicited mostly agonistic responses from targets whereas infants and juveniles received mostly neutral responses. These results support predictions from each hypothesis where harassment functions both as a mechanism of social exploration and as a tool to establish dominance rank.
Quantifying the environmental impacts of increasing high occupancy vehicle lanes in the United States

Abstract To what extent will increasing High Occupancy Vehicle (HOV) lane-kilometer incentivize carpooling and reduce emissions of air pollutants and greenhouse gases? To answer these questions, we develop a multiple regression model relating HOV lanes and other socioeconomic factors to carpooling propensity in all 50 U.S. states and the District of Columbia, then calculate the extent to which increasing HOV lane-kilometers would lead to reductions in carbon dioxide equivalent (CO 2e) and major air pollutants across the U.S., by state. Increasing HOV lane extent has the greatest potential to reduce annual CO2e in the District of Columbia, followed by Hawaii and New York. The smallest potential is found in states with the lowest population density, led by North Dakota. We then explore the extent to which recommendations made at one level of data aggregation (that of individual states) may be valid for another level, such as individual counties. The only state with sufficient data available to disaggregate the model to the county level is California, where we found a lower potential for state-wide CO2e emission reductions under the county-level model as compared to the state-level model (0.69% as compared to 1.08%, under the same hypothetical scenario), albeit with significant differences in emission reduction potential between counties with higher vs. lower population densities. This analysis demonstrates the potential to generate generalizable insight into the magnitude of vehicle emission reductions that might be achieved through expanding HOV lanes, and highlights the importance of data disaggregation in identifying the optimal locations for potential reductions.
Prospective Evaluation of Staphylococcus aureus Antibiotic Resistance Patterns from Respiratory Specimens in ICU Patients

Background: Staphylococcus aureus is the leading pathogen responsible for hospital-acquired pneumonia (HAP). Vancomycin is the primary antimicrobial choice for methicillin-resistant S. aureus (MRSA) HAP worldwide, but S. aureus isolates have been reported susceptible or even resistant to vancomycin. Objectives: This study compares automated and non-automated susceptibility patterns for MRSA isolates to vancomycin to determine comparability of testing methods for this drug. Methods: Respiratory samples submitted to Clinical Microbiology from patients in the ICU were plated onto sheep blood agar and chocolate agar media and visually inspected at 12-24 hours. The presence of S. aureus was determined serologically. S. aureus isolates were subcultured for susceptibility testing to detect MRSA respiratory isolates. Consecutive MRSA respiratory isolates were analyzed for susceptibility and minimum inhibitory concentration (MIC) using E-test strips and BD Phoenix automated system testing for vancomycin and the vancomycin alternative agents teicoplanin, linezolid and tigecycline. Results: Ninety-five MRSA respiratory isolates were collected. Three were obtained by bronchoalveolar lavage and the remainder by protected alveolar lavage. There was no heteroresistance detected by E-test at 24 hours, but there were 4 isolates at 48 hours demonstrating elevated vancomycin MIC values of 6 ug/ml. Conclusions: Vancomycin heteroresistance was not a problem in this series of isolates. Agreement between vancomycin automated MICs and E-test MICs was not universal. Although under-calls were few based upon automated MIC, several instances were indeed identified.These data show that Phoenix under-reports vancomycin MIC values for MRSA compared to E-test methodology.
Hospital-Based Physicians’ Intubation Decisions and Associated Mental Models when Managing a Critically and Terminally Ill Older Patient

Background. Variation in the intensity of acute care treatment at the end of life is influenced more strongly by hospital and provider characteristics than patient preferences. Objective. We sought...
Simulation as a Tool for Clinical Remediation: An Integrative Review

Abstract Development of clinical competency is a critical component of undergraduate nursing education. However, often when students struggle in the clinical setting with skills such as critical thinking and clinical reasoning, evidence-based resources for remediation are lacking. Because simulation is a well-established nursing pedagogy, could it be a valuable tool in clinical remediation for such students? The aim of this integrative review of literature was to examine what was currently known about clinical remediation using simulation and how simulation contributes to clinical competency. A literature search of three data bases was conducted to identify pertinent research using keywords such as simulation, remediation, nursing, education, clinical reasoning, clinical safety, and clinical competence. A total of 1,645 total articles were retrieved from databases, and 76 were retrieved from additional sources. Ultimately, 24 articles met the inclusion criteria and three main themes emerged which were the use of simulation as a nursing pedagogy, simulation use in clinical remediation, and effectiveness of simulation for development of critical thinking and clinical reasoning skills. The current evidence supports simulation as an effective pedagogy for development of clinical competency skills, such as critical thinking and clinical reasoning, but there is a significant deficit of literature on the use of simulation as a tool for clinical remediation of undergraduate nursing students.
Laparoscopic Nephroureterectomy for Upper Tract Transitional Cell Cancer

Standard therapy for most patients with upper-tract transitional cell carcinoma (TCC) is total nephroureterectomy with excision of an ipsilateral cuff of bladder, performed through two separate incisions or one long abdominal incision. Laparoscopic nephrectomy is a recognized form of ablative therapy for patients with benign renal disease; recently it has been extended to the management of renal cell carcinoma and upper-tract TCC. In May 1991, the first clinical laparoscopic nephroureterectomy (LNU) was performed at Washington University in St. Louis. Since then, a total of 20 patients with upper-tract TCC have undergone LNU at our institution. The technique begins with a transurethral unroofing and electrocoagulation of the ureteral orifice with placement of an external ureteral catheter. Next, a transperitoneal laparoscopic total or radical nephrectomy dissection is performed. Then, another 12-mm port is inserted infraumbilically and the ureter is dissected distally to the ureterovesical junction; a 12-mm laparoscopic GIA tissue stapler is fired across the bladder cuff. The specimen is placed into an entrapment sack and removed intact by enlarging one of the trocar sites to 7–10 cm. In our experience, LNU has had a short-term efficacy similar to that of open nephroureterectomy. However, LNU required an average of 3.6h longer operative time. In favor of LNU were a 74% reduction in analgesia requirements, a brief hospital stay (average, 4 days), and a rapid convalescence (average, 2.4 weeks).
Behandlung von Patienten an der Grenze

Der in Wien geborene chilenisch-amerikanische Psychiater OTTO F. KERNBERG gilt als Spezialist fur Borderline-Storungen und als Vermittler zwischen orthodoxen und revisionistischen Stromungen in der analytischen Gemeinschaft.
Robot assisted anterior pelvic exenteration for bladder cancer in female

The standard-of-care management of muscle invasive bladder cancer in females is anterior pelvic exenteration. This involves the surgical excision of the urinary bladder and the female reproductive organs in addition to pelvic lymphadenectomy. Among many factors, performing this procedure robotically requires thorough knowledge of female laparoscopic pelvic anatomy in order to conduct this complex surgery in a safe and efficient manner. However, most urologic surgeons are more familiar with male pelvic anatomy given the prevalence of the more frequently performed robotic prostatectomy. Our technique was developed based on minimal deviation from robotic radical cystectomy in males and this chapter will review its various steps and highlight the main differences.
Load-based testing methodology for fixed-speed and variable-speed unitary air conditioning equipment

A load-based methodology for testing and rating the performance of unitary air conditioning equipment has been developed and demonstrated using a laboratory psychrometric chamber test facility. The...
Integrating patient safety education into early medical education utilizing cadaver, sponges, and an inter-professional team

Introducing patient safety and quality improvement science to medical students is integral to improving healthcare. However, developing and implementing a patient safety curriculum can be challenging in a medical school curriculum that is already densely packed. Our aim was to develop and evaluate the impact of a workshop introducing patient safety and quality improvement science to a large class of first-year medical students. As a part of an evolving longitudinal patient safety curriculum, an introductory workshop on patient safety was integrated into an anatomy course. A high impact event (a simulated “retained sponge” discovery during an anatomy dissection lab) was used to introduce medical error. The educational session which followed consisted of a presentation by an interprofessional team utilizing the retained sponge as example of an error. Use of safety tools was introduced and quality improvement science was discussed using the evolution of methods to decrease retained foreign objects during surgery. A patient’s story told by a close family member about the personal impact of medical errors was presented. Students then participated in an interactive breakout activity and completed a module on safety. The impact of the workshop was assessed through pre- and post- session tests. Quantitative and qualitative evaluation reflected a positive effect of the session in improving students’ safety knowledge and attitudes. Students’ mean total knowledge improved from 7.58 to 8.98 (p = 0.000). Mean total attitudes score improved from 47.73 to 50.56 (p = 0.000). Students’ comments after the workshop reflected increased awareness and appreciation of the importance of addressing medical errors. A workshop introducing patient safety and quality improvement to first year medical students improved knowledge and attitudes regarding safety and increased awareness of the importance of addressing medical errors in their future careers. Integrating patient safety education into an existing foundational science course is a model for teaching patient safety at other medical schools.
PGE2 and IL-27: novel pro-inflammatory mechanisms involving dendritic cells and Tr1 cells

Interleukin-27 (p28/EBI3) is an immunomodulatory cytokine expressed by activated antigen presenting cells. Although first discovered to be involved in Th1 cell differentiation, further studies demonstrated the immunosuppressive functions of IL-27 including the inhibition of Th17 cell development and the induction of type 1 regulatory T cells (Tr1) and exhausted CD4 + T cells. The anti-inflammatory effects of IL-27 have been demonstrated in vivo in murine models of parasitic infections and autoimmune disease models such as experimental autoimmune encephalomyelitis and inflammatory bowel disease (IBD). We previously detailed the pro-inflammatory effects of PGE2 in collagen-induced arthritis and IBD through stimulation of IL-23 production leading to development of Th17 cells. Here we describe novel pro-inflammatory functions of PGE2, i.e. inhibition of IL-27 production by murine bone marrow-derived dendritic cells (DC), inhibition of Tr1 differentiation and of IL-10 production by Tr1 cells. We determined that the effect of PGE2 on IL-27 production in LPS-stimulated DC is mediated through EP2/EP4 receptors, induction of cAMP, and partial inhibition of both IRF1 and IRF3. Furthermore, we found that PGE2 treatment of LPS-stimulated DC reduces IRF1 binding to an essential ISRE site within the p28 promoter. In addition to the effects of IL-27 in DC, we also found that PGE2 directly inhibits IL-27-induced differentiation of Tr1 cells through EP4, and inhibits production of IL-10 by Tr1 cells through EP2/EP4. These studies further describe the pro-inflammatory effects of PGE2 and identify possible new targets for treatment of inflammatory diseases.
Validating the Suicide Status Form for the Collaborative Assessment and Management of Suicidality in a Psychiatric Adolescent Sample.

Background For adults, the Collaborative Assessment and Management of Suicidality (CAMS; Jobes, (2006, Managing suicidal risk: A collaborative approach, New York, Guilford) and Jobes, (2016, Managing suicidal risk: A collaborative approach, New York, Guilford)) is a treatment framework with replicated evidenced-based support for effectiveness. The current study is a psychometric validation of the Suicide Status Form (SSF-IV), the main assessment and treatment planning tool for CAMS, in an adolescent psychiatric sample. Methods Data were collected from 100 adolescents, aged 12-17, in inpatient settings (mean age = 14.6; 67.5% female, 80% white). Adolescents were administered Part A of the SSF-IV, as well as measures of overall suicide risk (both explicit and implicit), mental pain, Stress, Agitation, reasons for living, and self-esteem. Results Confirmatory factor analysis found a two-factor model to fit the data best, with Psychological Pain, Stress, and Agitation loading on one factor, and Hopelessness and Self-Hate on another. All of the core SSF constructs except Stress were significantly correlated with concurrent measures, and SSF overall suicide risk was significantly correlated with self-reported and implicit suicidality. Adolescents with suicide attempt history reported significantly higher scores on most core SSF items compared to no attempt history. Conclusions These results provide initial psychometric validation of the SSF for use with adolescents and indicate that it does not need to be adapted or modified for this age group.
Measurement of Biodiversity: Richness and Evenness

Evidence about the health of ecosystems is often thought to be related to biodiversity. Traditional attempts to define biodiversity consider two components: richness—the number of species in the ecosystem—and evenness—the extent to which species are evenly distributed. This chapter studies attempts to make both concepts precise using mathematical approaches. It describes a number of evenness indices that have been widely used, studies axioms for evenness that an index could be required to satisfy, and explores which evenness indices satisfy those axioms. The chapter also considers evenness indices that “preserve” certain partial orders. The relationship between richness and evenness and attempts to derive measures of biodiversity based on both richness and evenness are explored.
Institutionalizing torture in Israel: The Firas Tbeish decision. A commentary by John W. Schiemann, PhD

In her discussion of the court’s dismissal of the IP, she says there “is a legal system that discredits the IP’s potential while digging deeper into its own conception of torture.'' Shir has helped show that this is true more broadly of torture, beyond the IP. Indeed, I suspect the court may not view the IP as a “strange creature” causing “suspicion of the unfamiliar.” Instead, it may be by now a very familiar creature that threatens torture’s impunity in Israel, and what Shir shows is that the court has developed a systematic strategy to counter it. Torture is possible in Israel because the government and courts are complicit in deliberately creating a legal and institutional black hole where boundaries are ill-defined and obscure, and no light can shine.
Multi-Instanton Calculus in $c = 1$ String Theory

We formulate a strategy for computing the complete set of non-perturbative corrections to closed string scattering in $c=1$ string theory from the worldsheet perspective. This requires taking into account the effect of multiple ZZ-instantons, including higher instantons constructed from ZZ boundary conditions of type $(m,1)$, with a careful treatment of the measure and contour in the integration over the instanton moduli space. The only a priori ambiguity in our prescription is a normalization constant ${\cal N}_{m}$ that appears in the integration measure for the $(m,1)$-type ZZ instanton, at each positive integer $m$. We investigate leading corrections to the closed string reflection amplitude at the $n$-instanton level, i.e. of order $e^{-n/g_s}$, and find striking agreement with our recent proposal on the non-perturbative completion of the dual matrix quantum mechanics, which in turn fixes ${\cal N}_{m}$ for all $m$.
Multi-Target Stool DNA Testing for Colorectal Cancer Screening: Emerging Learning on Real-world Performance

Multi-target stool DNA (MT-sDNA) was approved in 2014 for use in screening average-risk patients for colorectal cancer (CRC). Here, we highlight recent literature from post-market studies to provide an update on clinical use and utility not possible from pre-approval studies. MT-sDNA has been included in major society guidelines as an option for colorectal cancer screening, and has seen exponentially increasing use in clinical practice. MT-sDNA appears to be attracting new patients to CRC screening, and patient adherence to diagnostic colonoscopy after a positive MT-sDNA test is high. Approximately two-thirds of these patients are found to have colorectal neoplasia (CRN), 80% of whom have at least one right-sided lesion; 1 in 3 will have advanced CRN. High yield of CRN is due not only to post-screening increase in probability but also likely improved endoscopist attention. In those with a negative high-quality colonoscopy after positive MT-sDNA test (“false positive MT-sDNA”), further interventions do not appear to be necessary. MT-sDNA is a promising tool to improve rates and quality of CRC screening. Further investigation should examine MT-sDNA performance in populations at increased risk for CRC, and as an interval test after colonoscopy to detect potentially missed lesions.
CAMPYLOBACTER PREVALENCE AND ANTIMICROBIAL RESISTANCE IN SWINE REARED IN ANTIMICROBIAL- FREE AND CONVENTIONAL PRODUCTION SYSTEMS

The objective of this study was to determine and compare the prevalence and antimicrobial resistance of Campylobacter species in swine reared in the conventional and antimicrobial free production (ABF) production systems as part of a multi-state study. To date, 19 conventional and 16 ABF groups have been followed. C. coli was the predominant species (99%) isolated in the study. Prevalence of C. coli was higher in ABF herds (60%) than conventional ones (55%). Overall, C. coli isolates exhibited highest frequency of resistance against tetracycline (Tet, 66.2%) followed by erythromycin (Ery, 53.6%). While frequency of resistance to these two antimicrobials was high in both production systems, it was significantly higher among conventional herds (83.4% and 80.8% for Tet and 77% and 81.4% for Ery on-farm and at slaughter respectively) than the ABF (56.2% and 36.6% for Tet and 34.5% and 40.4% for Ery on-farm and at slaughter respectively). Resistance against ciprofloxacin (n=17) with high MIC level (> 4 mg/liter) was also found at the farm level in both the ABF (0.6%) and conventional systems (2.8%).