cssi/SciSciGPT-SciSciNet huggingface dataset:
Effects of growth hormone–releasing hormone on cognitive function in adults with mild cognitive impairment and healthy older adults: results of a controlled trial.

Background Growth hormone–releasing hormone (GHRH), growth hormone, and insulinlike growth factor 1 have potent effects on brain function, their levels decrease with advancing age, and they likely play a role in the pathogenesis of Alzheimer disease. Previously, we reported favorable cognitive effects of short-term GHRH administration in healthy older adults and provided preliminary evidence to suggest a similar benefit in adults with mild cognitive impairment (MCI). Objective To examine the effects of GHRH on cognitive function in healthy older adults and in adults with MCI. Design Randomized, double-blind, placebo-controlled trial. Setting Clinical Research Center, University of Washington School of Medicine in Seattle. Participants A total of 152 adults (66 with MCI) ranging in age from 55 to 87 years (mean age, 68 years); 137 adults (76 healthy participants and 61 participants with MCI) successfully completed the study. Intervention Participants self-administered daily subcutaneous injections of tesamorelin (Theratechnologies Inc), a stabilized analog of human GHRH (1 mg/d), or placebo 30 minutes before bedtime for 20 weeks. At baseline, at weeks 10 and 20 of treatment, and after a 10-week washout (week 30), blood samples were collected, and parallel versions of a cognitive battery were administered. Before and after the 20-week intervention, participants completed an oral glucose tolerance test and a dual-energy x-ray absorptiometry scan to measure body composition. Main Outcome Measures Primary cognitive outcomes were analyzed using analysis of variance and included 3 composites reflecting executive function, verbal memory, and visual memory. Executive function was assessed with Stroop Color-Word Interference, Task Switching, the Self-Ordered Pointing Test, and Word Fluency, verbal memory was assessed with Story Recall and the Hopkins Verbal Learning Test, and visual memory was assessed with the Visual-Spatial Learning Test and Delayed Match-to-Sample. Results The intent-to-treat analysis indicated a favorable effect of GHRH on cognition (P = .03), which was comparable in adults with MCI and healthy older adults. The completer analysis showed a similar pattern, with a more robust GHRH effect (P = .002). Subsequent analyses indicated a positive GHRH effect on executive function (P = .005) and a trend showing a similar treatment-related benefit in verbal memory (P = .08). Treatment with GHRH increased insulinlike growth factor 1 levels by 117% (P Conclusions Twenty weeks of GHRH administration had favorable effects on cognition in both adults with MCI and healthy older adults. Longer-duration treatment trials are needed to further examine the therapeutic potential of GHRH administration on brain health during normal aging and “pathological aging.” Trial Registration clinicaltrials.gov Identifier: NCT00257712
Five Easy Pieces: the deconstruction of illuminatory data in research writing

Recently, the author completed a paper which examined possible creative strategies in the overall activity of data analysis, some of which were suggested by readings in post‐structuralism (1994, British Educational Research Journal,20, pp. 175‐185). The present paper focuses on the nature of support material in writing about and reporting qualitative research. The application of techniques of deconstruction to the use of such material are employed to see whether this might produce a useful discourse. To achieve this end, alternative or contradictory interpretations are elicited from the data used by researchers in Journal articles to illustrate their propositions. It is suggested that the examples researchers employ to illustrate the logic within their articles often undermine their basic propositions, owing to their ambiguous nature. The assumption underlying this paper is that by freeing ourselves from trying to achieve unitary and plausible accounts of social interactions, we may thus prevent certain u...
QoS policy verification for DiffServ networks

Configuring routers and network devices to achieve quality of service (QoS) goals is a challenging task. In a DiffServ environment, traffic flows are assigned specific classes of service, and service level agreements (SLA) are enforced at routers within the domain. We present a model for QoS policy configurations that facilitates efficient property-based verification. Network configuration is given as a set of policies governing each device. The model efficiently checks the SLA against the current configuration using computation tree logic model checking. By following possible decision paths for a specific flow from source to destination, properties can be checked at each hop, and assessments can be made on how well configurations adhere to the specified agreement. The model also covers configuration debugging given a specific QoS violation.
Flexible protocol specification and execution: applying event calculus planning using commitments

Protocols represent the allowed interactions among communicating agents. Protocols are essential in applications such as electronic commerce where it is necessary to constrain the behaviors of autonomous agents. Traditional approaches, which model protocols in terms of action sequences, limit the flexibility of the agents in executing the protocols. By contrast, we develop an approach for specifying protocols in which we capture the content of the actions through agents' commitments to one another. We formalize commitments in a variant of the event calculus. We provide operations and reasoning rules to capture the evolution of commitments through the agents' actions. Using these rules in addition to the basic event calculus axioms enables agents to reason about their actions explicitly to flexibly accommodate the exceptions and opportunities that arise at run time. This reasoning is implemented using an event calculus planner that helps us determine flexible execution paths that respect the protocol specifications.
The Molecular Perspective: DNA Topoisomerases

The Oncologist 2002;7:381-382 www.TheOncologist.com Each cell in your body contains about two meters of DNA, all bundled into a space a million times smaller. As you might imagine, this causes significant problems when cells manipulate their DNA, while accessing the genomic information and when dividing the DNA into two portions during cell division. To make things even more complicated, the DNA is a double helix, so it must be unwound to access its information. If you have ever tried to unravel the individual fibers in a rope, you will understand the challenges that this imposes. All living cells have a set of special enzymes, the DNA topoisomerases, that deal with these topological problems. There are two basic types that solve two major topological problems. Class I topoisomerases, shown in Figure 1, solve the problems caused by the helical nature of DNA. They grasp the DNA and make an incision, cutting the strand but keeping a firm grip on one of the severed ends. The gapped helix is then free to rotate around the other strand, releasing any strain that may be present from overwinding or underwinding. Once relaxed, the topoisomerase reconnects the broken strand. DNA topoisomerase I plays an essential role in DNA replication and DNA transcription. In both cases, the DNA must be unwound to allow reading of the information held inside. Topoisomerase performs its duty nearby, releasing the stresses that occur in the process. The class II topoisomerases, shown in Figure 2, perform an even more remarkable feat involving the juggling of two DNA strands. These topoisomerases grab a DNA double helix and break both strands, retaining a firm grip on each half. Then, a second DNA strand is passed through the gap. Finally, the first DNA is resealed behind it. Topoisomerase II plays an essential role in cell division, as the chromosomes are segregated into the two daughter cells. It releases any loops and tangles that may be linking the two chromosomes together as they separate. Some of the most commonly employed antitumor drugs attack the topoisomerases, taking advantage of their key role in cellular information flow. The anthracyclines, such as doxorubicin and daunorubicin, attack type II topoisomerases, and compounds based on the plant toxin campothecin attack type I topoisomerases. In both cases, the drugs bind to the complex of DNA and topoisomerase after the incisions have been made, blocking the reaction that reseals the DNA. The binding of the drug is reversible, so if the drug then unbinds, the topoisomerase can finish its job and everything is fine. But in some cases, a neighboring replication fork runs into the blocked topoisomerase, causing the release of a piece of the gapped DNA strand that is not chemically held by the topoisomerase. The result is breakage of the DNA, resulting in death of the cell. Fundamentals of Cancer Medicine The Oncologist
A summary of the Texas Tuberculosis Research Symposium 2009: Emerging directions in TB research and clinical affairs

Every year approximately nine million new tuberculosis cases are identified worldwide, with 1.7 million deaths attributed to the disease. Furthermore, there are at least 10 million individuals with latent tuberculosis, with the potential to kill nearly 30 million people over the next decade. In the United States alone, there were more than 13,200 reported cases of active tuberculosis. The magnitude of these figures, and the cost to both individuals and society as a whole, solidify the importance of developing novel directions in tuberculosis research and improvement in clinical related affairs to contain and control disease. The present issue contains a series of reviews, comments and original papers by speakers and presenters of the Texas Tuberculosis Research Symposium, held on February 7 th ,2 009 in
Optimal routing and scheduling in flexible manufacturing systems using integer programming

Here we consider the problem of maximum throughput routing and scheduling for flexible manufacturing systems/cells (FMS/FMC) and processing networks. Such a system consists of a set of machines which process materials and a transport network for moving materials among the machines. The goal in this problem is to find a policy for introducing jobs into the network and routing jobs through the network that maximizes the average number of jobs entering the system per unit time. We present an 0-1 linear program formulation of the maximum throughput routing and scheduling problem. This formulation is based on an extension of the linear programming formulation of the multistage network flow problem. For small problem instances, existing 0-1 solvers can be used to find an optimal schedule. For larger problem instances, we discuss the use of linear programming relaxations to find performance guarantees and rounding techniques for extracting feasible 0-1 solutions from the linear program solution. Finally, we demonstrate the general techniques described in the paper on a large-scale example. For this example, solving the linear programming relaxation and extracting a feasible schedule produces an optimal solution.
NEIGHBORHOOD STRUCTURAL CHARACTERISTICS, INDIVIDUAL-LEVEL ATTITUDES, AND YOUTHS' CRIME REPORTING INTENTIONS†

Although the “stop snitching” phenomenon has brought recent attention to crime reporting, researchers have recognized for a long time the importance of this issue. Early studies focused on individual-level factors related to reporting, but recently, researchers have begun to examine neighborhood-level predictors. Most of these studies, however, omit key individual-level predictors of reporting and provide relatively little insight into the individual-level processes through which neighborhood context might affect reporting. This study uses survey data from a multisite, school-based study to examine whether neighborhood structural characteristics and individual-level attitudes and experiences are related to youths’ intentions to report crime. In addition, we assess whether neighborhood characteristics influence reporting via their effect on individual-level attitudes and experiences. We find that neighborhood poverty has an inverse relationship with crime reporting intentions and that numerous individual-level measures are associated with reporting, including attitudes toward the police, delinquency, and perceptions of the community. Importantly, the effects of neighborhood characteristics are reduced when youths’ attitudes and experiences are included in the model. Taken together, our findings suggest that neighborhood context might affect reporting by shaping the attitudes and experiences of youth.
Polysomnographic values in adolescents with ataxia telangiectasia

Most adolescents with ataxia telangiectasia (A-T) develop progressive bulbar muscle weakness and decreased pulmonary reserve. The purpose of this study was to define the patterns of sleep and respiration during sleep, and to identify sleep-related breathing problems in subjects with A-T. To address these issues, overnight polysomnography was performed on 12 adolescents with A-T. Eleven of the 12 subjects completed overnight polysomnography. The median age was 16 years (range, 13–20 years). All subjects in the study were wheelchair-bound and the median forced vital capacity (% predicted of normal) was 44% (range, 16–82%). The mean sleep efficiency was 72.6% with a mean apnea hypopnea index (AHI) of 0.7 events/hr (range, 0–2.2). The majority of apnea/hypopneas were REM related. The mean central apnea index was 0.1 events/hr (range, 0–0.2). The mean oxygen saturation nadir was 92.7% (range, 87–96) and the mean peak end-tidal carbon dioxide ET value was 53.8 mm Hg (range, 49–60). Two of 11 subjects had ET values ≥50 mm Hg for more than 50% of total sleep time. In this study, the majority of A-T adolescents had infrequent partial or complete upper airway obstructions during sleep and minimal nighttime hypoxemia. They did, however, have decreased sleep efficiency most likely, due in part, to their underlying neurological condition. This decrease in total sleep time may underestimate hypoventilation. Based on these findings, overnight polysomnography should be considered in adolescents with A-T, particularly in those in which there is a clinical suspicion of sleep related breathing abnormalities. Pediatr Pulmonol. 2008; 43:674–679. © 2008 Wiley-Liss, Inc.
Structure and properties of tin‐containing polymers deposited from tetramethyltin HF plasma

There has been an increasing interest in depositing metal or metal-containing thin films through plasma polymerization for various applications. This work deals with the plasma graft polymerization of tetramethyltin (TMT) on polypropylene surfaces with an aim of producing special electrical and optical coatings. The fragmentation of TMT under cold plasma conditions and the recombination of discharge-generated active species were studied by analyzing the resulting molecular mixture trapped outside of the plasma zone by HR-MS and GC-MS techniques. It was found that the predominant ionic fragment is m/z = 165, and the most probable intermediate structure of the polymer formation mechanism is hexamethylditin. The structure of polymeric layers deposited on various substrates were investigated by ESCA and FT-IR methods. Intense oxidation of tin-based polymeric layers were observed under open laboratory conditions. The existence of weak SnSn and SnC bonds in the polymeric structure is suggested to be responsible for this reaction. This phenomenon was associated with enhanced UV transparency. Based on analytical data a plasma-enhanced polymerization mechanism of TMT is proposed. © 1995 John Wiley & Sons, Inc.
Nutrient Enrichment and Fish Nutrient Tolerance: Assessing Biologically Relevant Nutrient Criteria1

: Relationships between nutrient concentrations and fish nutrient tolerance were assessed relative to established nutrient criteria. Fish community, nitrate plus nitrite (nitrate), and total phosphorus (TP) data were collected during summer low-flow periods in 2003 and 2004 at stream sites along a nutrient-enrichment gradient in an agricultural basin in Indiana and Ohio and an urban basin in the Atlanta, Georgia, area. Tolerance indicator values for nitrate and TP were assigned for each species and averaged separately for fish communities at each site (TIVo). Models were used to predict fish species expected to occur at a site under minimally disturbed conditions and average tolerance indicator values were determined for nitrate and TP separately for expected communities (TIVe). In both areas, tolerance scores (TIVo/TIVe) for nitrate increased significantly with increased nitrate concentrations whereas no significant relationships were detected between TP tolerance scores and TP concentrations. A 0% increase in the tolerance score (TIVo/TIVe = 1) for nitrate corresponded to a nitrate concentration of 0.19 mg/l (compared with a USEPA summer nitrate criterion of 0.17 mg/l) in the urban area and 0.31 mg/l (compared with a USEPA summer nitrate criterion of 0.86 mg/l) in the agricultural area. Fish nutrient tolerance values offer the ability to evaluate nutrient enrichment based on a quantitative approach that can provide insights into biologically relevant nutrient criteria.
Subspace selection for partially adaptive sensor array processing

This paper introduces a cross-spectral metric for subspace selection and rank reduction in partially adaptive minimum variance array processing. The counter-intuitive result that it is suboptimal to perform rank reduction via the selection of the subspace formed by the principal eigenvectors of the array covariance matrix is demonstrated. A cross-spectral metric is shown to be the optimal criterion for reduced-rank Wiener filtering.
An inner–outer factorization in ℓp with applications to ARMA processes

Abstract The following inner–outer type factorization is obtained for the sequence space l p : if the complex sequence F = ( F 0 , F 1 , F 2 , … ) decays geometrically, then for any p sufficiently close to 2 there exist J and G in l p such that F = J ⁎ G ; J is orthogonal in the Birkhoff–James sense to all of its forward shifts S J , S 2 J , S 3 J , … ; J and F generate the same S-invariant subspace of l p ; and G is a cyclic vector for S on l p . These ideas are used to show that an ARMA equation with characteristic roots inside and outside of the unit circle has Symmetric-α-Stable solutions, in which the process and the given white noise are expressed as causal moving averages of a related i.i.d. SαS white noise. An autoregressive representation of the process is similarly obtained.
What's Wrong with Bribery

In this chapter analyzing the moral content of bribery, bribes are conceptualized as bilateral agreements between two parties (a briber and bribee) in which the briber gives or offers something of value in exchange for the bribee's agreeing to act on the briber's behalf. In taking part in such an agreement, the bribee violates a duty of loyalty arising out of his office, position, or involvement in some practice. The briber, in turn, commits the morally wrongful act of inducing another to be disloyal. Understanding bribery in this matter is shown to be helpful in resolving a number of perplexing practical problems in the law of bribery, including cases in which a putative bribee is given something of value (e.g., prosecutorial leniency, money) in return for doing the right thing - e.g., a witness' testifying truthfully for the government in a criminal case, or a senator's voting for legislation that is in the best interests of her constituents. An additional distinction between loyalty in the descriptive or empirical sense and loyalty in the moral or normative sense is useful in analyzing cases such as those in which a prison guard at Auschwitz is given something of value in return for allowing a prisoner to escape. Understanding disloyalty in terms of a violation of positional duty can also help explain what appears at first glance to be a puzzling cultural variation in attitudes regarding the tolerance of bribery. Finally, the chapter addresses the moral content of cases in which the putative briber or bribee either uses or is the victim of coercion.
Ultrasound directed self-assembly of user-specified patterns of nanoparticles dispersed in a fluid medium

We employ an ultrasoundwave field generated by one or more ultrasound transducers to organize large quantities of nanoparticles dispersed in a fluid medium into two-dimensional user-specified patterns. To accomplish this, we theoretically derive a direct method of calculating the ultrasound transducer parameters required to assemble a user-specified pattern of nanoparticles. The computation relates the ultrasoundwave field and the force acting on the nanoparticles to the ultrasound transducer parameters by solving a constrained optimization problem. We experimentally demonstrate this method for carbon nanoparticles in a water reservoir and observe good agreement between experiment and theory. This method works for any simply closed fluid reservoir geometry and any arrangement of ultrasound transducers, and it enables using ultrasound directed self-assembly as a scalable fabrication technique that may facilitate a myriad of engineering applications, including fabricating engineered materials with patterns of nanoscale inclusions.
Further Invesitgation of Modeling Limit Cycle Oscillation Behavior of the F-16 Fighter Using a Harmonic Balance Approach

A computational investigation of limit cycle oscillation behavior of the F-16 fighter configuration using a nonlinear frequency-domain harmonic-balance approach is presented. The research discussed in this latest paper is a follow-on to our work presented at the 2004 SDM conference. Our latest eorts have been directed toward assessing the eects of mean angle-of-attack, wingtip geometry, wing twist, and static aeroelastic deformation on flutter onset and LCO response.
Room temperature Frenkel-Wannier-Mott hybridization of degenerate excitons in a strongly coupled microcavity.

Hybrid organic-inorganic polaritons are formed by the simultaneous strong coupling of two degenerate excitons and a microcavity photon at room temperature. Wannier-Mott and Frenkel excitons in spatially separated ZnO and 3,4,7,8-napthalene tetracarboxylic dianhydride (NTCDA) layers, respectively, placed in a single Fabry-Perot microcavity contribute to the interaction with the cavity. A Rabi splitting of $(322\ifmmode\pm\else\textpm\fi{}8)\text{ }\text{ }\mathrm{meV}$ between the upper and middle branches of the three branch polariton energy-momentum dispersion is observed. This is compared to only $(224\ifmmode\pm\else\textpm\fi{}22)\text{ }\text{ }\mathrm{meV}$ and $(218\ifmmode\pm\else\textpm\fi{}8)\text{ }\text{ }\mathrm{meV}$ Rabi splittings for NTCDA-only and ZnO-only reference cavities, respectively, and indicates that the excitonic component of the polariton is a Frenkel-Wannier-Mott hybrid. Unlike previous reports of hybrid polaritons, the mixing of the organic and inorganic eigenstates occurs independently of angle due to their energetic degeneracy, and can be tailored by adjusting the optical field distribution within the cavity.
The ssrA-Tag Facilitated Degradation of an Integral Membrane Protein

ATP-dependent degradation plays a critical role in the quality control and recycling of proteins in cells. However, complete degradation of membrane proteins by ATP-dependent proteases in bacteria is not well-studied. We discovered that the degradation of a multidomain and multispan integral membrane protein AcrB could be facilitated by the introduction of a ssrA-tag at the C-terminus of the protein sequence and demonstrated that the cytoplasmic unfoldase-protease complex ClpXP was involved in the degradation. This is the first report to our knowledge to reveal that the ClpXP complex is capable of degrading integral membrane proteins. The chaperone SspB also played a role in the degradation. Using purified proteins, we demonstrated that the addition of the ssrA-tag did not drastically affect the structure of AcrB, and the degradation of detergent solubilized AcrB by purified ClpXP could be observed in vitro.
Locke’ Criticism of Innatism and Its Paradox

Locke’s criticism of innatism is particularly fierce. For a long time, while studies have usually focused on Locke’s denial of innate knowledge, little attention has been paid to the premises and inner contradictions of this criticism, which in turn impaired the importance of the criticism in the history of philosophy. The two premises are: "a clear and distinct idea in the mind must be perceived by it" and "it is impossible for the same thing to be and not to be in the mind". With the two premises Berkeley and Hume developed their empiricism but the premises also led British empiricism into a paradox.
The mode of material distribution in equipment manufacturing based on information system

Material distribution is a difficulty of management in equipment manufacturing, but information technololgy can be used to resolve problems occured in handwork mode,improve the capability of material distribution effectively. Driving distributing by the manufactural order, using virtual distributing, creating material drawing bill automatically, instructing the operation by label, to set up an effective procedure of material distribution, while improving the management level on stock control,cost control and quality management.
Contingency Contractor Optimization Phase 3 Sustainment Third-Party Software List - Contingency Contractor Optimization Tool - Prototype

The Contingency Contractor Optimization Tool - Prototype (CCOT-P) requires several third-party software packages. These are documented below for each of the CCOT-P elements: client, web server, database server, solver, web application and polling application.
Should patients with single renal stone occurrence undergo diagnostic evaluation

Abstract Diagnostic evaluation was conducted on 34 patients with a single episode of renal stone formation. Absorptive hypercalciuria was disclosed in 55.9 per cent (23.5 per cent type 1 and 32.4 per cent type II), renal hypercalciuria in 11.8 per cent, primary hyperparathyroidism in 2.9 per cent, hyperaricosuric calcium oxalate nephrolithiasis in 8.8 per cent and no metabolic abnormality in 20.6 per cent. Compared to the group with recurrent stone formation the group with a single stone episode had just as severe biochemical abnormalities or laboratory results, such as hypercalciuria and exaggerated calciuric response to oral calcium load in absorptive hypercalciuria, high fasting urinary calcium and cyclic adenosine monophosphate in renal hypercalciuria, hyperuricosuria in hyperuricosuric calcium oxalate nephrolithiasis and low urine volume in no metabolic abnormality. The results suggest that the same physiological and environmental disturbances characterize stone formation in patients with a single stone episode as in those with recurrent stone formation and indicate the need for diagnostic evaluation.
Social Dynamics of Legitimacy and Justice

Taking into consideration the welfare of collectivities in which individuals are embedded, interrelated justice and legitimacy processes draw attention to social stability and the potential conditions giving rise to social change. To explicate these dynamics, the chapter offers a detailed conceptualization of legitimacy. Two perspectives—one focused on procedural justice and the other on distributive—demonstrate how justice processes contribute to the emergence of legitimacy. Legitimacy processes, however, also color perceptions of justice and constrain responses to injustice. Given the bidirectional relationship between justice and legitimacy, emphasis rests on the nature of the social context and underlying cognitive, identity, and comparison processes to signal when legitimacy may dampen responses to injustice to maintain social stability or when such responses might challenge existing so-called legitimate inequalities.
To Resubmit or Not Resubmit and How to Do It

First the good news: the resubmission of a grant application that was not funded, whether to NIH or a private foundation, is often considerably easier than submitting the application the first time. In fact, it is much, much easier, and it is one reason to strongly consider resubmitting every single grant that fails, even if it requires dramatic reformatting. For NIH, this is due to a recent change in NIH policy, namely, that you can keep resubmitting a grant application even after it fails its “two strikes” policy. It will be judged as a new grant application on the third try, but with each successive application, it will likely continue to improve and hopefully, eventually, reach the point of funding. So let me repeat myself: regardless of the specific grant mechanism, strongly consider a resubmission if your first application did not succeed. It won’t seem nearly as daunting as putting it together in the first place.
Ionosphere characterization using received HF communications

In HF communications, both intra-and inter-symbol fading and losses can vary significantly between two nodes. While these channel effects may be problematic for maintaining a link, they may provide information about the structure of the ionosphere. We utilize our previously developed communications simulator which simulates a received RF data stream for a given channel response. Using channel responses estimated from the output from a ray-based propagation model, as well as modified modules within a Software Defined Radio framework, we map propagation channel variations to the received signal demodulator's corrective filters. By minimizing a cost function that compares predicted channel reponses to the true channel response, we devise an algorithm that enables estimating ionosphere features from the received signals.
Space Weather: Historical and Contemporary Perspectives

A somewhat personalized overview is presented of the effects of solar-terrestrial processes on electrical technologies, beginning with the electrical telegraphs in the mid-eighteenth century to the current era of extensive ground- and space-based commercial and governmental technical systems (including national security) upon which modern society depends. As human technologies increased in diversity over the last century and a half, space weather effects have continued to be of significant importance in the successful design and operations of many of these technologies.
Generating exponentially smaller POMDP models using conditionally irrelevant variable abstraction

The state of a POMDP can often be factored into a tuple of n state variables. The corresponding flat model, with size exponential in n, may be intractably large. We present a novel method called conditionally irrelevant variable abstraction (CIVA) for losslessly compressing the factored model, which is then expanded into an exponentially smaller flat model in a representation compatible with many existing POMDP solvers. We applied CIVA to previously intractable problems from a robotic exploration domain. We were able to abstract, expand, and approximately solve POMDPs that had up to 1024 states in the uncompressed flat representation.
Association of adjuvant chemotherapy with overall survival in resected pancreatic adenocarcinoma previously treated with neoadjuvant therapy.

404Background: Guidelines for adjuvant chemotherapy in patients with resected pancreatic adenocarcinoma (PDAC) who received neoadjuvant chemotherapy are equivocal. A lymph node ratio (LNR) ≥ 0.15 m...
Conclusion: Promising Partners or Strange Bedfellows? Faith-Based Providers and Government Funders

Our volume has set out to examine the dynamics of social service delivery with a principal focus on faith-based organizations. Our qualitative and comparative approach has analyzed the contours of welfare service provision across different social service domains (family, housing, addiction recovery), provider types (faith-intensive, faith-related, secular), and locales (Mississippi, Michigan, and Washington-Oregon ). A consistent analytical theme has also been explored throughout this volume in the form of the three C’s of social service provision. Using what we called a layered case study approach, we have been mindful of programmatic content (service delivery dynamics), organizational culture (agency mission, values, etc.), and ecological context (community environment, religious landscape, etc.).
Medical oncologists’ willingness to participate in bundled payment programs

Bundled payment programs play an increasingly important role in transforming reimbursement for oncologic care. We assessed determinants of oncologists’ willingness to participate in bundled payment programs for breast cancer. We hypothesized that providers would be more likely to participate in bundled payment programs if offered higher levels of reimbursement for each episode of care. Oncologists from Florida, New Jersey, New York, and Pennsylvania were identified in the AMA database or by patients listed in state cancer registries. Providers were randomized to receive one of four versions of a survey describing bundled payment programs offering different levels of compensation for the first year of localized breast cancer treatment ($5000, $10,000, $15,000, or $20,000). Physicians rated their likelihood of participation in a bundled program on a Likert scale. Logistic regression was used to analyze determinants of likelihood of participation in bundling. Among 460 respondents, only 17% of oncologists were highly likely to participate in a bundled program paying $5000 for the first year of care, rising to 41% for the $15,000 program, but falling to 34% for the $20,000 program. Likelihood of participation was higher among oncologists who were male, older, and believed that cancer patients should not be offered high-cost drugs with minimal survival benefit. Our results suggest that medical oncologists have limited enthusiasm for bundled payments, and higher payments may not overcome resistance to bundling among a substantial proportion of physicians.
Potential von Finanzanalysen: Ein Beispiel

Bedarf fur Finanzanalysen besteht nicht nur im betrieblichen, sondern auch im privaten Bereich. Dies gilt in besonderem Mase fur die Finanzierung privater Immobilien — auch dann, wenn diese zu eigenen Wohnzwecken genutzt werden. Traditionell steht hier der (darlehensfinanzierte) Eigentumserwerb im Vordergrund. Entscheidend fur die Moglichkeit, eine Immobilie zu eigenen Wohnzwecken nutzen zu konnen, ist aber nicht das Eigentum, sondern der Besitz.1 Alternativ zum Eigentumserwerb kann der Besitz einer Immobilie zu eigenen Wohnzwecken durch Miete oder Leasing erworben werden. Das daraus resultierende Entscheidungsproblem verdeutlicht die Komplexitat und Wichtigkeit fundierter Finanzanalysen und dient spater in Kapitel 4 als Basis der Beispiele, mit denen wir die Funktionalitat des dort entwickelten „Integrierten Finanzanalysesystems“ (IFAS) illustrieren werden.
Expression of the POTE gene family in human ovarian cancer

The POTE family includes 14 genes in three phylogenetic groups. We determined POTE mRNA expression in normal tissues, epithelial ovarian and high-grade serous ovarian cancer (EOC, HGSC), and pan-cancer, and determined the relationship of POTE expression to ovarian cancer clinicopathology. Groups 1 & 2 POTEs showed testis-specific expression in normal tissues, consistent with assignment as cancer-testis antigens (CTAs), while Group 3 POTEs were expressed in several normal tissues, indicating they are not CTAs. Pan-POTE and individual POTEs showed significantly elevated expression in EOC and HGSC compared to normal controls. Pan-POTE correlated with increased stage, grade, and the HGSC subtype. Select individual POTEs showed increased expression in recurrent HGSC, and POTEE specifically associated with reduced HGSC OS. Consistent with tumors, EOC cell lines had significantly elevated Pan-POTE compared to OSE and FTE cells. Notably, Group 1 & 2 POTEs (POTEs A/B/B2/C/D), Group 3 POTE-actin genes (POTEs E/F/I/J/KP), and other Group 3 POTEs (POTEs G/H/M) show within-group correlated expression, and pan-cancer analyses of tumors and cell lines confirmed this relationship. Based on their restricted expression in normal tissues and increased expression and association with poor prognosis in ovarian cancer, POTEs are potential oncogenes and therapeutic targets in this malignancy.
Posttraumatic Stress Disorder Symptoms, Functioning, and Suicidal Ideation in US Military Veterans: A Symptomics Approach.

Objective To examine the association between individual symptoms of posttraumatic stress disorder (PTSD) and measures of functioning, quality of life, and suicidal ideation given that previous research has focused on PTSD diagnosis and symptom clusters. Methods Data from a large, contemporary, nationally representative sample of 1,484 US military veterans who participated in the National Health and Resilience in Veterans Study from September-October 2013 were analyzed to examine the association between individual DSM-5 PTSD symptoms and measures of mental, physical, and cognitive functioning; quality of life; and suicidal ideation. Results Nonspecific anhedonic and hyperarousal symptoms of PTSD were significantly associated with the various measures of functioning and explained a significant portion of variance across the different measures (P values < .05). Specifically, the following symptoms explained the most variance in physical functioning: loss of interest (12.4%), sleep difficulties (12.3%), and psychogenic amnesia (8.3%); mental functioning: concentration difficulties (11.4%), negative thoughts (9.2%), and difficulties experiencing positive affect (8.4%); cognitive functioning: concentration difficulties (18.6%), heightened startle (6.4%), and difficulty experiencing positive affect and risky/destructive behavior (both 6.3%); quality of life: concentration difficulties (11.5%), difficulty experiencing positive affect (11.1%), and sleep difficulties (9.4%); and suicidal ideation: difficulty experiencing positive affect (12.3%), negative thoughts (11.3%), and irritability/aggression (9.5%). These findings persisted after adjustment for lifetime trauma burden and severity of PTSD and depressive symptoms. Conclusions Nonspecific PTSD symptoms are most strongly related to measures of functioning, quality of life, and suicidal ideation in US veterans. These results underscore the potential clinical utility of a symptom-based approach to the assessment, monitoring, and treatment of PTSD.
The Birth of the Reader: Inside the Final Edits to Infinite Jest

David Foster Wallace had a notoriously vexed relationship with copyeditors, which led D. T. Max to draw a natural conclusion: the exhausting round of corrections to the page proofs of Infinite Jest...
Role of Palliative Care in the Outpatient Management of the Chronic Heart Failure Patient

Patients with heart failure (HF) have an increased symptom burden and complex psychosocial and decision-making needs that necessitate the integration of palliative care. However, in the current era, palliative care is frequently evoked for these patients only at the end-of-life or in the inpatient setting; rarely is palliative care proactively utilized in outpatients with HF. The purpose of this review is to evaluate the current state of palliative care and heart failure and to provide a roadmap for the integration of palliative care into outpatient HF care. Recent studies, including PAL-HF, CASA, and SWAP-HF, have demonstrated that structured palliative care interventions may improve quality of life, depression, anxiety, understanding of prognosis, and well-being in HF. HF is associated with high mortality risk, significant symptom burden, and impaired quality of life. Palliative care can meet many of these needs; however, in the current era, palliative care consultations in HF occur late in the disease course and too often in the inpatient setting. Primary palliative care should be provided to all outpatients with heart failure based on their needs, with referral to secondary palliative care provided based on certain triggers and milestones.
Intraoperative ultrasound to monitor spinal cord blood flow after spinal cord injury

Spinal cord injury (SCI) affects approximately 2.5 million people worldwide. The primary phase of SCI is initiated by mechanical trauma to the spinal cord, while the secondary phase involves the ensuing tissue swelling and ischemia that worsen tissue damage and functional outcome. Optimizing blood flow to the spinal cord after SCI can mitigate injury progression and improve outcome. Accurate, sensitive, real-time monitoring is critical to assessing the spinal cord perfusion status and optimizing management, particularly in those with injuries severe enough to require surgery. However, the complex anatomy of the spinal cord vasculature and surrounding structures present significant challenges to such a monitoring strategy. In this study, Doppler ultrasound was hypothesized to be a potential solution to detect and monitor spinal cord tissue perfusion in SCI patients who required spinal decompression and/or stabilization surgeries. This approach could provide real-time visual blood flow information and pulsatility of the spinal cord as biomarkers of tissue perfusion. Importantly, Doppler ultrasound could be readily integrated into the surgical workflow, because the spinal cord was exposed during surgery, thereby allowing easy access for Doppler deployment, while keeping the dura intact. Doppler ultrasound successfully measured blood flow in single and bifurcated microfluidic channels at physiologically relevant flow rates and dimensions in both in-vitro and in-vivo porcine SCI models. Furthermore, perfusion was quantified from the obtained images. Our results provide a promising and viable solution to intraoperatively assess and monitor blood flow at the SCI site to optimize tissue perfusion and improve functional recovery in SCI patients.
The association between facility volume and overall survival in patients with Merkel cell carcinoma

BACKGROUND Merkel cell carcinoma is an uncommon malignancy often requiring multidisciplinary management. The purpose of this study was to determine whether high-volume facilities have improved outcomes in patients with Merkel cell carcinoma relative to lower-volume facilities. METHODS A total of 5304 patients from the National Cancer Database with stage I-III Merkel cell carcinoma undergoing surgery were analyzed. High-volume facilities were the top 1% by case volume. Multivariable Cox regression and propensity score-matching were performed to account for imbalances between groups. RESULTS Treatment at high-volume facilities (hazard ratio: 0.74; 95% confidence interval: 0.65-0.84, P < .001) was independently associated with improved overall survival (OS) in multivariable analyses. In propensity score-matched cohorts, 5-year OS was 62.3% at high-volume facilities vs 56.8% at lower-volume facilities (P < .001). Median OS was 111 months at high-volume facilities vs 79 months at lower-volume facilities. CONCLUSION Treatment at high-volume facilities is associated with improved OS in Merkel cell carcinoma. Given the impracticality of referring all elderly patients with Merkel cell carcinoma to a small number of facilities, methods to mitigate this disparity should be explored.
NK cells and CTLs are required to clear solid tumor in a novel model of patient-derived-xenograft

Existing patient-derived-xenograft (PDX) mouse models of solid tumors lack a fully tumor-donor matched 9syngeneic9 and functional immune system. We developed such a model by engrafting lymphopenic recipient mice with a fresh undisrupted piece of solid tumor, whereby tumor-infiltrating lymphocytes (TIL) expanded in the recipient mice for several weeks. Tumors engrafted in about seventy to eighty percent of syngeneic-immune-system-PDX (SIS-PDX) mice, which harbored tumor-exhausted immune-effector and functional immune-regulatory cells persisting for at least six-months post-engraftment. Interleukin-15 (IL-15)-stimulation in addition to immune checkpoint inhibition (ICI), prevented resistance, resulting in complete or partial response to combined treatment. Further, the depletion of Cytotoxic T lymphocytes (CTLs) and/or Natural Killer (NK) cells from combined immunotherapy in SIS-PDX mice revealed that both cell types are required for the maximal response to tumor. Our novel SIS-PDX model provides a valuable resource for powerful mechanistic and therapeutic studies designed to eradicate solid tumors.
Oregon’s approach to leveraging system-level data to guide a social determinants of health-informed approach to children’s healthcare

Background Children’s health and healthcare use are impacted by both medical conditions and social factors, such as their home and community environment. As healthcare systems manage a pediatric population, information about these factors is crucial to providing quality care coordination. Methods The authors developed a novel methodology combining medical complexity (using the Pediatric Medical Complexity Algorithm) and social complexity (using available family social factors known to impact a child’s health and healthcare use) to create a new health complexity model at both the population-level and individual-level. System-level data from Oregon’s Medicaid Management Information Systems and Integrated Client Services database was analysed, examining claims data and service utilization, to calculate the health complexity of children enrolled in Medicaid/Child Health Insurance Program (CHIP) across Oregon. Results Of the 390 582 children ages 0 to 17 enrolled in Medicaid/CHIP in Oregon from July 2015 to June 2016, 83.4% (n=325 900) had some level of medical and/or social complexity and 22.1% (n=85 839) had health complexity (both medical and social complexity). Statistically significant (p Conclusions Given the high proportion of children with health complexity, these findings demonstrate that a large number of Medicaid/CHIP-insured children could benefit from targeted care coordination and differential resource allocation. Reports have been shared with state, county and health system leaders to drive work across the state. This paper describes the collaborative process necessary for other states considering similar work.
Reflector-based Transrectal 3D Ultrasound Imaging System for Transperineal Needle Intervention

The conventional transrectal ultrasound (TRUS) probe for transperineal needle insertion is typically a sagittal viewing linear array or combined with another transverse curvilinear array. Physicians are required to manually move and rotate the probe back and forth to determine the needle trajectory or to render 3D volume. For the hands-free 3D imaging guidance of transperineal needle insertion, this paper proposes a reflector-based 3D TRUS imaging probe. The proposed probe is enabled by motorizing rotation of a forward-viewing array transducer and bending the ultrasound beam to cover whole prostate utilizing an acoustic mirror as reflector. The proposed device is capable of providing an arbitrary angled B-mode slice with respect to prostate based on the motorized probe rotation angle adjustment, and enables to render 3D images with volume-based reconstruction. In the experimental validation with the cyst phantom, the contrast-noise ratios in the 0 and 90-degree of rotation angle were 4.36 and 4.05 dB in the image acquisition with reflector, and 4.26 and 5.07 dB in that without reflector, respectively. Also, the 3D appearance of cyst can be rendered with maximum intensity projection. These results demonstrated the limited image quality deterioration by adding reflector, and indicate the reflector-based TRUS probe has a potential to improve the guidance of transperineal needle insertion.