cssi/SciSciGPT-SciSciNet huggingface dataset:
Ketoconazole effects on corticosteroid disposition

Lettre et reponse a l'editeur, a propos des effets du ketoconazole sur la distribution de prednisone oral ou de prednisolone intraveineuse, chez l'homme. La coadministration de ketoconazole et de prednisone augmente l'effet immunodepressif du ketoconazole par inhibition des fonctions cellulaires des lymphocytes T
Aggregate Tensile Strength and Friability Characteristics of Furrow and Sprinkler Irrigated Fields in Southern Idaho

Agricultural crops grown in southern Idaho are furrow or sprinkler irrigated. Therefore, the soil experiences several wetting and drying cycles each growing season that can contribute to changes in aggregate tensile strength and friability. The objective of the research was to evaluate the influence of irrigation on soil structural properties. Four furrow-irrigated fields were sampled at the top and bottom of the field, in the furrow and on the bed location of the furrow. Five sprinkler-irrigated fields were sampled at depths of 0–5 and 5–15 cm and at the top and bottom of the field. Results from this study indicate that differences in tensile strength in furrow-irrigated fields were only evident soon after irrigation; otherwise, there were few differences in tensile strength and friability. In sprinkler-irrigated fields tensile strength increased with depth in three of the five fields measured. Friability was less affected by depth.
New bounds on the information-theoretic key agreement of multiple terminals

We study the problem of information-theoretically secure secret key agreement under the well-known source model and channel model. In both of these models the parties wish to create a shared secret key that is secure from an eavesdropper with unlimited computational resources. In the channel model, the first party can choose a sequence of inputs to a discrete memoryless channel, which has outputs at the other parties and at the eavesdropper. After each channel use, the parties can engage in arbitrarily many rounds of interactive authenticated communication over a public channel. At the end, each party should be able to generate the key. In the source model, the parties wishing to generate a secret key (as well as the eavesdropper) receive a certain number of independent identically distributed copies of jointly distributed random variables after which the parties are allowed interactive authenticated public communication, at the end of which each party should be able to generate the key. We derive new lower and upper bounds on the secret key rate under the source model and the channel model, and introduce a technique for proving that a given expression bounds the secrecy rate from above in the channel model. Our lower bounds strictly improve what is essentially the best known lower bound in both the source model and the channel model. Our upper bound in the channel model strictly improves the current state of art upper bound. We do not know whether our new upper bound in the source model represents an strict improvement but it includes the current best known bound as a special case.
Effect of functional foot orthoses on first metatarsophalangeal joint dorsiflexion in stance and gait.

Reduction in first metatarsophalangeal joint maximum degree of dorsiflexion with dorsiflexion of the first ray has been proposed to be the predominant cause of hallux abducto valgus and hallux rigidus. We sought to determine whether orthoses made from a cast with the first ray plantarflexed and a 4-mm medial skive could increase the maximum degree of dorsiflexion in patients with functional hallux limitus in stance and gait. Forty-eight feet of 27 subjects were casted for orthoses with the first ray plantarflexed and in the customary neutral rearfoot position with locked midtarsal joint. First metatarsophalangeal joint maximum dorsiflexion was measured with and without orthoses in stance, and subhallux pressure was measured with and without orthoses at heel-off. Changes in mean maximum dorsiflexion in stance and in mean maximum subhallux pressure in gait with orthoses were significant. We investigated the relationship between this increase in dorsiflexion and gender, shoe size, resting calcaneal stance position, and change in resting calcaneal stance position with the use of orthoses. These correlations were not statistically significant. The biomechanical implication of increasing limited first metatarsophalangeal joint dorsiflexion with orthoses is discussed and related to the clinical treatment of deformities, including hallux valgus and hallux rigidus. The use of orthoses to decrease subhallux pressure is also discussed. (J Am Podiatr Med Assoc 96(6): 474-481, 2006)
Dose-Reduced Busulfan, Cyclophosphamide, and Autologous Stem Cell Transplantation for Human Immunodeficiency Virus–Associated Lymphoma: AIDS Malignancy Consortium Study 020

Abstract Intensive chemotherapy for human immunodeficiency virus (HIV)-associated non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) has resulted in durable remissions in a substantial proportion of patients. High-dose chemotherapy and autologous stem cell transplantation (AuSCT), moreover, has resulted in sustained complete remissions in selected patients with recurrent chemosensitive disease. Based on a favorable experience with dose-reduced high-dose busulfan, cyclophosphamide, and AuSCT for older patients with non-HIV–associated aggressive lymphomas, an AIDS Malignancy Consortium multicenter trial was undertaken using the same dose-reduced busulfan and cyclophosphamide preparative regimen with AuSCT for recurrent HIV-associated NHL and HL. Of the 27 patients in the study, 20 received an AuSCT. The median time to achievement of an absolute neutrophil count (ANC) of ≥ 0.5×10 9 /L was 11 days (range, 9-16 days). The median time to achievement of an unsupported platelet count of ≥ 20×10 9 /L was 13 days (range, 6-57 days). One patient died on day +33 posttransplantation from hepatic veno-occlusive disease (VOD) and multiorgan failure. No other fatal regimen-related toxicity occurred. Ten of 19 patients (53%) were in complete remission at the time of their day +100 post-AuSCT evaluation. Of the 20 patients, 10 were alive and event-free at a median of 23 weeks post-AuSCT. Median overall survival (OS) was not reached by 13 of the 20 patients alive at the time of last follow-up. This multi-institutional trial demonstrates that a regimen of dose-reduced high-dose busulfan, cyclophosphamide, and AuSCT is well tolerated and is associated with favorable disease-free survival (DFS) and OS probabilities for selected patients with HIV-associated NHL and HL.
An Orthotopic Bladder Cancer Model for Gene Delivery Studies

Bladder cancer is the second most common cancer of the urogenital tract and novel therapeutic approaches that can reduce recurrence and progression are needed. The tumor microenvironment can significantly influence tumor development and therapy response. It is therefore often desirable to grow tumor cells in the organ from which they originated. This protocol describes an orthotopic model of bladder cancer, in which MB49 murine bladder carcinoma cells are instilled into the bladder via catheterization. Successful tumor cell implantation in this model requires disruption of the protective glycosaminoglycan layer, which can be accomplished by physical or chemical means. In our protocol the bladder is treated with trypsin prior to cell instillation. Catheterization of the bladder can also be used to deliver therapeutics once the tumors are established. This protocol describes the delivery of an adenoviral construct that expresses a luciferase reporter gene. While our protocol has been optimized for short-term studies and focuses on gene delivery, the methodology of mouse bladder catheterization has broad applications.
A circuit-software co-design approach for improving EDP in reconfigurable frameworks

Use of two-dimensional memory array for lookup table (LUT) based reconfigurable computing frameworks has been proposed earlier for improvement in performance and energy-delay product (EDP). In this paper, we propose an integrated solution for achieving significantly higher EDP in these frameworks by leveraging on the read-dominant memory access pattern. First, we propose to employ an asymmetric memory cell design, which provides higher read performance (~2X) and lower read power (~1.6X) in order to improve the overall EDP during operation. Exploiting the fact that the proposed memory cell provides better read power/performance for cells storing logic '0', next we propose a content-aware application mapping approach, which tries to maximize the logic '0' content in the LUTs. We show that the joint circuit and application mapping level optimization approach provides significant improvement in system EDP for a set of benchmark circuits.
Challenging Police Discretion

Law enforcement officials have tremendous discretion to determine the amount and style of policing that occurs in their jurisdiction. These decisions — concerning whom to police and how much — are primarily matters of distributive justice, and are made at the level of the police department rather than on the street. These departmental decisions spread a variety of important social resources across communities, as well as imposing certain burdens on those communities as part of the prevention or investigation of crime.The police decide to apportion social resources through making policy, just as any other administrative agency concerned with resource-allocation might. Yet these policy decisions are mostly unregulated by the courts, and (unlike other some other agencies) closed to public input. Community members lack the ability to participate in — and especially, to challenge — police policy at the front-end during the equivalent of the drafting and comment process. The resulting policy is often based solely on law enforcement’s own internal assessment of the appropriate goals and values to pursue, independent of the interests of the community they police. The police remain immune from democratic challenge during the policy-making stage, and isolated from the deliberative insights of the community at the sharp end of police policy-making. These deliberative deficits have the potential to undermine the legitimacy and accuracy of the departmental policy-making process, and render the police politically remote from the community they patrol. The distributive consequences of police policy-making, expressed in the amount and style of policing on the ground, include a range of social harms that can generate friction between the police and the public. These harms are often concentrated in communities subject to the most intensive and invasive policing. Recent public demonstrations in Ferguson, Missouri, and Baltimore, Maryland, among others, have emphasized the harms of policing and community alienation from politically remote police decision-making. Yet these distributive concerns are neither captured nor allayed by the judicial system’s individualized focus on the reasonableness of police activity, and the remedies of exclusion or civil damages. In the light of these concerns, I employ the political theory of civic republicanism to advance one remedy: the possibility of public challenge to police policy-making. I propose some ways in which republican political structures can undermine the remoteness and fragmentation of the police and their policy-making process, to produce a more inclusive, egalitarian, and accurate set of police policies.
Listening to Patients

The paper by Stevenson et al. ([1][1]) in this issue of the Journal is, on first reading, an interesting report on how patients with advanced heart failure report their priorities for quality versus quantify of life using an arcane questionnaire called the time trade-off (TTO). On closer reading,
Too Rich to Be Poor? A Glimpse of the Poverty Situation in Zambia in the 1990s

For all its huge natural and human resource endowments, Zambia is suffering from intolerably high levels of both rural and urban poverty. The authors explore the causes of poverty, which include government policy bias against agriculture, the negative impact of World Bank and IMF conditionality, the disadvantaged position of women-headed rural households, and the devastating 1991-1992 drought. They identify and discuss the coping strategies that both the rural and the urban poor have been forced to adopt in order to survive. Among the urban poor some of the many ways of combating poverty include changing eating habits, 'street kidding' (school children who engage in income-generating activities), begging, street vending, prostitution, informal income-generating activities, beer brewing, crime, gambling, and cultivating vegetables and raising chickens in the backyard. The rural poor have, in addition, resorted to selling livestock, burning trees for charcoal, gathering wild fruits, casual work on the more established commercial farms, and petty thieving. These coping mechanisms are at best unsustainable, at worst highly indadequate, in halting the slippage of the poor into deeper poverty. The authors conclude with some general indications on what needs to be done.
Leading Organic Growth: Module Caselets

This is a series of 12 short caselets profiling individual growth leaders that--used in conjunction with "Business Model Innovation: A Process Model" (UVA-BP-0538)--will help students evaluate business situations for innovation opportunities. The course module focuses on enhancing the ability of students to identify and implement organic growth initiatives in mature organizations. An instructor teaching note accompanies the caselets series that contains an overview of the theoretical model underlying the course, a suggested session outline for a 15-session course, a summary of the growth leader caselets, and an overview of each caselet’s focus. The goal is to raise students’ awareness of and capabilities in each of the six key areas that emerged in the growth study, which include: repertoire, learning mindset, entrepreneurial thinking, reframing, learning by doing, and leading with pragmatic idealism. The module design incorporates these six aspects of growth leadership into a model offering a series of steps that guide class discussions—each with accompanying materials and exercises.
A comparison of two sampling approaches for assessing the urban forest canopy cover from aerial photography

Abstract Two different sampling approaches for estimating urban tree canopy cover were applied to two medium-sized cities in the United States, in conjunction with two freely available remotely sensed imagery products. A random point-based sampling approach, which involved 1000 sample points, was compared against a plot/grid sampling (cluster sampling) approach that involved a 1.83 m square grid of points embedded within 0.04 ha circular plots. The imagery products included aerial photography from the U.S. Department of Agriculture National Agricultural Imagery Program (viewed within ArcGIS), and Google Earth imagery. For Tallahassee, Florida, the estimate of tree canopy cover was 48.6–49.1% using Google Earth imagery and 44.5–45.1% using NAIP imagery within ArcGIS. Statistical tests suggested that the two sampling approaches produced significantly different estimates using the two different imagery sources. For Tacoma, Washington, the estimated tree canopy cover was about 19.2–20.0% using Google Earth imagery and 17.3–18.1% when using NAIP imagery in ArcGIS. Here, there seemed to be no significant difference between the random point-based sampling efforts when used with the two different image sources, while the opposite was true when using the plot/grid sampling approach. However, our findings showed some similarities between the two sampling approaches; hence, the random point-based sampling approach might be preferred due to the time and effort required, and because fewer opportunities for classification problems might arise. Continuous review of urban canopy cover estimation procedures suggested by organizations such as the Climate Action Reserve and others can provide society with information on the accuracy and effectiveness resource assessment methods employed for making wise decisions about climate change and carbon management.
Integracion Europea, Ciudadania y Solidaridad: Un proceso de Bootstrapping (European Integration, Citizenship and Solidarity: A Process of Bootstrapping)

Spanish Abstract: El articulo se centra en analizar los derechos de los ciudadanos de la Union Europea mediante el estudio de la evolucion de la jurisprudencia existente a nivel del Tribunal de Justicia . El analisis propuesto sirve para el obtener una vision estatica de la solidaridad existente entre los Estados miembros de la UE en particular con respecto a los derechos laborales y de salud .English Abstract: The paper delves into the rights of European Union Citizens by analyzing the evolution of the case law existing at the ECJ level. The proposed analysis serves for the purpose of gaining a static view of the existing solidarity between EU Member States particularly with regards of health and labor rights.
Somali Piracy: For the Money or for the Honor?

This chapter examines the motivations of Somali pirates using an economic model of job selection. We specifically examine the question of whether the main motivation of modern-day pirates is specifically monetary gain or the larger goal of protecting Somalia’s national interests from over-fishing and other unfair practices by foreign governments, as some have asserted. Simple calculations suggest that monetary gains constitute sufficient motivation for most Somalis, given the high return piracy promises relative to legal employment, coupled with the low expected cost of sanctions.
Programming temporal shapeshifting

Shapeshifting enables a wide range of engineering and biomedical applications, but until now transformations have required external triggers. This prerequisite limits viability in closed or inert systems and puts forward the challenge of developing materials with intrinsically encoded shape evolution. Herein we demonstrate programmable shape-memory materials that perform a sequence of encoded actuations under constant environment conditions without using an external trigger. We employ dual network hydrogels: in the first network, covalent crosslinks are introduced for elastic energy storage, and in the second one, temporary hydrogen-bonds regulate the energy release rate. Through strain-induced and time-dependent reorganization of the reversible hydrogen-bonds, this dual network allows for encoding both the rate and pathway of shape transformations on timescales from seconds to hours. This generic mechanism for programming trigger-free shapeshifting opens new ways to design autonomous actuators, drug-release systems and active implants.
Drama at Dunder Mifflin: Workplace Bullying Discourses on The Office:

This study examines the portrayal and affective framing of workplace bullying behaviors on the popular American television show The Office. Quantitative and qualitative content analyses were conducted on 54 episodes spanning the show's nine seasons. Results revealed 331 instances of workplace bullying, for an average of 6.13 bullying behaviors per episode. Workplace bullying behavior on The Office was grouped into five categories: sexual jokes, public humiliation, practical jokes, belittlement, and misuse of authority. In general, instances of workplace bully were scripted as humorous and lacking significant consequences, which could further contribute to social discourses that perpetuate the problem of bullying in real-life workplaces.
Clear Cell Change in Thyroid Carcinoma: A Clinicopathologic and Molecular Study with Identification of Variable Genetic Anomalies

Background: Clear-cell carcinoma of the thyroid has been regarded as a variant of follicular (FTC) or papillary (PTC) thyroid carcinoma. Twenty-one primary thyroid carcinomas with clear-cell features, diagnosed in 20 patients (12 female) were identified between 1992 and 2012 (0.5% of in-house thyroid carcinomas). Methods: Hematoxylin and eosin slides were reviewed. SNaPshot multigene mutational analysis and a translocation panel were successfully performed on 15 of these cases. Results: Twelve (57%) were FTC, five were conventional PTC, two were follicular variant of PTC, and two were poorly differentiated thyroid carcinomas. Five cases had RAS mutation (four FTC and one PTC); two had PAX8-PPARgamma translocations (both FTC, one with concurrent p53 mutation); one had an EML4-ALK translocation (PTC); and one had a TFG-MET translocation (follicular variant of PTC). Five carcinomas were metastatic to regional lymph nodes (three FTC and two PTC), and two were metastatic to bone (both FTC). Disease confined to...
Further evaluation of the potential anxiolytic activity of imidazo[1,5-a][1,4]diazepin agents selective for α2/3-containing GABA A receptors

Positive allosteric modulators of GABAA receptors transduce a host of beneficial effects including anxiolytic actions. We have recently shown that bioavailability and anxiolytic-like activity can be improved by eliminating the ester functionality in imidazo[1,5-a][1,4]diazepines. In the present series of experiments, we further substantiate the value of heterocyle replacement of the ester for potential treatment of anxiety. None of three esters was active in a Vogel conflict test in rats that detects anxiolytic drugs like diazepam. Compounds 7 and 8, ester bioisosters, were selective for alpha 2 and 3 over alpha 1-containing GABAA receptors but also had modest efficacy at GABAA alpha 5-containing receptors. Compound 7 was efficacious and potent in this anxiolytic-detecting assay without affecting non-punished responding. The efficacies of the esters and of compound 7 were predicted from their efficacies as anticonvulsants against the GABAA antagonist pentylenetetrazole (PTZ). In contrast, the related structural analog, compound 8, did not produce anxiolytic-like effects in rats despite anticonvulsant efficacy. These data thus support the following conclusions: 1) ancillary pharmacological actions of compound 8 might be responsible for its lack of anxiolytic-like efficacy despite its efficacy as an anticonvulsant 2) esters of imidazo[1,5-a][1,4]diazepines do not demonstrate anxiolytic-like effects in rats due to their low bioavailability and 3) replacement of the ester function with suitable heterocycles markedly improves bioavailability and engenders molecules with the opportunity to have potent and efficacious effects in vivo that correspond to human anxiolytic actions.
A shared neural integrator for human posture control.

Control of standing posture requires fusion of multiple inputs including visual, vestibular, somatosensory, and other sensors, each having distinct dynamics. We propose that postural control also e...
An investigation into four different sit–stand workstation use schedules

Twelve office workers participated in a study investigating effects of four sit/stand schedules (90-min sit/30-min stand, 80/40, 105/15, and 60/60) via several objective and subjective measures (muscle fatigue, foot swelling, spinal shrinkage, and self-reported discomfort). Results showed that there were no significant differences in shoulder and low back static muscle activities between sitting and standing. Muscle fatigue was developed during workday under all schedules. The longest standing schedule seemed to have a tendency of reducing muscle fatigue. None of the schedules helped or worsened foot swelling and spinal shrinkage. More active break-time activities seemed reducing muscle fatigue and foot swelling. While the self-reported bodily discomfort levels were generally low, the preferred schedules among the participants were varied, although the least standing schedule was the least preferred. We may conclude that effects of using sit-stand workstation to improve musculoskeletal health may be limited but promoting more active break-time activities can help. Practitioner Summary: Sit-stand workstations are used to reduce work-related musculoskeletal disorders. This study shows that office workers prefer sit/stand durations in the range between 1:1 and 3:1. Longer standing may have the potential to reduce muscle fatigue. However, active break-time activities may be more effective in reducing muscle fatigue and foot swelling.
Expression of C/EBPα, β and δ in fetal and postnatal subcutaneous adipose tissue

The C/EBP (CCAAT/enhancer binding protein) family of transcription factors (C/EBPα, β, and δ) has been implicated in the development and the metabolic regulation of adipocytes from in vitro studies, yet the function of these factors, particularly CEBPβ and δ, in vivo has not been characterized. To assess the role of these factors in vivo, subcutaneous adipose, tissue from fetal and postnatal pigs was examined for C/EBPα, β, and δ expression in developing and mature adipocytes. Western blot analysis of fetal adipose tissue showed a progressive increase of C/EBPα expression in 50, 75 and 95 day old fetuses. C/EBPβ and δ proteins were not observed in fetal adipose tissue. These results were confirmed with immunohistochemical studies of fetal adipose showing enhanced C/EBPα expression in the nuclei of adipocytes and cells closely associated with adipose cell clusters from 75 and 95 day old fetuses. For the same tissues only light background staining with no differential enhancement was found for C/EBP β and δ. In postnatal adipose tissue C/EBPα and C/EBPβ protein were expressed in both 8 day old postnatal and mature (180 day) pigs. C/EBPδ reactive products were found in postnatal tissues however, their molecular weights were lower than that found in fetal pig liver. Our data suggest that adipose cell terminal differentiation proceeds in the pig fetus without the expression of C/EBPβ and δ and that these factors may have a more important role in fully differentiated adipose cells in postnatal tissue.
Solar Cell Theory

As a result of comprehensive studies sponsored by NSF and NASA and by the National Academy of Science, it became evident in 1972 that a substantial reduction in production cost to approach 1$/W* and an increase of efficiencies beyond 10% for thin-film and beyond 20% for single crystal solar cells were feasible [1]. With significant government support mainly in the USA, Japan, and Western Europe, rapid progress was made and essentially all technical goals set in 1972 have been achieved and surpassed (thin-film efficiency 12% for CdS/CuInSe2 and 13% for α-Si, single crystal AMl efficiency 23% for Si and 23% for AlGaAs/GaAs; recent Sicells in concentrators have achieved 27% conversion efficiency) [7]. The economic goal (updated for competing with the increased electric energy generation cost and inflationary devaluation of the dollar) seems to be within reach and large quantities of solar panels sell currently for ~5 $/W. The life expectancies of better Si-panels (conservatively estimated) are well in excess of 20 years.
Characteristics of and services provided to youth in secure care facilities

Youth who are incarcerated in secure detention and commitment settings display a complex array of educational, behavioral, and mental health issues that affect the services they require, as well as...
Second-Look Endoscopy in Hospitalized Severe Ulcerative Colitis: A Retrospective Cohort Study.

Background Acute severe ulcerative colitis (ASUC) is a serious complication of ulcerative colitis (UC). Management of partial responders to steroids or rescue therapy remains challenging. Whether there is a role for re-look sigmoidoscopic evaluation in disease management is unknown. Methods Our study cohort consisted of patients who underwent 2 sigmoidoscopic procedures during the same index hospitalization for ASUC at our center. Reasons for repeat endoscopic evaluation and endoscopic and histologic severity of inflammation during both procedures were noted. Multivariable regression models were performed to identify predictors of improvement at the second endoscopic assessment and to determine the independent effect of such an improvement on in-hospital colectomy and at 3, 6, and 12 months. Results Our study included 49 patients (mean age, 42 years; 52% women). Just under one-third of patients (30%) were noted to have improved endoscopic appearance at the second sigmoidoscopy, at a median of 9 days after initial exam. None of the patients who had improvement on the second endoscopy underwent in-hospital colectomy, compared with 46% of those with worsening or persistent disease (P = 0.002). Similar differences in the improved group persisted at 3 months (P = 0.007) and 6 months (P = 0.027). Histologic severity at the first endoscopy was associated with increased risk of colectomy in-hospital (odds ratio, 3.8; 95% confidence interval, 1.02-14.21) and at 3 and 6 months. Conclusions After a median interval of 9 days, endoscopic improvement was noted in 30% of patients with ASUC undergoing a second sigmoidoscopy, which predicted lower rates of colectomy in-hospital and at 3 and 6 months.
Unstable angina: trends and characteristics associated with length of hospitalization in the face of diminishing frequency—an evidence of a paradigm shift

Background: Unstable angina (UA) has been one of the most common presentations of acute coronary syndrome. The numbers of admitted UA patients have been diminishing in the recent past. However, we are seeing higher costs and higher length of inpatient stay. We attempt to identify the trends and characteristics of length of hospitalization in patients admitted with UA using a nationally representative dataset. Methods: We used the nationwide inpatient sample (NIS) from 2002–2014 to assess the factors associated with length of stay in patients admitted with unstable angina using ICD-9 CM primary diagnosis codes (411.1, 411.81, and 411.89). All variables pertaining to hospitalization were compared across the 3 groups based on varied length of hospital stay. Results: A total of 131,601 patients were admitted with the diagnosis of UA. The length of inpatient stay was ≤1 day, 2–6 days, and ≥7 days in 60,309 (45.83%), 67,291 (51.13%), and 4,001 (3.05%) patients, respectively. In a multivariate adjusted model, the percentage increased odds of ≥2 days of inpatient stay was noted as follows: age ≥65 years (29%), female gender(24%), African-American race (28%), obesity (14%), diabetes mellitus (15%), chronic lung disease (33%), congestive heart failure (529%), renal failure (26%), coagulopathy (68%), alcohol abuse (21%), peripheral vascular disease (22%), myocardial infarction (17%), deep vein thrombosis (119%), sepsis (105%), pneumonia (171%), stroke (164%), urinary tract infection (112%), blood loss (95%), cardiac catheterization (86%), percutaneous transluminal coronary angioplasty (24%), and blood transfusion (206%). The percentage of UA patients with ≥2 days of hospital stay has decreased from 15% to 3.7%, whereas the average costs of managing a UA patient in the hospital have increased by 175%. Conclusions: More than half of patients admitted with UA stay in the hospital for ≥2 days, with the most important determinants being pre existing medical comorbidities and inpatient complications.
Self-stigma of depression in Christians versus the general population

ABSTRACTThe purpose of this survey study is to compare self-stigma of depression between Christians and the general population. Three hundred and fifteen participants completed a survey which inclu...
Strategies for the Enhancement of Nutrition Practice in a New York State Level 1 Trauma Center: A Hospital's Journey.

Background Provision of enteral nutrition (EN) support is historically inadequate in the critically ill population. An interdisciplinary approach utilizing various strategies has been shown to improve initiation of timely EN support. The purpose of this study was to examine whether the implementation of a series of interventions led by an interdisciplinary team was associated with changes in the initiation of nutrition support in a level 1 trauma center. Methods Patients admitted between 2009 and 2013 with isolated closed head trauma injuries were identified through the hospital's trauma center database. The initial population consisted of 159 patients; after exclusion criteria, 141 patients were included in the statistical analyses. Two statistical analyses were conducted. The first calculated the average days to the initiation of nutrition start by admission year. The second estimated the association between admission year and time to nutrition initiation with a generalized linear model. Results Time to initiate nutrition therapy was estimated to decrease by 1.46 days (47.31%) from 2009 to 2013. The time to initiate nutrition in 2013 was 1.63 days. A significant association was found between the time to initiate nutrition and the 2012 and 2013 binary variables while controlling for confounding variables. The time frame was estimated to be 1.09 (P = .008) and 1.75 (P = .000) days shorter in 2012 and 2013 relative to 2009. Conclusions An interdisciplinary effort utilizing multiple strategies identified and addressed barriers, resulting in a reduction of variability and a proactive approach to early EN.
Irrigation system design for management in mountainous areas

The paper reports research on engineering designs of irrigation systems in mountainous areas and the resulting implications for management. The engineering designs are important because they may or may not provide the social basis for local people to participate in system development and management. This hypothesis is analyzed by using field data from an irrigation development program in the Himachal Pradesh State in India. The development program will construct about 150 small-scale, gravity flow and lift irrigation schemes in a seven year period. The results of the analysis support the argument that the engineering designs critically influence local people's capability and willingness to manage irrigation facilities. In gravity flow irrigation schemes, water capture by permanent flow diversion structuress is extremely expensive and yet unreliable because of large variation in stream flow and unstable mountain slopes. A more practical alternative is to utilize diversion structures of temporary nature which are made with local materials. Construction and management of such structures will encourage local participation because of high maintenance requirements. In lift irrigation schemes a conventional design is to lift all water requirements to a single highest point in the command area. This practice results in unnecessarily high energy costs and in a water distribution system which is complex to manage. A better alternative is to design the pumps so that water can be delivered at variable elevations in the scheme area. This will allow disaggregation of the total area into smaller rotational units and, therefore, management of water distribution can be potentially easier and equitable.
Subcutaneous sarcoidosis of the upper and lower extremities: A case report and review of the literature.

Subcutaneous sarcoidosis of the upper and lower extremities: A case report and review of the literature
Autonomic Nervous System Modulation of the Epicardial Adipose Tissue in Heart Failure and Atrial Fibrillation

The epicardial adipose tissue (EAT) or epicardial fat, the visceral fat depot in the heart, contains intrinsic adrenergic and cholinergic nerves, which interact with the extrinsic cardiac sympathetic and parasympathetic nervous systems. These EAT nerves represent a significant source of several adipokines and other bioactive molecules, including norepinephrine and epinephrine. The production of these molecules is biologically relevant for the heart, because abnormalities in EAT secretory properties are implicated in the development of pathological conditions, including coronary atherosclerosis, atrial fibrillation, and heart failure. Because sympathetic hyperactivity and parasympathetic (cholinergic) derangement are associated with EAT dysfunction leading to a multitude of adverse cardiac conditions, such as heart failure, diastolic dysfunction, atrial fibrillation, etc., a number of recent studies have focused on exploring the autonomic regulation of EAT as it pertains to heart disease pathogenesis and progression. In this chapter, we provide an overview of these studies, immediately following brief introductions on the regulation of global cardiac function by the two branches of the autonomic nervous system (adrenergic and cholinergic).
CHAPTER 1 – INTRODUCTORY

Publisher Summary Automatic control systems are vital manifestations of modern technology and pervade almost every area of activity. The development of a new control system usually starts with a specification containing one or more criteria to be met. A theoretical assessment is then carried out of possible arrangements of components that are most likely to comply with the specification. It is these techniques of measurement that are used to evaluate control systems and their components. This chapter is concerned with the evaluation of the parameters of an engineering situation represented by a coupled system of physical components, and to determine a system's behavior. The development of any new control system starts with a customer specification that of a well-engineered system that functions consistently at an economic level. The control engineer is required to produce a much more detailed specification to be met in the subsequent development. This detailed specification is phrased in control engineering terminology and is based on the control engineer's special knowledge of factors that will contribute toward a successful system design.
Physiological signature of late-onset nonallergic asthma of obesity.

Introduction Obesity can lead to a late-onset nonallergic (LONA) form of asthma for reasons that are not understood. We sought to determine whether this form of asthma is characterised by any unique physiological features. Methods Spirometry, body plethysmography, multiple breath nitrogen washout (MBNW) and methacholine challenge were performed in four subject groups: Lean Control (n=11), Lean Asthma (n=11), Obese Control (n=11) and LONA Obese Asthma (n=10). The MBNW data were fitted with a novel computational model that estimates functional residual capacity (FRC), dead space volume (VD), the coefficient of variation of regional specific ventilation (CV,V'E) and a measure of structural asymmetry at the level of the acinus (sacin). Results Body mass index and waist circumference values were similar in both obese groups, and significantly greater than in lean asthmatic individuals and controls. Forced vital capacity was significantly lower in the LONA Asthma group compared with the other groups (p<0.001). Both asthma groups exhibited similar hyperresponsiveness to methacholine. FRC was reduced in the Obese LONA Asthma group as measured by MBNW, but not in obese controls, whereas FRC was reduced in both obese groups as measured by plethysmography. VD, CV,V'E and sacin were not different between groups. Conclusions Chronic lung compression characterises all obese subjects, as reflected by reduced plethysmographic FRC. Obese LONA asthma is characterised by a reduced ability to recruit closed lung units, as seen by reduced MBNW FRC, and an increased tendency for airway closure as seen by a reduced forced vital capacity.
Risk perceptions of health and safety in cruising

Cruise holidays have become increasingly popular in the past two decades, with passenger numbers increasing every year. The global COVID-19 pandemic resulted in several cruise ships being held in quarantine or stranded at sea with mass disruption and cancelled holidays for millions of vacationers. The pandemic highlights the significance of risk perceptions as risk influences travel decision-making. Little research exists on risk perceptions in ocean cruising, or how risk potentially influences tourists’ decision-making for a cruise as a holiday. Findings revealed a cruise is perceived as a safe holiday, but health risks are a significant concern. Non-cruisers perceive more risk in getting sick onboard, and cruisers develop strategies to minimize risks, and both groups acknowledge risk is inherent in travel. Findings reveal critical insight into how both cruisers and non-cruisers interpret health and safety risks in cruising, and is a significant empirical contribution to understanding risk in relation to cruising.
Four Decades of United States Mobile Source Pollutants: Spatial-Temporal Trends Assessed by Ground-Based Monitors, Air Quality Models, and Satellites.

On-road emissions sources degrade air quality, and these sources have been highly regulated. Epidemiological and environmental justice studies often use road proximity as a proxy for traffic-related air pollution (TRAP) exposure, and other studies employ air quality models or satellite observations. To assess these metrics' abilities to reproduce observed near-road concentration gradients and changes over time, we apply a hierarchical linear regression to ground-based observations, long-term air quality model simulations using Community Multiscale Air Quality (CMAQ), and satellite products. Across 1980-2019, observed TRAP concentrations decreased, and road proximity was positively correlated with TRAP. For all pollutants, concentrations decreased fastest at locations with higher road proximity, resulting in "flatter" concentration fields in recent years. This flattening unfolded at a relatively constant rate for NOx, whereas the flattening of CO concentration fields has slowed. CMAQ largely captures observed spatial-temporal NO2 trends across 2002-2010 but overstates the relationships between CO and elemental carbon fine particulate matter (EC) road proximity. Satellite NOx measures overstate concentration reductions near roads. We show how this perspective provides evidence that California's on-road vehicle regulations led to substantial decreases in NO2, NOx, and EC in California, with other states that adopted California's light-duty automobile standards showing mixed benefits over states that did not adopt these standards.
A Pilot Study of the Impact of Virtually Embodying a Patient with a Terminal Illness.

Compassionate end-of-life care matters deeply for patients and their caregivers, but studies continue to demonstrate ways in which physicians fall short. Despite specific training during medical school, many patients report lack of empathy in their providers with respect to end-of-life conversations. This is likely because empathy is simply hard to teach. Numerous activities have been tried to combat the decline in empathy during medical training with little to moderate success. However, virtual reality, which allows users to viscerally experience anything from another person’s point of view, could be a game changer for building empathy within medicine. This type of perspective-taking has previously shown to improve understanding, reduce biases, facilitate empathy, and promote prosocial behaviors. In this pilot study, virtual reality was used to allow students to “become a patient” virtually embodying their daily activities, symptoms, and interactions with caregivers. Using the Embodied Labs modules, first-year medical students were able to experience first-hand having a terminal illness, being told no further treatments are available and witnessing loved ones’ reactions. Data generated through surveys and reflections indicated a high level of place illusion, plausibility, and embodiment of users. This high level of immersion generated an increase in comfortability with talking about end-of-life issues, produced a better understanding of what patients and their families experience, and promoted a change in the way students would approach clinical skills. Analysis of reflections indicated a high level of empathy for the patient and his family members. Overall, the activity was highly received by students as a valuable learning activity. As such, we propose that virtual reality could be a useful pedagogical tool to facilitate empathy and clinical skills within medical education.
Demonstration of a laser powder bed fusion combinatorial sample for high-throughput microstructure and indentation characterization

Abstract High-throughput experiments that use combinatorial samples with rapid measurements can be used to provide process-structure-property information at reduced time, cost, and effort. Developing these tools and methods is essential in additive manufacturing where new process-structure-property information is required on a frequent basis as advances are made in feedstock materials, additive machines, and post-processing. Here we demonstrate the design and use of combinatorial samples produced on a commercial laser powder bed fusion system to study 60 distinct process conditions of nickel superalloy 625: five laser powers and four laser scan speeds in three different conditions. Combinatorial samples were characterized using optical and electron microscopy, x-ray diffraction, and indentation to estimate the porosity, grain size, crystallographic texture, secondary phase precipitation, and hardness. Indentation and porosity results were compared against a regular sample. The smaller-sized regions (3 mm × 4 mm) in the combinatorial sample have a lower hardness compared to a larger regular sample (20 mm × 20 mm) with similar porosity (
Inferring the number and position of changes in selective regime in a non-equilibrium mutation-selection framework

Recovering the historical patterns of selection acting on a protein coding sequence is a major goal of evolutionary biology. Mutation-selection models address this problem by explicitly modelling fixation rates as a function of site-specific amino acid fitness values.However, they are restricted in their utility for investigating directional evolution because they require prior knowledge of the locations of fitness changes in the lineages of a phylogeny. We apply a modified mutation-selection methodology that relaxes assumptions of equlibrium and time-reversibility. Our implementation allows us to identify branches where adaptive or compensatory shifts in the fitness landscape have taken place, signalled by a change in amino acid fitness profiles. Through simulation and analysis of an empirical data set of $$\beta $$ -lactamase genes, we test our ability to recover the position of adaptive events within the tree and successfully reconstruct initial codon frequencies and fitness profile parameters generated under the non-stationary model. We demonstrate successful detection of selective shifts and identification of the affected branch on partitions of 300 codons or more. We successfully reconstruct fitness parameters and initial codon frequencies in simulated data and demonstrate that failing to account for non-equilibrium evolution can increase the error in fitness profile estimation. We also demonstrate reconstruction of plausible shifts in amino acid fitnesses in the bacterial $$\beta $$ -lactamase family and discuss some caveats for interpretation.
Measuring global climate risk

Climate change generates multifaceted and difficult-to-measure risks to human and natural systems. Now, research offers a composite indicator of global climate risk that may help track progress in addressing climate change.