cssi/SciSciGPT-SciSciNet huggingface dataset:
Hospital electronic medical record enterprise application strategies: do they matter?

Background Successful implementations and the ability to reap the benefits of electronic medical record (EMR) systems may be correlated with the type of enterprise application strategy that an administrator chooses when acquiring an EMR system. Moreover, identifying the most optimal enterprise application strategy is a task that may have important linkages with hospital performance. Purpose This study explored whether hospitals that have adopted differential EMR enterprise application strategies concomitantly differ in their overall efficiency. Specifically, the study examined whether hospitals with a single-vendor strategy had a higher likelihood of being efficient than those with a best-of-breed strategy and whether hospitals with a best-of-suite strategy had a higher probability of being efficient than those with best-of-breed or single-vendor strategies. A conceptual framework was used to formulate testable hypotheses. Methodology A retrospective cross-sectional approach using data envelopment analysis was used to obtain efficiency scores of hospitals by EMR enterprise application strategy. A Tobit regression analysis was then used to determine the probability of a hospital being inefficient as related to its EMR enterprise application strategy, while moderating for the hospital's EMR "implementation status" and controlling for hospital and market characteristics. Findings The data envelopment analysis of hospitals suggested that only 32 hospitals were efficient in the study's sample of 2,171 hospitals. The results from the post hoc analysis showed partial support for the hypothesis that hospitals with a best-of-suite strategy were more likely to be efficient than those with a single-vendor strategy. Practice implications This study underscores the importance of understanding the differences between the three strategies discussed in this article. On the basis of the findings, hospital administrators should consider the efficiency associations that a specific strategy may have compared with another prior to moving toward an enterprise application strategy.
Ubiquinol:cytochrome c oxidoreductase (complex III). Effect of inhibitors on cytochrome b reduction in submitochondrial particles and the role of ubiquinone in complex III.

Two sets of studies have been reported on the electron transfer pathway of complex III in bovine heart submitochondrial particles (SMP). 1) In the presence of myxothiazol, MOA-stilbene, stigmatellin, or of antimycin added to SMP pretreated with ascorbate and KCN to reduce the high potential components (iron-sulfur protein (ISP) and cytochrome c 1) of complex III, addition of succinate reduced hemeb H followed by a slow and partial reduction of heme b L. Similar results were obtained when SMP were treated only with KCN or NaN3, reagents that inhibit cytochrome oxidase, not complex III. The average initial rate ofb H reduction under these conditions was about 25–30% of the rate of b reduction by succinate in antimycin-treated SMP, where both b H andb L were concomitantly reduced. These results have been discussed in relation to the Q-cycle hypothesis and the effect of the redox state of ISP/c 1 on cytochrome b reduction by succinate. 2) Reverse electron transfer from ISP reduced with ascorbate plus phenazine methosulfate to cytochrome b was studied in SMP, ubiquinone (Q)-depleted SMP containing ≤0.06 mol of Q/mol of complex III, and Q-replenished SMP. The results showed that Q was not required for electron transfer from ISP to b, a reaction that was inhibited by antimycin (also by myxothiazol or MOA-stilbene as reported elsewhere). It was also shown that antimycin did not inhibit electron transfer fromb (b H) to Q, in clear contrast to the assumption of the Q-cycle hypothesis regarding the site of antimycin inhibition.
Solvation effects upon the thermodynamic substrate activity; correlation with the kinetics of enzyme catalyzed reactions. I. Effects of added reagents such as methanol upon alpha-chymotrypsin.

Abstract Solvents, detergents, etc., have often been added to the medium to study the kinetics of enzyme action and for binding studies. They have been employed for diverse reasons such as solubilization of substrates or to stabilize an enzyme that was originally membrane bound. Thermodynamic considerations dictate that any added substance, such as methanol, which is present in significant quantity must affect the thermodynamic activities of the enzyme, enzyme-substrate complex, substrate and any other intermediates although cancellation effects may occur in this regard. The influence upon substrate activities is the only one that is easily experimentally accessible. These effects are shown, from the data of Bernard and Laidler, to be large in the case of the α-chymotrypsin catalysed hydrolysis of methylhydrocinnamate. The variation of the Michaelis-Menten constant is quantitatively explainable in terms of the alteration of the thermodynamic activity of the substrate by methanol.
Employee turnover: a study of private clubs in the USA

High employee turnover in hourly positions has been widely accepted, and documented, in the hospitality industry. This study examined annual turnover rates in private clubs and the reasons that employees left their jobs, as perceived by management. Members of the Club Managers Association of America were randomly selected and surveyed. The analysis compared turnover and managers’ perceptions of reasons for turnover with: manager’s years of experience in current position; years of experience in the industry; club type; club size; and whether or not the manager had a hospitality management degree. Concludes that it is crucial for team managers to develop a team environment in the workplace to increase club loyalty, ultimately reducing employee turnover. Highlights factors within a manager’s control which are strongly limited to employee turnover in private clubs.
Asymptotic performance of a distributed detection system in correlated Gaussian noise

The authors consider the detection of a constant signal in noise with a large set of geographically dispersed sensors. The noise at the sensors is correlated Gaussian. Two correlation models are considered: one where the correlation coefficient between any two sensors decreases geometrically as the sensor separation increases, and one in which the correlation coefficient between any two sensors is a constant. For both correlation models, the asymptotic (as the number of sensors becomes large) performances of a distributed detection system and a central system are examined. >
Anhedonia in Unipolar Major Depressive Disorder: A Review

Anhedonia, the decreased capacity to experience pleasure, is a defining symptom of unipolar major depressive disorder (MDD). This review summarizes definitions and measurement issues related to the assessment of hedonic capacity in MDD, epidemiological research addressing linkages between anhedonia and MDD, as well as biomedical research investigating the neurobiology of anhedonia in both pre-clinical and clinical contexts. A synthesis of available data is presented that suggests that anhedonia is a core symptom of MDD, the elucidation of which is critical for improved understanding, detection, and treatment of MDD.
Value from hedonic experience and engagement.

Recognizing that value involves experiencing pleasure or pain is critical to understanding the psychology of value. But hedonic experience is not enough. I propose that it is also necessary to recognize that strength of engagement can contribute to experienced value through its contribution to the experience of motivational force—an experience of the intensity of the force of attraction to or repulsion from the value target. The subjective pleasure/pain properties of a value target influence strength of engagement, but factors separate from the hedonic properties of the value target also influence engagement strength and thus contribute to the experience of attraction or repulsion. These additional sources of engagement strength include opposition to interfering forces, overcoming personal resistance, using the right or proper means of goal pursuit, and regulatory fit between the orientation and manner of goal pursuit. Implications of the contribution of engagement strength to value are discussed for judgment and decision making, persuasion, and emotional experiences.
Discrepancy Between Definitions of Learning Disabilities and School Practices An Empirical Investigation

Students referred by general education teachers to school study teams (SSTs) were evaluated for learning disabilities (LD) eligibility. We classified children as LD on the basis of a WISC-III Full Scale IQ of 82 or higher and a 22-point discrepancy between IQ and any WRAT-R achievement score. Research decisions were then contrasted with actual school-based decisions regarding the child as LD. Over half of the students referred to SSTs were certified by the schools as LD, yet less than half of these school-certified students with LD evidenced the aptitude-achievement discrepancy required by the state. Examination of the cases called LD by the schools revealed that children were classified as LD on the basis of low absolute achievement, regardless of whether or not a discrepancy existed. Moreover, in cases where a discrepancy was found but the school did not classify the child as LD, that child evidenced significantly higher achievement, despite exhibiting the requisite 22-point discrepancy. The school-identified students with LD constituted an extremely heterogeneous group, including students with mental retardation along with a substantial number who failed to qualify for any special education services. Findings are discussed in terms of the discrepancy between criteria specified in state regulations and what the committee members at the school site seemed to use in classifying children with LD.
Accurate and efficient numerical integration of weakly singular integrals in Galerkin EFIE solutions

A Galerkin descretization of the electric field integral equation for perfectly conducting surfaces using Rao-Wilton-Glisson (1982) basis functions requires the numerical evaluation of integrals with singular kernels over triangular regions. These singularities have been traditionally handled by utilizing a "singularity extraction" procedure to produce a regular integral and an analytic function to replace the original singular integral. A new approach is presented here in which the four-dimensional (4-D) weakly singular integrals unique to the Galerkin Rao-Wilton-Glisson electric field integral equation solution for perfectly conducting surfaces are transformed into integrals with regular integrands. The transformations allow some of the integrations to be performed analytically, in some cases reducing the original 4-D integral into a 1-D numerical integration. The accuracy and convergence properties of the new method are demonstrated by evaluating the scalar potential function over a unit triangle.
Dietary Fat Supply to Failing Hearts Determines Dynamic Lipid Signaling for Nuclear Receptor Activation and Oxidation of Stored Triglyceride

Background—Intramyocardial triglyceride (TG) turnover is reduced in pressure-overloaded, failing hearts, limiting the availability of this rich source of long-chain fatty acids for mitochondrial β-oxidation and nuclear receptor activation. This study explored 2 major dietary fats, palmitate and oleate, in supporting endogenous TG dynamics and peroxisome proliferator–activated receptor-α activation in sham-operated (SHAM) and hypertrophied (transverse aortic constriction [TAC]) rat hearts. Methods and Results—Isolated SHAM and TAC hearts were provided media containing carbohydrate with either 13C-palmitate or 13C-oleate for dynamic 13C nuclear magnetic resonance spectroscopy and end point liquid chromatography/mass spectrometry of TG dynamics. With palmitate, TAC hearts contained 48% less TG versus SHAM (P=0.0003), whereas oleate maintained elevated TG in TAC, similar to SHAM. TG turnover in TAC was greatly reduced with palmitate (TAC, 46.7±12.2 nmol/g dry weight per min; SHAM, 84.3±4.9; P=0.0212), as was ...
Modafinil for the Treatment of Multiple Sclerosis-Related Fatigue

Objective:To review the efficacy and safety of off-label use of modafinil in the treatment of multiple sclerosis (MS)–related fatigue.Data Sources:Literature was accessed via MEDLINE (1966–January 2010) and International Pharmaceutical Abstracts (1960–2010), using the medical subject heading terms modafinil, multiple sclerosis, and fatigue.Study Selection and Data Extraction:All English-language, peer reviewed publications were analyzed for relevance. Studies appropriate to the objective were evaluated, including 3 open-label trials, 1 single-blind trial, and 2 randomized placebo-controlled trials.Data Synthesis:Fatigue symptoms, assessed by a variety of self-reported symptom scales, improved in each of the uncontrolled studies reviewed when participants with MS received modafinil 200 mg or less daily for up to 12 weeks. These benefits were not maintained, however, in one uncontrolled study when modafinil was increased to 400 mg daily. Of the 2 randomized, controlled trials, 1 study found that modafinil 2...
Borrowing Ideas from Nature: Peptide Specific Binding to Gallium Arsenide

Biological systems have a unique ability to control crystal structure, phase, orientation and nanostructural regularity of inorganic materials. An example is seen with the control of crystallographic phase and orientation of calcium carbonate with the polyanionic proteins isolated from shells of the marine gastropod abalone. We are currently investigating the principles of natural biological molecular recognition in materials and developing new methods to pattern useful non-biological electronic and magnetic materials on new length scales. A peptide combinatorial approach has been employed to identify proteins that select for and specifically bind to inorganic structures such as semiconductor wafers, nanoparticles and quantum confined structures. This approach utilizes the inherent self-organizing, highly selective properties of biologically derived molecules. We are currently investigating peptide recognition and interaction with III-V and II-VI semiconductor materials, magnetic materials, calcium carbonates and phosphates. We have selected peptides that can specifically bind and discriminate between zinc-blende III-V semiconductor surfaces. These peptides show crystal face specificity and are being used to organize nanoparticle heterostructures. Long term potential application of these materials would include opto-electronic devices such as light emitting displays, optical detectors, lasers, and nanometer scale computer components.
Federalism and technological change in blood products.

Recent research has shown how federalism affects health care finance, health care reform, and health policy innovation. The purpose of this article is to extend this research program to study the linkages between federalism and techno- logical change. It does so using comparative case studies spanning five countries to examine innovation and diffusion of two blood technologies — enzyme-linked immu- nosorbent assays (ELISA blood tests) and heat treatment — in response to the threat to the blood supply posed by HIV during the 1980s. Prior research has produced three contradictory models of the federalism-innovation relationship. This article attempts to resolve these contradictions, posits new hypotheses, and highlights sources of omitted variable bias that have important implications for understanding technologi- cal change. The case studies show that overall decentralization, rather than federalism alone, aids technological progress by allowing its supporters to "venue shop" around political resistance. Decentralization also makes the state less vulnerable to capture by status-quo interest groups. Moreover, political decentralization may have a posi- tive effect on technological diffusion, but a far weaker effect on innovation. Thus, prior research that conflates these two effects should be revisited.
The Influence of Pnx/Pn0 Grouping in a Multivariate Setting for Outcome Modeling in Patients with Clear Cell Renal Cell Carcinoma

Purpose: Lymphadenectomy, especially extended lymphadenectomy, is not commonly performed in patients undergoing a radical nephrectomy for clear cell renal cell carcinoma. Surgeons may sample suspicious regional lymph nodes, but the lymph node status of many patients with renal cell carcinoma remains unknown, termed stage pNx. Outcome models based on large institutional reviews have been criticized for grouping stages pNx and pN0 cases because of concern that the pNx category may include unrecognized stages pN1/pN2 disease. We evaluated cancer specific survival differences in patients with clear cell renal cell carcinoma and a lymph node stage of pNx, pN0 or pN1/pN2.Materials and Methods: We searched the registry at our institution for patients who underwent radical nephrectomy for clear cell histology renal cell carcinoma between 1970 and 1998. Those with distant metastases at surgery were excluded from study. Clinical features obtained from the medical record included age at surgery, history of tobacco u...
Mitochondrial Reactive Oxygen Species and Vascular Function Less Is More

Reactive oxygen species (ROS), conventionally known for causing cellular damage, are now accepted as important signaling molecules both physiologically and in the pathogenesis of cardiovascular disease. Elevated levels of ROS have been linked to the development of disorders, such as diabetes mellitus, hypertension, hypercholesterolemia, obesity, and atherosclerosis.1–4 Conversely, oxidative stress has been shown to stimulate and regulate multiple cell functions, including cell growth and proliferation, apoptosis, host defense, genomic stability, and vascular tone.5–8 An emerging concept is evolving of an optimal physiological range of ROS required to maintain cell homeostasis. Redox balance in the endothelium is a model example where ROS critically regulate vascular smooth muscle tone and tissue perfusion. See accompanying article on page 752 Endothelial cells produce an array of ROS, including superoxide (O2·–), hydrogen peroxide (H2O2), peroxynitrite (ONOO–), hydroxyl radicals (OH·), lipid peroxides, and other radicals. O2·– production in the picomolar range reacts quickly with superoxide dismutase to form H2O2, a freely diffusible and stable form of ROS, with typical characteristics of a cell-signaling molecule that can participate in compensatory vasodilation in disease.2,9 Peroxynitrite, formed as the product of excess O2·– quenching available nitric oxide (NO), adds to both cellular nitrosative and oxidative stress.10 The associated decrease in NO bioavailability with concurrent elevation in oxidative stress impairs endothelium-dependent vasodilation, producing what is referred to as endothelial dysfunction, …
A Conceptual Model for the Expansion of Behavioral Consultation Training

In this article, a general model and specific program that expand traditional behavioral consultation training are presented. The training program involves five interrelated components: (a) procedural and content skills, (b) role and relationship considerations, (c) entry/systems issues, (d) field-based experience, and (e) peer supervision. As a system, each component is necessary but not sufficient in the development of consulting expertise. Likewise, each component is subsumed by one or more components that encompass this broader framework. A theoretical rationale, model for implementation, and future training and research directions are also presented.
Acute Heart Failure Due to Midaortic Occlusion as the Initial Manifestation of Takayasu Arteritis

An afebrile 8-year-old Japanese girl was referred with hypotensive shock and respiratory distress. She presented with a cough of 1-week duration followed by lethargy, dyspnea, and anuria, with which she was admitted to a previous hospital. She was intubated and given intravenous catecholamines, which did not improve her symptoms. Then, she was transferred to our hospital. Physical examination revealed a right arm blood pressure of 128/64 mm Hg and a left arm blood pressure of 94/56 mm Hg while on 4.6 μg/kg per min of dopamine and dobutamine. However, no blood pressure was obtained in the lower limbs. The heart sounds were distant with no murmur audible. Coarse crackles were prominent in both lungs. Laboratory data showed the following values: creatine kinase of …
Harnessing the power of fusion? A valiant but flawed effort to obviate the need for a distinct mental health law

When it comes to involuntary interventions, the notion that people with mental disorders should be treated identically to persons with general medical disorders has an undoubted appeal. As Dawson and Szmukler have argued previously, principles of fairness and non-discrimination would appear to be well served by basing involuntary hospitalization and treatment in both contexts on incapacity to provide consent. In this commentary, I take note of some of the intellectual forebears of the Szmukler, Daw, and Dawson proposal, and ask why – despite the formidable intellects that have lined up behind similar approaches in the past – they have not been adopted. I also consider some aspects of the current proposal itself, including the unresolved tensions between equal and differential treatment of persons with mental disorders, and the potential practical consequences, especially for persons with general medical disorders. I conclude that the rationale for fusing two disparate bodies of law may itself be irremediably flawed, and the undesirable consequences significant.
Embracing cultural similarities and bridging differences in supportive communication

This paper critically reviews cultural similarities and differences between European Americans and Asians or Asian Americans found in contemporary supportive communication research. In addition to research primarily examining and reporting cultural differences of social support between European Americans and Asians or Asian Americans, recent research in culture and social support has been focusing on examining both cultural similarities and differences. Broad similarities across cultures have been found regarding evaluations of support provision goals, messages, behaviors, ratings of support provision beliefs, attitudes, and intentions, likelihood of seeking support and so forth. These findings therefore provide us an alternative lens to examine supportive communication across cultures: rather than highlighting cultural differences, we instead want to attend to both cultural similarities and differences. Theoretically, this transition allows us to have a comprehensive understanding about support processes across cultures. Practically, this change of focus provides bridging opportunities and helps enhance understanding between European Americans and Asians or Asian Americans during supportive interactions.
The effects of cognitive load conditions upon performance, anxiety, and self-efficacy in computer-based learning environments

The present study examined whether an extraneous cognitive load condition adversely affected participants' performance, self-efficacy, and anxiety. The participants were sixty-six pre-service teacher education students across two pre-service undergraduate teacher education courses who volunteered to take part in this study. The correlation coefficient was used for the content because Nolen (1995) found that self-efficacy for statistics was related to cognitive engagement. Participants were randomly assigned to either an extraneous cognitive load or non-extraneous cognitive load condition. This study yielded a mixture of significant and non-significant findings regarding the effect of extraneous cognitive load upon motivation and performance. The results suggest two things. First, the correlation instruction improved participants' self-efficacy. Second, that there were confounds such as processing time and content domain that may have affected the results. This suggests that extraneous cognitive load conditions can still adversely impact motivation and performance, but further research is needed to examine these issues.
Facing History: Denial and the Turkish National Security Concept

This article poses the question: why do the current political and legal establishments in Turkey believe that acknowledging the Armenian genocide poses a threat to Turkish national security? The author submits that the answer is revealed in the history of post-WWI, when the victorious Entente Powers divided up the Ottoman Empire and began sentencing the perpetrators of the genocide. The article explores the tension between the concepts of national security and human rights and suggests possible approaches to reintegrating human rights into the Turkish perspective on history, as well as into contemporary Turkish policies.
Accelerator Reactor Coupling for Energy Production in Advanced Nuclear Fuel Cycles

This article is a review of several accelerator–reactor interface issues and nuclear fuel cycle applications of accelerator-driven subcritical systems. The systems considered here have the primary goal of energy production, but that goal is accomplished via a specific application in various proposed nuclear fuel cycles, such as breed-and-burn of fertile material or burning of transuranic material. Several basic principles are reviewed, starting from the proton beam window including the target, blanket, reactor core, and up to the fuel cycle. We focus on issues of interest, such as the impact of the energy required to run the accelerator and associated systems on the potential electricity delivered to the grid. Accelerator-driven systems feature many of the constraints and issues associated with critical reactors, with the added challenges of subcritical operation and coupling to an accelerator. Reliable accelerator operation and avoidance of beam trips are critically important. One interesting challenge is measurement of blanket subcriticality level during operation. We also review the potential benefits of accelerator-driven systems in various nuclear fuel cycle applications. Ultimately, accelerator-driven subcritical systems with the goal of transmutation of transuranic material have lower 100,000-year radioactivity than a critical fast reactor with recycling of uranium and plutonium.
Wisdom is Thrown into Jail: Using Therapeutic Jurisprudence to Remediate the Criminalization of Persons with Mental Illness

The common wisdom is that there are two related villains in the saga of the “criminalization of persons with mental illness”: the dramatic elimination of psychiatric hospital beds in the 1970s and 1980s as a result of the “civil rights revolution,” and the failure of the deinstitutionalization movement. Both of these explanations are superficially appealing, but neither is correct; in fact, the causal link between deinstitutionalization and criminalization has never been rigorously tested. It is necessary, rather, to consider another issue to which virtually no attention has been or is being paid: the near-disappearance of mental status issues from the criminal trial process. It was never an attractive option for a criminal defense lawyer to put forth a lack of responsibility defense or to raise the question of her client’s mental status at time of trial. A number of events in the past three decades, however, have made these options even less attractive – the narrowing of the insanity defense in many jurisdictions; the Supreme Court’s decision in Jones v. United States, sanctioning periods of confinement following insanity acquittals longer (often far longer) than the maximum sentence for the underlying crime; the states’ continued failure to adequately implement Jackson v. Indiana; the greater use of involuntary anti-psychotic medication as a means of seeking to restore incompetent defendants’ competency to stand trial. As a result, there is much less of an incentive for lawyers to explore these options as, realistically, their clients will most likely be incarcerated for far less time if there is no court decision on competency or sanity. This paper discusses: (1) why the common wisdom is wrong, (2) why and how the universe of mental status/defense has shrunk so markedly, (3) how therapeutic jurisprudence should be pursued as potentially remediating influences on the current state of affairs, and (4) why it is crucial that lawyers be trained in the intricacies of this complex area of law and policy.
Augustine's Ciceronian Response to the Ciceronian Patriot

AbstractThis article argues that in the City of God Augustine takes up Cicero's project of cultivating good citizens through philosophy and rhetoric. He addresses the same audience, the dedicated citizen, with a new teaching, echoing the Ciceronian concern with Rome's moral decline and affirming the Ciceronian longing for justice, peace and true community. Yet, in teaching why neither Rome nor the Roman is better off when the citizen devotes himself completely to his earthly patria, Augustine challenges Cicero's construal of good citizenship. In this way, he offers dedicated citizens a new paradigm that remains true to Ciceronian concerns while surpassing the Ciceronian framework.
A new imaging/therapy platform by using external radionuclide ( 192 Ir)

Radionuclides are commonly used as internal radiation sources for diagnostic imaging or external radiation sources for treatment purposes. As most radionuclides have a higher energy level than imaging X-ray tubes, radionuclides are rarely used as a transmission-based external imaging source. In this study, we designed and simulated an imaging model by using 192Ir as an external imaging source to investigate the feasibility of this new imaging method. The goal of this study is to build a portable and flexible dual-function platform that can conduct both imaging and radiation treatment by using a single radiation source. This study uses the Monte Carlo (MC) method to simulate breast fan beam computed tomography (FBCT) and cone beam computed tomography (CBCT) by using 192Ir as an external source. The whole breast phantom is built from a real patient’s chest CT data. We designed an imaging model and embedded it into the Electron Gamma Shower (EGS) simulation environment. CBCT and FBCT data were obtained through EGS simulations. Different image processing techniques were applied to the data. A total of 47 images were reconstructed. Among these images, 16 images have high-density areas (lesions). Comparing with the original CT slices, the lesion volume from both FBCT and CBCT data sets can be identified. CBCT-reconstructed images contain more blurring and noise than FBCT images because of the scattering effects. The 192Ir radionuclide can be used as a possible external radiation source for breast imaging. Considering 192Ir’s therapeutic application and outcomes from its imaging simulation by this study, a new imaging/therapy platform can be potentially created.
Proof of regional classification results of health resources allocation by using dimensionless constructing method

Objective:In order to obtain each regional comprehensive marking value of Yunnan province,the dimensionless constructing method was adopted to verify the regional classification correctness of 16 counties and municiplaities in Yunnan health resouces allocation in 2000.Methods:The dimensionless constructin method was used to create a formula of regional classification marking value based on the seven indicators retrieved from literature.Then,the seven indexes and their growth rates of each region were substituted into the regional classification marking value formula,and each region marking value was calculated and divided into different categories.Conclusion:The results of the two kinds of classification methods are consistent.The index selection is considered correct,representative and stable.The conclustion that Yunnan provinces is calssified into five types regions is reasonable.
334 COUMARIN EMBRYOPATHY: CASE REPORT AND REVIEW OF LONG-TERM OUTCOMES

Coumarin derivatives are preferred anticoagulants for management of patients with mechanical heart valves, however fetal exposure in the first trimester of pregnancy is known to cause birth defects. We report a case and review the medical literature with respect to long-term follow-up of growth and cognition of individuals exposed to coumarin derivatives in utero. BJ was born at 37 weeks to an 18-year old mother whose pregnancy was complicated by coumadin therapy. His mother had congenital heart disease with mitral regurgitation, which required mechanical valve replacement and long-term anticoagulation therapy. She sought prenatal care 6 weeks after her last menstrual period, and was switched to heparin. The cardiologist was concerned about the presence of a potential clot, therefore coumadin was restarted at 11 weeks, 3 days. Pregnancy was otherwise uncomplicated with frequent prenatal ultrasounds, which demonstrated normal growth and nasal hypoplasia on fetal face profile. There was no evidence of joint echodensities suggestive of epiphyseal stippling. At birth he was noted to have characteristic nasal hypoplasia, noisy breathing, and congestion after oral feeds. A skeletal survey demonstrated epiphyseal stippling in the knees, proximal femurs, lower spine and glenoid fossa. He had mild nail hypoplasia of the fingers and 5th toes, and was otherwise neurologically normal. This fetus was exposed to coumadin from the time of conception to an estimated 3 weeks and 5 days post-conception, and he was re-exposed from 9 weeks and 3 days estimated post-conception to birth. The window of risk is considered between the 6th and 12th week of gestation, but this child demonstrates coumarin embryopathy while adhering to the standard recommendation for anticoagulation therapy. In reviewing reports on long-term follow-up of fetuses exposed to coumarin derivatives for counseling purposes, it is remarkable that there are few cohorts described in the medical literature. Pregnancy loss is relatively high and the risk for developing the embryopathy is approximately 5%. In small series, growth tends to be well-preserved and cognition is not significantly different from a non-exposed matched cohort. In the embryopathy group, primary concerns relate to the degree of nasal hypoplasia and meatal stenosis. Even though the coumarin embryopathy is clearly recognized in obstetric and cardiology practices, information on outcomes in prospectively acquired cohorts is lacking.
Turning a Blind Eye

On April 6, 1994 Rwanda’s taut wire snapped. Violence was the immediate product as the killing of political opponents and Tutsi evolved into both genocide and a resumption of the civil war. Hutu extremists seized the reins of government, and UNAMIR started to disintegrate. The UN Security Council, in an egregious dereliction of moral responsibility, then decided to reduce the size of UNAMIR rather than reinforce its troop strength to meet the challenge. This turned out to be the most fateful act of the entire Rwandan tragedy.
General Sources for Study of Construction

Other than your brilliant lectures, there are various sources from which some information about construction can be obtained for learning by the students. This chapter has some comments on the use of the most ordinary of these, in the context of a typical lecture course situation.
Themes of the Book

I never expected to write this very personal book about aged people and nursing homes. My late wife and I had extensive experience with these facilities in connection with our parents in the 1960s and 70s. These were sobering experiences for several reasons. The first was that what passes for care of old people was impersonal and devoid of any attempt to keep the minds of residents active, to prevent retreat into a private world that stayed private until they died. Their “bodies” were never neglected but their minds were.
Multiple Family SES Indices: Variations between Middle Class and Lower Social Class Undergraduate Samples

Angesichts soziookonomischer Notlagen, zielten auf Jugend ausgerichtete Programme Sozialer Arbeit nicht nur auf die untere soziale Klasse, sondern auch auf die Mittelschicht. Um die Notwendigkeit einer soziookonomischen Status (SES) Untersuchung potenzieller Adressaten solcher Programms hervorzuheben, wurden Familien SES-Indizes fur zwei weitgehend middle-class undergraduate samples und einem soziookonomisch benachteiligten working student sample aus den Philippinen aufgestellt. Indizes wurden entlang von Vermogen, Wohnraum und Einrichtung, subjektiv wahrgenommener finanzieller Schwierigkeiten, finanzieller Lebensumstande und finanzieller Grundsicherung gebildet. Ubereinstimmungen welche sich aus einer nichtlinearen Hauptkomponentenanalyse ergaben dienten als Grundlage die Indikatoren fur einen Index zu reduzieren. Die resultierenden Indizes fur die mittleren und unteren sozialen Klasse Proben unterscheiden sich im Wesentlichen in ihren Indikatoren und zugrunde liegendem Faktor, was unterschiedliche Ausmase und Muster der soziookonomischen Notlage wiederspiegelt. Die Indizes fur das middle-class sample unterscheiden zwischen objektiven Indikatoren und subjektiv wahrgenommen finanziellen Schwierigkeiten. Die Indizes fur die unteren sozialen Klasse zeigen eine umfassende und mehrdimensionale Erfahrung der soziookonomischen Notlage.
The Potential Use of Ultrasound‐Magnetic Resonance Imaging Fusion Applications in Musculoskeletal Intervention

We sought to assess the potential use of an application allowing real-time ultrasound spatial registration with previously acquired magnetic resonance imaging in musculoskeletal procedures. The ultrasound fusion application was used to perform a range of outpatient procedures including piriformis, sacroiliac joint, pudendal and intercostal nerve perineurial injections, hamstring-origin calcific tendonopathy barbotage, and 2 soft tissue biopsies at our institution in 2015. The application was used in a total of 7 procedures in 7 patients, all of which were technically successful. The ages of patients ranged from 19 to 86 years. Particular use of the fusion application compared to sonography alone was noted in the biopsy of certain soft tissue lesions and in perineurial therapeutic injections.
Erlotinib-associated rash correlates with plasma levels at steady state.

13008 Background: Erlotinib is a small molecule epidermal growth factor receptor tyrosine kinase inhibitor that is approved for non-small cell lung cancer as a single agent and for pancreatic cance...
Insight into the interactions between pyrene and polystyrene for efficient quenching nitroaromatic explosives

A pyrene (Py) in polystyrene (PS) matrix shows rapid fluorescence quenching in the presence of 2,4-dinitrotoluene (2,4-DNT). The fluorescence quenching does not occur in the absence of the PS matrix, implying that the molecular architecture of the PS chain is critical. However, the function of the PS matrix is not well understood. Here, we investigate various Py/PS binary thin films containing PS of diverse molecular architecture (i.e., linear, centipede and 4-arm star) and molecular weight (i.e., 2.5, 35, 192, 350 and 900 kDa) to understand the effects of these molecular descriptors on the fluorescence quenching. The findings suggest that the electron-rich nature of Py/PS facilitates the photoinduced electron transfer from Py/PS to the electron-deficient 2,4-DNT, resulting in effective quenching of Py excimers. Moreover, cyclic voltammetry (CV) and UV-vis absorption verified that PS reduces the lowest unoccupied molecular orbital level of Py, promoting the Py excimer quenching efficiency in the presence of nitroaromatic molecules. The quenching process is found to be independent of molecular architecture and molecular weight, suggesting that energy migration along the PS backbone may not be the key mechanism. This simple and concise concept provide the insight into the selection for highly-efficient sensing materials.
“Yes, and … ”: continuing the scholarly conversation about immigration and higher education

To maintain the flow of the performance, a central rule in improv is to respond with “yes, and … ” to lines that come before you (instead of “no” or “yes, but”). The idea is to create an environmen...
Energy harvesting controls for solar direct-drive medical cold chain equipment

Solar direct-drive (SDD) appliances including refrigerators and freezers are widely used for storing vaccines and other medical products in locations without reliable mains electricity. The capacity of the solar array powering an SDD appliance must be large enough to provide sufficient compressor runtime during periods of reduced solar irradiance. SDD appliance solar arrays therefore create useful quantities of excess electricity that are currently not utilized. An energy harvest control (EHC) that prioritizes the power requirements of the appliance and diverts excess electricity to other purposes has the potential to power a wide range of electrical devices, including health facility lights, appliance data loggers, medical devices, and mobile phone chargers. This paper discusses results of laboratory testing of two EHC prototypes employing different control logics using simulated and actual solar power, as well as results from field testing. In laboratory testing, the prototype EHCs demonstrated diversion of useful amounts of electricity to secondary loads without adversely affecting refrigerator performance in most cases. Some problematic interactions between the refrigerator compressor controller and EHCs were observed. Field tests of the EHC prototypes in Colombia demonstrated the usefulness and acceptance of EHCs in providing power to community- and district-level health facilities. Development of more low-powered medical devices that can take advantage of the limited power provided by EHCs would be of great benefit to health facilities in areas without reliable mains electricity. Prioritized control of loads on solar arrays may have applications beyond medical refrigeration appliances.
A New Constructive and Elementary Proof of a Bernstein–Walsh Theorem, Improved to Infinite Order Convergence, for Functions C ∞ in an Intricate but Smooth Two-Dimensional Real Domain

We give a constructive proof that a C∞ function f(x, y) can be approximated by a polynomial with an infinite order rate of convergence on a general two-dimensional domain that is specified as the set where a smooth function B(x, y) is non-negative and which can be embedded within a rectangle. We explicitly construct a C∞ smoothed approximation to the characteristic function of the domain as $\rho (x,y) \equiv \mathcal {H}([1 + SB(x,y)])$ where S > 0 is a constant, $\mathcal {H}$ is a “ramp” (a smoothed approximation to the Heaviside step function) and ρ ≡ 1 on the domain Ω. The product f(x, y)ρ(x, y) is identically equal to f on the domain, but is of compact support. From this, we prove that ρf has a bivariate Chebyshev series on a rectangle that embeds Ω. We prove also that this expansion converges with increasing N, where N is the series truncation, faster than any finite inverse power of N, which is the definition of “infinite order” convergence. Bernstein–Walsh-type theorems have a long history, but the proofs use mathematical tools far removed from the education of the engineers and scientists. In contrast, our proof is constructive using tools accessible to applied practitioners. The proof of exponential convergence for functions with only C∞ smoothness has not been previously given by any methodology.
Teaching NeuroImages: A Cutaneous Vascular Malformation Hides Giant Cerebral Aneurysms

A 64-year-old man acutely developed right hemianopsia. Brain MRI showed an ischemic stroke in the left occipital lobe (figure 1A). Angio-CT revealed giant aneurysms of the left vertebral and internal carotid arteries (figure 1B); the left subclavian artery and the left jugular vein presented abnormal dilation. On the same side of the neck, he presented a cutaneous lesion consistent with hemangioma (figure 2). The stroke was most likely due to embolization from the vertebral aneurysm.
Hands in the Cookie Jar? The Case of Management Buyouts 1

This paper investigates the effects of managerial ownership on shareholder wealth gains in management buyouts to study whether target managers expropriate public shareholder interests when they buy out a firm. We find that the transaction premiums are negatively associated with the buyout managers' stock holdings, but not with their option holdings. This evidence indicates that acquiring managers, using their corporate power associated with their stock holdings, pursue their own interests at the expense of public shareholders, and that their interest in the post-buyout firm dominates their interest associated with their options. We also find that the transaction premiums are not associated with the non-buyout managers' stock and option holdings. JEL classification: G34 G14
Modeling Cost and Expenditure for Healthcare

Data on healthcare expenditures and costs often have a substantial fraction of cases with zero values, right-skewed positive values, and responses that vary by type of service or by level of expenditure. This article explores a number of econometric and statistical methods to address such data to avoid biased and inefficient estimates. Conventional econometric methods often fail on one or both scores. Model selection issues are discussed.
Toward a Counter-visual Education: Cinema, Race, and the Reorientation of White Visuality

This chapter explores how racial hegemony is instrumentalized and resisted through popular and mass-mediated visual culture. Using Critical Race Theory in combination with phenomenologies of difference and film theory, the authors juxtapose the Hollywood film 12 Years a Slave and cell phone videos that helped galvanize the Black Lives Matter movement to show how the politico-aesthetic strategies and frames employed in the making of these two visual sites/sights effectively and affectively challenge dominant white visuality. The discussion considers the way images of race “teach” viewers how to look and how such practices of looking contribute to the visual production of racial knowledge, identities, and power relations. Implications are drawn for a counter-visual arts education that confronts dominant white visuality.
Jurassic Palynostratigraphy of Offshore Eastern Canada

Abstract The Scotian Shelf and Grand Banks, offshore southeastern Canada, cover approximately 175,000 square miles and extend over 850 miles from northeast to southwest. More than 100 exploratory wells drilled to date have encountered Lower Paleozoic to Recent sediments, which frequently contain rich and age diagnostic palynomorph assemblages. Based upon the analysis of twenty wells, ten palynomorph zones have been defined within the Jurassic. These zones have been correlated with the standard European Jurassic stages, all of which are recognised, although the Hettangian-Sinemurian and Toarcian-Aalenian cannot, as yet, be separated. Both marine (dinoflagellates) and non-marine (spores) palynomorphs are utilized for zonation and for the interpretation of environments. On the Scotian Shelf the oldest encountered sediments, the Eurydice Formation, are Rhaetian-Hettangian, and are overlain by the Argo Salt, probably of Hettangian-Sinemurian age. The succeeding non-marine or marginally marine Iroquois Formation contains distinctive spore assemblages which have no known correlatives, but are tentatively dated Sine-murian-Pliensbachian. On the Grand Banks, marginally marine and eva-poritic Hettangian-Sinemurian strata are overlain by the marine Whale Unit, whose dinoflagellates closely compare with Pliensbachian-Toarcian assemblages from Europe. Throughout the Middle and Late Jurassic, predominantly shallow marine deposition occurred in both areas, with some non-marine episodes. Dinoflagellate species diversity, low in the Early Jurassic and Aalenian-Bajocian, increased to a peak in the Kimmeridgian and subsequently declined in the Portlandian.