cssi/SciSciGPT-SciSciNet huggingface dataset:
Value of perioperative inhaled epoprostenol with low tidal volume ventilation for complex endocarditis surgery.

BACKGROUND AND AIM To compare outcomes of patients treated with inhaled epoprostenol and low tidal volume ventilation during cardiopulmonary bypass with those who did not receive this medication in the operating room at all, and those who received it as a rescue therapy at the end of the case. METHODS Retrospective chart review between 2014 and 2017, follow-up included the entire hospital stay. RESULTS Seventy-one patients were included, and mean age was 54 years. 78.9% of the patients were male. Procedures included 96% (n = 68) aortic valve replacement, 28% (n = 20) reconstruction of the intravalvular fibrosa, and 13% (n = 9) repair of an endocarditis-related intracardiac fistula. Patients who received epoprostenol (iEpo) (treatment and rescue groups), when compared with the control group had more intra-aortic balloon pump placement (23% vs 2.5%, P = .018), open chest after surgery (32% vs 7.5%, P = .012), and duration of mechanical ventilation (8.3 ± 2.7 vs. 2.4 ± 0.4 days, P = 0.01). There was no significant difference between the two groups in terms of extracorporeal circulatory support (6.5% vs 2.5%, P = .577) and hospital death (13% vs 10%, P = .72). In a subanalysis, hospital death and duration of mechanical ventilation were higher in the recue group when compared with the treatment group (P = .004 and .056, respectively). CONCLUSIONS Prophylactic application of iEpo with low tidal volume ventilation for an anticipated complex endocarditis operation may contribute to favorable outcome when compared with postoperative epoprostenol rescue.
Immunomagnetic Capture of Big Six Shiga Toxin-Producing Escherichia coli Strains in Apple Juice with Detection by Multiplex Real-Time PCR Eliminates Interference from the Food Matrix.

ABSTRACT Having reliable methods for detecting Shiga toxin–producing Escherichia coli (STEC) in foods is an important food safety goal. The majority of STEC outbreaks have involved either the O157:...
The Policy Ecology of Behavioral Health Homes: Case Study of Maryland's Medicaid Health Home Program.

Behavioral health homes, shown to improve receipt of evidence-based medical services among people with serious mental illness in randomized clinical trials, have had limited results in real-world settings; nonetheless, these programs are spreading rapidly. To date, no studies have considered what set of policies is needed to support effective implementation of these programs. As a first step toward identifying an optimal set of policies to support behavioral health home implementation, we use the policy ecology framework to map the policies surrounding Maryland’s Medicaid behavioral health home program. Results suggest that existing policies fail to address important implementation barriers.
Robotic Sacrospinous Ligament Suspension

Video Objective To describe a robotic approach for performing a sacrospinous ligament suspension. Setting A 78 year-old woman presented with stage 3 uterine prolapse with the sole complaint of vaginal pressure. She had no urinary or bowel dysfunction. Her gynecologic surgical history included anterior and posterior vaginal wall mesh-augmented repairs. On examination, she had uterovaginal prolapse with underlying palpable uterus and calcified fibroid and the leading edge of he cervix at +6 cm from the hymen. Anterior, posterior and introital measurements on POP-Q were normal. This represented an isolated stage 3 Uterine Prolapse. Interventions A robotic hysterectomy with bilateral salpingo-oophorectomy was completed. Uterosacral ligaments were attenuated and could not be utilized for vaginal apical support. Alternatively, a robotic right sacrospinous ligament suspension was attempted successfully. Steps for this procedure include: developing the right pararectal space, identifying the levator ani muscles and sacrospinous ligament followed by suspension of the vaginal cuff to the sacrospinous ligament using resorbable suture. This surgical clip demonstrates the technique. Conclusion A robotic approach can be utilized for vaginal apical suspension to the sacrospinous ligament when uterosacral ligaments are attenuated. Pelvic floor and sidewall anatomic knowledge is required for successful completion of this procedure.
Impact of renal impairment on light chain amyloidosis outcomes after autologous hematopoietic stem cell transplantation.

Light chain amyloidosis (AL) is a rare clonal plasma cell neoplasm characterized by the deposition of amyloid fibrils derived from the aggregation of misfolded immunoglobulin light chains in vital organs such as heart and kidneys resulting in irreversible organ damage (1). The severity of organ damage is the most important determinant of outcome. Both cardiac and renal staging systems have been proposed and validated as predictors of outcome. Cardiac staging system, initially developed and then revised by the Mayo Group, utilizes cardiac biomarkers (NT-proBNP, troponin T and I) and serum free light chain levels to stratify the patients (2,3). Renal staging system, developed by the Pavia Group, depends on the degree of proteinuria and glomerular filtration rates (GFRs) (4). Cardiac stage in general is a predictor of non-relapse mortality and overall survival, while renal stage is a predictor of renal recovery and dialysis dependence (2-4). Renal involvement is seen in approximately 70% of patients with AL (5). However, there are limited data on the impact of baseline renal dysfunction on the outcomes of AL after autologous stem cell transplantation (ASCT).
CaCl2-Activated Carbon Nitride: Hierarchically Nanoporous Carbons with Ultrahigh Nitrogen Content for Selective CO2 Adsorption

Bulk carbon nitride (C3N4) was transformed into hierarchically nanoporous, nitrogen-rich (N-rich) carbons via calcium chloride (CaCl2) mediated thermal activation. By systematically varying the ann...
Evaluating the potential of treated effluent as novel habitats for aquatic invertebrates in arid regions

Increasing anthropogenic demands for freshwater have altered many aquatic systems, including the drying of formerly perennial streams. The discharge of treated effluent has returned perennial flow in some of these streams, especially in arid and semi-arid regions, but the ability of treated effluent to support diverse aquatic communities is poorly understood. We examined the potential of treated effluent to create aquatic invertebrate habitat using the effluent-dependent Santa Cruz River in southern Arizona, USA as a case study. We identified 92 invertebrate taxa across our ten sampling sites and two sampling dates. Community composition was primarily shaped by water quality but also by stream drying (on daily time scales) and benthic substrate. Specifically, Linear Mixed-Effects models revealed a strong positive relationship between dissolved oxygen and taxonomic richness and a strong negative relationship between stream drying and invertebrate density. Although there are unique challenges to biota in effluent-dependent systems, our results suggest that treated wastewater could be managed to augment or recreate aquatic habitats that have been otherwise diminished or lost.
Humeral intramedullary nail placement through the rotator interval: an anatomic and radiographic analysis.

Background Antegrade humeral intramedullary nails are an effective fixation method for certain proximal humeral fractures and humeral shaft fractures. However, owing to potential rotator cuff damage during nail insertion, shoulder pain remains a common postoperative complaint. The purpose of this study was to provide quantitative data characterizing the anatomic and radiographic location of the rotator interval (RI) for an antegrade humeral intramedullary nail using a mini-deltopectoral approach. Methods Six consecutive fresh-frozen intact cadaveric specimens (mean age, 69 ± 12.8 years) were obtained for our study. Demographic data were collected on each specimen. A mini-deltopectoral approach was used, followed by placement of a guidewire in the RI. Quantitative anatomic relationships were calculated using a fractional carbon fiber digital caliper. Radiographic measurements were performed by 2 orthopedic residents and 1 practicing fellowship-trained orthopedic surgeon. In addition to re-measurement of similar anatomic relationships on radiographs, the ratio of the distance from the lateral humeral edge to the starting point relative to the width of the humeral head on the anteroposterior (AP) view was calculated. Similarly, on the lateral view, the ratio of the distance from the anterior humeral edge to the starting point relative to the humeral head width was calculated. Results In all cases, the described approach allowed for preservation of the biceps tendon and access to the RI for guidewire insertion, with no subsequent rotator cuff or humeral articular cartilage damage identified following nail insertion. The ratio of the distance from the lateral humeral edge to the starting point relative to the humeral head width on the AP view was 0.4 ± 0.0. The ratio of the distance from the anterior humeral edge to the starting point relative to the humeral head width on the lateral view was 0.3 ± 0.0. Conclusion This study demonstrates the clinical feasibility of a mini-deltopectoral approach and shows that the ideal starting point through the RI radiographically lies along the medial aspect of the lateral third of the humeral head on the AP view and along the posterior aspect of the anterior third of the humeral head on the lateral view.
Mentoring in nursing education: An essential element in the retention of new nurse faculty.

Abstract Background Mentoring in nursing education is essential to retaining nurse faculty; whether they are new to academia or experienced, but new to the institution in which they teach. Furthermore, mentoring promotes awareness of faculty roles and responsibilities, decreases ambiguity and increases retention of qualified nurse faculty. Purpose This study examined whether there was a relationship between nurse educator mentor's perception of their mentoring effectiveness and nurse educator mentee's perception of their mentor's effectiveness. Method A Spearman's rho correlation was conducted on a convenience sample of 119 nurse educators who completed the Principles of Adult Mentoring Inventory (PAMI), which measured six core mentoring behaviors. A secondary analysis using an independent samples t-test was also performed. Results Statistically significant results were revealed in two of the six mentoring behaviors; relationship emphasis (p = 0.035) and confrontive focus (p = 0.043). The Mentor Role Competency Profile (MRCP), a measure accompanying the PAMI, indicated concerns that could be counterproductive within the mentoring relationship. A secondary analysis using a t-test confirmed concerns as identified in the initial analysis. Conclusion Continuous improvement and training are critical to acquiring and reinforcing effective mentoring skills. Requiring evaluation and follow up for mentors could result in increased satisfaction for both mentor and mentee and improve retention of new faculty in academia.
A Public Health Ethics Case for Mitigating Zoonotic Disease Risk in Food Production

This article argues that governments in countries that currently permit intensive animal agriculture - especially but not exclusively high-income countries - are, in principle, morally justified in taking steps to restrict or even eliminate intensive animal agriculture to protect public health from the risk of zoonotic pandemics. Unlike many extant arguments for restricting, curtailing, or even eliminating intensive animal agriculture which focus on environmental harms, animal welfare, or the link between animal source food (ASF) consumption and noncommunicable disease, the argument in this article appeals to the value of protecting populations from future global health emergencies and their broad social, economic, and health impacts, taking the SARS-CoV-2 virus as a particularly salient example. The article begins by identifying how intensive animal agriculture contributes to the outbreak (and risk of future outbreaks) of zoonotic diseases. Next, we explore three specific policy options: 1. Incentivizing plant-based and cell-based ASF alternatives through government subsidies; 2. Disincentivizing intensive ASF production through the adoption of a “zoonotic tax”; and 3. Eliminating intensive ASF production through a total ban. We argue that all three of these measures are permissible, although we remain agnostic as to whether these measures are obligatory. We argue for this conclusion on the grounds that each measure is justified by the same sorts of considerations that justify other widely accepted public health interventions, and each is compatible with a variety of theories of justice. We then address potential objections. Finally, we discuss how our novel argument relates to extant ethical arguments in favor or curtailing ASF production and consumption.
Monopolizers of the Soil: The Commons as a Source of Public Trust Responsibilities

In the seventeenth century, public resources were essential to the survival of the English poor. The common law, stretching back to Magna Carta and the Forest Charter, provided them with usufructuary rights to the commons. Those rights were violated by the enclosure movement, which received royal assent beginning with Charles I’s absolutist reign in 1625. As a result, the common people joined with Parliament to overthrow Charles I. After the Interregnum, Matthew Hale wrote De Jure Maris, a treatise foundational to the public trust doctrine in America and the doctrine’s expansion abroad. Hale lived through the Civil War which resulted from the king’s abuse of his prerogatives, and his treatise was written during an effluvium of ideas about the obligations that a sovereign incurs incidental to their rule. Two of the most radical groups to espouse reciprocal rule were the Levellers and the Diggers. Their ideas were also among the most popular expressions of anti-monopoly sentiment during Hale’s lifetime. Hale’s works became the foundation for the public trust doctrine in America when American jurists relied on his treatise beginning with Arnold v. Mundy in the early 19th century. The public trust doctrine should therefore include in its pedigree these populist groups and their ideas about stewardship of common resources and the duty to prevent their alienation for private gain that influenced Hale.
Adaptation to Hypoxia

Hypoxia occurs if the oxygen requirement of the tissues is greater than the oxygen supply. In man at rest the basal requirement is fixed and if supply does not match this demand, normal function is interrupted.
Seward: Lincoln's Indispensable Man. By Walter Stahr. (New York, NY: Simon & Schuster, 2012. Pp. 703. $32.50.)

In terms of its impact on the public, Steven Spielberg's recent movie on America's “Great Emancipator” outshone even the five‐year bicentennial celebration of Abraham Lincoln's birth in 2009. Many ...
Quantum Cryptography over 14 Km of Installed Optical Fiber

Cryptography, the science of secret communications, is becoming increasingly important with the growth of computer networks and electronic transactions. When sensitive information is transferred from place-to-place it becomes vulnerable to eavesdropping or tampering with potentially catastrophic consequences. Thus, two of the main goals of cryptography are: the encryption of a message to render it unintelligible to a third party; and authentication of a message to certify to the legitimate recipient that it has not been altered in transit. Both of these objectives can be accomplished, with provable security, if the sender (conventionally referred to as “Alice”) and recipient (“Bob”) possess a secret random bit sequence (“key” material), which is therefore a valuable resource. For example, Alice may encrypt her messages to Bob by first rendering them into binary numbers and then adding the random key bits to the message modulo 2 (no “carries”). Bob can decrypt this communication by subtracting his key bits. This encryption system is known as the “onetime pad” and is secure because the encrypted transmission from Alice to Bob has all the characteristics of purely random numbers, and therefore gives no clue as to how it is to be decrypted.
A Wavelength Meter

Two years ago we set out to design and build a wavelength meter [1] that would complement our tunable source research. [2] The design goals were a device that measured wavelengths for both pulsed and cw lasers, displayed single pulse laser bandwidths, used inexpensive broadband optics and could be interfaced with a minicomputer.
Planeación transfronteriza: ¿un caso de provocación sofisticada?

Este documento se propone examinar criticamente los argumentos de Hansen a favor de un marco formal y legalmente comprometido, para la planeacion transfronteriza y cooperacion en la frontera de Estados Unidos y Mexico. Primero se procedera a resumir los argumentos de Hansen favorables para una cooperacion transfronteriza mas estrecha. Tres conjuntos de argumentos seran discutidos: aquellos relacionados con su concepcion de regiones fronterizas como "artificialmente" divididas por convenciones politicas; aquellos relacionados con la autonomia regional; y aquellos relacionados con la cooperacion economica internacional. Siguiendo con esta revision, se trabajara sobre lo que se consideran las falacias basicas en el razonamiento de Hansen, concluyendo que su propuesta para una estrecha cooperacion transfronteriza, basada en sus ejemplos europeos, debe ser rechazada.
Early afterdepolarization formation in cardiac myocytes: analysis of phase plane patterns, action potential, and membrane currents.

Early Afterdepolarization Formation, introduction: Early afterdepolarizations (EADs) are among the mechanisms proposed to underlie ventricular arrhythmias. Sea anemone toxin, ATXII, known to delay Na inactivation and to induce plateau level voltage oscillations, was used to study the formation of EADs. Methods and Results: Action potential and membrane currents were studied in rat ventricular myocytes using whole cell current and voltage clamp techniques. Phase plane trajectories were generated by plotting membrane potential (V) versus the first time derivative of membrane potential (dV/dt). Under current clamp conditions, ATXII (40 nM) consistently prolonged the action potential and induced EADs. The EADs developed at a plateau voltage between -10 and -40 mV. Calcium channel blockers, verapamil 10 μM and cobalt 4 μM, and the sarcoplasmic reticulum modulator, ryanodine (1 μM) did not antagonize ATXII effects on the action potential and EADs. However, Na channel blockers, tetrodotoxin 0.3μM and lidocaine 40μM. and rapid stimulation consistently shortened the prolonged action potential and suppressed EADs. Under voltage clamp conditions in the presence of ATXII, a slowly decaying inward current followed the fast inward current during depolarizing pulses. Membrane currents flowing at or later than 100 msec after the test pulse were analyzed. The control isochronal current-voltage (I-V) curves showed no late inward currents. In the presence of ATXII, all the isochronal I-V curves showed an inward current that was more prominent between -40 and 0 mV. The ATXII-induced current at the 100-msec isochronc activated at a potential of approximately -60 mV, peaked at about -20 mV, and reversed at +40 mV consistent with the Na current I-V curve. The isochronal I-V curves obtained after lidocaine superfusion resembled those of the control. The phase plane trajectory of the action potential obtained with ATXII showed an oscillatory behavior corresponding to the t AD range of potential; within this voltage range, the isochronal I-V curves were shown to cross the abscissa three times instead of once. Conclusion: These results suggest that, in this experimental model, neither sarcolemmal L-type Ca current nor sarcoplasmic reticulum Ca release plays a significant role in the genesis of ATXII-induced EADs. EADs are generated by a voltage-dependent balance between a markedly prolonged Na inward current and K outward currents within the voltage plateau range of the action potential hut not by Ca current reactivation and inactivation.
Nonpoint Source Pollution Impacts of Agricultural Land Use

ABSTRACT The amounts of soluble and particulate phosphorus (P) and nitrogen (N) transported in runoff from agricultural land were predicted using relationships describing the physical and chemical processes involved in their transport. These values were compared with amounts measured in runoff from nine unfertilized grassed, six fertilized wheat, and five fertilized mixed crop watersheds in Oklahoma and Texas over a 10-year period. An estimate of the bioavailability of sediment-bound phosphorus (0.1 M sodium hydroxide extractable) was also included in the analysis. Measured and predicted soluble phosphorus (R2=0.97), particulate phosphorus (R2=0.93), bioavailable phosphorus (R2=0.98), and total nitrogen concentrations (R2=0.93) in runoff from all 20 watersheds in 801 events were not significantly different (5 percent level), with an average standard error of 11,13,13, and 16 percent, respectively, for the predicted value. This was the case for a wide range in measured concentrations (8–9132, 10–88076, and...
Progress in epilepsy: reducing the treatment gap and the promise of biomarkers.

Purpose of review Since the antiquities, the history of epilepsy has been characterized by ignorance and human suffering. People with epilepsy have benefited substantially from results of modern basic and clinical research; however, serious challenges remain. Two programs begun in the past decade offer the promise of even greater progress in the future. Recent findings The International League against Epilepsy, the International Bureau for Epilepsy and the WHO launched the Global Campaign against Epilepsy in 1997, which is using socioepidemiologic approaches to reduce the treatment gap and improve quality of life for people with epilepsy in the developing world. The US National Institute of Neurological Disorders and Stroke, and the American Epilepsy Society began a national neurobiological effort to move from targeting control of symptoms to strategies of prevention and cure, and in 2001 established benchmarks for future epilepsy research. The first of these benchmarks is to develop reliable biomarkers of epileptogenesis and epileptogenicity that could revolutionize our approach to diagnosis, treatment, prevention, and cure. Summary Epilepsy continues to be a major health burden worldwide. The Global Campaign against Epilepsy is leading the way towards universal acceptability of epilepsy and access to medical care. Among the many current neurobiological research objectives, development of reliable epilepsy biomarkers would be a major step toward realizing a world where no one is compromised by epilepsy.
Forms of Social Capital in India: A Case Study of Jhabua District

This paper derives literature-based components of social capital. Since social capital changes form given the context, the paper uses the theoretical concepts of social capital to observe how they play out in rural tribal India. A qualitative data-coding software is used to sieve through the literature as well as to analyze the empirical data from Jhabua. The coding procedure combines theoretical codes based on previous literature and emergent codes derived from interview data. The paper suggests that not all forms of social capital are positive. However, each component must be clearly understood to promote community-driven actions towards development.
Hosting the .NET Runtime in Microsoft SQL server

The integration of the .NET Common Language Runtime (CLR) inside the SQL Server DBMS enables database programmers to write business logic in the form of functions, stored procedures, triggers, data types, and aggregates using modern programming languages such as C#, Visual Basic, C++, COBOL, and J++. This paper presents three main aspects of this work. First, it describes the architecture of the integration of the CLR inside the SQL Server database process to provide a safe, scalable, secure, and efficient environment to run user code. Second, it describes our approach to defining and enforcing extensibility contracts to allow a tight integration of types, aggregates, functions, triggers, and procedures written in modern languages with the DBMS. Finally, it presents initial performance results showing the efficiency of user-defined types and functions relative to equivalent native DBMS features.
The distribution of population and employment in a polycentric city: the case of Los Angeles.

The distribution of population and employment in metropolitan Los Angeles in 1970 and 1980 is examined in this paper. Population continued to disperse in the 1970s, whereas the geographical distribution of employment combined job clustering around a few major employment centers with a high degree of general job dispersion. In Los Angeles polycentrism has been associated with shorter work trips, particularly intracounty trips in the more peripheral counties.
Experimental and Theoretical Study of the Reactions between Small Neutral Iron Oxide Clusters and Carbon Monoxide

Reactions of small neutral iron oxide clusters (FeO1−3 and Fe2O4,5) with carbon monoxide (CO) are investigated by experiments and first-principle calculations. The iron oxide clusters are generated by reaction of laser-ablation-generated iron plasma with O2 in a supersonic expansion and are reacted with carbon monoxide in a fast flow reactor. Detection of the neutral clusters is through ionization with vacuum UV laser (118 nm) radiation and time-of-flight mass spectrometry. The FeO2 and FeO3 neutral clusters are reactive toward CO, whereas Fe2O4, Fe2O5, and possibly FeO are not reactive. A higher reactivity for FeO2 [σ(FeO2 + CO) > 3 × 10−17 cm2] than for FeO3 [σ(FeO3 + CO) ∼ 1 × 10−17 cm2] is observed. Density functional theory (DFT) calculations are carried out to interpret the experimental observations and to generate the reaction mechanisms. The reaction pathways with negative or very small overall barriers are identified for CO oxidation by FeO2 and FeO3. The lower reactivity of FeO3 with respect to ...
Differential expression and regulation of IL-23 and IL-12 subunits and receptors in adult mouse microglia.

Abstract IL-23 and IL-12 are functionally related heterodimeric cytokines that share the IL-12p40 subunit. IL-23 and IL-12 function through heterodimeric receptors, which share the IL-12Rβ1 subunit. Production of IL-23, a heterodimer of IL-12p40 and IL-23p19, by CNS antigen-presenting cells (APC) is critical for susceptibility to experimental autoimmune encephalomyelitis (EAE), the animal model for multiple sclerosis (MS). We report that the expression of IL-23p19 mRNA is highly induced by stimulation with IFN-γ and LPS in adult mouse microglia and a microglia cell line, EOC13. Expression of the IL-12R subunits, IL-12Rβ1 and IL-12Rβ2, is upregulated in both microglia and splenic macrophages upon stimulation with LPS or IFN-γ and LPS, whereas the IL-23R subunit is upregulated only in macrophages. In EAE, an early peak of IL-23p19 mRNA expression is found in CD11b+ CNS APC, compared with peripheral macrophages. In contrast, IL-12p40 and IL-12p35 mRNA maximum levels in the CNS are detected at peak of disease. The expression of IL-12p35 mRNA is more sustained than that of IL-12p40 and IL-23p19. Thus, IL-23 produced by CNS microglia/macrophages may contribute to the early induction of EAE. In the CNS, IL-23 may preferentially target infiltrating mononuclear cells, which upregulate IL-23R, rather than parenchymal microglia.
Essential fatty acid synthesis and its regulation in mammals

The tissue content of highly unsaturated fatty acids (HUFA) such as arachidonic acid and docosahexaenoic acid is maintained in a narrow range by feedback regulation of synthesis. Delta-6 desaturase (D6D) catalyzes the first and rate-limiting step of the HUFA synthesis. Recent identification of a human case of D6D deficiency underscores the importance of this pathway. Sterol regulatory element binding protein-1c (SREBP-1c) is a key transcription factor that activates transcription of genes involved with fatty acid synthesis. We recently identified sterol regulatory element (SRE) that is required for activation of the human D6D gene by SREBP-1c. Moreover, the same SRE also mediates the suppression of the D6D gene by HUFA. The identification of SREBP-1c as a key regulator of D6D suggests that the major physiological function of SREBP-1c in liver may be the regulation of phospholipid synthesis rather than triglyceride synthesis. Peroxisome proliferators (PP) induce fatty acid oxidation enzymes and desaturases in rodent liver. However, the induction of desaturases by PP is slower than the induction of oxidation enzymes. This delayed induction may be a compensatory reaction to the increased demand of HUFA caused by increased HUFA oxidation and peroxisome proliferation in PP administration. Recent studies have demonstrated a critical role of peroxisomal beta-oxidation in DHA synthesis, and identified acyl CoA oxidase and D-bifunctional protein as the key enzymes.
Quality improvement in heart failure: a simple solution to the beta-blocker problem

In a landmark report published in 2001, the Institute of Medicine (IOM) called attention to the marked discrepancy between existing knowledge about what constitutes best clinical practice (ie, the evidence base), and the extent to which this knowledge is applied in routine patient care, a discrepancy that the IOM has branded the “quality chasm”. Notably, however, the IOM’s report is not an indictment of physicians, but rather of the US healthcare system, which is simply not designed to provide care for a progressively aging population beset by multiple chronic and often complex medical illnesses. Moreover, the current system lacks the necessary infrastructure to rapidly and efficiently translate new research findings and practice guidelines into standard clinical care at the level of the individual physician and patient. To remedy what is a patently cumbersome and dysfunctional system, the IOM advocates sweeping changes in the structure of healthcare delivery in the U.S., accompanied by the development of new models of health care that emphasize safe, effective, patient-centered, timely, efficient, and equitable care for all Americans. Recognizing the immensity of the challenge to implement change in an organization as vast, complex, and inhomogeneous as the U.S. health care system, the IOM has selected 5 priority areas as initial targets for its efforts: asthma, depression, diabetes, pain control in advanced cancer, and chronic heart failure (HF). The selection of HF as a prime target for health system change is entirely appropriate. HF is the leading cause of hospitalization in the Medicare population, and it is the most costly medical illness by a factor of almost 2. In addition, annual hospitalizations for HF, which account for
X11 Interaction with β-Amyloid Precursor Protein Modulates Its Cellular Stabilization and Reduces Amyloid β-Protein Secretion

The protein interaction domain of the neuronal protein X11 binds to the YENPTY motif within the cytoplasmic domain of beta-amyloid precursor protein (betaAPP). Amyloid-beta protein (Abeta), the major constituent of the amyloid deposited in brain of Alzheimer's disease patients, is generated by proteolytic processing of betaAPP, which occurs in part following betaAPP internalization. Because the YENPTY motif has a role in the internalization of betaAPP, the effect of X11 binding on betaAPP processing was studied in mouse neuroblastoma N2a, human embryonic kidney 293, monkey kidney COS-1, and human glial U251 cell lines transfected with wild type or mutated betaAPP cDNAs. Secretion of soluble betaAPP via alpha-secretase activity increased significantly in cells transfected with betaAPP variants containing mutations that impair interaction with X11 when compared with cells transfected with wild type cDNA. Cotransfection of betaAPP and X11 caused retention of cellular betaAPP, decreased secretion of sbetaAPPalpha, and decreased Abeta secretion. Thus, betaAPP interaction with the protein interaction domain of X11 stabilizes cellular betaAPP and thereby participates in the regulation of betaAPP processing pathways.
Effects of heparin-induced non-esterified free fatty acid on minimal model-derived insulin sensitivity in individuals with varying degrees of glucose intolerance

The effects of heparin-induced non-esterified free fatty acid (NEFA) release on insulin sensitivity index were studied in individuals with varying degrees of glucose intolerance and beta cell dysfunction during the frequently sampled intravenous glucose tolerance test (IVGTT). The groups comprised: Group 1 (n = 5): newly diagnosed Type 2 diabetic patients, Group 2 (n = 11): impaired glucose tolerance patients (IGT), and Group 3 (n = 16): healthy normal glucose tolerance subjects. The serum insulin and c-peptide levels were severely blunted in the diabetic patients when compared to both non-diabetic groups. Mean fasting and post-heparin plasma NEFA levels were approximately 1.8 fold greater (p < 0.05) in the diabetic patients when compared to the other two groups. The mean insulin sensitivity index was lowest in the diabetic patients, intermediate in the IGT patients, and highest in the healthy controls. A significant negative relationship was found between the insulin sensitivity index and stimulated NEFA (r = -0.537, p < 0.008) but not with the fasting NEFA levels in our subjects. In summary, the frequently sampled IVGTT protocol that employs heparin flushes results in marked elevations in NEFA in Type 2 diabetic patients with poor beta cell dysfunction but not in subjects with intermediate or normal glucose tolerance. The higher plasma NEFA levels during heparin injections could worsen the model-derived, insulin sensitivity index and could impair the ability to achieve an acceptable modelling in Type 2 diabetic patients. We therefore suggest heparin should be avoided in such patients when using this protocol.
The existence of serial correlation and its effect on the format of a championship playoff series

The specific home/away sequencing of games has been a point of contention in the championship series of professional sports leagues. This research analyses data from the National Basketball Association (NBA) Finals in developing a logistic-regression model to predict the outcome of games that takes into consideration several factors, including home-court advantage and game-to-game momentum. It is found that negative serial correlation exists such that the team that wins one game is more likely to lose the next game of the series. This model is then used to predict the probability of each team winning each of the games within the series, and these probabilities are combined to evaluate alternative playoff formats. It is found that different formats are appropriate depending on the nature of momentum, and that the format used by the NBA may minimize travel requirements, but other formats may perform better in extending the length of the series.
Summary of current cooperative group clinical trials in thoracic malignancies

Abstract Historically, thoracic surgeons have played a pivotal role in the success of clinical trials for early-stage thoracic malignancies. This is illustrated by the experience of the Veterans Administration Surgical Oncology Group and by the Lung Cancer Study Group. Since the dissolution of the Lung Cancer Study Group, the other cooperative groups have been unable to complete any large randomized trials because of a lack of surgical participation. A group of thoracic surgeons is now addressing this problem by unifying research efforts across the cooperative groups. The aim of this summary is to disseminate information about those efforts and to encourage the involvement of North American thoracic surgeons in current clinical trials.
Performance limitations of polymer electrolytes based on ethylene oxide polymers

Abstract Studies of polymer electrolyte solutions for lithium-polymer batteries are described. Two different salts, lithium bis(trifluoromethanesulfonyl)imide (LiTFSI) and lithium trifluoromethanesulfonate (LiTf), were dissolved in a variety of polymers. The structures were all based upon the ethylene oxide unit for lithium ion solvation, and both linear and comb-branch polymer architectures have been examined. Conductivity, salt diffusion coefficient and transference number measurements demonstrate the superior transport properties of the LiTFSI salt over LiTf. Data obtained on all of these polymers combined with LiTFSI salts suggest that there is a limit to the conductivity achievable at room temperature, at least for hosts containing ethylene oxide units. The apparent conductivity limit is 5×10 −5 S/cm at 25°C. Providing that the polymer chain segment containing the ethylene oxide units is at least 5–6 units long, there appears to be little influence of the polymer framework to which the solvating groups are attached. To provide adequate separator function, the mechanical properties may be disconnected from the transport properties by selection of an appropriate architecture combined with an adequately long ethylene oxide chain. For both bulk and interfacial transport of the lithium ions, conductivity data alone is insufficient to understand the processes that occur. Lithium ion transference numbers and salt diffusion coefficients also play a major role in the observed behavior and the transport properties of these polymer electrolyte solutions appear to be quite inadequate for ambient temperature performance. At present, this restricts the use of such systems to high temperature applications. Several suggestions are given to overcome these obstacles.
Comparative Virulence of Staphylococcus epidermidis Isolates in a Murine Catheter Model

ABSTRACT: Among coagulase-negative staphylococci, Staphylococcus epidermidis is the species most commonly implicated in catheter-related infections. Whether some staphylococcal organisms are inherently more virulent than others, or whether their ability to infect relates more to the sheer numbers of organisms at the catheter site, remains unclear. We therefore compared eight S. epidermidis isolates and two other coagulase-negative staphylococci using a murine model that allowed us to quantify catheter colonization and abscess formation in the same animal. The organisms were isolated from different clinically relevant settings and were classified according to their slime phenotype. The ability to evoke abscesses or colonize catheters in half of the animals (ID50) was assessed. ID50 inoculum titers (log10 data ± SD) ranged widely, from 8.5 ± 0.3 to 10.2 ± 0.2 for abscess formation (p < 0.005) and from 7.5 ± 0.5 to 10.3 ± 1.0 for catheter colonization (p < 0.005). ID50 values by statistical criteria suggested variability among organisms in the ability to induce abscess formation. High slime production correlated with both parameters, but not with the clinical source of the isolate. Our findings demonstrate impressive heterogeneity in the ability of a representative group of S. epidermidis isolates to colonize catheters and to evoke abscess formation and implicate slime productivity as a major virulence factor. The murine model used permitted simultaneous analysis of multiple factors involved in pathogenesis and should be useful in establishing the basis of S. epidermidis pathogenicity.
On a quotient operator for sequences

We introduce a quotient operator Q defined by Q(Xn)=Xn+1/Xn as a direct analogue to the usual difference operator applied to sequences. We then consider a variety of properties and applications of this operator, including higher order quotients and solutions of quotient equations. Finally, we consider some ideas on how such an operator can be introduced into mathematics courses.
Gait characteristics of children with hemiplegic cerebral palsy before and after modified constraint-induced movement therapy

This investigation assessed selected gait parameters of children with hemiparesis before and after participation in a modified constraint-induced movement therapy program (mCIMT). Recent advances in the understanding of the relationship between mCIMT and cortical reorganization supports the use of upper-extremity mCIMT to treat lower extremity deficits. However, the effects of mCIMT on the gait patterns of children with hemiparesis remain unclear. Twelve preschool children participated in a mCIMT program for 5 consecutive days, 6 h each day. Pre- and post-intervention data, on the temporal-spatial aspects of gait, were collected with the GAITRite walkway. Data were analyzed using a repeated measures generalized linear model. Base of support decreased significantly (p < 0.001) following treatment and improvements were noted in most other gait descriptors. The results of this study suggest that mCIMT can increase stability and improve the overall gait pattern. This study provides a new dimension in the effe...
Quantum-crystal alloys I: Mass-fluctuation waves

The mass fluctuations in a quantum-crystal alloy lead to a long-range interaction between the particles. For low $^{3}\mathrm{He}$ concentrations in $^{4}\mathrm{He}$, this interaction requires a modification of the simple picture of mass-fluctuation waves. We determine the effect of this interaction on the motion of a $^{3}\mathrm{He}$ particle through $^{4}\mathrm{He}$ and give an alternate explanation of the data that is assumed to show the existence of these excitations. We set a limit at ${x}_{3}\ensuremath{\ll}{10}^{\ensuremath{-}3}$ for the onset of mass-fluctuation-wave behavior.
The reactions of alkoxy radicals with O2. II. n-C3H7O radicals

n-C3H7ONO was photolyzed with 366 nm radiation at −26, −3, 23, 55, 88, and 120°C in a static system in the presence of NO, O2, and N2. The quantum yields of C2H5CHO, C2H5ONO, and CH3CHO were measured as a function of reaction conditions. The primary photochemical act is and it proceeds with a quantum yield ϕ1 = 0.38 ± 0.04 independent of temperature. The n-C3H7O radicals can react with NO by two routes The n-C3H7O radical can decompose via or react with O2 via Values of k4/k2 ≃ k4b/k2 were determined to be (2.0 ± 0.2) × 1014, (3.1 ± 0.6) × 1014, and (1.4 ± 0.1) × 1015 molec/cm3 at 55, 88, and 120°C, respectively, at 150-torr total pressure of N2. Values of k6/k2 were determined from −26 to 88°C. They fit the Arrhenius expression: For k2 ≃ 4.4 × 10−11 cm3/s, k6 becomes (2.9 ± 1.7) × 10−13 exp{−(879 ± 117)/T} cm3/s. The reaction scheme also provides k4b/k6 = 1.58 × 1018 molec/cm3 at 120°C and k8a/k8 = 0.56 ± 0.24 independent of temperature, where
Long-term monitoring of polychlorinated biphenyls in the Hudson River (New York) using caddisfly larvae and other macroinvertebrates

Concentrations of polychlorinated biphenyls (PCBs) in the Hudson River were monitored from 1978 through 1985, by chromatographic analysis of the tissue residues of hydropsychid caddisflies and the contents of artificial substrate samplers. For both means of assessment, levels of Aroclor® 1016 and Aroclor® 1254 were positively correlated. Temporally, PCB concentrations decreased at all sampling stations from 1978 to 1980, but increased and remained stable from 1981 through 1985.
Hitting the Target with Bifunctional Phage

Peptide libraries are rich sources of cell-targeting peptides. In this issue of Chemistry & Biology, Pasqualini and coworkers have developed a chimeric cell-targeting phage system that can easily be modified to delivery of a variety of reagents without need for chemical conjugation [1].
Complementary circuits connecting the orbital and medial prefrontal networks with the temporal, insular, and opercular cortex in the macaque monkey.

The origin and termination of axonal connections between the orbital and medial prefrontal cortex (OMPFC) and the temporal, insular, and opercular cortex have been analyzed with anterograde and retrograde axonal tracers, injected in the OMPFC or temporal cortex. The results show that there are two distinct, complementary, and reciprocal neural systems, related to the previously defined “orbital” and “medial” prefrontal networks. The orbital prefrontal network, which includes areas in the central and lateral part of the orbital cortex, is connected with vision-related areas in the inferior temporal cortex (especially area TEav) and the fundus and ventral bank of the superior temporal sulcus (STSf/v), and with somatic sensory-related areas in the frontal operculum (OPf) and dysgranular insular area (Id). No connections were found between the orbital network and auditory areas. The orbital network is also connected with taste and olfactory cortical areas and the perirhinal cortex and appears to be involved in assessment of sensory objects, especially food. The medial prefrontal network includes areas on the medial surface of the frontal lobe, medial orbital areas, and two caudolateral orbital areas. It is connected with the rostral superior temporal gyrus (STGr) and the dorsal bank of the superior temporal sulcus (STSd). This region is rostral to the auditory parabelt areas, and there are only relatively light connections between the auditory areas and the medial network. This system, which is also connected with the entorhinal, parahippocampal, and cingulate/retrosplenial cortex, may be involved in emotion and other self-referential processes. J. Comp. Neurol. 506:659–693, 2008. © 2007 Wiley-Liss, Inc.
D2dopamine receptor-mediated inhibition of forskolin-stimulated adenylate cyclase activity in rat striatum

Forskolin markedly stimulates striatal adenylate cyclase activity in a concentration-dependent manner, and at 10(-4) M produces an approximate 40-fold increase in enzyme activity above basal levels. Dopamine (in the presence of 100 nM SCH 23390), bromocryptine and quinpirole (LY 171555) significantly inhibit both basal and forskolin-stimulated adenylate cyclase activity. There is a significant increase in the absolute but not in the percent inhibition of enzyme activity by dopaminergic agonists as a function of forskolin concentration. This inhibition is agonist-concentration dependent and antagonized by the D2 antagonist, spiperone. These results suggest that forskolin may be used as a tool for amplifying the abolute D2-receptor-mediated inhibition of adenylate cyclase in rat striatal homogenates.