cssi/SciSciGPT-SciSciNet huggingface dataset:
Correlation of clot imaging with endovascular recanalization in internal carotid artery terminus occlusion.

Background and purpose In a swine stroke model we have previously demonstrated a high-intensity fluid attenuated inversion recovery (FLAIR) signal representing the erythrocyte component of the clot. We hypothesized that the intensity of the FLAIR clot signal in patients with acute stroke may predict the efficacy of recanalization by thrombectomy devices. In this study we compared the pretreatment FLAIR signal intensity of the clots in the distal internal carotid artery (ICA) and the degree of angiographic recanalization rate after mechanical thrombectomy. Methods 25 consecutive acute stroke patients with ICA terminus (ICA-T) occlusion diagnosed with MRI at the UCLA Medical Center between 2002 and 2013 were retrospectively reviewed. The intensity of the FLAIR clot signal at the distal ICA was blindly compared with the angiographic recanalization status (successful recanalization defined as Thrombolysis In Cerebral Infarction (TICI) score of 2b–3) and non-successful recanalization as TICI score 0–2a) after endovascular treatment. Multivariate logistic regression analysis for successful recanalization was performed. Results Successful recanalization was achieved in 40% of patients (10/25) and showed a significantly higher FLAIR intensity (p=0.014). The cut-off value for clot intensity on the FLAIR sequence to predict recanalization was 0.7952, with 70% sensitivity and 80% specificity (95% CI 0.59 to 0.96) using a receiver operating characteristic curve. In multivariate logistic regression analysis, only a high FLAIR clot intensity (>0.7952) was associated with successful recanalization (OR 16.79; 95% CI 1.29 to 218.92; p=0.031). Conclusions High signal intensity on FLAIR clot imaging may predict successful recanalization after endovascular therapy for ICA-T occlusion.
Defect chemistry and physical properties of transparent conducting oxides in the CdO-In2O3-SnO2 system

Combined solid state phase diagram studies and physical property measurements of the various n-type transparent conducting oxide (TCO) phases in the CdO-In 2 O 3 -SnO 2 system have been carried out. The 1175°C (air) subsolidus phase diagram has been established, including solid solution limits for binary and ternary compositions. From these limits and electrical property measurements vs. doping and degree of reduction, the prevailing defect mechanisms can be deduced. In addition to intrinsic (native) defects (e.g. oxygen vacancies) and extrinsic donor-doping of the end member compounds (e.g. Sn 1n in In 2 O 3 ), ternary solid solutions exhibit both isovalent doping (e.g. [Cd' In ] = [Sn In ] in bixbyite, spinel) and donor-to-acceptor imbalance (e.g. [Sn In ] > [Cd' In ] in bixbyite, spinel). Aliovalent doping can also lead to the formation of point defect associates, as in Sn-doped In 2 O 3 (ITO), as confirmed by combined Rietveld analyses of X-ray and neutron diffraction data. Cation exchange between sublattices in the spinel phase plays an important role in determining phase stability and band structure. The physical properties of the TCO phases in the CdO-In 2 O 3 -SnO 2 system are presented for both bulk ceramics and thin films.
Computing the Low-Elevation Variant of the Haines Index for Fire Weather Forecasts

The Haines index is used in wildfire forecasting and monitoring to evaluate the potential contributions of atmospheric stability and humidity to the behavior of plume-dominated wildfires. The index has three variants (“low,” “mid,” and “high”) that accommodate differences in surface elevation. As originally formulated, the low variant is calculated from temperature observations at the 950- and 850-hPa levels and humidity observations at 850 hPa. In the early 1990s the National Weather Service implemented a new mandatory level for radiosonde observations at 925 hPa. Following this change, measurements at 950 hPa became less frequent. An informal survey of several forecast offices found no formalized adjustment to the calculation of the low Haines index to take into account the nonavailability of 950-hPa measurements. Some sources continue to use 950-hPa temperature, usually interpolated from 925-hPa and surface temperatures, to calculate the low Haines index. Others directly substitute the 925-hPa temperature for the originally specified 950-hPa value. This study employs soundings from the central United States when both 950- and 925-hPa levels were available to investigate the impact of different calculation approaches on the resulting values of the low variant of the Haines index. Results show that direct substitution of 925-hPa temperature for the 950-hPa temperature can dramatically underestimate the potential wildfire severity compared with the original formulation of the Haines index. On the other hand, a low-elevation variant of the Haines index calculated from the interpolated 950-hPa temperature is usually in close agreement with the original formulation of the index.
Development and validation of a tightly coupled CFD/6-DOF solver for simulating floating offshore wind turbine platforms

Simulations of offshore floating wind turbine platform dynamics typically utilize engineering tools that include simplified modeling assumptions. In this study, an open-source CFD/6-DOF solver is developed using OpenFOAM for high-fidelity simulation of offshore floating wind turbine platforms. The solver tightly couples the fluid and 6-DOF equations of motion using subiterations and dynamic relaxation to eliminate the artificial added mass instability. Validation of the tightly coupled CFD/6-DOF solver is carried out on a benchmark case of the free decay of a heaving cylinder. The solver is then used in simulations of the DeepCwind semisubmersible platform and compared with FAST, a NREL engineering tool. The CFD/6-DOF solver and FAST are compared in four cases including both rotational and translational motion. Overall, the results demonstrate that the tightly coupled solver compares well with FAST. The tightly coupled CFD/6-DOF solver represents an advance in modeling of offshore wind turbine platform dynamics using open-source software that may be used for wind turbine research, design, and analysis.
Characteristics of Strong Updrafts in Precipitation Systems over the Central Tropical Pacific Ocean and in the Amazon

Abstract Airborne in situ measurements of updrafts in tropical convective storms were analyzed to determine the similarities and differences between updrafts in a tropical continental and a tropical oceanic region. Two hundred fifteen updraft cores from the Tropical Rainfall Measuring Mission (TRMM) component of the Large Scale Biosphere–Atmosphere (LBA) experiment (tropical continental wet season) and 377 updraft cores from the Kwajalein Experiment (KWAJEX) (tropical oceanic) were analyzed in a similar manner to that of previous studies of tropical updrafts. Average speed, maximum speed, width, and mass flux of the updraft cores from the TRMM-LBA and KWAJEX were generally similar to each other and also were similar to results from previous studies of tropical updrafts.
Cancellation of motion artifacts in electrogastrogram - a comparison of time-, transform, and frequency-domain adaptive filtering

Adaptive cancellation of motion artifacts in the electrogastrogram (EGG) is presented. Three different sorts of adaptive filters were investigated, and their efficiencies in cancellation of motion artifacts were compared. These were time-domain, transform-domain, and frequency-domain adaptive filters. A series of simulations was conducted to investigate the performance of these adaptive filters in cancellation of respiratory and motion artifacts. The frequency-domain adaptive filter is shown to have superior performance to the time- and transform-domain adaptive filters in the cancellation of stationary respiratory artifacts in the EGG. >
Fundamental period of irregular eccentrically braced tall steel frame structures

Abstract This paper presents the results of investigation on the fundamental periods of eccentrically braced frame (EBF) structures with varying geometric irregularities. A total of 12 EBFs are designed and analyzed. Based on the results obtained from vibration theory, equations for the approximate fundamental periods are put forth for EBFs which take into account vertical and horizontal irregularities. Through statistical comparison, it was found that a 3-variable power model which is able to account for irregularities resulted in a better fit to the Rayleigh data than equations which were dependent on height only. The proposed equations were validated through a comparison of available measured period data for EBFs. These proposed equations will allow design engineers to quickly and accurately estimate the fundamental period of EBF structures by taking into account their irregularities.
The City of Prineville Railway and the Economic Development of Crook County

(1967). The City of Prineville Railway and the Economic Development of Crook County. Economic Geography: Vol. 43, No. 2, pp. 170-181.
Linguistic Analysis of the Wepman Auditory Discrimination Test and the Appropriateness of its Use with Black-English Speaking Children

Since the 1960s controversy has surrounded the Black-English speaking child's acquisition of standard English and the effects of Black English in academic and social situations (Banks, 1980; Baratz, 1969; Dillard, 1971; Taylor, 1970; Wolfram, 1969, 1976). As a result, many speech and language specialists are faced with difficult decisions regarding assessment of children who speak Black English. In addition, state and federal mandates require nondiscriminatory testing (Public Law 94-142, 1975; Lau vs. State of California, 1976). Speech and language specialists who work in racially isolated schools populated with lower socioeconomic black children need appropriate assessment tools for evaluating speech and language abilities. Many of the tests used today are based on validity, reliability and normative data generated on the predominantly middle-class standard-English speakers of the Euro-American speech community. If one considers that middleclass, white speech is different from lower class, black speech these tests clearly do not account for the linguistic variations of the two speech communities. Therefore, since these tests may be useless for identifying a speech/language deficit in the Black-English speaker, results of a diagnosis using such instruments may reveal pseudo-deficits in Black-Englishspeaking children. Researchers have shown that children from black cultures, specifically those who speak Black English, demonstrate phonological patter s which are different from those of standard English (Fasold & Wolfram, 1970; Labov, 1965). T ese phonological patterns are consistent and rule based (Baratz, 1968; Labov, 1965; McDavid, 1967). Geissal and Knaffle (1977) pointed out that the linguistic rules of one's dialect determine how one perceives speech sounds. Furthermore, some items on auditory discrimination tests may prove to be difficult for adults and nearly impossible for children with different linguistic systems. One can detect fine differences in phonemic sounds only when differences are significant in one's own phonological system (Gottlesman, 1968). According to the well-known linguist, Ward Goodenough (1971), the phonological system includes a set of standards for discriminating the differences in sound, intonation and stress that are consistently associated with differences in meaning..., the phonological system of each language involves a set of discriminations in sound.... For any particular language, then, there are combinations of distinctive features that are recognized by its speakers as making a difference in meaning. Thus, the unconscious dynamics of sounds make it less obvious that we are accepting them and make it hard to hear another language. Wolfram (1976) addressed the problem of linguistic interference, emphasizing that a person who speaks language variety "A" and has trou-
Impact of Fuel and Injection Timing on Partially Premixed Charge Compression Ignition Combustion

Advanced combustion modes have drawn much attention from researchers due to increasingly strict emissions regulations. Partially premixed compression ignition (PCCI) combustion creates a partially premixed charge inside the cylinder before ignition occurs. As a result, NOx and particulate matter (PM) emissions can be reduced simultaneously relative to those of conventional diesel combustion. The basic operating mechanism of PCCI combustion is to prolong the time period for mixing of the fuel–air mixture by separating the end of injection and start of combustion. Three different fuels, ultralow sulfur diesel (ULSD), diesel fuel produced via a low temperature Fischer–Tropsch process (LTFT), and a renewable diesel (RD), which is a hydrotreated camelina oil, are tested in this study. Engine combustion performance, PM, NOx, CO, total hydrocarbon (THC) emissions, particle size distribution, soot morphology, and nanostructure are examined for conventional combustion and various PCCI conditions. PCCI combustion c...
Quantitative determination of amantadine in amantadine mixture by diphasic titration

Objective: To determine the contents of amantadine in the mixture. Methods: The diphasic titration was used in the test. Results: The average recovery rates of amantadine hydrochloride were 101.5%, 99.38%, 101.7% and RSD were 0.38%, 0.46%, 0.55%. Conclusion: The method was simple and accurately, and the method could be used as quality control of the amantadine mixture.
Managing Multiparty Disputes

Over the last few decades, commercial transactions have become increasingly complicated. Whereas simple bilateral contracts were once the norm, contemporary commercial practice sees numerous instances of interlocking contractual commitments. Although many of these contracts appear bilateral on their face, the agreements often form a web of overlapping obligations that can create a cascade effect of defaults and breaches should one relationship run into trouble. Because most lawyers have been trained to look at dispute resolution exclusively through a bilateral lens, corporate and outside counsel tend to adopt a two-party paradigm when considering how to manage a multiparty dispute. However, that approach can lead to increased litigation costs and missed opportunities for settlement, regardless of whether the matter is resolved in litigation, arbitration or mediation. This article helps practitioners understand the unique challenges associated with managing multiparty disputes and identifies a number of practical techniques to help resolve these types of matters quickly and efficiently.
Multilingual children increase language differentiation by indexing communities of practice

An area in need of study in child language acquisition is that of complex multilingual contexts in which there is little language separation by interlocutor or domain. Little is known about how multilingual children use language to construct their identities in each language or in both languages. Identity construction in monolingual contexts has been examined closely using a community of practice model, with case studies of adolescents and teenagers. Language is viewed as social practice, as individuals use language to actively construct a shared community of practice. This study examines multilingual children’s (ages 6–12) lexical and phonological choices in two of their languages, Light Warlpiri and Warlpiri, that share many lexical items and most nominal morphology. The children’s choices contribute to language differentiation and in some instances drive language differentiation further than adult speech does. The motivation is captured in a community of practice model.
Determination of L-Ascorbic. Acid and Erythorbic Acid in

This paper described thedetermination of ascorbic acid and erythorbic acid in foods by a reverse phase high performance liquid chromatographic method. The chromatographic system included an Inertsil ODS-2 column and a mobile phase consisting of 0.01M sodium dihydrogenphosphate buffer (pH 4.0) and methanol (95+5v/v) containing5mM tetra-namylammanium bromide and 0.03mM disodium ethylenediaminetetraacetate. The column was cooled at 20°C and an amperometric detector was set at +500mV usAg/AgCl and 320nAFS. Food samples were homogenized with metaphaspharicac acid solution and then treated with a reverse phase C 18 mini column. Recoveries of ascorbic acid and erythorbic acid added to beverage, sausage and pickled radish were94. 2-97. 1% for 100μg/g and 93.7-97.1 for 500μg/g, and there was no interfering substance on examined samples. Their detection limits were5μg/g.
Technology-Enhanced Practice Courses and Collaborative Learning in Distance Education

ABSTRACTThis article describes the use of a research-based teaching model using digital technology to enhance self-efficacy and group work practice skills in an undergraduate social work course. Our project focused on the development of group leadership interactional skill training for undergraduate social work students. We present pedagogical and theoretical approaches explaining a teaching model, which is designed to utilize digital technology and collaborative learning strategies in Interactive Video Connected (IVC) and traditional face-to-face classrooms. We explore how the teaching model impacts student perception of self-efficacy regarding group work practice skills.
The comparative benefits and hazards of EFBs and paper documents in the cockpit

Electronic Flight Bags (EFBs) are replacing the traditional paper documents used by pilots for pre-flight planning and in-flight operations. Simulation studies comparing information retrieval times...
Provision of integrated psychosocial services for cancer survivors post-treatment

Summary Meeting the psychosocial needs of patients with cancer has been recognised as a priority within oncology care for several decades. Many approaches that address these needs have been developed and described; however, until recently much of this work had focused on patients during treatment and end-of-life care. With continued improvement in therapies, the population of cancer survivors who can expect to live for 5 or more years after cancer diagnosis has increased dramatically, as have associated concerns about how to meet their medical, psychosocial, and health behaviour needs after treatment. Guidelines and models for general survivorship care routinely address psychosocial needs, and similar guidelines for psychosocial care of patients with cancer are being extended to address the needs of survivors. In this Series paper, we summarise the existing recommendations for the provision of routine psychosocial care to survivors, as well as the challenges present in providing this care. We make specific recommendations for the integration of psychosocial services into survivorship care.
A Tale of Two Sisters

A Tale of Two Sisters represents an attempt to portray different approaches to organizational situations through creative story telling. A small but growing number of writers in the field of public administration have used creative writing to capture the interest of bureaucrats. Stories are powerful in that they can fire the imagination of the reader and provide an experience that is both enjoyable and meaningful. Acceptance of story teling and creative writing in public administration allows for new and different talent to participate in defining what it means to be a public administrator. Creative writing is also an excellent vehicle for connecting the teachings of different disciplines and belief systems in a metaphorical way. The ideals of servant leadership and the teachings of Buddhism comed together in the following story as we witness a meeting between twin sisters.
X-ray Spectroscopic Interrogation of Transition-Metal-Mediated Homogeneous Catalysis: Primer and Case Studies

In this perspective, we highlight recent studies that use X-ray spectroscopic methods to identify and elucidate the molecular and/or electronic structures of intermediate and resting transition-metal species implicated in homogeneous catalysis. We begin with a brief survey of the data that can be accessed with these spectroscopic methods, followed by case studies that showcase advances in the interpretation of X-ray spectroscopic data, demonstrate how these methods complement other types of spectroscopy, and call attention to common misconceptions associated with X-ray spectroscopic techniques. In some cases, we suggest research areas in which alternative spectroscopic tools could aid advances. We conclude with an unorthodox perspective on the reactivity of “high-valent” late transition metals on the basis of recent X-ray spectroscopic insights into their chemical bonding.
A Deployable High-Gain Antenna Bound for Mars: Developing a new folded-panel reflectarray for the first CubeSat mission to Mars.

This article describes the development of a deployable high-gain antenna (HGA) for the proposed Mars Cube One (MarCO) CubeSat mission to Mars. The antenna is a new folded-panel reflectarray (FPR) designed to fit on a 6U (10 ? 20 ? 34 cm3) CubeSat bus and support 8.425-GHz Mars-to-Earth telecommunications. The FPR provides a gain of 29.2 dBic with right-hand circular polarization (RHCP). Small stowage volume is a key advantage of the FPR design, as it only consumes ~4% of the usable spacecraft payload volume with a mass of less than 1 kg.
Near-field thermal upconversion and energy transfer through a Kerr medium.

We present an approach for achieving large Kerr χ(3)–mediated thermal energy transfer at the nanoscale that exploits a general coupled-mode description of triply resonant, four-wave mixing processes. We analyze the efficiency of thermal upconversion and energy transfer from mid- to near-infrared wavelengths in planar geometries involving two slabs supporting far-apart surface plasmon polaritons and separated by a nonlinear χ(3) medium that is irradiated by externally incident light. We study multiple geometric and material configurations and different classes of intervening mediums—either bulk or nanostructured lattices of nanoparticles embedded in nonlinear materials—designed to resonantly enhance the interaction of the incident light with thermal slab resonances. We find that even when the entire system is in thermodynamic equilibrium (at room temperature) and under typical drive intensities ~ W/μm2, the resulting upconversion rates can approach and even exceed thermal flux rates achieved in typical symmetric and non-equilibrium configurations of vacuum-separated slabs. The proposed nonlinear scheme could potentially be exploited to achieve thermal cooling and refrigeration at the nanoscale, and to actively control heat transfer between materials with dramatically different resonant responses.
The Evolution of Courtship Behavior in Plethodontid Salamanders, Contrasting Patterns of Stasis and Diversification

Abstract An examination of courtship in salamanders helps resolve the puzzling problem of long-term evolutionary stasis in behavior. To address the companion issues of stasis and diversification, we summarize and synthesize courtship observations in Rhyacotriton and 13 genera of plethodontids. We use a modular analysis of courtship to identify conservative, as well as variable behavioral elements and sequences. We use time-calibrated, molecular phylogenies to reconstruct the evolutionary history of key elements in courtship at different time levels. In deep time (40–175 mya), we reconstruct the evolution of courtship among plethodontid genera, using Rhyacotriton and Ambystoma as outgroups. On a shorter time scale (10–40 mya), we reconstruct courtship history among species within three genera (Aneides, Plethodon, and Desmognathus). These reconstructions reveal extraordinary stasis for greater than 130 million years (Myr) in the courtship modules that align sexual partners and accomplish sperm transfer. Alt...
Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases

Abstract Objective The study objective was to assess the technical and process improvement and clinical outcomes of robotic mitral valve surgery by examining the first 1000 cases performed in a tertiary care center. Methods We reviewed the first 1000 patients (mean age, 56 ± 10 years) undergoing robotic primary mitral valve surgery, including concomitant procedures (n = 185), from January 2006 to November 2013. Mitral valve disease cause was degenerative (n = 960, 96%), endocarditis (n = 26, 2.6%), rheumatic (n = 10, 1.0%), ischemic (n = 3, 0.3%), and fibroelastoma (n = 1, 0.1%). All procedures were performed via right chest access with femoral perfusion for cardiopulmonary bypass. Results Mitral valve repair was attempted in 997 patients (2 planned replacements and 1 resection of fibroelastoma), 992 (99.5%) of whom underwent valve repair, and 5 (0.5%) of whom underwent valve replacement. Intraoperative postrepair echocardiography showed that 99.7% of patients receiving repair (989/992) left the operating room with no or mild mitral regurgitation, and predischarge echocardiography showed that mitral regurgitation remained mild or less in 97.9% of patients (915/935). There was 1 hospital death (0.1%), and 14 patients (1.4%) experienced a stroke; stroke risk declined from 2% in the first 500 patients to 0.8% in the second 500 patients. Over the course of the experience, myocardial ischemic and cardiopulmonary bypass times ( P P = .003), and intensive care unit and postoperative lengths of stay ( P Conclusions Robotic mitral valve surgery is associated with a high likelihood of valve repair and low operative mortality and morbidity. The combination of algorithm-driven patient selection and increased experience enhanced clinical outcomes and procedural efficiency.
THE THREE-RING CONCEPTION OF GIFTEDNESS: A DEVELOPMENTAL APPROACH FOR PROMOTING CREATIVE PRODUCTIVITY IN YOUNG PEOPLE

This paper aims to present in detail the Three Ring Conception of Giftedness developed by its author (Renzulli, 1978), as well as the identification system and the services offered to students with High Skills/Giftedness. The authors are presenting a summary of 40 years of research in the area, explaining the components of their definition and the most frequently asked questions related to the definition. At the same time they explain the tools used and the people involved in the identification of the “Talent Pool”, as well as the Schoolwide Enrichment Model (SEM), its components and the advantages of its use in educational institutions. Finally, the authors introduce recent contributions about how students can use their gifts in a socially constructive way, addressing the relationships between the “co-cognitive” personal characteristics and the role these characteristics play in the development of “social capital”
The organizing effects of elevated CO2 on competition among estuarine primary producers.

Fossil fuel combustion, eutrophication, and upwelling introduce excess CO2 into coastal zones. The extent to which marine autotrophs may benefit from elevated CO2 will be a function of their carbon limitation and, among other factors, competition with other primary producers. Here, we report on experiments performed with North Atlantic species of Ulva and Gracilaria grown in situ or exposed to ambient (~400 µatm) and elevated pCO2 (~2500 µatm) and/or subjected to competition with each other and/or with natural plankton assemblages. Elevated pCO2 significantly increased the growth rates of Gracilaria and Ulva and yielded significant declines in tissue δ13C, suggesting that increased growth was associated with increased CO2 use relative to HCO3-. Gracilaria growth was unaffected by competition with plankton or Ulva, while Ulva experienced significantly reduced growth when competing with Gracilaria or plankton. Dinoflagellates experienced significantly increased growth when exposed to elevated pCO2 but significantly slower growth when competing with Gracilaria. Elevated carbon-to-nitrogen ratios among macroalgae suggested that competition for nitrogen also shaped interactions among autotrophs, particularly Ulva. While some estuarine autotrophs benefit from elevated pCO2, the benefit can change when direct competition with other primary producers is considered with Gracilaria outcompeting Ulva and dinoflagellates outcompeting diatoms under elevated pCO2.
Novel Direct Annuloplasty Fastener System for Minimally Invasive Mitral Valve Repair

The development of less invasive approaches for mitral valve repair remains an important objective, particularly in patients with multiple comorbidities. We describe a novel method to affix a mitral valve annuloplasty ring in a minimally invasive manner. A delivery apparatus for an annuloplasty fastener system was designed. Two channels were created, one for advancing the annuloplasty ring, and another to accommodate the fastener applicator. Custom designed fasteners, either with a helical-shaped screw or a strap-shaped tack structure, were tested. Fasteners were primed within an application device and automatic alignment of fasteners was achieved to allow accurate firing of the fixators securing the ring. The delivery apparatus was constructed to be deployed within a 10 mm trocar through a left atrial approach. Using a cadaveric swine heart model, access to the mitral valve from the left atrium was obtained with insertion of a trocar. The delivery apparatus was accurately directed to the mitral annulus under echocardiographic guidance. Fasteners were placed along the annular plane to secure the annuloplasty ring. Both fastener designs achieved considerable fixation force; the helical-shaped screw was found to have significantly greater fixation force compared to the strap-shaped tack design. The annuloplasty ring remained intact and did not experience any structural deformity during the fixation process. The use of a novel fastener system was successful in deploying and securing a mitral valve annuloplasty ring. These promising results may have further application for minimally invasive mitral valve repairs. Additional evaluation of this procedure with pre-clinical in vivo animal studies is necessary.
Analyzing Students’ Collaborative Regulation Behaviors in a Classroom-Integrated Open Ended Learning Environment

Identifying the effects of students’ collaborative regulation behavior when working on a task is an important step towards a better understanding of how collaboration supports learning. We discuss a study where we combined analysis of students’ dialogues with an automated analysis of their action patterns as they constructed science models in an open-ended learning environment. Our results show that students use different types of collaborative regulation be-haviors, and that these behaviors affect their performance on the system as well as their pre-post learning gains. We also showed that groups, which adopt more shared regulation used different learning strategies than groups that did not.
Impact of an antimicrobial stewardship program on outcomes in patients with community-acquired pneumonia admitted to a tertiary community hospital.

Purpose Results of a study evaluating the impact of an antimicrobial stewardship program (ASP) on clinical outcomes in patients hospitalized for community-acquired pneumonia (CAP) are reported. Methods A retrospective records review was conducted at a 400-bed hospital to identify patients admitted over 3 years with CAP documented as a primary or secondary diagnosis. Clinical and medication-use outcomes during a 1-year baseline period and in the first and second years after ASP implementation (post-ASP years 1 and 2) were analyzed. A local CAP guideline was implemented around the beginning of post-ASP year 2. Results The mean hospital length of stay declined from 7.24 days in the baseline period to 5.71 days in post-ASP year 1 ( p = 0.011) and 5.52 days in post-ASP year 2 ( p = 0.008). Mean inpatient antimicrobial days of therapy (DOT) declined from 5.68 days in the baseline period to 5.08 days ( p = 0.045) and 4.99 days ( p = 0.030) in post-ASP years 1 and 2, respectively. Mean DOT per 100 total days of antimicrobial therapy declined from 9.69 days in the baseline period to 8.85 days in post-ASP year 1 ( p = 0.019) and 8.38 days in post-ASP year 2 ( p = 0.001). Conclusion ASP implementation was associated with specific clinical benefits in patients with CAP, including decreased length of stay, decreased durations of antimicrobial therapy, and a shift in utilization to a primary regimen shown to produce superior clinical outcomes.
Axillary Nodal Evaluation in Elderly Breast Cancer Patients: Potential Effects on Treatment Decisions and Survival.

Recent studies suggest that surgical lymph node (LN) evaluation may be omitted in select elderly breast cancer patients as it may not influence adjuvant therapy decisions. To evaluate differences in adjuvant therapy receipt and overall survival (OS), we compared clinically node-negative (cN0) elderly patients who did and did not undergo axillary surgery. Patients aged ≥70 years in the National Cancer Database (2004–2014) with cT1-3, cN0 breast cancer were divided into two cohorts—those with surgical LN evaluation (one or more nodes removed) and those without (no nodes removed). Propensity scores were used to match patients based on age, year of diagnosis, tumor grade, cT stage, estrogen receptor status, and Charlson–Deyo comorbidity score. A Cox proportional hazards model was used to estimate the effect of LN surgery on OS. Overall, 133,778 patients were matched, of whom 102,247 patients (76.4%) underwent nodal surgery. Patients undergoing nodal surgery were more likely to receive chemotherapy (pN1-3: 22.2%; pN0: 5.8%; cN0-no nodal surgery: 2.8%; p < 0.001), radiation (pN1-3: 49.7%; pN0: 47.5%; cN0-no nodal surgery: 26%; p < 0.001), and endocrine therapy (pN1-3: 72%; pN0: 58.5%; cN0-no nodal surgery: 46.5%; p < 0.001). After adjustment for known covariates, patients who did not undergo nodal surgery had a worse OS (hazard ratio 1.66, 95% confidence interval 1.61–1.70). For elderly cN0 breast cancer patients, axillary surgery was associated with higher rates of adjuvant therapy and improved OS. A selective approach to omitting nodal surgery should be considered in elderly patients with cN0 breast cancer as axillary staging may influence subsequent treatment decisions and long-term outcomes.
How "Universal" are Universal Precautions?

Guidelines to improve observance of universal precaution standards and reporting of needlestick injuries by medical students and resident physicians. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.
Optimal haemodynamics during left ventricular assist device support are associated with reduced haemocompatibility-related adverse events

Aims Left ventricular assist device (LVAD) therapy improves the haemodynamics of advanced heart failure patients. However, it is unknown whether haemodynamic optimization improves haemocompatibility-related adverse events (HRAEs). This study aimed to assess HRAEs in patients with optimized haemodynamics. Methods and results Eighty-three outpatients [aged 61 (53-67) years, 50 male] underwent a haemodynamic ramp test at 253 (95-652) days after LVAD implantation, and 51 (61%) had optimized haemodynamics (defined as central venous pressure 2.2 L/min/m2 ) following LVAD speed adjustment. One-year survival free of any HRAEs (non-surgical bleeding, thromboembolic event, pump thrombosis, or neurological event) was achieved in 75% of the optimized group and in 44% of the non-optimized group (hazard ratio 0.36, 95% confidence interval 0.18-0.73, P = 0.003). The net haemocompatibility score, using four escalating tiers of hierarchal severity to derive a total score for events, was significantly lower in the optimized group than the non-optimized group (1.02 vs. 2.00 points/patient; incidence rate ratio 0.51, 95% confidence interval 0.29-0.90, P = 0.021). Conclusion Left ventricular assist device patients in whom haemodynamics can be optimized had greater freedom from HRAEs compared to those without optimized haemodynamics.
The Stakes of Symbolic Boundaries

Sociological theories of symbolic boundaries (understandings of who belongs to in-groups and out-groups) and social boundaries (material stratification) argue both are related, but empirical analys...
Sigmoid gallstone ileus: a challenging diagnosis.

Gallstone ileus is a rare (1%–4%) complication of gallstone disease. Gallstones entering the gastrointestinal tract by penetration may cause obstruction at any point along their course through the tract; however, they have a predilection to obstruct the smaller-caliber lumen of the small intestine (80.1%) or stomach (14.2%). The condition is seen more commonly in the elderly who often have significant co-morbidities. Gallstone ileus causing large bowel obstruction is rare. We report the case of a 95-year-old woman who presented with a history of abdominal pain without fever, nausea, vomiting, or diarrhea. Computed tomography of the abdomen and pelvis with oral contrast revealed a high-density structure within the lumen of the distal sigmoid colon, initially suspected to be a foreign body. Medical management failed and surgical intervention was not possible. Autopsy revealed peritonitis and a rupture of the sigmoid colon at the site of a cylindrical stone found impacted in an area of fibrotic narrowing with multiple diverticula. A necrotic, thick-walled gallbladder had an irregular stone in its lumen that was a fracture match with the stone in the sigmoid. Adhesions, but no discrete fistula, were identified between the gallbladder and the adjacent transverse colon. The immediate cause of death was peritonitis caused by colonic perforation by the gallstone impacted at an area of diverticular narrowing. To our knowledge, such autopsy findings have not been previously reported.
On the Rationality of Exponentials and Logarithms.

Various questions may occur as a stu dent studies exponentials and logarithms. For instance, must ab be irrational if a and b are? Or, is loga? irrational if a and b are? In this note we will show that whatever may be the assumptions about the ration ality of a and b, instances exist where ab is rational, and instances exist where ab is ir rational. Similarly, nothing about the ra tionality of \ogab can be inferred from the rationality of a and b. The proofs assume only the basic laws of exponents and loga rithms.
DC-Based Religious and Secular Media Coverage of the District’s Death with Dignity Act

ABSTRACTIn 2016, the District of Columbia passed the Death with Dignity Act, allowing physicians to prescribe a lethal dose of medicine to terminally ill patients. A framing analysis of religious a...
Enterprise Architecture for Healthcare Information Exchange (HIE) Cloud Migration

Ensuring a timely transfer of health records is an essential function of Health Information Exchange (HIE). However, HIEs face several challenges in accomplishing this due to the variety of health data, frequency in healthcare events, constraints in managing health data transfer, etc. To address such challenges, HIEs are working to leverage cloud technologies in the storage and processing of health data. In this article, we propose an Enterprise Architecture (EA) that supports the migration of HIEs to a cloud infrastructure.
Improving Capnography Use for Critically Ill Emergency Patients: An Implementation Study.

Objectives Capnography has established benefit during intubation and cardiopulmonary resuscitation (CPR). Implementation within emergency departments (EDs) has lagged. We sought to address barriers to improve documented capnography use for patients requiring intubation or CPR. Methods A controlled before- and after-implementation study was performed in 2 urban EDs. The control site had an existing policy for capnography use. Interventions for the experimental site included a 5-minute informational video, placement of capnography monitors with a shortened warm-up period in all resuscitation rooms, laminated reminder cards, and feedback during staff meetings. Staff members were surveyed about knowledge before and after the intervention. Records were reviewed for documented capnography use for 3 months before and 6 months after the intervention. Change in documented use at the experimental site was compared with the control site. Results At the experimental site, 118 providers participated and 190 records were reviewed; 544 records were reviewed from the control site. There was a significant increase in the proportion of documented capnography use at the experimental site (8% versus 19%, P = 0.04) compared with the control site (64% versus 71%, P = 0.10). However, there was no significant trend over time at the experimental site after the intervention (P = 0.86). Despite high baseline knowledge about capnography, providers had improvements in survey responses regarding indications for intubation and CPR, normal values, and minimum effective values during CPR. Conclusions Documented capnography use increased with simple interventions but with no positive trend. Additional work is needed to improve use, including further evaluation of capnography's implementation in the ED.
Prevalence and social determinants of tobacco use in Afghanistan.

Background Limited evidence exists on the prevalence and social determinants of tobacco use in Afghanistan-a fragile post-war context where the tobacco epidemic is on the rise. This study aimed to estimate the prevalence and social determinants of tobacco use in Afghan men and women. Methods Data from the 2015 Afghanistan Demographic and Health Survey of 10 760 men and 29 461 women were used to generate weighted prevalence estimates for smoking, smokeless tobacco (SLT) products including chew and snuff tobacco, 'any tobacco use' and 'dual tobacco use'. We also modelled associations with tobacco outcomes using binary logistic regressions. Results We found that for men, smoking cigarettes was the most prevalent form of tobacco use (21.9% [95% confidence interval {CI} 21.2-22.7]). Prevalence rates were far lower for women, with cigarette/pipe smoking at 3.4% (95% CI 3.2-3.7). For both sexes, tobacco use was inversely associated with education and positively associated with agricultural and skilled and unskilled manual labour occupations. Wealth increased the odds of smoking for men but decreased the odds for women. Media exposure had little influence on tobacco use among women; however, the effects were more varied for men. Conclusions Our results demonstrate social inequalities in tobacco use among Afghan men and women, which calls for stronger tobacco control measures and continued monitoring of this growing epidemic.
Perceptions of Police Response to Domestic Violence in Puerto Rico: Law 54 and Human Rights

This article addresses perceptions of police response to domestic violence against women in Puerto Rico after police reforms in 2013. Puerto Rico has high rates of fatalities due to domestic violence and police practices preventing fatalities are found to be lacking. Authors address the intersection of domestic violence against women and the systemic failings of Puerto Rican law enforcement and resistance to handling of domestic violence incidents as required by law. The findings of an exploratory, qualitative pilot study with key stakeholders working with women survivors of domestic violence in Puerto Rico are presented. Using a human rights perspective, the study participants note an association between police response to domestic violence and machismo, patriarchy, and colonialism.
Learning from Versus Learning with Technology: Supporting Constructionist Reading Comprehension Learning with iPad Applications

Approaches to using devices in the classroom can be classified as learning with technology or learning from technology (Howland et al., 2011). Though the benefits of constructionist, learning with technology learning experiences has been discussed (e.g., Baytak & Land, 2011; Levinsen, 2008), few studies have compared learning with technology to learning from technology in the classroom. This study is a comparison of a constructionist, learning with technology approach to an instructionist, learning from technology approach to using iPad applications in support of reading comprehension. Findings show a significant difference favoring the learning with technology class on in-depth reading test scores and motivation. This study suggests that a learning with technology approach to using iPads for reading comprehension has motivational and learning benefits.
Leveraging machine learning methods to estimate heterogeneous effects: father absence in China as an example

Individuals differ in their personal and environmental characteristics, and the same treatment or condition may affect individuals in different ways or magnitudes. Heterogeneity in effects thus has...
Point-of-Care 3-D Printed Spectrophotometer for Therapeutic Drug Monitoring in Tuberculosis Patients

Tuberculosis (TB) is a highly infectious disease and remains as one the leading causes of mortality around the globe. Many drugs, such as rifampin, isoniazid, ethambutol, and pyrazinamide, are routinely prescribed for its treatment. The dosage requirements for treatment depend on a patients age, gender, and preexisting conditions, if any. Using therapeutic drug monitoring (TDM), clinicians can observe drug absorbance in a patient and adjust the drug dosage accordingly. Here, we have developed a 3-D printed hand-held portable spectrophotometer, which can be used for quantifying antibiotics in biological samples (e.g., urine) for TDM. Using the portable spectrophotometer, we quantified different amounts of rifampin in phosphate buffer saline and synthetic urine and found R 2 values of 0.92 and 0.94, respectively, compared to the standard clinical instrument. The presented system can potentially aide clinicians in making more informed decisions and serves as a first step toward the development of a fully automated point-of-care (POC) system for TDM in TB patients undergoing therapy.
Dynamic modeling of sea-level rise impact on coastal flood hazard and vulnerability in New York City's built environment

Abstract There is a consensus that future sea-level rise (SLR) will increase the exposure of population and assets to coastal flooding. However, the extent to which SLR affects flood hazards and human vulnerability to flooding in the built environment is not well understood. This study investigates the effects of future SLR on coastal flood hazards and human vulnerability to flooding in New York City's built environment. With a focus on a hurricane-induced flood event, we utilize a building-scale hydrodynamic model to simulate flood hazards under different 21st-century SLR scenarios. We further implement a human vulnerability model to reveal how the physical vulnerability of individuals to flooding would respond to the effects of SLR on flood hazards. We find that SLR would result in a substantial increase in not only the floodwater depth but also the floodwater velocity in the study area. For example, under a 1.04 m SLR scenario, the increase in the max floodwater speed exceeds 2.7 m/s (1271%) in 5% of the area that was flooded under the no-SLR scenario (control run). Model results show that, due to nonlinear interactions, the floodwater depth simulated by the hydrodynamic model for a SLR scenario could substantially differ from the depth estimated based on a linear addition of the SLR to the control-run floodwater depth. We find that the effects of SLR on flood hazards would, in turn, substantially affect the extent, intensity, and duration of human physical vulnerability to flooding, which could potentially increase the number of injuries and mortalities.