cssi/SciSciGPT-SciSciNet huggingface dataset:
Privatization and Corruption

Privatization of services that were formerly provided by governmental agencies has been an important issue for both local and national governments. The purpose of this paper is to examine the issue of privatization in the context of the provision of a public good such as street cleaning and refuse collection, which can be contracted out or provided in-house. Since these services require relatively low technology and both outputs and inputs are readily observable, one would think "privatization" by contracting out is a straightforward proposition. History shows otherwise. Our analysis is motivated by a study of the New York City experience in the 19th Century. Throughout most of the century, street cleaning and refuse collection were contracted out. Yet, the contract system was a total failure. The failure of the system occurred even though various safeguards to ensure contractors' performance were in place. The private contract system was effectively undermined by corruption. Toward the end of the century, the contract system was abandoned and the municipal government took over the provision of services. In this paper, we develop a framework for analysis that focuses on corruption on the part of players when a public good can be either outsourced or provided in-house. Two variations of the rotten apple theory are modeled, one in which player-type is exogenously determined and another in which players choose their type (actions). We identify conditions under which private contracting is more costly than municipal provision of the public good.
WITHDRAWN: Neuroimaging Features of Idiopathic Intracranial Hypertension Persist After Resolution of Papilledema

Abstract Background Papilledema is a key clinical finding in the diagnosis of Idiopathic Intracranial Hypertension (IIH). However, newly proposed criteria allow diagnosis without papilledema only if certain neuroimaging features are present, and it is currently unclear if these findings persist upon resolution of papilledema and intracranial hypertension. We performed an exploratory study to assess whether or not these neuroimaging changes persist after resolution of papilledema. Methods A retrospective chart review identified three groups of patients (6 per group) who had received orbital imaging within 4weeks of fundoscopic examination: 1) IIH patients without active papilledema, 2) IIH patients with active papilledema, and 3) patients with no history of IIH or papilledema. All magnetic resonance imaging (MRI) scans were reviewed and graded by a neuroradiologist who was blinded to clinical status. Neuroimaging features were compared by nonparametric rank testing using the Kruskal-Wallis one-way analysis of variance. Results Measurements of sellar and optic nerve configuration (including globe flattening and optic nerve protrusion) showed a statistical trend with papilledema status. For the control group versus the active papilledema group, the values were 0.0597 and 0.0621, respectively. For the control group versus the resolved papilledema group, the values were 0.0485 and 0.0512, respectively. However, globe and sellar p-values for the resolved papilledema group versus the active papilledema group were not significant, 1.000 and 0.6023, respectively. Conclusions Some of the characteristic neuroimaging features of IIH, specifically sellar and globe configuration, suggest a statistical trend for persistence after papilledema has resolved and intracranial pressure (ICP) has normalized. Careful clinical correlation and fundus examination is essential because some of these neuroimaging features can be seen in normal patients and those with resolved IIH, and their presence on MRI may not necessarily indicate active disease or elevated ICP.
Doubt or Deference: Comparing the South Dakota and Washington School Finance Decisions

In Davis v. South Dakota, the Supreme Court of South Dakota held that the legislature complied with the State Constitution when it enacted the State’s school finance system. Conversely, in McCreary v. Washington, the Supreme Court of Washington declared that the legislature violated the State Constitution when it enacted the State’s school finance system. This is the norm in school finance litigation. Two courts decide cases involving virtually identical issues within five months of each other, but reach opposite results. While there are important differences between the two school finance systems at issue and while the Education Clauses of the respective State Constitutions are worded differently, the primary reason for the opposite result is the Courts utilized completely different constitutional standards. The different constitutional standards resulted from different views of the nature of the constitutional challenges, different interpretations of the state constitutional provisions at issue, and different constitutional constructions of those provisions. A comparison of these differences illuminates insights and perspectives on the judicial role in school finance litigation. Sometimes the best way to understand a particular decision is to understand why a different body made the exact opposite decisions.The purpose of this Article is to compare judicial approaches of the South Dakota and Washington Courts in order to better understand judicial decision-making in school finance litigation. This Article accomplishes this purpose in three parts. Part I provides a general overview of school finance litigation including the relevant constitutional strategies and history. Part II discusses the reasoning of both the South Dakota and Washington Courts. Part III compares the judicial approaches of the two tribunals. Using the interpretative theories set out in the recent works of Bauries and Thro, Part III examines how each Court viewed nature of the constitutional challenges, interpreted the state constitutional provisions, and developed constitutional constructions.
Region of Interest Measurements of Structural Volumes in Patients with Parkinson's Disease, Atypical Parkinsonism, and REM Sleep Behavior Disorder: Baseline Measurements from a Prospective Longitudinal Study (P06.076)

Objective: Measure baseline Magnetic Resonance Imaging (MRI) volumes of select anatomical structures in patients with Idiopathic Parkinson9s Disease (PD), Atypical Parkinsonism (PS), REM sleep behavior disorder (RBD), and healthy controls in a prospective longitudinal study. Background RBD is considered a subclinical neurodegenerative disorder that precedes the development of PD and PS by decades. Design/Methods: Region of interest baseline volumes of the olfactory bulb (OB), putamen, caudate, amygdala, hippocampus, and entorhinal gray were measured using 3T MRI for PD (N=12), PS (N=10), RBD (N=9), and Control (N=10) groups. OB volumes were measured manually while others were automatically calculated. Volumes were normalized for whole brain volume and converted to a percentage of total brain volume for each individual subject. Intragroup and intergroup differences were analyzed for significance using mean ± s.e.m. Results: Intragroup differences were significant for OB in the RBD group (p=0.050, Left=0.125±0.027, Right=0.102±0.022), putamen in the PD group (p=0.043, Left=2.240±0.085, Right=2.356±0.084), and amygdala in the PD, RBD, and control groups (p=0.010, Left=0.642±0.023, Right=0.697±0.021; p=0.003, Left=0.629±0.030, Right=0.688±0.034; p=0.020, Left=0.632±0.023, Right=0.696±0.029 respectively). There were significant intergroup differences in the normalized left caudate volume of PS versus RBD (p=0.0164, PS =1.839±0.1012, RBD =1.538±0.03923) and versus control (p=0.0318, PS =1.839±0.1012, Control=1.579±0.04756), normalized right caudate volume of PS versus control (p=0.0196, PS =1.828±0.09645, Control =1.536±0.06013), and normalized total caudate volumes of PS versus RBD (p=0.0209, PS =3.667±0.1954, RBD =3.099±0.08852) and versus control (p=0.0205, PS =3.667±0.1954, Control =3.116±0.09428). Conclusions: Preliminary baseline structural volumes are presented with intragroup differences found in the amygdala of PD, RBD, and control groups and also in the OB of RBD patients. Intergroup differences were found in the caudate volumes of the PS group versus RBD and controls. These measurements provide a baseline for evaluation over time and future correlation with behavioral and clinical measures. Disclosure: Dr. Copeland has nothing to disclose. Dr. Ellmore has nothing to disclose. Dr. Beurlot has nothing to disclose. Dr. Liang has nothing to disclose. Dr. Suescun has nothing to disclose. Dr. Furr-Stimming has nothing to disclose. Dr. Castriotta has nothing to disclose. Dr. Schiess has nothing to disclose.
Erich Fromm’s Ecological Messianism: The First Biophilia Hypothesis as Humanistic Social Theory

Revisiting Erich Fromm’s works provides a theoretical foundation for a comprehensive and normative theory of human–nature relations that contains psychical, social, economic, and ethical components...
Detection technology for captured nodes in wireless sensor networks

Collection of sensitive data is usually needed in many practical applications in wireless sensor networks, thus security measures are crucial. Once the sensor node is compromised, if no appropriate measure is taken, all the information inside the node will be leaked. The attacker can launch internal attacks on the compromised node within the network, which will result in a sharp decline of network security. So far, there are a variety of techniques to detect the compromised nodes. The current detection techniques are summarized in this paper. The research directions in the future are looked ahead.
Curve crossing in a protein: coupling of the elementary quantum process to motions of the protein

The quintessential quantum process in biology and chemistry involves electrons switching between two states. Two examples are electron transfer reactions in proteins when an electron moves from an orbital on the donor moiety D to an orbital on the acceptor moiety A and bond formation or bond breaking in an enzyme when electrons shift from a non-bonding state to a bonding state or vice versa. The energy expectation values of the two states E 1(t) and E 2(t)vary in time due to motions along a reaction coordinate, but also due to thermal fluctuations of the remaining degrees of freedom of the combined reaction—protein system. Often the interaction energies which couple the two electronic states involved in the reaction are weak, i.e., are small compared to the temporal variations of E 1(t) and E 2(t). In this rather typical case the actual reaction process is confined to moments when the two electronic states become energetically degenerate [E 1(t) = E 2(t)] or, to use a widely accepted phrase, when the curves E l and E 2 cross.
A metabolic stress-induced cell cycle checkpoint in stem cells

Control of eukaryotic cell division and growth involves molecular circuits, known as “cell cycle checkpoints” that stop or slow the cell cycle in conditions unfavorable for cell division and theref...
The Ambiguity of Vision

This is a conceptual paper that examines the role of a well-conceived and clearly articulated vision statement in the long-term success of an organization. It is not based on empirical research, and its purpose is to provoke discussion rather than to provide answers. In that sense, it is an exploratory paper, and its methodology is primarily one of probing inquiry rather than systematic research. The role of visionary leaders in the success of organizations has been discussed in management literature for many years (Tichy & Devanna 1986, Bennis 1989, Nanus 1995, Collins and Porras 1991, 1996). The importance of articulating this vision in the form of a "vision statement", and the ideal form and structure of such vision statements, are also topics that have been explored at length (Lipton 1996, Collins and Porras 1996). This paper takes another look at the construct of organizational vision, and examines whether a vision statement has a more central role to play in the long-term success of an organization than generally thought. It also examines whether a vision statement ought to be framed in the context of the broader global business environment. In many ways, this paper is a re-affirmation of what Lipton has stated in his seminal article on the subject, although it does differ conceptually in some respects, as explained later (Lipton 1996). In view of the increasing size and complexity of organizations world-wide, as well as increased diversity due to globalization, it is becoming harder for leaders to frame and articulate a unified organizational vision (Collins and Porras 1991). We thought this was an appropriate time to revisit the subject. The conclusion reached in this paper is that the vision of an organization’s leaders and the clarity and effectiveness with which it is articulated are instrumental in an organization's long term success. It argues that the measure of a good vision statement is not whether it reads well, has uplifting language or can be easily memorized, but whether (a) it is framed within the context of the changes taking place in the global environment; (b) it conjures up a desired state for the organization at a chosen point in time; and (c) it inspires a significant number of the employees to greater effort toward attaining that desired state.
High Q and High Tuning Range FinFET Based Varactors for Low Cost SoC Integration

In this paper, we investigate varactor design on the variants of FinFET technology (Fried et al., 2003) and (Mathew et al., 2004) to provide future low cost mobile wireless solutions by SoC RF CMOS circuit integration
Using Affinity To Provide Long-Term Delivery of Antiangiogenic Drugs in Cancer Therapy

Antiangiogenic drugs encompass many of the different cancer drugs currently under clinical investigation. One of the drawbacks of antiangiogenic therapy, though, is that upon cessation of drug treatment tumors can recur with an accelerated growth rate. In this study we investigate the capacity of using affinity interactions between a polymer made from cyclodextrin and four antiangiogenic drugs, tranilast, SU5416, 2-methoxyestradiol, and silibinin, with the ultimate goal of creating delivery profiles on the order of antiangiogenic processes (needing weeks, rather than hours of delivery). In these systems, release rate is dependent on affinity, so using in silico molecular docking studies followed by surface plasmon resonance we determined that silibinin possesses the highest affinity among the drugs screened. Silibinin also showed a differential binding affinity among various cyclodextrins tested, with a greater affinity toward the larger molecular pocket of γ-cyclodextrin than for β-cyclodextrin. Release ...
A 200-year archaeozoological record of Pacific cod (Gadus macrocephalus) life history as revealed through ion microprobe oxygen isotope ratios in otoliths

Abstract We measured δ18O values in modern and archaeological Pacific cod (Gadus macrocephalus) otoliths recovered from Aialik Bay on the Pacific coast of the Kenai Peninsula, Alaska, using a high precision ion microprobe. Values of δ18O were measured in as many as sixty 10-μm spots along 2–3 mm transects from the otolith core to its margin with high spot-to-spot analytical precision (δ18O ± 0.3‰). We obtained sample densities along a linear transect that were at least 2 to 3 times greater than micromilling/conventional mass spectrometry techniques. From modern Pacific cod otoliths (using in situ temperatures from electronic archive tags) we calibrated an empirical fractionation equation of aragonite δ18O to sea water temperature (r2 = 0.75, p
Acute Affective Reactivity and Quality of Life in Older Adults with Amnestic Mild Cognitive Impairment: A Functional MRI Study.

Objectives Poor quality of life (QoL) is a major concern among older adults with amnestic mild cognitive impairment (MCI). Maladaptive affective regulation and its relevant frontal dysfunction that are often observed in older adults with MCI may provide an insight into the understanding of their QoL. Methods In this case-controlled study, participants (MCI patients, N = 18; healthy comparisons [HC], N = 21) completed cognitive tasks, and underwent resting-state functional magnetic resonance imaging (rs-fMRI) immediately before and after the tasks. The amplitude of low-frequency fluctuations (ALFF) of rs-fMRI signals was calculated to examine the brain's spontaneous activity. The change in valence from the Self-Assessment Manikin indexed affective reactivity. QoL was assessed using Quality of Life-AD measure. Multiple mediator model was used to examine the mediating effect of frontal regions' ALFF reactivity between the affective reactivity and QoL. Results The MCI group had significantly worse QoL and more negative affective reactivity than HC group. Less negative affective reactivity was significantly associated with better QoL in MCI not HC. ALFF in the anterior cingulate cortex, medial prefrontal cortex (MPFC), and superior frontal gyrus (SFG) increased significantly less after cognitive tasks in MCI than HC. For the entire sample, greater increases of ALFF in MPFC and SFG were significantly associated with better QoL, and SFG alone significantly mediated the association between affective reactivity and QoL. Conclusions Enhancing SFG activation, especially among those with MCI, may provide a therapeutic target for addressing the negative impact of maladaptive affective regulation on QoL.
Optical Radiation Models

This chapter outlines the basic models appropriate to the optical region from the visible through the thermal infrared region. The science of radiometry is applied to define the major processes involved in remote sensing in this spectral region. The chapter discusses that at longer wavelengths, materials at normal temperatures begin to actively emit thermal radiation. A description of the way by which solar radiation propagates and is modified prior to sensing by an optical system is described. The chapter illustrates the most important components for remote sensing with image examples. The chapter concludes the following points: (1) the energy collected by a remote sensing system is proportional to the surface reflectance (solar reflective region), surface emissivity, and surface temperature (thermal region); (2) a spatially invariant but spectrally dependent constant bias term arising from atmospheric scattering (solar reflective region) and atmospheric emission (thermal region) is present in the sensed signal; and (3) a “coupling” exists between the surface and the atmosphere—they interact as a function of the surface reflectance, emission, and topography.
Epilepsy, language, and social skills

Language and social skills are essential for intrapersonal and interpersonal functioning and quality of life. Since epilepsy impacts these important domains of individuals' functioning, understanding the psychosocial and biological factors involved in the relationship among epilepsy, language, and social skills has important theoretical and clinical implications. This review first describes the psychosocial and biological factors involved in the association between language and social behavior in children and in adults and their relevance for epilepsy. It reviews the findings of studies of social skills and the few studies conducted on the inter-relationship of language and social skills in pediatric and adult epilepsy. The paper concludes with suggested future research and clinical directions that will enhance early identification and treatment of epilepsy patients at risk for impaired language and social skills.
A Defense System for Defeating DDoS Attacks in SDN based Networks

Software-Defined Networking (SDN) is a network architecture that aims at providing high flexibility through the decoupling of the network logic from the forwarding functions. The ease of programmability makes SDN a great platform implementation of various initiatives that involve application deployment, security solutions, and decentralized network management in a multi-tenant data center environment. Although this can introduce many applications in different areas and leads to the high impact on several aspects, security of SDN architecture remains an open question and needs to be revisited based on the new concept of SDN. Current SDN-based attack detection mechanisms have some limitations. In this paper, we investigate two of those limitations: Misbehavior Attack and NewFlow Attack. We propose a secure system that periodically collects network statistics from the forwarding elements and apply Machine Learning (ML) classification algorithms. Our framework ensures that the proposed solution makes the SDN architecture more self-adaptive, and intelligent while reacting to network changes.
Multi-SKAT: General framework to test multiple phenotype associations of rare variants

In genetic association analysis, a joint test of multiple distinct phenotypes can increase power to identify sets of trait-associated variants within genes or regions of interest. Existing multi-phenotype tests for rare variants make specific assumptions about the patterns of association of underlying causal variants, and the violation of these assumptions can reduce power to detect association. Here we develop a general framework for testing pleiotropic effects of rare variants based on multivariate kernel regression (Multi-SKAT). Multi-SKAT models effect sizes of variants on the phenotypes through a kernel matrix and performs a variance component test of association. We show that many existing tests are equivalent to specific choices of kernel matrices with the Multi-SKAT framework. To increase power to detect association across tests with different kernel matrices, we developed a fast and accurate approximation of the significance of the minimum observed p-value across tests. To account for related individuals, our framework uses a random effects for the kinship matrix. Using simulated data and amino acid and exome-array data from the METSIM study, we show that Multi-SKAT can improve power over single-phenotype SKAT-O test and existing multiple phenotype tests, while maintaining type I error rate.
High Order Approximation by Multivariate Sublinear and Max-Product Operators

Here we study quantitatively the approximation of multivariate function by general multivariate positive sublinear operators with applications to multivariate Max-product operators. These are of Bernstein type, of Favard–Sz asz–Mirakjan type, of Baskakov type, of sampling type, of Lagrange interpolation type and of Hermite–Fejer interpolation type. Our results are both: under the presence of smoothness and without any smoothness assumption on the function to be approximated. It follows (Anastassiou, Approximation by Multivariate Sublinear and Max-Product Operators, 2017, submitted, [4]).
Instrumentation in Ophthalmic Plastic Surgery

The use of proper instrumentation in ophthalmic plastic surgery is an essential element to successful surgical outcomes. However, the surgeon must be aware that without proper adherence to the basic surgical principles, surgical outcomes will be suboptimal. The surgeon must have an intimate knowledge of the eyelid, orbital, and facial anatomy. Furthermore, an understanding of the anatomy and the natural tissue planes allows the surgeon to surgically dissect the tissue planes as atraumatically as possible with the aid of appropriate and adequate instrumentation.
Thinking about place branding: Ethics of concept

This article introduces a critical theory-induced approach to the concept of place branding to expose the ethical drawbacks within the field. The author argues that the dominant approaches and definitions of place branding limit the thinking of scholars to market-driven subjects, such as measurement, effectiveness and strategies. It is difficult even to discuss ethical issues at a conceptual level within these approaches. With an attempt to further investigate these widely ignored issues, place branding is redefined through a communicative action framework, and a two-step model of place branding is devised – composed of domestic communicative action (Step 1) and international communicative action (Step 2). Step 1 highlights (i) legitimacy and (ii) inclusion as ethical concerns, whereas Step 2 brings in the question of (iii) consistency between the messages in the domestic and international arena. Critical theory makes it possible to take an analytical look at the mainstream approaches and present ethical issues at the conceptual level. Future studies should aim to integrate this theoretical approach to the practice of place branding.
Non-destructive Imaging and Residual Strength of Composite Materials After Exposure to Blast Loading

An experimental study has been conducted to evaluate the compressive residual strength of glass fiber/epoxy laminates after exposure to air blast loading. Controlled blast loading experiments were conducted using a shock tube facility which induced damage on the panels. The resulting damage in the material was quantified using non-destructive imaging technologies, specifically Terahertz (THz) and Flash Infrared Thermography (FIRT). Residual compressive strength was subsequently measured using subpanels cut from the main panel, per ASTM D7137. Furthermore, an empirical relationship has been developed to predict the residual compressive strength of the composite laminates as a function of a combined damage parameter based on individual damage mechanisms. The results show that THz and FIRT imaging can be used to quantify internal damage in a composite laminate after shock loading. Additionally, residual strength experiments show that increased shock damage causes a corresponding reduction in remaining compressive strength. The residual strength of the composite panel follows a linear trend as a function of a combined damage parameter.
Developmental trajectories of autonomic functioning in autism from birth to early childhood.

Abstract Deficits in social engagement emerge in autism during the infant and toddler period and may be related to emotion regulation and stress response systems. This study examined patterns of growth in autonomic functioning related to autism diagnosis and addresses the hypothesis that there are differences in autonomic functioning related to autism in infancy. Heart rate (HR) and respiratory sinus arrhythmia (RSA) were measured at 8 time points from 1 to 72 months of age in infants later diagnosed with autism (n = 12) and a non-autistic comparison group (n = 106). Multilevel models were used to describe the developmental course of HR and RSA and to test the effect of autism diagnosis on growth trajectories. Both groups showed an expected age-related decrease in HR and increase in RSA. Groups did not differ in the rate of decrease of HR over time. However, infants with autism demonstrated a smaller linear increase in RSA, indicating slower growth in RSA over time in comparison to controls. These results suggest that differences in physiological regulation may develop with age in autism. The slowed RSA growth in autism was most evident after 18 months of age, at a time when behavioral symptoms become prominent. This is consistent with the view that RSA is a marker of functional status in autism rather than a cause of social deficits in autism.
Cervical spondylodiscitis caused by Candida albicans in a non-immunocompromised patient: A case report and review of literature.

Background Fungal cervical spondylodiscitis is rare and accounts for less than 1% of all cervical, thoracic, and lumbar vertebral osteomyelitis and discitis. Case Description A 32-year-old non-immunocompromised male presented with persistent neck pain and paresthesias. The magnetic resonance imaging of the cervical spine demonstrated a contrast-enhancing erosive lesion involving the cervical C6 and C7 vertebral bodies accompanied by epidural phlegmon. Blood culture was negative. The patient underwent a C6 and C7 anterior corpectomy with instrumented fusion (e.g., expandable cage C5 to T1). Intraoperatively, frank pus was noted within the C6-C7 disc space and was accompanied by thick prevertebral and epidural phlegmon extending from C5 to T1. Intraoperative cultures grew Candida albicans. Three days later, a C6-C7 laminectomy with C4-T2 posterior instrumented fusion was performed; the cultures again grew C. albicans. The patient was treated with intravenous micafungin for 14 days followed by 6-12 months of 400 mg oral fluconazole daily. Conclusion There are few cases in literature where non-immunocompromised patients developed fungal cervical spondylodiscitis. Prompt diagnosis and appropriate management are critical to effectively treat these patients. Surgical intervention may warrant corpectomy, discectomy, and operative debridement followed by long-term targeted antifungal therapy.
Islamophobia in Reactionary News: Radicalizing Christianity in the United States

The accuracy and relevance of United States print news media has been called into question at increasing rates in the post-truth era. Conservatives, in particular, have long expressed concerns that mass and digital media censor conservative as well as Christian viewpoints while promoting a progressive and, more recently, pro-Muslim, platform. They have increasingly turned to alternative-right and alternative right-wing sources for news and discussion within what they deem to be unfiltered and unbiased networks. This article employs a mixed method approach of content and discourse analysis of sources from 1 January to 15 May of 2019 pertaining to discourse concerning the relationship between Christianity and Islam within and in response to articles in three such sources: Breitbart, The Federalist, and FrontPage Magazine. The role of these three websites is considered in the radicalization of those who aim to defend a monolithic form of Christianity rather than a particular Christian denomination or belief.
EFFECT OF EARLY VERSUS DELAYED PERCUTANEOUS REVASCULARIZATION IN NON-ST SEGMENT ELEVATION MYOCARDIAL INFARCTION WITH CARDIOGENIC SHOCK

We assessed the impact of early ( 24 hours) revascularization with percutaneous coronary intervention (PCI) in patients with non-ST elevation myocardial infarction (NSTEMI) and cardiogenic shock (CS). Data from National Inpatient Sample 2005-16 were used to identify
Health literacy, health outcomes, and the caregiver role in traumatic brain injury.

Purpose/Objective: The purpose of this study is to estimate the occurrence of low health literacy among caregivers of people with traumatic brain injury (TBI), and to evaluate associations of health literacy with caregiver health-related quality of life (HRQOL) and perceptions of the caregiving role. Research Method/Design: The TBI-CareQOL measurement system assesses important self-reported outcomes for caregivers of civilians or service members/veterans (SMVs) with TBI. The validation phase included the Health Literacy Assessment Using Talking Touchscreen Technology (Health LiTT) measure. Multivariable regression evaluated the impact of low health literacy on generic and TBI-specific HRQOL and appraisals of the caregiving role, adjusted for caregiver gender, race/ethnicity and education, and the functional status of the TBI care recipient. Results: Among 131 caregivers, 28 (21%) had low health literacy. Compared with the high health literacy group, the group with low health literacy had fewer women, more racial/ethnic minorities, and lower education (all p < .05). The low health literacy group reported more subjective caregiving burden, less satisfaction with their relationship with the TBI recipient, less caregiving mastery, and poorer physical health (all p < .05). There were no differences between health literacy groups in caregiving ideology, caregiver-specific HRQOL or general mental health. Conclusions/Implications: A better understanding of the links between health literacy and caregiver HRQOL and the caregiving role can help identify strategies to meet the needs of this underserved population. Tailored interventions for caregivers with low health literacy could improve outcomes for both the caregiver and the care recipient. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
National Institute of Standards and Technology transportable tunable ultraviolet laser irradiance facility for water pathogen inactivation.

A method of ultraviolet germicidal irradiation (UVGI) for water pathogen inactivation effectiveness using tunable, narrowband laser light is described. A transportable tunable UV (TTUV) laser system for providing a known irradiance (μW/cm2) or dose (mJ/cm2) suitable for irradiating water samples in Petri dishes over the wavelength range of 210 nm–300 nm was developed by the National Institute of Standards and Technology. The TTUV facility, consisting of a 1 kHz pulsed UV laser and light-tight enclosure containing the optics necessary to uniformly irradiate a water sample, was used in a microbiology laboratory to dose drinking water pathogens and surrogates as part of a Water Research Foundation study in the summer and fall of 2012. The approach demonstrated improved accuracy and simplified spectral analysis over conventional pathogen inactivation sources consisting of broadband UV sources and bandpass filters. In this work, the TTUV facility design and key components are described, including modifications in the field to provide the required irradiance levels. The irradiance and dose levels produced by the tunable UV laser during the project are also presented. The transportability of the TTUV system enabled it to be brought to a microbiology facility allowing the water samples (microbial suspensions) to be irradiated in a location with experienced staff and facilities for preparing, handling, analyzing, storing, and shipping the many samples studied. These results, published elsewhere, established that the tunable UV laser system provides unique UVGI capabilities for use with water pathogens and has applications for other pathogen experiments, for example, air-purification studies.
Randomized feasibility trial to assess tolerance and clinical effects of lithium in progressive multiple sclerosis.

Abstract Background Disability accumulation in progressive multiple sclerosis (MS) results from inflammatory and neurodegenerative mechanisms. In animal models of MS, lithium acts to reduce inflammatory demyelination, and in models of neurodegenerative diseases, lithium also slows neuronal death. Prospective studies of lithium in MS patients have not been previously undertaken. Objective To determine the tolerance and feasibility of using low-dose (150–300 mg/daily) lithium as a pharmaceutical intervention in a cohort of subjects with progressive MS, and to gauge preliminary effects of lithium on change in brain volume over time. Methods Patients with primary or secondary progressive MS were recruited into a 2-year, single-blind crossover trial in which subjects were randomly assigned to take lithium in year 1 or 2. The primary outcomes of interest were tolerance of lithium and percentage brain volume change (PBVC) on vs. off lithium. Secondary outcomes included relapse rates, disability changes, and self-report scales assessing fatigue, mood, and quality of life (QOL). Results Of 24 screened patients, 23 were randomized to take lithium during year 1 (n = 11) or 2 (n = 12). Two subjects discontinued the trial due to lithium side effects. Other reasons for discontinuation included personal reasons (n = 2), worsening MS (n = 1), and development of multiple myeloma (n = 1). For the 17 who completed the trial, change in PBVC on lithium (+0.107) did not significantly differ from the observation period (-0.355, p = 0.346). Disability measured by Expanded Disability Status Scale and MS Functional Composite did not differ by lithium treatment status. On patient reported measures of mental well-being, subjects reported fewer depressive symptoms on the Beck Depression Inventory (12.3 vs. 15.8, p = 0.016) and more favorably on the mental domains of the MSQOL inventory (56.7 vs. 52.4, p = 0.028). Conclusions Low-dose lithium is well tolerated in persons with MS. Taking lithium did not result in differences in PBVC, relapses, or disability, but conclusions were limited by study design and sample size. Despite concern for lithium-associated neurological side effects, subjects taking lithium did not report worsened fatigue or physical well-being. On measures of mood and mental health QOL, subjects scored more favorably while taking lithium. Clinicaltrials.gov identifier NCT01259388.
Opioid Prescribing in Patients Undergoing Neck Dissections With Short Hospitalizations.

ObjectiveTo evaluate postoperative opioid prescribing in patients undergoing neck dissections with short hospitalizations.Study DesignRetrospective cohort study.SettingTertiary academic hospital.Me...
Seasonality of Influenza-Like-Illness and Acute Cardiovascular Events Are Related Regardless of Vaccine Effectiveness.

Background Influenza has been identified as a trigger for stroke and myocardial infarction (MI) with prior studies demonstrating that influenza vaccination may decrease risk of stroke and MI. Metho...
Non-classical phase diagram for virus bacterial coevolution mediated by clustered regularly interspaced short palindromic repeats.

CRISPR is a newly discovered prokaryotic immune system. Bacteria and archaea with this system incorporate genetic material from invading viruses into their genomes, providing protection against future infection by similar viruses. The condition for coexistence of prokaryots and viruses is an interesting problem in evolutionary biology. In this work, we show an intriguing phase diagram of the virus extinction probability, which is more complex than that of the classical predator–prey model. As the CRISPR incorporates genetic material, viruses are under pressure to evolve to escape recognition by CRISPR. When bacteria have a small rate of deleting spacers, a new parameter region in which bacteria and viruses can coexist arises, and it leads to a more complex coexistence patten for bacteria and viruses. For example, when the virus mutation rate is low, the virus extinction probability changes non-montonically with the bacterial exposure rate. The virus and bacteria coevolution not only alters the virus extinction probability, but also changes the bacterial population structure. Additionally, we show that recombination is a successful strategy for viruses to escape from CRISPR recognition when viruses have multiple proto-spacers, providing support for a recombination-mediated escape mechanism suggested experimentally. Finally, we suggest that the re-entrant phase diagram, in which phages can progress through three phases of extinction and two phases of abundance at low spacer deletion rates as a function of exposure rate to bacteria, is an experimentally testable phenomenon.
Assisting the Heart to Assist the Lungs: LVAD Support in Restrictive Physiology and Pulmonary Hypertension

Introduction Pulmonary hypertension (PH) is a risk factor for mortality after heart transplantation (HTx). We present a case of treatment of post-capillary PH in a small pediatric patient with restrictive physiology using continuous flow ventricular assist device (VAD) support to achieve candidacy for HTx. Case Report A 4.5 year old female (0.57m2) with a history of acute myeloid leukemia and anthracycline chemotherapy in infancy developed mildly depressed left ventricular (LV) function at 2 years of age. Hemodynamic catheterization (cath) showed pre- and post-capillary PH secondary to LV diastolic dysfunction and restrictive physiology (Table). She was cautiously initiated on PDE5 inhibitor therapy (sildenafil) while maintaining LV reverse remodeling therapies. Her heart failure (HF) symptoms and biventricular systolic function worsened over the subsequent 2 years. Subsequent caths showed increasing PVRi, which was responsive to 100% FiO2 and inhaled nitric oxide (iNO), but also accompanied by increase in LV end-diastolic pressures (LVEDP). She was transitioned to endothelin receptor antagonist therapy (bosentan), but continued to worsen clinically, requiring initiation of milrinone. Due to her underlying restrictive physiology leading to worsening PH and severely depressed right ventricular (RV) function, a HeartWare HVAD (cannulation LV to Aorta) was implanted to allow aggressive optimization of PH therapies with simultaneous LV decompression. This enabled up-titration of bosentan as well as re-addition of sildenafil. After PH therapies including VAD implantation, PVRi decreased from a high of 10.7 WU.m2 to 4.7 WU.m2, and marked decline of LVEDP from 22 mmHg pre-VAD to 5 mmHg. She underwent HTx 6 months after VAD implantation, and was discharged home 12 days post-HTx on sildenafil. Summary VAD support in tandem with optimal PH therapies is a feasible strategy to treat post-capillary PH, optimize pulmonary vasculature to reduce RV dysfunction, and enable a successful bridge to HTx.
Prothrombin Complex Concentrate for Emergent Reversal of Intracranial Hemorrhage in Patients with Ventricular Assist Devices

Intracranial hemorrhage (ICH) is a devastating complication for patients with ventricular assist devices (VADs). The safety of emergent anticoagulation reversal with four-factor prothrombin complex concentrate (PCC) and optimal timing of anticoagulation resumption are not clear. In addition, lactate dehydrogenase (LDH) is used as a biomarker for thromboembolic risk, but its utility in guiding anticoagulation management after reversal with PCC has not be described. We retrospectively reviewed a consecutive series of patients with VADs presenting with ICH between 2014 and 2020 who received four-factor PCC for rapid anticoagulation reversal. We collected the timing of PCC administration, timing of resumption of anticoagulation, survival, occurrence of thromboembolic events, and LDH levels throughout hospitalization. We identified 16 ICH events in 14 patients with VADs treated with rapid anticoagulation reversal using four-factor PCC (11 intraparenchymal, 4 subdural, 1 subarachnoid hemorrhage). PCC was administered at a mean of 3.3 ± 0.3 h after imaging diagnosis of ICH. Overall mortality was 63%. Survivors had higher presenting Glasgow Coma Scale (median 15, interquartile range [IQR] 15–15 versus 14, IQR 8–14.7, P = 0.041). In all six instances where the patient survived, anticoagulation was resumed on average 9.16 ± 1.62 days after reversal. There were no thromboembolic events prior to resumption of anticoagulation. Three events occurred after anticoagulation resumption and within 3 months of reversal: VAD thrombosis in a patient with thrombosis at the time of reversal, ischemic stroke, and readmission for elevated LDH in the setting of subtherapeutic international normalized ratio. Our limited series found no thromboembolic complications immediately following anticoagulation reversal with PCC prior to resumption of anticoagulation. LDH trends may be useful to monitor thromboembolic risk after reversal.
An Attention Model for Hypernasality Prediction in Children with Cleft Palate

Hypernasality refers to the perception of abnormal nasal resonances in vowels and voiced consonants. Estimation of hypernasality severity from connected speech samples involves learning a mapping between the frame-level features and utterance-level clinical ratings of hypernasality. However, not all speech frames contribute equally to the perception of hypernasality. In this work, we propose an attention-based bidirectional long-short memory (BLSTM) model that directly maps the frame-level features to utterance-level ratings by focusing only on specific speech frames carrying hyper-nasal cues. The models performance is evaluated on the Americleft database containing speech samples of children with cleft palate and clinical ratings of hypernasality. We analyzed the attention weights over broad phonetic categories and found that the model yields results consistent with what is known in the speech science literature. Further, the correlation between the predicted and perceptual rating is found to be significant (r = 0.684, p < 0.001) and better than conventional BLSTMs trained using frame-wise and last-frame approaches.
Pooled platelet concentrates provide a small benefit over single-donor platelets for patients with platelet refractoriness of any etiology.

BackgroundAt our institution, patients with platelet refractoriness (of any etiology) are sometimes switched from apheresis platelets to pooled platelets before human leukocyte antigen (HLA)-matche...
CMS-BN: A cognitive modeling and simulation environment for human performance assessment, part 2 — Application

Abstract Human operators play a critical role in the operation of complex engineered systems, in particular under abnormal conditions. It is important to assess human performance under conditions of interest and to improve upon the performance by taking effective measures. In this paper we present the application of a previously developed cognitive modeling and simulation environment to address these two problems. The developed environment simulates how a human operator dynamically interacts with the external system, with focus on the operator’s cognitive activities. Based on the Three Mile Island accident, specifically the stuck-open failure of the pilot operated relief valve, we demonstrate how the developed environment can be used for human reliability analysis and human performance improvement. For human reliability analysis, besides providing a single human error probability value the proposed environment allows us to examine in detail how an operator reached a decision or missed an action. For human performance improvement, the proposed environment provides an easy approach for investigating the effects of changes, for example, in operator training and system design, on human performance and therefore identifying the most effective changes to improve human performance.
The Commercial Bank Leverage Factor in U.S. Asset Prices

I present novel results on a commercial bank leverage factor that drives U.S. asset prices with important implications for both the time-series and the cross-section of returns. To motivate these findings, I modify the recovery rate of assets in a disaster model to include aggregate credit growth as an additional macroeconomic risk factor. It turns out there is a positive relationship between the postulated "resilience" of an asset and the stage of aggregate credit recovery. The intuition is behavioral in nature: credit expansions (contractions) breed investor overoptimism (pessimism), asset "resilience" increases (decreases) and the risk-premium decreases (increases). Additional implications in the cross-section are generated by the interaction of the credit cycle with the stock-specific recovery rate. The commercial bank leverage factor has a larger effect on small-, less profitable-, and value-stocks. A simple buy-and-hold strategy of the market index at short- and medium-horizons illustrates how investors can earn significantly higher excess returns and Sharpe ratios in recoveries and early stages of an expansion as opposed to credit booms.