cssi/SciSciGPT-SciSciNet huggingface dataset:
Endogenous Opioid Function and Responses to Morphine: The Moderating Effects of Anger Expressiveness

Abstract Long-term use of opioid analgesics may be ineffective or associated with significant negative side effects for some people. At present, there is no sound method of identifying optimal opioid candidates. Individuals with chronic low back pain (n = 89) and healthy control individuals (n = 102) underwent ischemic pain induction with placebo, opioid blockade (naloxone), and morphine in counterbalanced order. They completed the Spielberger Anger-Out subscale. Endogenous opioid function × Anger-out × Pain status (chronic pain, healthy control) interactions were tested for morphine responses to ischemic threshold, tolerance, and pain intensity (McGill Sensory and Affective subscales) and side effects. For individuals with chronic pain and healthy control participants, those with low endogenous opioid function and low anger-out scores exhibited the largest morphine analgesic responses, whereas those with high anger-out and low endogenous opioid function showed relatively weaker morphine analgesic responses. Further, individuals with chronic pain with low endogenous opioid function and low anger-out scores also reported the fewest negative effects to morphine, whereas those with low endogenous opioid function and high anger-out reported the most. Findings point toward individuals with chronic pain who may strike a favorable balance of good analgesia with few side effects, as well as those who have an unfavorable balance of poor analgesia and many side effects. Perspective We sought to identify optimal candidates for opioid pain management. Low back pain patients who express anger and also have deficient endogenous opioid function may be poor candidates for opioid therapy. In contrast, low back patients who tend not to express anger and who also have deficient endogenous opioid function may make optimal candidates for opioid therapy.
Executive leadership and surgical quality: A guide for senior hospital leaders

Healthcare and the provision thereof is a remarkable combination of skill, clinical judgment, and teamwork. This surgical teamwork requires sound and thoughtful oversight so to ensure that the appropriate leadership and administrative structure is in place. The Chief Surgical Quality and Patient Safety Officer is a primary driver of process improvement and measurement of outcomes so to ensure a culture of surgical safety and the best patient care environment. Training and resources are required, as are reporting structures and administrative committee support. Strategic alignment and leadership must be inherent to the department so to develop not only a culture of safety but also high reliability at all levels of the department. Data analytics and validation coupled with metric development and goal setting coupled with dash boarding and bench marking allow incentives and compensation to be aligned with outcomes. Innovation in process improvement and continuous engagement of the entire team ensure truly patient centric care which requires all surgeons to actively manage the tension between quality, efficiency, and patient satisfaction.
Temple of art on Second Avenue

ABSTRACTFrom the end of the First World War and until the 1950s, New York’s Second Avenue was the world capital of the Yiddish stage. At the heart of this Jewish entertainment area that stretched from Houston to 14th Streets stood four flagship Yiddish playhouses built specifically for a Jewish clientele. Only one of the four has survived to this date: the Yiddish Art Theatre, also known as the Jaffe Theater, located on Second Avenue and 12th Street. Protected by its official interior landmark status, the building now functions a movie theatre. This essay focuses on its ornate neo-Moorish style, linking it to the style that is typical of numerous synagogues. It discusses the Yiddish Art Theatre as an example for the underlying stylistic and ideological affinity between religious sanctuary and theatre.
Impaired Activity of the Ubiquitin–Proteasome System in Transgenic Mice Expressing ALS/Dementia-Linked Mutant UBQLN2 (P02.170)

OBJECTIVE: To further explore the pathogenic mechanism of UBQLN2-mediated ALS and ALS/dementia and the effect of mutant UBQLN2 on the ubiquitin-proteasome system (UPS). BACKGROUND: The UPS may be responsible for the accumulation of potentially harmful ubiquitinated proteins in neurodegenerative disorders. In ALS, UPS dysfunction may be central to motor neuron death. Recently, we showed that mutations in UBQLN2, which encodes the ubiquitin-like protein ubiquilin 2, cause dominant X-linked juvenile and adult-onset ALS and ALS/dementia. Ubiquilin 2 is a member of the ubiquilin family, which regulates the degradation of ubiquitinated proteins. Functional analysis showed that mutations in UBQLN2 lead to an impairment of protein degradation. Therefore, our findings linked abnormalities in ubiquilin 2 to defects in the protein degradation pathway, abnormal protein aggregation and neurodegeneration, indicating a common pathogenic mechanism. DESIGN/METHODS: We first developed transgenic mice expressing an ALS/dementia-linked UBQLN2 mutation (P497H) using the human genomic DNA transgene. These mice recapitulate the behavioral and pathological characteristics of human ubiquilinopathy. To functionally investigate the UPS in ALS motor neurons in vivo, we crossed the UBQLN2-P497H transgenic mice with transgenic mice expressing a fluorescently tagged UPS reporter substrate (Ub-G76V-GFP). In Ub-G76V-GFP/UBQLN2-P497H double-transgenic mice, we stained brain sections and performed immunohistochemisrty using antibodies generated against ubiquilin2 and ubiquitin. Western blotting was also performed to confirm our results. RESULTS: Prominent ubiquilin2-positive inclusions were observed in the hippocampus of Ub-G76V-GFP/UBQLN2-P497H double-transgenic mice. Confocal microscopy shows co-localization of ubiquilin2 with ubiquitin and Ub-G76V-GFP in these hippocampal inclusions, consistent with UPS impairment and accumulation of Ub-G76V-GFP due to inefficient reporter degradation. Accumulation of ubiquitinated proteins and Ub-G76V-GFP in these mice was also confirmed using Western blotting. CONCLUSIONS: Our data suggest that UPS impairment occurs in hippocampal neurons in UBQLN2-P497H transgenic mice and may be central to neurodegeneration observed in UBQLN2-linked ALS and ALS/dementia. Supported by: NIH Grants (NS050641, NS078504, T32 AG20506), Les Turner ALS Foundation, Vena E. Schaff ALS Research Fund, Harold Post Research Professorship, Herbert and Florence C. Wenske Foundation. Disclosure: Dr. Fecto has nothing to disclose. Dr. Gorrie has nothing to disclose. Dr. Zhai has nothing to disclose. Dr. Liu has nothing to disclose. Dr. Deng has nothing to disclose. Dr. Siddique has nothing to disclose.
Insights into the molecular roles of Zika virus in human reproductive complications and congenital neuropathologies

Summary The recent upsurge in the association of congenital neurological disorders and infection by the Zika virus (ZIKV) has resulted in increased research focus on the biology of this flavivirus. Studies in animal models indicate that ZIKV can breach the placental barrier and selectively infect and deplete neuroprogenitor cells (NPCs) of the developing fetus, resulting in changes of brain structures, reminiscent of human microcephaly. In vitro and ex vivo studies using human cells and tissues showed that human NPCs and placental cells are targeted by ZIKV. Also of concern is the impact of ZIKV on human reproductive structures, with the potential to cause infertility, as the virus appears to remain in the genital tract for extended periods of time. This review discusses the putative roles of ZIKV on human reproductive complications and congenital neuropathologies.
A Unique Rodent Fauna from the Whitneyan (Middle Oligocene) of Southwestern Montana

ABSTRACT Nine rodents are described from the Whitneyan (middle Oligocene) White Hills fauna of Montana. Of these, three new genera are described: the aplodontid Altasciurus, the cylindrodontid Lophicylindrodon, and the castorid Montanacastor. Prosciurus relictus (Cope, 1873) is named as the type species of Altasciurus. The other genera are unique to this fauna and are based on new species; Lophicylindrodon expiratus and Montanacastor simplicidens. In addition, two more new species are described: the eomyid Orelladjidaumo exiguus and the cricetid Willeumys argosorus. The rodent fauna from White Hills is believed to be Whitneyan in age because of the occurrence of Eumys brachyodus Wood, 1937, and Leptodontomys douglassi (Burke, 1934); both elsewhere known from the Whitneyan. The rodent fauna is unique for several reasons: 1) a much lower diversity of rodents than in comparably aged faunas; 2) the number of unique species (four of nine); 3) the relict occurrence of a cylindrodontid (otherwise latest occurren...
Advanced Thermal Sensors for Broadband AC Voltage Metrology

We report on the development and application of a new generation of multijunction thermal converters (MJTCs). These devices, fabricated on fused silica substrates, show exceptional performance over...
Evolution of transparent manufacturing: An architecture for a Java-based controller of a CIM cell

Because of recent advances in the area of networking and information systems, today's manufacturing systems face an increasing demand for easy access, and easy integration. This demand has driven the area of factory automation towards a more transparent structure, especially at the shop-floor control level. In this light, the cell level controller must not only allow consistent operation within the cell, but also provide networking facilities to the applications in the higher tier. In this paper, a Java-based architecture for such a controller is proposed, and pertinent design issues discussed. An implementation of this architecture is also investigated for feasibility in a multi-platform environment. Case studies and evaluation of the controller are presented.
Violating the California Voting Rights Act? Uncovering Racially Polarized Voting in a Majority Latino City's At-Large Council Elections

Are at-large formats for electing city councils inherently discriminatory? This paper briefly reviews the history of the introduction of at-large elections during the Progressive Era. Then it examines the standards under the Federal Voting Rights Act of 1965, and the California Voting Rights Act of 2001 for determining whether or not an at-large election is discriminatory. Finally, the paper analyzes the 2010 Whittier city council elections, finding evidence of racially polarized voting by non-Latino voters, which diluted minority voting power and denied them the ability to elect candidates of their choice.
Forest Biotic Agent Stress: Air Pollutants and Disease Caused by Microbial Pathogens

Abnormal physiology, or disease, in woody plants follows infection and subsequent development of an extremely large number and diverse group of microorganisms internally or on the surface of tree parts. All stages of tree life cycles and all tree tissues and organs are subject, under appropriate environmental conditions, to impact by a heterogeneous group of microbial pathogens including viroids, viruses, mycoplasmas, bacteria, fungi, and nematodes. The influence of a specific disease on the health of an individual tree may range from innocuous to mild to severe. Over extended time periods, the interaction of native pathogens with natural forest ecosystems is significant, and frequently beneficial, in terms of ecosystem development and metabolism. As in the instance of insect interactions (Chapter 13), microbes and the diseases they cause, play important roles in forest succession, species composition, density, competition, and productivity. In the short term, the effects of microbial pathogens may conflict with forest management objectives and may assume a considerable economic or managerial as well as ecologic significance (Smith, 1970).
A new genus and three new species of noctuid moths from western United States of America and Mexico (Lepidoptera, Noctuidae, Noctuinae, Eriopygini).

The genus Rhabdorthodesgen. n. is described for three previously unnamed noctuid moths from the mountains of south-western United States and Mexico. It is assigned to subfamily Noctuinae, tribe Eriopygini. Rhabdorthodespattersonisp. n. from the United States and Rhabdorthodesdurangosp. n. and Rhabdorthodespetersonisp. n. from Mexico are described. These moths are small, dull gray brown, and lack highly diagnostic wing markings, but are distinctive structurally. The adults and genitalia of both sexes are illustrated and distribution maps are presented. Two species eponyms honor persons who have facilitated the study and enjoyment of moths in North America by creating moth-specific websites.
Patient involvement interventions for older adults in transitional care between hospital and primary care: a scoping review protocol.

Review question/objective:The objective of this scoping review is to identify and map existing evidence of patient involvement interventions for older adults in transitional care between hospital and primary care.The questions of this review are:What types of patient involvement interventions for ol
Electromagnetic Scattering by Particles and Particle Groups: An Introduction

Preface Acknowledgements 1. Introduction 2. The macroscopic Maxwell equations and monochromatic fields 3. Fundamental homogeneous-medium solutions of the macroscopic Maxwell equations 4. Basic theory of frequency-domain electromagnetic scattering by a fixed finite object 5. Far-field scattering 6. The Foldy equations 7. The Stokes parameters 8. Poynting-Stokes tensor 9. Polychromatic electromagnetic fields 10. Polychromatic scattering by fixed and randomly changing objects 11. Measurement of electromagnetic energy flow 12. Measurement of the Stokes parameters 13. Description of far-field scattering in terms of actual optical observables 14. Electromagnetic scattering by a small random group of sparsely distributed particles 15. Statistically isotropic and mirror-symmetric random particles 16. Numerical computations and laboratory measurements of electromagnetic scattering 17. Far-field observables: qualitative and quantitative traits 18. Electromagnetic scattering by discrete random media: far field 19. Near-field scattering by a sparse discrete random medium: microphysical radiative transfer theory 20. Radiative transfer in plane-parallel particulate media 21. Weak localization 22. Epilogue Appendix A. Dyads and dyadics Appendix B. Free-space dyadic Green's function Appendix C. Euler rotation angles Appendix D. Spherical-wave expansion of a plane wave in the far zone Appendix E. Integration quadrature formulas Appendix F. Wigner d-functions Appendix G. Stationary phase evolution of a double integral Appendix H. Hints and answers to selected problems Appendix I. List of acronyms References Index.
Contraceptive Options for the Patient with Pulmonary Arterial Hypertension

The World Health Organization describes contraception as desirable for many reasons. It allows families to make informed choices about their reproductive years. It allows family planning, with spac...
Comparison of treatment planning approaches for spatially fractionated irradiation of deep tumors.

Purpose The purpose of this work was to compare the dosimetry and delivery times of 3D-conformal (3DCRT)-, volumetric modulated arc therapy (VMAT)-, and tomotherapy-based approaches for spatially fractionated radiation therapy for deep tumor targets. Methods Two virtual GRID phantoms were created consisting of 7 "target" cylinders (1-cm diameter) aligned longitudinally along the tumor in a honey-comb pattern, mimicking a conventional GRID block, with 2-cm center-to-center spacing (GRID2 cm ) and 3-cm center-to-center spacing (GRID3 cm ), all contained within a larger cylinder (8 and 10 cm in diameter for the GRID2 cm and GRID3 cm , respectively). In a single patient, a GRID3 cm structure was created within the gross tumor volume (GTV). Tomotherapy, VMAT (6 MV + 6 MV-flattening-filter-free) and multi-leaf collimator segment 3DCRT (6 MV) plans were created using commercially available software. Two tomotherapy plans were created with field widths (TOMO2.5 cm ) 2.5 cm and (TOMO5 cm ) 5 cm. Prescriptions for all plans were set to deliver a mean dose of 15 Gy to the GRID targets in one fraction. The mean dose to the GRID target and the heterogeneity of the dose distribution (peak-to-valley and peak-to-edge dose ratios) inside the GRID target were obtained. The volume of normal tissue receiving 7.5 Gy was determined. Results The peak-to-valley ratios for GRID2 cm /GRID3 cm /Patient were 2.1/2.3/2.8, 1.7/1.5/2.8, 1.7/1.9/2.4, and 1.8/2.0/2.8 for the 3DCRT, VMAT, TOMO5 cm , and TOMO2.5 cm plans, respectively. The peak-to-edge ratios for GRID2 cm /GRID3 cm /Patient were 2.8/3.2/5.4, 2.1/1.8/5.4, 2.0/2.2/3.9, 2.1/2.7/5.2 and for the 3DCRT, VMAT, TOMO5 cm , and TOMO2.5 cm plans, respectively. The volume of normal tissue receiving 7.5 Gy was lowest in the TOMO2.5 cm plan (GRID2 cm /GRID3 cm /Patient = 54 cm3 /19 cm3 /10 cm3 ). The VMAT plans had the lowest delivery times (GRID2 cm /GRID3 cm /Patient = 17 min/8 min/9 min). Conclusion Our results present, for the first time, preliminary evidence comparing IMRT-GRID approaches which result in high-dose "islands" within a target, mimicking what is achieved with a conventional GRID block but without high-dose "tail" regions outside of the target. These approaches differ modestly in their ability to achieve high peak-to-edge ratios and also differ in delivery times.
Social Media and Dynamic Capabilities: Mining Millennial Resources

Because the human element contributes greatly to a firm’s competencies and related competitiveness, and because the talent pool of prospective employees increasingly includes social media-savvy Millennials, the strategic human resource function must take full and appropriate advantage of social media tools in its acquisition of human assets. The ability to do so is, in fact, a dynamic capability that may be informed by examining the effects of hiring managers’ use of social media as an influence in employment and related decisions. How talent evaluators perceive and make decisions has always impacted the hiring process. The current effort explores cognitive and behavioral issues related to textual and contextual factors and their influence on strategic human resource decisions.
Whisper: a unilateral defense against VoIP traffic re-identification attacks

Encrypted voice-over-IP (VoIP) communication often uses variable bit rate (VBR) codecs to achieve good audio quality while minimizing bandwidth costs. Prior work has shown that encrypted VBR-based VoIP streams are vulnerable to re-identification attacks in which an attacker can infer attributes (e.g., the language being spoken, the identities of the speakers, and key phrases) about the underlying audio by analyzing the distribution of packet sizes. Existing defenses require the participation of both the sender and receiver to secure their VoIP communications. This paper presents Whisper, the first unilateral defense against re-identification attacks on encrypted VoIP streams. Whisper works by modifying the audio signal before it is encoded by the VBR codec, adding inaudible audio that either falls outside the fixed range of human hearing or is within the human audible range but is nearly imperceptible due to its low amplitude. By carefully inserting such noise, Whisper modifies the audio stream's distribution of packet sizes, significantly decreasing the accuracy of re-identification attacks. Its use is imperceptible by the (human) receiver. Whisper can be instrumented as an audio driver and requires no changes to existing (potentially closed-source) VoIP software. Since it is a unilateral defense, it can be applied at will by a user to enhance the privacy of its voice communications. We demonstrate that Whisper significantly reduces the accuracy of re-identification attacks and incurs only a small degradation in audio quality.
Identifying Cardiac Enlargement on an AP Chest Radiograph

This chapter addresses cardiac enlargement on an AP Chest radiograph. It provides the reader with the basic definition of cardiac enlargement and the contours associated with various chamber enlargements in a question and answer format.
Stockout: The impact of national haloperidol tablet shortage to physician prescription pattern and patient outcomes

Introduction Drug shortages are common in the United States, and in 2019 alone there are 11 psychiatric medications out of a total of 270 drugs that are current listed as in shortage by the FDA. One of these medications is haloperidol, which has been in shortage since October 2018 for its low dosage tablet forms, only one out of two pharmaceutical companies recently restocked these forms as of September 2019. Consequently, patients are impacted due to compromised efficacy, possible medication or dosage errors, of which these lead to higher cost for substitute drug and increased risk of rehospitalization. In Canada, for example, those impacted by haloperidol decanoate shortage had higher rehospitalization rate after switching to a different long acting injectable (LAI) medication. As such, it is important for physicians to be aware of current drug shortages and be ready to address the concerns of patients and their caregivers. Methods We conducted a retrospective chart-review mirror study of the nine months before and after the shortage occurred in October 2018 in 37 patients who are on haloperidol followed in geriatric psychiatry outpatient clinic in Brooklyn, New York. Results The preponderance of subjects in this study were diagnosed with either primary psychotic disorders or dementia with behavioral disturbances. Twelve out of 37 (32%) patients who are prescribed haloperidol had to be switched to a higher dose or liquid form. All twelve patients were previously prescribed less than five milligrams of haloperidol daily. None of the patients had a psychiatric emergency visit or hospitalization in the last year prior to haloperidol shortage, but two of the 12 patients had poor medication adherence following the mandatory medication switch. For these two patients, one agreed to a switch to LAI form and the other decompensated and required a visit to the Comprehensive Psychiatric Emergency Program (CPEP). None of the 25 patients who were unaffected by the shortage had a change or decompensation. Conclusions Low dose haloperidol tablet shortage resulted in subsequent change in medication form in our cohort. Medication adherence became an issue following the switch with resultant emergency visit. These findings reflect the underreported impact of psychiatric drug shortages and specific measures should be taken to better coordinate drug supply chain to minimize negative impact to otherwise chronically stable patients. This research was funded by: This study is funded by the Department of Psychiatry, SUNY Downstate Medical Center
Image-Guided Surgery and Intraoperative Imaging in Rhinology: Clinical Update and Current State of the Art.

Introduction:Image-guided surgery (IGS) has gained widespread acceptance in otorhinolaryngology for its applications in sinus and skull base surgery. Although the core concepts of IGS have not chan...
Black bourgeois: class & sex in the flesh: by Candice M. Jenkins, Minneapolis, Minnesota, University of Minnesota Press, 2019, 280pp., US$27.00 (paperback), ISBN 978-1-5179-0580-4

When, in May 2020, Christian Cooper asked a white woman in New York City’s Central Park to put her dog on a leash, the woman threatened to tell the police “there’s an African American man threateni...
Immune Therapy for Central Nervous System Metastasis

Brain metastases lead to substantial morbidity and mortality among patients with advanced malignancies. Although treatment options have traditionally included largely palliative measures, studies of brain metastasis response to immunotherapy are promising. Immune checkpoint inhibitors have shown efficacy in studies of patients with melanoma, renal cell carcinoma, and lung cancer brain metastases. Patients with brain metastases are more frequently included in clinical trials, ushering in a new era in immunotherapy and management for patients with brain metastases. Gaining an understanding of the molecular determination for response to immunotherapies remains a major challenge and is an active area of future research.
Minimally invasive Heller myotomy with partial posterior fundoplication for the treatment of achalasia: long-term results from a tertiary referral center.

Few studies have reported the long-term results of minimally invasive Heller myotomy (HM) for the treatment of achalasia. Herein, we detail our 17-year experience with HM for the treatment of achalasia from a tertiary referral center. All patients undergoing elective HM at our institution from 2000 to 2017 were identified within a prospective institutional database. These patients were sent mail and electronic surveys to capture their symptoms of dysphagia, chest pain, and regurgitation pre- and postoperatively and were asked to evaluate their postoperative gastrointestinal quality of life. Responses from adult patients who underwent minimally invasive Heller myotomy with partial posterior (i.e., Toupet) fundoplication (HM-TF) were analyzed. 294 patients were eligible for study inclusion; 139 (47%) completed our survey. Median time from HM-TF to survey response was 5.6 years. A majority of patients reported improvement in their dysphagia (91%), chest pain (70%), and regurgitation (87%) symptoms. Patients who underwent HM-TF more than 5 years ago were most likely to report heartburn symptoms. One (1%) patient went on to require esophagectomy for ongoing dysphagia and one (1%) patient required revisional fundoplication for their heartburn symptoms. Minimally invasive Heller myotomy and posterior partial fundoplication is a durable treatment for achalasia over the long term. Additional prospective and multi-institutional studies are needed to validate our results.
The Lawyer’s Perspective: The Gap Between Individual Decisions and Collective Consequences in Legal Ethics

Legal ethicists often make arguments about what will happen if lawyers in general behave in a certain way. They sometimes assume that these arguments about the collective consequences of lawyers’ actions can help individual lawyers decide what they have most reason to do. But collective consequences are not necessarily reasons for individual lawyers to choose one action over another. To understand why arguments from collective consequences sometimes fail, it is important to understand two ways of looking at legal ethics. The first is the policy-maker’s perspective. Policy-makers are necessarily concerned with collective consequences, because legal rules and social norms operate generally. But individual practitioners do not make decisions about what lawyers collectively will do. And they often know that their individual choices will not have any real impact on collective goods. For example, society generally may depend on lawyers to make sure that unpopular views are represented in court. But my individual decision to turn away an unpopular client will not undermine that value. One solution to this problem is for lawyers to find intrinsic value in the kinds of actions which, in the aggregate, promote good consequences. Legal ethicists should aim to help lawyers understand how it can be intrinsically valuable for them to act in certain ways even when their individual choices will not affect collective goods. But intrinsic value can be understood only from the lawyer’s perspective.
Emerging Roles for AKT Isoform Preference in Cancer Progression Pathways

The phosphoinositol-3 kinase (PI3K)-AKT pathway is one of the most mutated in human cancers, predominantly associated with the loss of the signaling antagonist, PTEN, and to lesser extents, with gain-of-function mutations in PIK3CA (encoding PI3K-p110α) and AKT1. In addition, most oncogenic driver pathways activate PI3K/AKT signaling. Nonetheless, drugs targeting PI3K or AKT have fared poorly against solid tumors in clinical trials as monotherapies, yet some have shown efficacy when combined with inhibitors of other oncogenic drivers, such as receptor tyrosine kinases or nuclear hormone receptors. There is growing evidence that AKT isoforms, AKT1, AKT2, and AKT3, have different, often distinct roles in either promoting or suppressing specific parameters of oncogenic progression, yet few if any isoform-preferred substrates have been characterized. This review will describe recent data showing that the differential activation of AKT isoforms is mediated by complex interplays between PTEN, PI3K isoforms and upstream tyrosine kinases, and that the efficacy of PI3K/AKT inhibitors will likely depend on the successful targeting of specific AKT isoforms and their preferred pathways.
Qualitative analysis of reasons for hospitalization for severe hypoglycemia among older adults with diabetes

Hospital admissions for severe hypoglycemia are associated with significant healthcare costs, decreased quality of life, and increased morbidity and mortality, especially for older adults with diabetes. Understanding the reasons for hypoglycemia hospitalization is essential for the development of effective interventions; yet, the causes and precipitants of hypoglycemia are not well understood. We conducted a qualitative study of non-nursing home patients aged 65 years or older without cognitive dysfunction admitted to a single tertiary-referral hospital with diabetes-related hypoglycemia. During the hospitalization, we conducted one-on-one, in-depth, semi-structured interviews to explore: (1) experiences with diabetes management among patients hospitalized for severe hypoglycemia; and (2) factors contributing and leading to the hypoglycemic event. Major themes and sub-themes were extracted using the constant comparative method by 3 study authors. Among the 17 participants interviewed, the mean age was 78.9 years of age, 76.5% were female, 64.7% African American, 64.7% on insulin, and patients had an average of 13 chronic conditions. Patients reported: (1) surprise at hypoglycemia despite living with diabetes for many years; (2) adequate support, knowledge, and preparedness for hypoglycemia; (3) challenges balancing a diet that minimizes hyperglycemia and prevents hypoglycemia; (4) the belief that hyperglycemia necessitates medical intervention, but hypoglycemia does not; and (5) tension between clinician-prescribed treatment plans and self-management based on patients’ experience. Notably, participants did not report the previously cited reasons for hypoglycemia, such as food insecurity, lack of support or knowledge, or treatment errors. Our findings suggest that some hypoglycemic events may not be preventable, but in order to reduce the risk of hypoglycemia in older individuals at risk: (1) healthcare systems need to shift from their general emphasis on the avoidance of hyperglycemia towards the prevention of hypoglycemia; and (2) clinicians and patients need to work together to design treatment regimens that fit within patient capacity and are flexible enough to accommodate life’s demands.
Educator–Counselor: A Nondual Identity for School Counselors:

In this special issue, the editors and each team of contributing authors offer examples of how a combined identity as educator–counselor can affect the various roles and responsibilities associated...
The Heroine Concept in a Filipino Graphic Narrative

This study explored the concept of “HEROINE” in the context of “Darna,” a Filipino graphic narrative written by Mars Ravelo that was first published on May 13, 1950 by Filipino Komiks. Extracted from the 27 episodes of “Darna” are realities of experience as well as innuendos related to the real character of Darna, the super heroine. Further, the study delved into a deeper meaning of heroine beyond its lexical meaning. As a result, the researcher formulated her own definition of “HEROINE” as “Humaneness and Equanimity in Reimagining Optimistic, Iconic, Novel, and Empowered” persona, which led to the findings that, indeed, Darna has reached her apotheosis as a superheroine. These insights were not fathomed had it not been for the researcher’s focus on close reading, application of Expressive Realism, and “Argustic” reading. Keen eyes are needed to enjoy reading a graphic narrative which is both visual and verbal. The study proved that in Philippine society, Darna is the most accepted, loved and idolized Filipino icon as savior of a devastated and crippled society after World War II. Lastly, it is aimed that this humble analysis will put itself into the realm of a body of Pop Literature and the Humanities.
Altered sense of self during seizures in the posteromedial cortex

The posteromedial cortex (PMC) is known to be a core node of the default mode network. Given its anatomical location and blood supply pattern, the effects of targeted disruption of this part of the brain are largely unknown. Here, we report a rare case of a patient (S19_137) with confirmed seizures originating within the PMC. Intracranial recordings confirmed the onset of seizures in the right dorsal posterior cingulate cortex, adjacent to the marginal sulcus, likely corresponding to Brodmann area 31. Upon the onset of seizures, the patient reported a reproducible sense of self-dissociation-a condition he described as a distorted awareness of the position of his body in space and feeling as if he had temporarily become an outside observer to his own thoughts, his "me" having become a separate entity that was listening to different parts of his brain speak to each other. Importantly, 50-Hz electrical stimulation of the seizure zone and a homotopical region within the contralateral PMC induced a subjectively similar state, reproducibly. We supplement our clinical findings with the definition of the patient's network anatomy at sites of interest using cortico-cortical-evoked potentials, experimental and resting-state electrophysiological connectivity, and individual-level functional imaging. This rare case of patient S19_137 highlights the potential causal importance of the PMC for integrating self-referential information and provides clues for future mechanistic studies of self-dissociation in neuropsychiatric populations.
Geochronology and Radwaste

Absolute age determination based on radioactive decay of parent isotopes to stable daughter isotopes is an accepted tool for geologic research. Rocks as old as the age of the earth (i.e., meteorites and some lunar samples) have been successfully dated, and the time scale for the earth has been rigorously worked out by a combination of several geochronologic methods.
Cognitive Therapy for Depression in a Group Format

Can depressed patients be treated with cognitive therapy in a group format? We think that they can. Cognitive therapy, the systematic attempt to identify and alter dysfunctional, depressogenic cognitions, appears to be a powerful intervention for depressed clients. A group treatment format allows the clinician to treat more people in the same amount of therapy time. In addition, a group format may offer certain advantages not available in an individual treatment context.
Becoming Bilingual, Biliterate, and Bicultural

In this chapter, we have sketched the challenges that becoming literate poses to all learners, then elaborated evidence that learning to read is a particular challenge for the L2/C2 learner. There have been two themes in our analysis. The first is the complexity of the challenges posed, both to newcomers in a society and to the locals who are responsible for teaching, working with, or interacting with the newcomers, by the need to learn each others' languages, literacies, discourse patterns, and culturally prescribed ways of operating. We have argued that, if L2/C2 learners are to catch up with monolinguals in the academic, linguistic, and literacy skills needed for success in school and in the workplace, educational procedures are needed that enhance transfer, thus exploiting the knowledge of the L1 and C1 that learners bring with them. The second theme is the need, in complex and multifaceted domains like second-language learning and education for language minorities, for practice-embedded and practice-inspired research to complement the contributions of traditional basic and applied research. The fastest route to understanding what educational treatments work best to ensure language and literacy acquisition for various subgroups of L2 learners is to study successful practice, build on the wisdom accumulated by successful practitioners, and systematize that wisdom so as to be able to test it and to make it public. Keywords: academic achievement; bilingual education; cultural assimilation; immigration; language proficiency; literacy acquisition; second-language learning
Comparison of VIM and STN DBS for Parkinsonian Resting and Postural/Action Tremor

Background : Resting tremor is common in Parkinson’s disease (PD), but up to 47% of PD patients have action tremor, which is sometimes resistant to medications. Deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) of the thalamus or subthalamic nucleus (STN) is effective for medication-refractory tremor in PD, though it remains unclear whether STN DBS is as effective as VIM DBS for postural/action tremor related to PD. Methods : We carried out a single-center retrospective review of patients with medication-refractory resting, postural, and action PD tremor, treated with either VIM or STN DBS between August 2004 and March 2014. We assessed the degree of improvement using items 20 and 21 of the Unified Parkinson’s Disease Rating Scale (UPDRS) motor scale and examined the proportion of patients achieving tremor arrest. Results : A total of 18 patients were analyzed, 10 treated with STN and eight treated with VIM, with similar off-medication motor UPDRS scores. There was no significant difference in improvement in tremor scores or in the proportion of patients experiencing tremor arrest between the two stimulation sites. Overall, 56% and 72% of patients experienced complete absence of postural/action tremor and resting tremor, respectively, at last follow-up. Discussion : This study demonstrated excellent outcomes on both resting and postural/action tremor after either VIM or STN DBS. Resting tremor improved to a greater degree than postural/action tremor in both groups. These results suggest that a large randomized controlled trial is needed to show a superior effect of one target on PD tremor.
A fentanyl epidemic in Maryland 1992.

In early 1992, the Office of the Chief Medical Examiner, State of Maryland, encountered 30 cases where fentanyl was identified in the postmortem specimens. Twenty-five of the decedents were found in Baltimore City and five were found in the surrounding counties. Four of the decedents were female and eight of the victims were white. The blood fentanyl concentrations ranged from 2.2 to 100 µg/L. Ethanol and other abused drugs were detected in 28 of these cases. The cause of death in all cases was ethanol-, drug intoxication, or both.
Declarations of Independence: Home School Families' Perspectives on Education, the Common Good, and Diversity

This study examined the perspectives of home school families regarding the rights, interests, and responsibilities of family and state over education. These families viewed the common good differently than critics of home schooling. They believed the diversity of curriculum and worldview in their home schools positively impacts the common good by increasing the overall diversity of society. These families situated the practice of home schooling within the exercise of religion inserting a Constitutional challenge into the debate over home schooling. The voices of these families, their declarations of independence from the educational norm in our nation, challenge our views of what really is the common good, what diversity we value, and what activities we include in our definition of the free exercise of religion.
Processing of in vitro-synthesized gag precursor proteins of human immunodeficiency virus (HIV) type 1 by HIV proteinase generated in Escherichia coli.

Abstract We expressed the gag and proteinase regions of human immunodeficiency virus (HIV) type 1 by transcription and translation in vitro. A synthetic RNA spanning the gag and pro domains gave primarily the unprocessed capsid precursor pr53. Efficient cleavage of this precursor was observed when the gag and pro domains were placed in the same translational reading frame, yielding equimolar amounts of the gag protein and of proteinase (PR). Expression of HIV type 1 PR in Escherichia coli as a fusion protein gave rapid autocatalytic processing to an HIV-specific protein of approximately 11 kilodaltons. HIV PR generated in E. coli specifically induced cleavage of the HIV capsid precursor, whereas deletion of the carboxy-terminal 17 amino acids of the proteinase rendered it inactive. Inhibitor studies showed that the enzyme was insensitive to inhibitors of serine and cysteine proteinases and metalloproteinases and was inhibited only by a very high concentration (1 mM) of pepstatin A.
KAM Theory and Dynamical Astronomy

The work of Kolmogrov that was extended by Arnol’d and Moser (the KAM theory) has had a major impact on the study of conservative dynamical systems. An exposition of some aspects of the theory together with two applications is presented.
Intrauterine fluid with ectopic pregnancy: a reappraisal.

Objectives To determine the incidence of intrauterine fluid in patients with ectopic pregnancy and to define the characteristics that distinguish this fluid from an early intrauterine gestational sac. Methods We identified all patients scanned transvaginally at our institution from July 2008 through August 2011 for suspected ectopic pregnancy, who proved to have ectopic pregnancy based on pathologic, surgical, or adnexal sonographic findings. We reviewed the sonograms to characterize any fluid in the uterus as to shape, contents, and location. Fluid was classified as type A if it was pointy edged, contained echoes, and/or was clearly located within the uterine cavity or type B if it was smooth walled and anechoic and location was in the decidua or uncertain. The appearance of type A fluid is inconsistent with a gestational sac, while the appearance of type B overlaps that of a gestational sac. Results Our study population included 229 women with ectopic pregnancy. In 38 (16.6%), sonography showed fluid in the uterus, which was classified as type A in 31 and type B in 7. Only 2 patients (0.9%) had type B fluid with no adnexal findings suggestive of ectopic pregnancy. Based on these results and the published incidence of ectopic pregnancy (2% of all pregnancies), we calculated that a patient with a positive pregnancy test, an intrauterine smooth-walled anechoic cystic structure, and no adnexal mass has a 0.02% probability of ectopic pregnancy, while the probability of intrauterine pregnancy in such a patient is 99.98%. Conclusions Fluid can be seen in the uterus in 16.6% of patients with ectopic pregnancy. On transvaginal sonography, it can be distinguished from an early intrauterine gestational sac based on shape, contents, and/or location in most cases. In the remaining cases, the fluid appears indistinguishable from, and is highly likely to represent, an early intrauterine gestation.
Extended flowering intervals of bamboos evolved by discrete multiplication

Numerous bamboo species collectively flower and seed at dramatically extended, regular intervals - some as long as 120 years. These collective seed releases, termed 'masts', are thought to be a strategy to overwhelm seed predators or to maximise pollination rates. But why are the intervals so long, and how did they evolve? We propose a simple mathematical model that supports their evolution as a two-step process: First, an initial phase in which a mostly annually flowering population synchronises onto a small multi-year interval. Second, a phase of successive small multiplications of the initial synchronisation interval, resulting in the extraordinary intervals seen today. A prediction of the hypothesis is that mast intervals observed today should factorise into small prime numbers. Using a historical data set of bamboo flowering observations, we find strong evidence in favour of this prediction. Our hypothesis provides the first theoretical explanation for the mechanism underlying this remarkable phenomenon.
Which Value for the First Dissociation Constant of Carbonic Acid Should Be Used in Biological Work

The apparent first dissociation constant of carbonic acid has been defined in different ways in the literature. Harned and co-workers (8-10) have defined it in terms of molalities of the participat...
The Museum Visit: It’s an Experience, Not a Lesson

Museums offer visitors direct experiences—such as visual experiences—that are not available elsewhere in daily life. Learning through verbal information is part of it, yet the aesthetic experience is always outside of the “right-answer paradigm.” Cognitive development occurs when perceptions inform thinking, thoughts are expressed in language, and expressed thoughts invite reconsideration of the material at hand. Both science and art require the development of these skills. Science and art museum educators can and should advocate the value of looking, thinking, wondering about complexity, and discussing the results.
Immunophenotyping of T cell subpopulations in HIV disease.

This unit illustrates the challenges associated with measurements of T cell subpopulations, and describes how those challenges can be overcome by using polychromatic (5+ color) approaches to flow cytometry. Such approaches are immensely powerful and directly applicable to studies of T cell biology in HIV disease; however, their development requires careful consideration of the antibodies and fluorochromes employed, as discussed here. Furthermore, factors generally known to influence T cell counts can also govern the success or failure of polychromatic experiments; therefore, these factors are reviewed and provide recommendations for minimizing their influence on polychromatic measurements of T cell subsets. Keywords: Polychromatic flow cytometry; T cell subsets; immunophenotyping; CD4 count
On the Estimation of a Variance Ratio.

Abstract The estimation of the ratio of two independent normal variances is considered under scale invariant squared error loss function, when the means are unknown. The best invariant estimator is shown to be inadmissible. Two new classes of improved estimators are obtained, one by extending Stein (1964) and the other by extending Brown (1968). Numerical studies are presented to indicate the percent improvements in risk.
Measuring Readiness to Respond to Intervention in Students Attending Disciplinary Alternative Schools

The purpose of this study was to investigate the factor structure, internal consistency, and reliability of the Readiness to Respond to Intervention Scale (RRIS), which is designed to assess adolescents’ readiness to change. This measure is based on the Stage of Change Scale and assesses three stages of the Stage of Change Model (i.e., Precontemplation, Contemplation, and Action). The measure was administered to secondary students enrolled in disciplinary alternative schools. Factor analyses provided initial support for the use of the RRIS to assess respondents’ readiness to change. The internal consistency and reliability of the measure also supported its use. Additional results, from a series of MANOVAs, indicated that when compared to boys, girls were more likely to be in the Action stage, and Black and Hispanic students were more likely than White students to be in the Precontemplation stage. Implications for practice and recommendations for future research are discussed.