cssi/SciSciGPT-SciSciNet huggingface dataset:
Preventing Dementia in Older Cardiovascular Patients

Cardiovascular disease (CVD) contributes to risk of dementia by either enhancing the development and progression of brain vascular disease and subsequent neurodegeneration and Alzheimer's disease (AD) pathology, ie, amyloid plaques and neurofibrillary tangles, acts as a precipitant of dementia in older individuals with preexisting subclinical neuropathology of dementia. Atrial fibrillation, congestive heart failure (CHF), stroke, and myocardial infarction are associated with increased risk of dementia. All older individuals age 65–70+ can be considered to be at very high risk of vascular disease and dementia and candidates for aggressive CV preventive therapies, such as lipid lowering, antihypertensive therapy, increased physical activity, antidiabetic therapies, smoking cessation, etc to prevent heart attacks subsequent CHF, atrial fibrillation, stroke, frailty, and dementia. Furthermore, preventing or delaying dementia should be a primary outcome of all CV trials in older individuals.
SENSORY QUALITY OF GALA APPLES AS INFLUENCED BY CONTROLLED AND REGULAR ATMOSPHERE STORAGE

The sensory quality of Gala apples stored for up to 4 months in delayed controlled atmosphere (CA), regular atmosphere (RA), and a combination of sequential CA and RA storage (CR) was evaluated. Sensory analysis included difference and acceptance testing. Firmness, soluble solids and titratable acidity contents, and volatile flavor profiles were measured analytically. Acceptability decreased with storage time. Apples stored in RA were more acceptable than apples stored in CA or CR; the differences between storage treatment were not significant after 4 months of storage. Firmness decreased with storage time, but was not affected by storage treatment. Soluble solids and titratable acidity contents were not affected by storage treatment or time. Storage treatment, storage time, and lot had a significant effect on the volatile flavor profiles. CA storage and extended storage contributed to decreases in the content of volatile flavor compounds.
Persistent Viral Shedding during Asymptomatic Aleutian Mink Disease Parvoviral Infection in a Ferret

A 2-year-old domestic ferret that appeared clinically healthy was repeatedly seropositive for Aleutian mink disease parvovirus (ADV) over a 2-year observation period. Antibody titers, determined by counter-immunoelectrophoresis, ranged from 1024 to 4096. Viral DNA also was identified in serum, urine, feces, and blood cell fractions by polymerase chain reaction analysis. Ultimately, DNA in situ hybridization revealed ADV DNA in histologic sections of various tissues and organs. These data indicate that this asymptomatic ferret was persistently infected with ADV.
Finding and tracking the flow in creative artistry – the path to creative nirvana

I have yet to come to a play conference where someone does not make the common assertion or rejoinder: ‘Play is a four-letter word,’ the implication being that play is a bad thing. The exact opposi...
Bandwagon and Sandbagging Effects: Some Measures of Dissonance Reduction

Although consistency has been condemned as a "petty virtue," there is a common tendency in human beings to attempt a reconciliation of their discrepant attitudes and actions. This tendency toward the reduction of dissonance is studied in the following article in the context of a school bond issue election where two prevalent norms, citizen responsibility to vote and the expectation of a low turnout in such elections, offer alternative foci for the resolution of conflicting attitudes and behavior. The author is Research Associate in the Institute for Communication Research at Stanford University.
Primary brain tumor incidence in mice exposed to split-dose ionizing radiation and circularly polarized 60 Hz magnetic fields

Three sections of brain tissue from 2657 female C57BL/6 mice were stained with hematoxylin and eosin and evaluated microscopically for proliferative lesions. Mice had been treated with either split-dose ionizing radiation (0, 3.0, 4.0 and 5.1 Gy), chronic lifetime 60 Hz circularly polarized magnetic field exposure (ambient or 14.2 G, 1.4 mT), or both, and were evaluated after natural death or euthanasia for humane reasons. Among 950 mice which were not treated with ionizing radiation, two benign spontaneous lipomatous hamartomas were observed. Seven primary brain tumors of various types not found in untreated animals were observed among the 1707 irradiated mice. Possible promotional effects of magnetic field exposure on primary brain tumor development and incidence could not be assessed due to the low number of tumors observed.
Evaluating Contrast Agent Waste and Costs of Weight-Based CT Contrast Bolus Protocols Using Single- or Multiple-Dose Packaging

OBJECTIVE. Although weight-based contrast agent injection protocols can improve contrast-enhanced CT, one disadvantage is waste caused by differences between the amount of contrast material required for a weight-based algorithm and full-package protocols used with single-use packaging of contrast material. The availability of 500-mL multiple-use packaging of contrast material should facilitate the implementation of weight-based contrast bolus protocols for CT because arbitrary volumes of contrast agent can be loaded without significant waste. Our hypothesis was that multiple-use packaging when used with a weight-based contrast bolus protocol would reduce costs compared with single-use packaging. MATERIALS AND METHODS. Contrast agent volume loaded and volume actually delivered to 1304 patients undergoing abdominal and pelvic CT were recorded. Model 1 used volume loaded to estimate contrast material cost, model 2 used volume delivered, and model 3 assumed that patients received either 100 or 150 mL from a s...
klingon, a novel member of the Drosophila immunoglobulin superfamily, is required for the development of the R7 photoreceptor neuron

klingon is a member of the Immunoglobulin superfamily and is expressed in a restricted pattern of neurons during embryonic neurogenesis and in the R7 photoreceptor precursor throughout its development. Starting from the H214 enhancer trap line, we identified a transcription unit, klingon, that encodes a putative protein of 528 amino acids and contains three C2-type Immunoglobulin-like domains followed by one fibronectin type III repeat. When Klingon is expressed in S2 tissue culture cells, it is associated with the cell membrane by a glycosyl-phosphatidylinositol linkage and can mediate homophilic adhesion. Genetic analysis has revealed that klingon is an essential gene that participates in the development of the R7 neuron. Ectopic expression of klingon in all neurons in a sevenless background can alter the position of the R8 rhabdomere.
A comparison of the regulatory properties of striatal and cortical adenylate cyclase.

Abstract —Biochemical properties of adenylate cyclase in striatal and cortical membranes have been analyzed in parallel with their regulation by cholinergic compounds. Striatal adenylate cyclase is more sensitive to forskolin, while the cortical enzyme is more stimulated by GTP. In the presence of GTP, more inhibition by acetylcholine is seen in the cortex than in the striatum. Acetylcholine inhibits striatal adenylate cyclase activity equally in the presence or absence of forskolin but has a diminished ability to inhibit forskolin-stimulated adenylate cyclase in the cortex. The greater sensitivity of cortical muscarinic receptor-coupled adenylate cyclase to EGTA and calcium indicates predominant involvement of the calcium/calmodulin-dependent subtype of the enzyme. The relative effectiveness of antagonists, demonstrating an order of potency of atropine > amitriptyline > pirenzepine > gallamine in reversing the inhibition of adenylate cyclase by acetylcholine for both brain regions, suggests predominantly m4 receptor-mediated responses. These results suggest an m4-type receptor may be coupled to subtypes of adenylate cyclase in the striatum and cortex which differ in their biochemical properties.
Update on Human Immunodeficiency Virus (HIV)-2 Infection

Infection with human immunodeficiency virus type 2 (HIV-2) occurs mainly in West Africa, but an increasing number of cases have been recognized in Europe, India, and the United States. In this era of global integration, clinicians must be aware of when to consider the diagnosis of HIV-2 infection and how to test for this virus. Although there is debate regarding when therapy should be initiated and which regimen should be chosen, recent trials have provided important information on treatment options for HIV-2 infection. In this review, we present information on recent clinical advances in our understanding of HIV-2 infection and highlight remaining diagnostic and therapeutic challenges.
In vitro evaluation of osteoblastic differentiation on amorphous calcium phosphate‐decorated poly(lactic‐co‐glycolic acid) scaffolds

Calcium phosphate-decorated polyester matrices are promising scaffolds for bone tissue engineering that combine the tunable degradation of synthetic polymers and the osteoconductivity of calcium phosphate minerals. In this study, scaffolds decorated with stabilized amorphous calcium phosphate (ACP) minerals-which exhibit sustained dissolution and release of calcium and phosphate ions-were tested for their ability to support osteoblast proliferation and stimulate differentiation. The two ACPs tested were zirconia-hybridized ACP (ZrACP), which releases ions over a few days and converts in aqueous solution to hydroxyapatite (HAP), and zinc-hybridized ACP (ZnACP), which has a longer period of sustained ion release. MC3T3-E1 pre-osteoblasts were cultured in these scaffolds for up to 21 days, and cell number, alkaline phosphatase (ALP) activity and expression of osteogenic and bone-specific proteins were measured. Cell number, prostaglandin E(2) (PGE(2) ) synthesis and osteopontin (OPN) mRNA expression were elevated on calcium phosphate-decorated scaffolds relative to PLGA controls, while mRNA expression of osteocalcin (OCN), bone sialoprotein and bone morphogenetic protein (BMP)-4 were suppressed. Although MC3T3-E1 responses to the two ACPs were not statistically different, ZrACP-which converts more quickly to HAP-gave rise to slightly higher levels of mRNA expression for BMP-4, osterix, vascular endothelial growth factor (VEGF)-A, OCN and OPN, but slightly lower levels of PGE(2) synthesis, ALP activity and cell number. These results indicate that sintered PLGA microsphere scaffolds decorated with 0.5 wt% ZnACP or ZrACP support cell attachment and elicit a series of biological responses, but these responses do not appear to accelerate osteoblast differentiation.
Lenticular gypsum; occurrences in nature, and experimental determinations of effects of soluble green plant material on its formation

ABSTRACT Lens-shaped gypsum crystals are common in both modern and ancient evaporite deposits, but laboratory experiments demonstrate that the presence of certain types of dissolved organic material is the major factor promoting growth of this particular habit rather than warm saline water conditions. A very widespread type of soluble organic material results from green plant decomposition. Experiments utilizing diffusion-controlled growth of gypsum within sediments of various types, and also utilizing evaporation-controlled solution growth indicate that this organic material promotes the growth of lenticular gypsum, but only under alkaline conditions. In acid conditions, both in the presence or absence of added plant material, only elongate prismatic gypsum develops. The type of sediment with n which gypsum grows has only minor effects on its morphology unless the sediment is contaminated with soluble organics. These observations help to explain why lenticular gypsum forms in some instances, and prismatic gypsum in others, within natural sedimentary environments.
Motor behavior reflects reduced hemispheric asymmetry in the psychosis risk period.

Abstract Background A body of work focusing on brain connectivity, language dominance, and motor laterality research suggests that reduced hemispheric asymmetry is a core feature in schizophrenia. However, there is little consensus about whether reduced dominance is present in those at ultrahigh risk (UHR) for psychosis. Methods A total of 94 demonstrated right-handed neuroleptic free participants (38 UHR and 56 matched healthy controls) were assessed with structured clinical interviews and completed an innovative handwriting task using a digital tablet computer. A laterality quotient (LQ) was calculated using kinematic variables from the participant's left and right hands. A subset of the sample (26 UHR and 29 controls) returned after 12-months to complete clinical interviews in order to examine relationships between handwriting laterality and progression of psychosis risk symptoms. Results The UHR group showed decreased dextrality compared to healthy controls. At the 12-month follow-up, decreased dextrality accounted for 8% of the variance in worsened positive symptoms within the UHR group. Conclusion The current results suggest that disrupted cerebral dominance is also present in the ultrahigh risk period and that decreased dextrality may serve as a novel biomarker for the progression of psychosis risk.
Evaluation of National Wetland Inventory maps in a heavily forested region in the upper Great Lakes

National Wetland Inventory (NWI) maps are widely used in the United States but have not been independently evaluated in the Great Lakes region nor in forested areas with level topography. Field data from 148 plots in the Hiawatha National Forest ecological classification and inventory program were combined with an additional review to evaluate NWI mapping accuracy. NWI maps were over 90% accurate in identifying uplands and jurisdictional wetlands. All nonforested wetlands were identified correctly. Uplands were correctly identified 96.9% of the time. The lowest level of accuracy, 90.7%, was achieved in identifying forested wetlands. The most common error was the NWI classification of wetlands on the AuGres soil series, a somewhat poorly drained upland soil that often occurs in complexes with wetland soils in the region. Forested wetlands with a cover type similar to adjacent uplands were also a source of error on NWI maps. The already high accuracy of NWI maps could be improved by the mapping of wetland-upland complexes, a development corresponding to the increased mapping of hydric-nonhydric soil complexes in area soil surveys. The continued refinement of regional lists of hydrophytic vegetation is supported by indicator status discrepancies between an extensive Hiawatha National Forest database and the current NWI list for the region.
Mapping Queer Bioethics: Space, Place, and Locality.

This article, which introduces the special issue of the Journal of Homosexuality on “Mapping Queer Bioethics,” begins by offering an overview of the analytical scope of the issue. Specifically, the...
Gasping for answers. Focus on "Calpain activation by ROS mediates human ether-a-go-go-related gene protein degradation by intermittent hypoxia".

obstructive sleep apnea (OSA) is one of the common sleep disorders that affects the health and quality of life for millions of people in the US, particularly obese or overweight middle-aged men. OSA is characterized by brief periodic recesses in breathing or instances of shallow breathing during
Calibration requirements for detecting the 21 cm epoch of reionization power spectrum and implications for the SKA

21 cm Epoch of Reionization observations promise to transform our understanding of galaxy formation, but these observations are impossible without unprecedented levels of instrument calibration. We present end-to-end simulations of a full EoR power spectrum analysis including all of the major components of a real data processing pipeline: models of astrophysical foregrounds and EoR signal, frequency-dependent instrument effects, sky-based antenna calibration, and the full PS analysis. This study reveals that traditional sky-based per-frequency antenna calibration can only be implemented in EoR measurement analyses if the calibration model is unrealistically accurate. For reasonable levels of catalog completeness, the calibration introduces contamination in otherwise foreground-free power spectrum modes, precluding a PS measurement. We explore the origin of this contamination and potential mitigation techniques. We show that there is a strong joint constraint on the precision of the calibration catalog and the inherent spectral smoothness of antennae, and that this has significant implications for the instrumental design of the SKA and other future EoR observatories.
Recent developments in the subcutaneous ICD

The subcutaneous implantable cardioverter-defibrillator (ICD) was developed as a simple device to reduce the morbidity of ICD therapy while providing a comparable reduction in sudden death from ventricular fibrillation. This review highlights the differences compared to the traditional ICD. It includes recent data on safety and efficacy, as well as best practices on screening and programming, and discusses expected future developments.
Motives as Predictors of the Public's Attitudes Toward Solid Waste Issues

/ Surveys focusing on solid-waste-related issues, conducted over a period of several years, provided data from independent samples of residents of a Midwestern, USA, community. The collection of these data yielded useful information about the relationship between residents' recycling motives and their attitudes toward solid waste management in light of several changes in the solid waste infrastructure of the community over that time. The initial survey assessed baseline beliefs and attitudes, while later surveys were conducted after the implementation of a community educational program and a curbside recycling program. The findings indicated that for recyclers and nonrecyclers, different motives predicted endorsement of solid waste programs and policies. Although a similar percentage of recyclers and nonrecyclers were in support of various proposed programs and policies, concern for the environment was found to be positively related to nonrecyclers' support of proposed programs, particularly before these programs were implemented. Prior to program implementation, motives other than environmental altruism were found to be related to recyclers' support of the programs. Additional findings support the idea that educational programs and increased accessibility to recycling opportunities affect the relationship between people's attitudes toward solid waste management and their recycling motives.
Erythrocyte distribution in arterial blood flow: II. The hypothesis of minimal energy dissipation

In a previous paper (Bull. Math. Biophysics,29, 549–563, 1967) the author derived equations to represent the flow of blood in an artery. It was pointed out that these did not completely characterize the system and that an additional hypothesis was required. The hypothesis of minimal energy dissipation had been thought to imply a central tendency on the part of suspended particles (erythrocytes). It is here shown that if the fluid is non-Newtonian this may not be so.
Management of Dermatologic Toxicities

Dermatologic toxicities related to cancer therapies have become even more common with the use of targeted treatments. A proactive approach is necessary to reduce the pain and suffering these patients experience. The oncologist should become comfortable in preventing and managing these complications to keep patients on optimal drugs and doses. At the NCCN 20th Annual Conference, Dr. Mario E. Lacouture advised clinicians on appropriate strategies to manage rash, paronychia, alopecia, and other dermatologic conditions frequently seen in patients with cancer.
Research on HV line protection relay based on characteristic of main transient frequencies

The transient component on the high voltage(HV) transmission line is represented as a series of main transient frequencies in the frequency domain.Aiming at studying the feasibility and reliability of a protection scheme based on those frequencies,the transient characteristic of the fault HV transmission line was firstly analyzed,a relationship between fault distance and main frequencies was put forward,which indicating the size of those series of main transient frequencies can determine the size of the fault distance.Thus the distance by getting the size of a certain main transient frequency was calculated.Then the factors that influence the reliability of the protection scheme were studied and some measures to reduce the influence were advised.A simulation of ATP was carried out to prove the feasibility of this method.The results indicate that the method referred meets the demand of fast speed quality and the fault distance measurement error is related to factors like the precision of the transient frequency,the distance of the fault and the size of the main transient frequency.
Advances in high- Q tunable filter technologies

Modern trends towards multi-frequency and multi-standard communication services have created the need for highly versatile RF transceivers which in turn call for RF filters with tunable transfer function. In this paper, recent advances in reconfigurable waveguide-resonator based filter architectures are reported. Alternative tuning concepts that are primarily based on radio frequency micro-electro-mechanical systems and facilitate the actualization of RF filters with wide tuning range (>2:1) and high quality factor (Q > 300–1000) are discussed. Three-dimensional (3-D) integration concepts and novel fabrication technologies that allow the realization of these filters at frequency bands as low as UHF-band (300–3000 MHz) to as high as W-band (75–110 GHz) are thoroughly reviewed.
Theory of invariants‐based formulation of k·p Hamiltonians with application to strained zinc‐blende crystals

Group theoretical methods and k·p theory are combined to determine spin-dependent contributions to the effective conduction band Hamiltonian. To obtain the constants in the effective Hamiltonian, in general all invariants of the Hamiltonian have to be determined. Hence, we present a systematic approach to keep track of all possible invariants and apply it to the k·p Hamiltonian of crystals with zinc-blende symmetry, in order to find all possible contributions to effective quantities such as effective mass, g-factor and Dresselhaus constant. Additional spin-dependent contributions to the effective Hamiltonian arise in the presence of strain. In particular, with regard to the constants C3 and D which describe spin-splitting linear in the components of k and e, considering all possible terms allowed by symmetry is crucial.
Cognitive remediation to enhance mobility in older adults: the CREM study

Mobility disabilities represent the most prevalent disability among seniors. Emerging evidence indicates that executive functions play an important role in maintaining mobility. However, the use of cognitive remediation programs to enhance mobility has not been investigated in a full-scale randomized control trial. The CREM study is a single-blind randomized control trial to examine the effect of computerized cognitive remediation versus computer-based health education training on mobility in 420 seniors. The primary outcome is change in gait speed during normal walking and walking-while-talking conditions from baseline to postintervention. Secondary outcomes are change in mobility, mobility-related cognitive processes and neuroplasticity. Results of this study will fill an important gap in the efficacy and feasibility of cognitive remediation to improve mobility in seniors.
The Cystic Fibrosis Survival Gap: Why Do Canadians Fare Better Than Americans?

Stephenson and colleagues report a sobering comparison of cystic fibrosis survival between Canada and the United States, with a marked advantage for Canadians beginning around 1995. The editorialis...
Feasibility of an Ultrasonic Bone-Marrow Harvester

The feasibility of an ultrasonic bone-marrow harvester is explored. Since current methods to extract bone marrow could put donors or patients at risk of medical complications, a new method to extract bone marrow is needed. This can be accomplished through the use of an ultrasonic device. A piezoelectric actuator enclosed in a concave casing is used to generate a focused ultrasound signal, which can be used to disrupt the cellular matrix of bone marrow, facilitating catheter advancement and the enhanced aspiration of bone marrow. It was found that with more than 100 ms of ultrasound exposure, bone marrow could be mechanically disrupted with 28.1% less force without inducing bone marrow cell death. This work demonstrates the ability of the ultrasound device to disrupt bone marrow, which can enable higher rates of extraction with the addition of suction.
Automation and Adaptive Behavior

In his well-researched and thought-provoking article, David Kaber identifies what he believes to be a number of gaps in the research literature on human–automation interaction (HAI), spanning the s...
Recovery of Citrus By-Products and Specialty Products From Florida Citrus

The Florida Citrus Industry has come to realize that by-products and specialty products are important ingredients in the overall economic returns from citrus processing. The purpose of this paper is to show the potential recoveries of various commodities that can be produced from Valencia oranges, Marsh and Duncan grapefruit. It is hoped that these data will generate interest in improving present processes to obtain greater recoveries, and at the same time create a desire on the part of citrus processors to produce more sophisticated specialty products of greater economic value. Many different trade-offs and options are available in any given by-product operation, and it must be realized that not all of the products discussed can be produced simultaneously. Certainly future profits to a great extent, will be dependent on an adequate understanding of a more sophisticated by-product and specialty product technology.Paper published with permission.Compilation Copyright © 2018 ASME
School Refusal Behavior

School refusal behavior (SRB), missing school due to truancy, school phobia, or anxiety, occurs in approximately 5–35% of students and often presents considerable challenges for educators, parents, and caregivers (Haight, Kearney, Hendron, & Schafer, 2011; Kearney, Lemos, & Silverman, 2004; Kearney, 2008b). Specifically, SRB is associated with school dropout, social dysfunction, low academic achievement, family conflict, poverty, employment difficulties, psychopathology, suicide attempts, and substance abuse. Not surprisingly, the majority students (56.7%) with SRB also have comorbid conditions such as anxiety disorders, mood disorders, enuresis, and posttraumatic stress disorder. A smaller percentage (4.2%) experience conduct disorder and attention deficit/hyperactivity disorder (Kearney, 2006).
Twining and dynamic recrystallization in austenitic Alloy 718 during friction welding

Abstract Quantitative boundary misorientation analysis verified that discontinuous dynamic recrystallization (DDRX) was the primary grain refinement mechanism in friction welding of Alloy 718. Two models were developed to explain the formation mechanism of intragranular twins and intergranular twins, respectively. Intragranular twins were caused by grain boundary growth incidents. After twin initiation, the twin boundary migrated toward the plastic-deformed grain interior to reduce the stored energy. Additionally, intergranular twin boundaries were ascribed to boundary growth stagnation. When boundary growth stagnation occurred, twin boundaries could form and altered the orientation of the boundary migration front, so that boundary migration could progress, leaving a single twin boundary behind.
The Effect of Altered Physiological States on Intravenous Anesthetics

This chapter begins with the rationale for the intense interest in how altered physiologic states change the effect seen following administration of similar doses of intravenous anesthetic drugs. It then traces the development of two types of pharmacokinetic models that have been used to understand the relationship between pharmacokinetics and cardiovascular physiology. Physiologic pharmacokinetic models are constructed from detailed knowledge of tissue blood flow, tissue weight, and blood: tissue partitioning characteristics. The invasive methods involved are often destructive of the subjects being studied. Rodent models are developed and scaled to simulate human subjects under a variety of physiologic conditions. Traditional pharmacokinetic models, based on drug concentration versus time data from easily obtained blood samples, can also be plumbed for physiologic information. Whereas the physiologic estimates obtained are less detailed than those from physiologic models, they do represent the actual pharmacokinetics for the subjects studied and give sufficient physiological detail to delineate the basis for the changed pharmacokinetics of intravenous pharmacokinetics.
Blockchain and its Implications for Libraries

This article examines the potential uses for Bitcoin and Blockchain technology in libraries. This article will also explore legal aspects of smart contracts as a means for paying for electronic res...
Data Fusion Pipelines for Autonomous Smart Manufacturing

In smart manufacturing, data-driven models characterize variable relationships, which are used for decision making to achieve optimal operations. However, data-driven models may not be adequate when modeling assumptions are violated in manufacturing personalization. To advance smart manufacturing to future autonomous manufacturing, we propose data fusion pipelines as a combination of method options (i.e., data fusion or machine learning steps) for manufacturing process modeling. To avoid executing all pipelines, we associate the pipelines with a learning-to-rank method to rank the pipelines with Top-N prediction accuracy, where $N$ is determined by the computation resources. This approach improves the ease of using data fusion and machine learning methods, and effectively avoids large computation workloads in executing of all data fusion pipelines. Case studies in thermal spray coating, aerosol® jet printing, and fused deposition modeling manufacturing are used to demonstrate the effectiveness and efficiency of the proposed approach. The proposed approach is scalable for a larger collection of method options, different manufacturing conditions, and various computation systems and networks.
Burden of 30-Day Readmissions Associated With Discharge Against Medical Advice Among Inpatients in the United States

Abstract Background Discharges against medical advice are common among inpatients in the United States. The impact of discharge against medical advice on readmission rates and subsequent hospitalization outcomes is uncertain. We sought to ascertain the effect of discharge against medical advice on 30-day readmission rates and outcomes of readmission. Methods We used the 2014 Nationwide Readmissions Database to identify index hospitalizations among patients older than 18 years of age. The primary exposure variable was discharge against medical advice, and the primary outcome measure was all-cause unplanned 30-day readmission. We used multivariate hierarchical logistic regression modeling to ascertain the effect of discharge against medical advice on 30-day readmission rates. Results There were an estimated 23,110,641 index hospitalizations nationwide with an overall unplanned 30-day readmission rate of 10.2%. 1.3% of index admissions resulted in a discharge against medical advice. Patients who were discharged against medical advice were younger (mean age 47.1 years vs 56.5 years, P Conclusions Discharge against medical advice is associated with over twice the odds of all-cause unplanned 30-day readmission compared with routine discharge. There is large hospital-level variation in rates of discharge against medical advice. Interventions to reduce discharges against medical advice, particularly at hospitals with high rates of such discharges, may reduce the overall readmission burden in this challenging and high-risk patient population.
Coronary Angiography after Cardiac Arrest - The Right Timing or the Right Patients?

The treatment of patients who are comatose after out-of-hospital cardiac arrest involves a complex, multidisciplinary approach that includes the use of targeted temperature management, aggressive h...
Candida albicans Morphogenesis Programs Control the Balance between Gut Commensalism and Invasive Infection.

Candida albicans is a gut commensal and opportunistic pathogen. The transition between yeast and invasive hyphae is central to virulence but has unknown functions during commensal growth. In a mouse model of colonization, yeast and hyphae co-occur throughout the gastrointestinal tract. However, competitive infections of C. albicans homozygous gene disruption mutants revealed an unanticipated, inhibitory role for the yeast-to-hypha morphogenesis program on commensalism. We show that the transcription factor Ume6, a master regulator of filamentation, inhibits gut colonization, not by effects on cell shape, but by activating the expression of a hypha-specific pro-inflammatory secreted protease, Sap6, and a hyphal cell surface adhesin, Hyr1. Like a ume6 mutant, strains lacking SAP6 exhibit enhanced colonization fitness, whereas SAP6-overexpression strains are attenuated in the gut. These results reveal a tradeoff between fungal programs supporting commensalism and virulence in which selection against hypha-specific markers limits the disease-causing potential of this ubiquitous commensal-pathogen.
The Cambridge Handbook of Multimedia Learning: Principles Based on Social Cues in Multimedia Learning: Personalization, Voice, Image, and Embodiment Principles

The modality effect refers to a cognitive load learning effect that occurs when a mixed-mode (partly visual and partly auditory) presentation of information is more effective than a single-mode (either visual or auditory alone) presentation of the same information. For learning to occur, novel material must be organised and incorporated into long-term memory via a limited working memory. For instruction to be effective, it has to be designed in ways in which the limitations of working memory are overcome. As distraction and interference impose an additional memory load, their impact on the limited working memory system has to be taken into consideration in a multimedia context where the different formats of words and pictures allow for many possible ways of presenting information. The instructional predictions that flow from the experimental work on the modality effect are straightforward. From a practical perspective, the modality effect provides guidelines for effective instruction.
Patient Perceptions and Preferences for Osteoporosis Treatment.

Purpose Despite the high prevalence, morbidity, and treatment costs for osteoporosis-related fractures, studies have shown that patients infrequently receive the recommended treatment for low bone density (LBD). This study investigated patient perceptions about evaluation, management, and willingness to pursue osteoporosis treatment to further elucidate potential barriers to LBD treatment. Methods A survey was prospectively administered to patients over 50 years old addressing patient history of fragility fractures and osteoporosis evaluation and treatment, medication administration preferences, and willingness to start a new medication to treat or prevent future fragility fractures. Results Three hundred twenty-five patients completed surveys (63.1% women, 36.9% men; mean age, 64.1 years). Patients reported the following: 50.8% had taken supplements or medication for LBD. Patients who had never taken LBD prescription medications were asked about their willingness to take these medications if physician-recommended. The mean response on a 0 to 10 scale was 7.3 ± 3.2, which was not significantly different between fracture or bone density subgroups. Several barriers to taking LBD medications were identified: 85.7% said no medical provider had prescribed them; 14.0% stated they already took too many medications; 10.4% were afraid of potential side effects; 4.3% had conflicting provider recommendations; and 1.8% cited financial concerns. Conclusions Patients held a favorable opinion on taking LBD medications when prescribed. Although 29.8% of patients had an abnormal dual-energy x-ray absorptiometry (DEXA) result, 85.7% of all patients reported that no medical provider had prescribed LBD medications. A sizeable gap remains between current practice and optimal osteoporosis education and management. Clinical relevance Despite the large reported and increasing prevalence of osteoporosis in patients with upper extremity fragility fractures, the rate of treatment for LBD remains suboptimal.
Sequential paracrine mechanisms are necessary for the therapeutic benefits of stem cell therapy.

Stem cell injections are an attractive therapeutic tool. It has been demonstrated that injected stem cells promote tissue repair and regeneration via paracrine mechanisms. However, the effects of i...
EARLY RETINAL MICROVASCULAR ABNORMALITIES IN YOUNG ADULTS WITH TYPE 1 DIABETES MELLITUS WITHOUT CLINICALLY EVIDENT DIABETIC RETINOPATHY.

PURPOSE To characterize the early retinal microvascular changes in young adults (age: 22.69 ± 3.50 years) with Type 1 diabetes mellitus without clinically detectable diabetic retinopathy using optical coherence tomography angiography and investigate the associated factors. METHODS A total of 36 participants with Type 1 diabetes mellitus (70 eyes) and 34 healthy controls (57 eyes) were retrospectively reviewed. The analyzed optical coherence tomography angiography indices included capillary vessel density, foveal avascular zone area/perimeter/acircularity index, and foveal vascular density, acquired in the 6 × 6-mm2 area centered on the fovea. The generalized estimation equations model was applied to compare the mean values and to study the associated factors. RESULTS In subjects with diabetes, statistically significant decreases were observed in parafoveal vessel density in both superficial and deep capillary plexuses, foveal avascular zone area/perimeter, and foveal vascular density when compared with controls (all P < 0.05). Higher glycated hemoglobin level was independently associated with the decrease of parafoveal vessel density as well as the increase of foveal avascular zone area/perimeter (all P < 0.05). Prepubescent onset of diabetes mellitus was also independently associated with the decrease of superficial parafoveal vessel density, foveal avascular zone area/perimeter, and foveal vascular density (P = 0.015, 0.011, 0.015, and 0.001, respectively). CONCLUSION In young adults with Type 1 diabetes mellitus lacking clinical signs of diabetic retinopathy, optical coherence tomography angiography revealed alterations in retinal microvasculature that were associated with glycated hemoglobin level and onset of diabetes mellitus related to puberty.
Examining the impacts of the Great Recession on the commuting dynamics and jobs-housing balance of public and private sector workers

Abstract Research examining commuting-related phenomena remains a key area of geographical research. And although substantial research has attempted to explore the relationships between transportation and land use, little is known about how the impacts of major economic changes such as the Great Recession would affect related commuting dynamics. In addition, commuting studies examining the plight of workers in private versus the public sectors are also virtually non-existent, though the two-groups' commuting dynamics would potentially be affected very differently by the Great Recession. This study contributes to a better understanding of commuting and jobs-housing balance during the Great Recession. We employ metrics from the excess commuting and jobs-housing balance literature in an effort to examine the commuting dynamics of private and public sector workers, with a focus on the time period around the Great Recession. Our analysis is conducted for the Atlanta, GA Metropolitan area. Findings of the study are that private workers experienced better jobs-housing balance over the study period, but they commute longer and more inefficiently when compared with public workers. While the Great Recession worsened both groups' commuting situation, the effect was more significant for public workers in terms of increasing their travel burdens. Since the public sector response to the Great Recession was delayed, policy implications suggest monitoring employment trends during and after economic shocks and recognizing the transportation disadvantages public sector workers may face in future crises. Keywords: excess commuting, jobs-housing balance, the Great Recession, private and public employment, spatial optimization.
Lead aVR predicts early revascularization but not long-term events in patients referred for stress electrocardiography

Background Exercise stress electrocardiography (ExECG) is recommended as a first-line tool to assess ischemia, but standard ST-analysis has limited diagnostic accuracy. ST elevation in lead aVR has been associated with left main and LAD disease in the population undergoing coronary angiography but has not been studied in the general population undergoing stress testing for the initial evaluation of CAD without coronary angiography. We sought to determine the predictive value of lead aVR elevation for ischemia, early revascularization, and subsequent cardiac events in consecutive patients undergoing ExECG. Methods and results The study cohort included 641 subjects referred for ExECG who were dichotomized by presence or absence of aVR elevation ≥1mm and compared for prevalence and predictors of ischemia and a composite of cardiac death, nonfatal myocardial infarction, and late revascularization. The cohort had a median age of 57 and 57% were male. The prevalence of aVR elevation was 11.5%. The prevalence of significant ischemia on patients who received imaging was significantly higher with aVR elevation (14.3% vs 2.3%, p<0.001). Early revascularization occurred in 10.9% with vs 0.2% without aVR elevation, p<0.001. No subjects without aVR elevation or ST-depression underwent early revascularization. However, cardiac event rates were similar over a median 4.0 years of follow-up with and without aVR elevation (2.8% vs. 2.6%, p = 0.80). aVR elevation did not predict long-term cardiac events by Kaplan-Meier survival analysis (p = 0.94) or Cox proportional hazards modeling (p = 0.35). Conclusions aVR elevation during ExECG predicts ischemia on imaging and early revascularization but not long-term outcomes and could serve as a useful adjunct to standard ST-analysis and potentially reduce the need for concurrent imaging.
Doubled-Up: How HUD Mistakenly Excludes a Vulnerable Population

The United States Department of Housing and Urban Development’s (HUD) homeless definition excludes most of those living in doubled-up situations. Living doubled-up means the person or family is living in another’s home. This Article argues that HUD’s interpretation of the HEARTH Act’s definition of homeless is incorrect based on legislative history and modern understandings of homelessness. The federal response to homelessness has historically evolved in response to crises. In the 1980s and late 2000s, the country faced national economic and housing crises, prompting the government to address national homelessness. While the understanding of homelessness in the 1980s was driven by healthcare disparities, the 2009 housing crisis forced the federal response to evolve to address homelessness as the complex economic and social issue it is. In light of this evolution in federal understandings of homelessness and the similarities between the doubled-up and those in shelters, this Article argues that HUD wrongfully excludes most of the doubled-up and should therefore amend its definition to include them.
The role of Wnt signaling in skin fibrosis

Skin fibrosis is the excessive deposition of extracellular matrix in the dermis. Cutaneous fibrosis can occur following tissue injury, including burns, trauma, and surgery, resulting in scars that are disfiguring, limit movement and cause significant psychological distress for patients. Many molecular pathways have been implicated in the development of skin fibrosis, yet effective treatments to prevent or reverse scarring are unknown. The Wnt signaling pathways are known to play an important role in skin homeostasis, skin injury, and in the development of fibrotic skin diseases. This review provides a detailed overview of the role of the canonical Wnt signaling pathways in regulating skin scarring. We also discuss how Wnt signaling interacts with other known fibrotic molecular pathways to cause skin fibrosis. We further provide a summary of the different Wnt inhibitor types available for treating skin scarring. Understanding the role of the Wnt pathway in cutaneous fibrosis will accelerate the development of effective Wnt modulators for the treatment of skin fibrosis.
Mechanism of transcription initiation and primer generation at the mitochondrial replication origin OriL

The intricate process of human mtDNA replication requires the coordinated action of both transcription and replication machineries. Transcription and replication events at the lagging strand of mtDNA prompt the formation of a stem-loop structure (OriL) and the synthesis of a ∼25 nt RNA primer by mitochondrial RNA polymerase (mtRNAP). The mechanisms by which mtRNAP recognizes OriL, initiates transcription, and transfers the primer to the replisome are poorly understood. We found that transcription initiation at OriL involves slippage of the nascent transcript. The transcript slippage is essential for initiation complex stability and its ability to translocate the mitochondrial DNA polymerase gamma, PolG, which pre-binds to OriL, downstream of the replication origin thus allowing for the primer synthesis. Our data suggest the primosome assembly at OriL-a complex of mtRNAP and PolG-can efficiently generate the primer, transfer it to the replisome, and protect it from degradation by mitochondrial endonucleases.