North Park University

OBJECTIVE: To examine mortality rates in the largest systemic lupus erythematosus (SLE) cohort ever assembled. METHODS: Our sample was a multisite international SLE cohort (23 centers, 9,547 patients). Deaths were ascertained by vital statistics registry linkage. Standardized mortality ratio (SMR; ratio of deaths observed to deaths expected) estimates were calculated for all deaths and by cause. The effects of sex, age, SLE duration, race, and calendar-year periods were determined. RESULTS: The overall SMR was 2.4 (95% confidence interval 2.3-2.5). Particularly high mortality was seen for circulatory disease, infections, renal disease, non-Hodgkin's lymphoma, and lung cancer. The highest SMR estimates were seen in patient groups characterized by female sex, younger age, SLE duration <1 year, or black/African American race. There was a dramatic decrease in total SMR estimates across calendar-year periods, which was demonstrable for specific causes including death due to infections and death due to renal disorders. However, the SMR due to circulatory diseases tended to increase slightly from the 1970s to the year 2001. CONCLUSION: Our data from a very large multicenter international cohort emphasize what has been demonstrated previously in smaller samples. These results highlight the increased mortality rate in SLE patients compared with the general population, and they suggest particular risk associated with female sex, younger age, shorter SLE duration, and black/African American race. The risk for certain types of deaths, primarily related to lupus activity (such as renal disease), has decreased over time, while the risk for deaths due to circulatory disease does not appear to have diminished.

Structural equation modeling is used to estimate the mediating effects of affective, continuance, and normative commitment on the relationship between job satisfaction and intent to leave. Several competing configurational models are tested to determine whether the best fitting model is one whereby multidimensional commitment fully mediates, partially mediates, or does not mediate the relationship between job satisfaction and intent to leave. The results suggest that contrary to Meyer and Allen's (1991) fully mediated three-component model of organizational commitment, a partially mediated model fits the data best for this study. Copyright © 2000 John Wiley & Sons, Ltd.

To assess the effect of “metacognitive” instruction on reading comprehension, 20 studies, with a total student population of 1,553, were compiled and quantitatively synthesized. For 115 effect sizes, or contrasts of experimental and control groups' performance, the mean effect size was .71, which indicates a substantial effect. In this compilation of studies, metacognitive instruction was found particularly effective for junior high students (seventh and eighth grades). Among the metacognitive skills, awareness of textual inconsistency and the use of self-questioning as both a monitoring and a regulating strategy were most effective. Reinforcement was the most effective teaching strategy.

In most of the world, people have regular exposure to multiple accents. Therefore, learning to quickly process accented speech is a prerequisite to successful communication. In this paper, we examine work on the perception of accented speech across the lifespan, from early infancy to late adulthood. Unfamiliar accents initially impair linguistic processing by infants, children, younger adults, and older adults, but listeners of all ages come to adapt to accented speech. Emergent research also goes beyond these perceptual abilities, by assessing links with production and the relative contributions of linguistic knowledge and general cognitive skills. We conclude by underlining points of convergence across ages, and the gaps left to face in future work.

Infection with human immunodeficiency virus (HIV) may cause viral antigenemia, detected primarily as p24 viral core protein. Among 16 patients with the acquired immunodeficiency syndrome (AIDS) or AIDS-related complex studied serially, 12 had or developed antigenemia ranging from 16 to 3006 pg/mL in plasma. The level could be categorized as high (greater than 100 pg/mL) or low (15 to 65 pg/mL). Three patients with anti-p24 antibody had no antigenemia. Zidovudine (AZT), 200 or 250 mg every 4 hours, reduced antigenemia by about 90%; other regimens were less effective. Leukocyte cultures were positive for HIV from patients with antigenemia, and in one third of samples in the absence of antigenemia. High levels of antigenemia correlated with symptoms, CD4 cell count, and prognosis. Drug toxicity requiring a lower dose was followed by increased antigenemia, recurrent symptoms, and decreased CD4 cells, suggesting lymphocyte toxicity. Monitoring antigenemia can be useful in evaluating patients with HIV infection and in evaluating the effect of antiviral chemotherapy.

BACKGROUND: Cocaine abuse has been implicated as a cause of death due to sudden cardiac arrest. METHODS AND RESULTS: We examined the hemodynamic and electrophysiological effects of cocaine administered as a series of 5-mg/kg i.v. boluses coupled with a continuous infusion in anesthetized dogs. Sodium bicarbonate (50 meq i.v.) was administered as a potential antidote in 11 of 15 dogs, and intravenous 5% dextrose was given in the remaining four. In a dose-dependent fashion, cocaine significantly decreased blood pressure, coronary blood flow, and cardiac output; increased PR, QRS, QT, and QTc intervals and sinus cycle length; and increased ventricular effective refractory period and dispersion of ventricular refractoriness. No afterdepolarizations were noted in the monophasic action potential recording. Nonsustained monomorphic ventricular tachycardia occurred spontaneously in two dogs, and sustained ventricular tachycardia could be induced by programmed stimulation at the end of the dosing protocol in five of 11 animals. Sodium bicarbonate promptly decreased cocaine-induced QRS prolongation to nearly that measured at baseline but had no effect on the other electrocardiographic or hemodynamic variables. In one dog, sodium bicarbonate administration was associated with reversion of ventricular tachycardia to sinus rhythm. CONCLUSIONS: We conclude that high-dose cocaine possesses negative inotropic and potent type I electrophysiological effects. Sodium bicarbonate selectively reversed cocaine-induced QRS prolongation and may be a useful treatment of ventricular arrhythmias associated with slowed ventricular conduction in the setting of cocaine overdose.

A new computational approach to the problem of limit analysis with quadratic yield condition is developed and tested. The problem is solved using the exact convex yield condition and the general case of unbounded yield set, corresponding to unrestricted hydrostatic pressure, is treated. The discretization by the finite element method is based on an analysis of the duality between the static principle and the kinematic principle of limit analysis. Also the solution method for the discrete optimization problem is new and exploits this duality. The method simultaneously computes approximations to the fields of stresses and flow in the collapse state. The software used for the optimization problem is independent of continuum mechanics, but has been developed with applications in limit analysis as a primary objective. The efficiency and accuracy of the method for large problems is demonstrated by solving a classical problem in the plane strain model: approximately 90 000 finite element nodes with 3 stress components and 2 velocity components at each node. In two space dimensions this may be overkill, but it shows that we are able to solve problems in three space dimensions. Copyright © 1999 John Wiley & Sons, Ltd.

Abstract Affect plays a central role in human experience, providing the ongoing hedonic tone that colors the everyday lives of individuals. Not surprisingly, therefore, affect occupies an equally prominent role in the psychological and social science literature. As such, a number of different approaches exist for assessing mood and emotion. This chapter focuses on outlining and describing a variety of self-report measures that are available to affect researchers. In outlining the available means for measuring affect, we must address two central issues. First, we must be clear about the definitions of affect, emotion, and mood that will be used within this chapter. The constructs of mood and emotion are similar in that they both refer to feeling states that can be broadly characterized as pleasant or unpleasant (i.e., as positive or negative) and that reflect what is happening within the organism (Parkinson, Totterdell, Brinner, &amp; Reynolds, 1996). It is also widely believed that they contain some common components and are controlled by similar processes (Clark &amp; Watson, 1999; Parkinson et al., 1996).

Synthetic biology offers opportunities for experiential educational activities at the intersection of the life sciences, engineering, and design. However, implementation of hands-on biology activities in classrooms is challenging because of the need for specialized equipment and expertise to grow living cells. We present BioBits™ Bright, a shelf-stable, just-add-water synthetic biology education kit with easy visual outputs enabled by expression of fluorescent proteins in freeze-dried, cell-free reactions. We introduce activities and supporting curricula for teaching the central dogma, tunable protein expression, and design-build-test cycles and report data generated by K-12 teachers and students. We also develop inexpensive incubators and imagers, resulting in a comprehensive kit costing <US$100 per 30-person classroom. The user-friendly resources of this kit promise to enhance biology education both inside and outside the classroom.

BACKGROUND: Hepatosplenic T-cell lymphoma (HSTCL) is a rare, lethal disease generally seen in young male patients with inflammatory bowel disease. The study of biologic and immunomodulator naive patients in Crohn's disease (SONIC), advocates combining infliximab with an immunomodulator in moderate-to-severe Crohn's disease. Unfortunately, combined immunosuppression increases risk for HSTCL. We herein review all cases of HSTCL reported to the Food and Drug Administration (FDA) in patients receiving TNF-α inhibitors. METHODS: Individual reports from the FDA Adverse Event Reporting System database for lymphomas from the biological agents - infliximab, adalimumab, certolizumab, natalizumab, and etanercept were downloaded and analyzed with Microsoft Access. Full reports for all identified HSTCL cases were obtained from the FDA. RESULTS: Twenty-five cases of HSTCL were identified. Twenty-two (88%) patients had inflammatory bowel disease and three had rheumatoid arthritis. Four cases (16%) were in women and four patients were above 65 years of age. Twenty-four cases (96%) also received an immunomodulator (azathioprine, 6-mercaptopurine, or methotrexate). Two patients received adalimumab alone. CONCLUSION: HSTCL is no longer restricted to the previously identified risk group of young male patients, but can also occur in patients with rheumatoid arthritis, females and older adults receiving TNF-α inhibitors and immunomodulators. Improved disease outcomes using combination therapy should be tempered by the risk of developing HSTCL.

Convective quasi-equilibrium (QE) has for several decades stood as a key postulate for parametrization of the impacts of moist convection at small scales upon the large-scale flow. Departures from QE have motivated stochastic convective parametrization, which in its early stages may be viewed as a sensitivity study. Introducing plausible stochastic terms to modify the existing convective parametrizations can have substantial impact, but, as for so many aspects of convective parametrization, the results are sensitive to details of the assumed processes. We present observational results aimed at helping to constrain convection schemes, with implications for each of conventional, stochastic or 'superparametrization' schemes. The original vision of QE due to Arakawa fares well as a leading approximation, but with a number of updates. Some, like the imperfect connection between the boundary layer and the free troposphere, and the importance of free-tropospheric moisture to buoyancy, are quantitatively important but lie within the framework of ensemble-average convection slaved to the large scale. Observations of critical phenomena associated with a continuous phase transition for precipitation as a function of water vapour and temperature suggest a more substantial revision. While the system's attraction to the critical point is predicted by QE, several fundamental properties of the transition, including high precipitation variance in the critical region, need to be added to the theory. Long-range correlations imply that this variance does not reduce quickly under spatial averaging; scaling associated with this spatial averaging has potential implications for superparametrization. Long tails of the distribution of water vapour create relatively frequent excursions above criticality with associated strong precipitation events.

Musculoskeletal performance assessment is critical in the analysis of physical training programs in order to prioritize goals for decreasing injury risk and focusing performance goals. Abdominal endurance as part of this analysis is often assessed with techniques that have validity that has been debated in literature. The purpose of this study was to develop normative sex- and athlete-specific percentiles for a trunk stabilization and muscular endurance by using a prone forearm plank test in college-aged students. A second purpose of this study was to investigate the effect of habitual physical activity and the reason for test termination. There were 471 participants (means ± SE; males: n = 194, age 20.4 ± 0.2 years, body height 179.4 ± 0.5 cm, body mass 81.1 ± 1.2 kg; females: n = 277, age 20.2 ± 0.2 years, body height 165.7 ± 0.4 cm, body mass 63.9 ± 0.7 kg) who performed this test to volitional or technique failure. Males produced significantly higher test durations than females (means ± SD; 124 ± 72 seconds vs. 83 ± 63 seconds) and athletes produced significantly longer test durations than non-athletes (123 ± 69 s vs. 83 ± 63 s) but no interaction effects were seen in the variables of sex and athletic status. The activity level was found to have a threshold of influence (>3 times/week) on abdominal endurance that is dose-specific where greater than 5 times/week showed the greatest influence. The fatigue of the abdominals was the termination reason producing the lowest test duration and there was no sex effect on reason for test termination. These normative percentiles for abdominal endurance suggest that the abdominal plank test can now be used as an alternative to other abdominal assessments in college students, but further investigation is warranted prior to confirmation and generalization to other populations.

Big Five and affective traits were measured at three assessments when participants were on average 18, 21, and 24 years old. Rank-order stability analyses revealed that stability correlations tended to be higher across the second compared to the first retest interval; however, affective traits consistently were less stable than the Big Five. Median stability coefficients for the Big Five increased from .62 (Time 1 vs. Time 2) to .70 (Time 2 to Time 3); parallel increases also were observed for measures of negative affectivity (median rs=.49 and .55, respectively) and positive affectivity (median rs=.48 and .57, respectively). Growth curve analyses revealed significant change on each of the Big Five and affective traits, although many of the scales also showed significant variability in individual trajectories. Thus, rank-order stability is increasing for a range of personality traits, although there also is significant variability in change trajectories during young adulthood.

Both subjective impressions and previous research with monolingual listeners suggest that a foreign accent interferes with word recognition in infants, young children, and adults. However, because being exposed to multiple accents is likely to be an everyday occurrence in many societies, it is unexpected that such non-standard pronunciations would significantly impede language processing once the listener has experience with the relevant accent. Indeed, we report that 24-month-olds successfully accommodate an unfamiliar accent in rapid word learning after less than 2 minutes of accent exposure. These results underline the robustness of our speech perception mechanisms, which allow listeners to adapt even in the absence of extensive lexical knowledge and clear known-word referents.

Importance: Awake prone positioning may improve hypoxemia among patients with COVID-19, but whether it is associated with improved clinical outcomes remains unknown. Objective: To determine whether the recommendation of awake prone positioning is associated with improved outcomes among patients with COVID-19-related hypoxemia who have not received mechanical ventilation. Design, Setting, and Participants: This pragmatic nonrandomized controlled trial was conducted at 2 academic medical centers (Vanderbilt University Medical Center and NorthShore University HealthSystem) during the COVID-19 pandemic. A total of 501 adult patients with COVID-19-associated hypoxemia who had not received mechanical ventilation were enrolled from May 13 to December 11, 2020. Interventions: Patients were assigned 1:1 to receive either the practitioner-recommended awake prone positioning intervention (intervention group) or usual care (usual care group). Main Outcomes and Measures: Primary outcome analyses were performed using a bayesian proportional odds model with covariate adjustment for clinical severity ranking based on the World Health Organization ordinal outcome scale, which was modified to highlight the worst level of hypoxemia on study day 5. Results: A total of 501 patients (mean [SD] age, 61.0 [15.3] years; 284 [56.7%] were male; and most [417 (83.2%)] were self-reported non-Hispanic or non-Latinx) were included. Baseline severity was comparable between the intervention vs usual care groups, with 170 patients (65.9%) vs 162 patients (66.7%) receiving oxygen via standard low-flow nasal cannula, 71 patients (27.5%) vs 62 patients (25.5%) receiving oxygen via high-flow nasal cannula, and 16 patients (6.2%) vs 19 patients (7.8%) receiving noninvasive positive-pressure ventilation. Nursing observations estimated that patients in the intervention group spent a median of 4.2 hours (IQR, 1.8-6.7 hours) in the prone position per day compared with 0 hours (IQR, 0-0.7 hours) per day in the usual care group. On study day 5, the bayesian posterior probability of the intervention group having worse outcomes than the usual care group on the modified World Health Organization ordinal outcome scale was 0.998 (posterior median adjusted odds ratio [aOR], 1.63; 95% credibility interval [CrI], 1.16-2.31). However, on study days 14 and 28, the posterior probabilities of harm were 0.874 (aOR, 1.29; 95% CrI, 0.84-1.99) and 0.673 (aOR, 1.12; 95% CrI, 0.67-1.86), respectively. Exploratory outcomes (progression to mechanical ventilation, length of stay, and 28-day mortality) did not differ between groups. Conclusions and Relevance: In this nonrandomized controlled trial, prone positioning offered no observed clinical benefit among patients with COVID-19-associated hypoxemia who had not received mechanical ventilation. Moreover, there was substantial evidence of worsened clinical outcomes at study day 5 among patients recommended to receive the awake prone positioning intervention, suggesting potential harm. Trial Registration: ClinicalTrials.gov Identifier: NCT04359797.

PURPOSE: The purpose of this study was a psychometric evaluation of the PAINAD to assess pain in hospitalized cognitively impaired and intact older adults admitted for surgical repair of a hip fracture. METHOD: A descriptive correlational design was used. A convenience sample of older patients hospitalized for surgical repair of a hip fracture was used. Twelve of the patients had cognitive impairment and 13 were cognitively intact. All were assessed for pain using both the self-report numeric rating scale and an observational assessment tool, the PAINAD. FINDINGS: A positive correlation was found between the PAINAD and a self-report pain scale, providing evidence of concurrent validity. PAINAD scores were higher when patients were likely to experience pain than when unlikely, providing evidence of discriminant validity. The results of this study provide evidence supporting the validity and reliability of the PAINAD in the pain assessment of hospitalized post-orthopaedic surgical older adults who are unable or reluctant to self-report pain.

The potential of using the optically stimulated luminescence (OSL) technique with aluminium oxide (Al(2)O(3):C) dosimeters for a precise and accurate estimation of absorbed doses delivered by high-energy photon beams was investigated. This study demonstrates the high reproducibility of the OSL measurements and presents a preliminary determination of the depth-dose curve in water for a 6 MV photon beam from a linear accelerator. The uncertainty of a single OSL measurement, estimated from the variance of a large sample of dosimeters irradiated with the same dose, was 0.7%. In the depth-dose curve obtained using the OSL technique, the difference between the measured and expected doses was < or =0.7% for depths between 1.5 and 10 cm, and 1.1% for a depth of 15 cm. The readout procedure includes a normalization of the response of the dosimeter with respect to a reference dose in order to eliminate variations in the dosimeter mass, dosimeter sensitivity, and the reader's sensitivity. This may be relevant for quality assurance programmes, since it simplifies the requirements in terms of personnel training to achieve the precision and accuracy necessary for radiotherapy applications. We concluded that the OSL technique has the potential to be reliably incorporated in quality assurance programmes and dose verification.

BACKGROUND: Few safe and effective dietary supplements are available to promote weight loss. We evaluated the safety and efficacy of glucomannan, a water-soluble fiber supplement, for achieving weight loss in overweight and moderately obese individuals consuming self-selected diets. METHODS: Participants were randomly assigned to take 1.33 grams of glucomannan or identically looking placebo capsules with 236.6 mL (8 ounces) of water one hour before breakfast, lunch, and dinner for 8 weeks. The primary efficacy outcome was change in body weight after 8 weeks. Other efficacy outcomes were changes in body composition, hunger/fullness, and lipid and glucose concentrations. Safety outcomes included gastrointestinal symptoms/tolerance and serum liver enzymes and creatinine levels. RESULTS: A total of 53 participants (18-65 years of age; BMI 25-35 kg/m²) were enrolled and randomized. The two groups did not differ with respect to baseline characteristics and compliance with the study supplement. At 8 weeks, there was no significant difference between the glucomannan and placebo groups in amount of weight loss (-.40 ± .06 and -.43 ± .07, resp.) or other efficacy outcomes or in any of the safety outcomes. CONCLUSIONS: Glucomannan supplements administered over 8 weeks were well tolerated but did not promote weight loss or significantly alter body composition, hunger/fullness, or lipid and glucose parameters. This trial is registered with NCT00613600.

The purposes of this study were: 1) to examine how predictive three types of childhood teasing (competency, weight, and appearance) were of later self-esteem; and 2) to examine how predictive these same three variables were of later body image. Additionally, the pattern of relations for each gender was be explored. Each of these questions will be explored for males and females separately. The participants in this study were 89 female and 75 male undergraduates from two midwestern universities, with a mean age of 20. Results showed that more frequent teasing in childhood was significantly predictive of lower self-esteem and poorer body image among females and males. However, the findings varied by teasing types. Certain types of teasing were found to be related to self-esteem and body image while other types of teasing were not. Different patterns emerged for each gender. Implications of these findings and applications for professionals are discussed.

Leiomyomata represent the most common gynecologic tumors and are responsible for over 200,000 hysterectomies per year. They are almost invariably benign and represent clonal expansion of individual myometrial cells. They can cause a variety of symptoms including menometrorrhagia, dysmenorrhea, pelvic pain, reproductive failure, and compression of adjacent pelvic viscera, or be totally asymptomatic. Leiomyomata are more common in African-American women and have a non-Mendelian inheritance pattern with up to a 50% recurrence rate after surgical removal. The therapeutic choices depend on the goals of therapy, with hysterectomy most often used for definitive treatment, and myomectomy when preservation of childbearing is desired. Intracavitary and submucous leiomyomata can be removed by hysteroscopic resection. Laparoscopic myomectomy is now technically possible but apparently with an increased risk of uterine rupture during pregnancy. Although gonadotropin-releasing hormone-agonist-induced hypogonadism can reduce the volume of leiomyomata, the severe side effects and prompt recurrences make them useful only for short-term goals such as reversing anemia or shrinking an intracavitary tumor prior to hysteroscopic resection. Nonextirpative approaches such as myolysis and uterine artery embolization are being evaluated, and may provide more options if they prove to be safe and efficacious in long-term follow-up. Ultimately, if the genetic basis for fibroid development and/or the molecular mechanism(s) of myometrial proliferation are understood, additional nonsurgical therapeutic interventions may be forthcoming. Current clinical needs are to a) determine an effective prevention strategy in genetically predisposed individuals; b) slow the growth of leiomyomata; c) identify the mechanisms of infertility; d) improve early detection; e) develop better surgical techniques; f) reduce recurrences after myomectomy; g) develop nonextirpative options; and h) evaluate their long-term results.