University of Tennessee System

BACKGROUND: Scientific research in the 21st century is more data intensive and collaborative than in the past. It is important to study the data practices of researchers--data accessibility, discovery, re-use, preservation and, particularly, data sharing. Data sharing is a valuable part of the scientific method allowing for verification of results and extending research from prior results. METHODOLOGY/PRINCIPAL FINDINGS: A total of 1329 scientists participated in this survey exploring current data sharing practices and perceptions of the barriers and enablers of data sharing. Scientists do not make their data electronically available to others for various reasons, including insufficient time and lack of funding. Most respondents are satisfied with their current processes for the initial and short-term parts of the data or research lifecycle (collecting their research data; searching for, describing or cataloging, analyzing, and short-term storage of their data) but are not satisfied with long-term data preservation. Many organizations do not provide support to their researchers for data management both in the short- and long-term. If certain conditions are met (such as formal citation and sharing reprints) respondents agree they are willing to share their data. There are also significant differences and approaches in data management practices based on primary funding agency, subject discipline, age, work focus, and world region. CONCLUSIONS/SIGNIFICANCE: Barriers to effective data sharing and preservation are deeply rooted in the practices and culture of the research process as well as the researchers themselves. New mandates for data management plans from NSF and other federal agencies and world-wide attention to the need to share and preserve data could lead to changes. Large scale programs, such as the NSF-sponsored DataNET (including projects like DataONE) will both bring attention and resources to the issue and make it easier for scientists to apply sound data management principles.

The Academy of Nutrition and Dietetics (Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommend that a standardized set of diagnostic characteristics be used to identify and document adult malnutrition in routine clinical practice. An etiologically based diagnostic nomenclature that incorporates a current understanding of the role of the inflammatory response on malnutrition's incidence, progression, and resolution is proposed. Universal use of a single set of diagnostic characteristics will facilitate malnutrition's recognition, contribute to more valid estimates of its prevalence and incidence, guide interventions, and influence expected outcomes. This standardized approach will also help to more accurately predict the human and financial burdens and costs associated with malnutrition's prevention and treatment and further ensure the provision of high-quality, cost-effective nutrition care.

deaths (88,900 men; 70,490 women) occurred from the disease. 1 Only 15% of all lung cancer patients are alive 5 years or more after diagnosis (http://seer.cancer.gov/statfacts/html/lungb.html).

The centrality dependence of the charged-particle multiplicity density at midrapidity in Pb-Pb collisions at sqrt[s_{NN}]=2.76 TeV is presented. The charged-particle density normalized per participating nucleon pair increases by about a factor of 2 from peripheral (70%-80%) to central (0%-5%) collisions. The centrality dependence is found to be similar to that observed at lower collision energies. The data are compared with models based on different mechanisms for particle production in nuclear collisions.

This paper describes a method for partitioning 3D surface meshes into useful segments. The proposed method generalizes morphological watersheds, an image segmentation technique, to 3D surfaces. This surface segmentation uses the total curvature of the surface as an indication of region boundaries. The surface is segmented into patches, where each patch has a relatively consistent curvature throughout, and is bounded by areas of higher, or drastically different, curvature. This algorithm has applications for a variety of important problems in visualization and geometrical modeling including 3D feature extraction, mesh reduction, texture mapping 3D surfaces, and computer aided design.

Social capital refers to the resources derived from social relationships. Although the concept of social capital has been applied at the individual, group, and organizational levels of analysis, researchers have yet to fully embrace social capital’s potential as a multilevel lens through which we might better understand management and organizational phenomena. With a central objective of advancing social capital’s potential as a multilevel theoretical perspective, the authors make two contributions to the management literature. First, the authors comprehensively review two decades of management research to highlight how social capital has been empirically applied across levels of analysis. Second, based on the shortcomings and challenges revealed through the literature review, the authors identify and discuss avenues for future multilevel research, including suggestions for both macro and micro researchers.

The purpose of this study was to apply a magnetic resonance (MR) imaging-compatible positron emission tomographic (PET) detector technology for simultaneous MR/PET imaging of the human brain and skull base. The PET detector ring consists of lutetium oxyorthosilicate (LSO) scintillation crystals in combination with avalanche photodiodes (APDs) mounted in a clinical 3-T MR imager with use of the birdcage transmit/receive head coil. Following phantom studies, two patients were simultaneously examined by using fluorine 18 fluorodeoxyglucose (FDG) PET and MR imaging and spectroscopy. MR/PET data enabled accurate coregistration of morphologic and multifunctional information. Simultaneous MR/PET imaging is feasible in humans, opening up new possibilities for the emerging field of molecular imaging.

Neuroendocrine tumors account for approximately 20% of lung cancers; most (≈15%) are small cell lung cancer (SCLC). These NCCN Clinical Practice Guidelines in Oncology for SCLC focus on extensive-stage SCLC because it occurs more frequently than limited-stage disease. SCLC is highly sensitive to initial therapy; however, most patients eventually die of recurrent disease. In patients with extensive-stage disease, chemotherapy alone can palliate symptoms and prolong survival in most patients; however, long-term survival is rare. Most cases of SCLC are attributable to cigarette smoking; therefore, smoking cessation should be strongly promoted.

OBJECTIVE: To demonstrate the feasibility of a placebo-controlled trial of antipsychotics for delirium in the intensive care unit and to test the hypothesis that antipsychotics would improve days alive without delirium or coma. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Six tertiary care medical centers in the US. PATIENTS: One hundred one mechanically ventilated medical and surgical intensive care unit patients. INTERVENTION: Patients were randomly assigned to receive haloperidol or ziprasidone or placebo every 6 hrs for up to 14 days. Twice each day, frequency of study drug administration was adjusted according to delirium status, level of sedation, and side effects. MEASUREMENTS AND MAIN OUTCOMES: The primary end point was the number of days patients were alive without delirium or coma. During the 21-day study period, patients in the haloperidol group spent a similar number days alive without delirium or coma (median [interquartile range], 14.0 [6.0-18.0] days) as did patients in the ziprasidone (15.0 [9.1-18.0] days) and placebo groups (12.5 [1.2-17.2] days; p = 0.66). No differences were found in secondary clinical outcomes, including ventilator-free days (p = .25), hospital length of stay (p = .68), and mortality (p = .81). Ten (29%) patients in the haloperidol group reported symptoms consistent with akathisia, compared with six (20%) patients in the ziprasidone group and seven (19%) patients in the placebo group (p = .60), and a global measure of extrapyramidal symptoms was similar between treatment groups (p = .46). CONCLUSIONS: A randomized, placebo-controlled trial of antipsychotics for delirium in mechanically ventilated intensive care unit patients is feasible. Treatment with antipsychotics in this limited pilot trial did not improve the number of days alive without delirium or coma, nor did it increase adverse outcomes. Thus, a large trial is needed to determine whether use of antipsychotics for intensive care unit delirium is appropriate.

SUMMARY Over the past two decades, the corporate governance literature in accounting and auditing has grown rapidly. To better understand this body of work, we discuss 12 recent literature review or meta-analysis papers and summarize selected results (i.e., clusters of papers with new and interesting results) from recent empirical research papers, after reviewing the findings of over 250 studies. Our corporate governance focus is primarily on corporate board and audit committee issues. We discuss the major insights from this literature and the practice implications of these findings. In addition, we identify a number of opportunities for future research. In particular, we make suggestions for: (1) improved research paradigms in corporate governance, (2) extensions of existing research, and (3) new or emerging lines of research.

OBJECTIVE: To examine neuropsychological function, depression, and quality of life 6 months after discharge in patients who received mechanical ventilation in the intensive care unit. DESIGN: Prospective cohort study. SETTING: Tertiary care, medical and coronary intensive care unit of a university-based medical center. STUDY POPULATION: A total of 275 consecutive, mechanically ventilated patients from a medical intensive care unit were prospectively followed. At 6 months, 157 were alive, of whom 41 (26%) returned for extensive follow-up testing. MEASUREMENT AND MAIN RESULTS: Neuropsychological testing and assessment of depression and quality of life were performed at 6-month follow-up. Seven of 41 patients were excluded from further analysis due to preexisting cognitive impairment determined via surrogate interviews using the Modified Blessed Dementia Rating Scale and a review of medical records. On the basis of strict criteria derived from normative data, we found that 11 of 34 patients (32%) were neuropsychologically impaired. Impairment was generally diffuse but occurred primarily in areas of psychomotor speed, visual and working memory, verbal fluency, and visuo-construction. The rate of neuropsychological deficits in the study population was markedly higher than population norms for mild dementia. Scores on the Geriatric Depression Scale-Short Form were significantly more abnormal in the neuropsychologically impaired group than in the nonimpaired group at hospital discharge (p =.04) and at 6-month follow-up (p =.02), and clinically significant depression was found in 27% of impaired subjects at hospital discharge and in 36% at 6-month follow-up. No differences were observed between groups in quality of life as measured with the Short Form Health Survey-12 at discharge or 6-month follow-up. CONCLUSIONS: Prolonged neuropsychological impairment is common among survivors of the medical intensive care unit and occurs with greater than anticipated frequency when compared with relevant normative data. Future investigations are warranted to elucidate the nature of the association between critical illness, neuropsychological impairment, depression, and decreased quality of life.

CONTEXT: Low literacy is an important barrier for patients with diabetes, but interventions to address low literacy have not been well examined. OBJECTIVE: To examine the role of literacy on the effectiveness of a comprehensive disease management program for patients with diabetes. DESIGN, SETTING, AND PARTICIPANTS: Analysis of the influence of literacy on glycemic control and systolic blood pressure using data from a randomized controlled trial (conducted from February 2001 through April 2003) of a comprehensive diabetes management program. Participants were 217 patients aged 18 years or older with type 2 diabetes and poor glycemic control (glycosylated hemoglobin [HbA1c] levels > or =8.0%) and presenting to a US academic general internal medicine practice. INTERVENTIONS: All communication to patients was individualized and delivered to enhance comprehension among patients with low literacy. Intervention patients received intensive disease management from a multidisciplinary team. Control patients received an initial management session and continued with usual care. MAIN OUTCOME MEASURES: Achievement of goal HbA1c levels and systolic blood pressure at 12-month follow-up for control and intervention patients stratified by literacy status. RESULTS: Complete 12-month data were available for 193 patients (89%). Among patients with low literacy, intervention patients were more likely than control patients to achieve goal HbA1c levels (< or =7.0%) (42% vs 15%, respectively; adjusted odds ratio [OR], 4.6; 95% confidence interval [CI], 1.3 to 17.2; P = .02). Patients with higher literacy had similar odds of achieving goal HbA1c levels regardless of intervention status (24% vs 23%; adjusted OR, 1.0; 95% CI, 0.4 to 2.5; P = .98). Improvements in systolic blood pressure were similar by literacy status. CONCLUSIONS: Literacy may be an important factor for predicting who will benefit from an intervention for diabetes management. A diabetes disease management program that addresses literacy may be particularly beneficial for patients with low literacy, and increasing access to such a program could help reduce health disparities.

Purpose The purpose of this paper is to present a hybrid manufacturing system that integrates stereolithography (SL) and direct print (DP) technologies to fabricate three‐dimensional (3D) structures with embedded electronic circuits. A detailed process was developed that enables fabrication of monolithic 3D packages with electronics without removal from the hybrid SL/DP machine during the process. Successful devices are demonstrated consisting of simple 555 timer circuits designed and fabricated in 2D (single layer of routing) and 3D (multiple layers of routing and component placement). Design/methodology/approach A hybrid SL/DP system was designed and developed using a 3D Systems SL 250/50 machine and an nScrypt micro‐dispensing pump integrated within the SL machine through orthogonally‐aligned linear translation stages. A corresponding manufacturing process was also developed using this system to fabricate 2D and 3D monolithic structures with embedded electronic circuits. The process involved part design, process planning, integrated manufacturing (including multiple starts and stops of both SL and DP and multiple intermediate processes), and post‐processing. SL provided substrate/mechanical structure manufacturing while interconnections were achieved using DP of conductive inks. Simple functional demonstrations involving 2D and 3D circuit designs were accomplished. Findings The 3D micro‐dispensing DP system provided control over conductive trace deposition and combined with the manufacturing flexibility of the SL machine enabled the fabrication of monolithic 3D electronic structures. To fabricate a 3D electronic device within the hybrid SL/DP machine, a process was developed that required multiple starts and stops of the SL process, removal of uncured resin from the SL substrate, insertion of active and passive electronic components, and DP and laser curing of the conductive traces. Using this process, the hybrid SL/DP technology was capable of successfully fabricating, without removal from the machine during fabrication, functional 2D and 3D 555 timer circuits packaged within SL substrates. Research limitations/implications Results indicated that fabrication of 3D embedded electronic systems is possible using the hybrid SL/DP machine. A complete manufacturing process was developed to fabricate complex, monolithic 3D structures with electronics in a single set‐up, advancing the capabilities of additive manufacturing (AM) technologies. Although the process does not require removal of the structure from the machine during fabrication, many of the current sub‐processes are manual. As a result, further research and development on automation and optimization of many of the sub‐processes are required to enhance the overall manufacturing process. Practical implications A new methodology is presented for manufacturing non‐traditional electronic systems in arbitrary form, while achieving miniaturization and enabling rugged structure. Advanced applications are demonstrated using a semi‐automated approach to SL/DP integration. Opportunities exist to fully automate the hybrid SL/DP machine and optimize the manufacturing process for enhancing the commercial appeal for fabricating complex systems. Originality/value This work broadly demonstrates what can be achieved by integrating multiple AM technologies together for fabricating unique devices and more specifically demonstrates a hybrid SL/DP machine that can produce 3D monolithic structures with embedded electronics and printed interconnects.

Electric transportation has many attractive features in today's energy environment including decreasing greenhouse gas emissions from the transportation sector, reducing dependence on imported petroleum, and potentially providing consumers a lower cost alternative to gasoline. Plug-in hybrid electric (PHEV) vehicles represent the most promising approach to electrification of a significant portion of the transportation sector. Electric power utilities recognize this possibility and must analyze the associated impacts to electric system operations. This paper provides details of analytical framework developed to evaluate the impact of PHEV loading on distribution system operations as part of a large, multi-utility collaborative study. This paper also summarizes partial results of the impact of PHEVs on one utility distribution feeder.

Overview Upper gastrointestinal tract cancers originating in the esophagus, esophagogastric junction (EGJ), and stomach constitute a major health problem around the world. An estimated 37,640 new cases of and 25,070 deaths from upper gastrointestinal cancers occurred in the United States in 2010.1 A dramatic shift in the location of upper gastrointestinal tumors has occurred in the United States.2,3 Changes in hisNCCN

OBJECTIVE: To determine a contemporary failed extubation rate, risk factors, and consequences of extubation failure in pediatric intensive care units (PICUs). Three hypotheses were investigated: a) Extubation failure is in part disease specific; b) preexisting respiratory conditions predispose to extubation failure; and c) admission acuity scoring does not affect extubation failure. DESIGN: Twelve-month prospective, observational, clinical study. SETTING: Sixteen diverse PICUs in the United States. PATIENTS: Patients were 2,794 patients from the newborn period to 18 yrs of age experiencing a planned extubation trial. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A descriptive statistical analysis was performed, and outcome differences of the failed extubation population were determined. The extubation failure rate was 6.2% (174 of 2,794; 95% confidence interval, 5.3-7.1). Patient features associated with extubation failure (p <.05) included age < or =24 months; dysgenetic condition; syndromic condition; chronic respiratory disorder; chronic neurologic condition; medical or surgical airway condition; chronic noninvasive positive pressure ventilation; the need to replace the endotracheal tube on admission to the PICU; and the use of racemic epinephrine, steroids, helium-oxygen therapy (heliox), or noninvasive positive pressure ventilation within 24 hrs of extubation. Patients failing extubation had longer pre-extubation intubation time (failed, 148.7 hrs, SD +/- 207.8 vs. success, 107.9 hrs, SD +/- 171.3; p <.001), longer PICU length of stay (17.5 days, SD +/- 15.6 vs. 7.6 days, SD +/- 11.1; p <.001), and a higher mortality rate than patients not failing extubation (4.0% vs. 0.8%; p <.001). Failure was found to be in part disease specific, and preexisting respiratory conditions were found to predispose to failure whereas admission acuity did not. CONCLUSION: A variety of patient features are associated with an increase in extubation failure rate, and serious outcome consequences characterize the extubation failure population in PICUs.

The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Pancreatic Adenocarcinoma discuss the workup and management of tumors of the exocrine pancreas. These NCCN Guidelines Insights provide a summary and explanation of major changes to the 2012 NCCN Guidelines for Pancreatic Adenocarcinoma. The panel made 3 significant updates to the guidelines: 1) more detail was added regarding multiphase CT techniques for diagnosis and staging of pancreatic cancer, and pancreas protocol MRI was added as an emerging alternative to CT; 2) the use of a fluoropyrimidine plus oxaliplatin (e.g., 5-FU/leucovorin/oxaliplatin or capecitabine/oxaliplatin) was added as an acceptable chemotherapy combination for patients with advanced or metastatic disease and good performance status as a category 2B recommendation; and 3) the panel developed new recommendations concerning surgical technique and pathologic analysis and reporting.

The ALICE experiment has measured the inclusive $J/\ensuremath{\psi}$ production in Pb-Pb collisions at $\sqrt{{s}_{\mathrm{NN}}}=2.76\text{ }\text{ }\mathrm{TeV}$ down to zero transverse momentum in the rapidity range $2.5&lt;y&lt;4$. A suppression of the inclusive $J/\ensuremath{\psi}$ yield in Pb-Pb is observed with respect to the one measured in $pp$ collisions scaled by the number of binary nucleon-nucleon collisions. The nuclear modification factor, integrated over the 0%--80% most central collisions, is $0.545\ifmmode\pm\else\textpm\fi{}0.032(\mathrm{stat})\ifmmode\pm\else\textpm\fi{}0.083(\mathrm{syst})$ and does not exhibit a significant dependence on the collision centrality. These features appear significantly different from measurements at lower collision energies. Models including $J/\ensuremath{\psi}$ production from charm quarks in a deconfined partonic phase can describe our data.

The oomycete vegetable pathogen Phytophthora capsici has shown remarkable adaptation to fungicides and new hosts. Like other members of this destructive genus, P. capsici has an explosive epidemiology, rapidly producing massive numbers of asexual spores on infected hosts. In addition, P. capsici can remain dormant for years as sexually recombined oospores, making it difficult to produce crops at infested sites, and allowing outcrossing populations to maintain significant genetic variation. Genome sequencing, development of a high-density genetic map, and integrative genomic or genetic characterization of P. capsici field isolates and intercross progeny revealed significant mitotic loss of heterozygosity (LOH) in diverse isolates. LOH was detected in clonally propagated field isolates and sexual progeny, cumulatively affecting >30% of the genome. LOH altered genotypes for more than 11,000 single-nucleotide variant sites and showed a strong association with changes in mating type and pathogenicity. Overall, it appears that LOH may provide a rapid mechanism for fixing alleles and may be an important component of adaptability for P. capsici.

The ALICE Collaboration at the LHC has measured the J/ and photoproduction at mid-rapidity in ultra-peripheral Pb-Pb collisions at s NN = 2.76 TeV. The charmonium is identified via its leptonic decay for events where the hadronic activity is required to be minimal. The analysis is based on an event sample corresponding to an integrated luminosity of about 23 b -1 . The cross section for coherent and incoherent J/ production in the rapidity interval -0.9 < y < 0.9, are d coh J/ /dy = 2.38 +0.34 -0.24 (sta + sys) mb and d inc J/ /dy = 0.98 +0.19 -0.17 (sta + sys) mb, respectively. The results are compared to theoretical models for J/ production and the coherent cross section is found to be in good agreement with those models incorporating moderate nuclear gluon shadowing at Bjorkenx around 10 -3 , such as EPS09 parametrization. In addition the cross section for the process e + e -has been measured and found to be in agreement with models implementing QED at leading order.