You Can\u27t Imagine This Life. Diaries and Letters of a Southern-Jewish Grande Dame, Josephine Joel Heyman, 1901-1993.

Josephine Jo Joel Heyman (1901--1993) provides an intimate and touching record of twentieth century upper-middle-class Atlanta-Jewish life through her teenage and young adult diaries and letters. Through her autobiographical writings, this twentieth century Southern-Jewish woman\u27s regional, ethnic, and gender identities are revealed. Mrs. Heyman, an influential civic leader in Atlanta, Georgia, graduated Phi Beta Kappa from Smith College. She began writing diaries as a child to express her private feelings and thoughts, and as a young adult she wrote letters from college to her future fiance. The backdrop of her personal story is the story of the Southern-Jewish community, which began with her grandparents immigrating to the United States in the nineteenth century and continues with the lives of her children and grandchildren into the twenty-first century. Josephine Joel\u27s childhood was conventional for an Atlanta Jewish girl, but she developed a particularly forceful personality. As an adult she chose to use her talents to better humankind through an extensive volunteer, leadership career. She was active in progressive Atlanta Jewish circles during turbulent and memorable decades of fights for African American Civil Rights. Mrs. Heyman\u27s adult life provides a prime example of the new roles provided for women and American Jews in the twentieth century

Applying the transtheoretical model of change to court-ordered/DUI outpatient treatment clients

This study applied the Transtheoretical model of change to a court ordered/DUI client population to aid counselors in developing a more effective differential treatment model. Clients were individuals convicted of DUI and referred for treatment to one of 4 community mental health centers. at their first meeting, 150 clients completed surveys measuring stage of change (SOC), processes of change, self-efficacy, and decisional balance concerning their drinking. Demographic data was also taken. After treatment, number of sessions attended and successful or unsuccessful discharge was recorded.;Results found significantly more men (122) than women (28). There were significantly more men (81%) than women (51%) in the Precontemplation SOC, with significantly more women (25%) than men (10%) in the Action SOC. A comparison of SOC with the volunteer alcoholism treatment clients in DiClemente & Hughes (1990) study showed significantly more Precontemplators and significantly fewer Action clients.;All 10 processes of change were significantly higher both in the Action SOC and Contemplation SOC than in the Precontemplation SOC. Self-efficacy scores were higher than temptation scores throughout all 3 SOC and did not vary according to the SOC. Cons of drinking were higher than the pros during all 3 SOC. Pros of drinking did not vary according to the SOC but the cons varied with both Contemplators and Action clients reporting significantly higher scores than Precontemplators. Approximately 64% of clients completed treatment successfully, 32% completed unsuccessfully, and 4% moved away during treatment regardless of agency, counselor, or stage of change.;Results support application of this model to a court ordered population

HfO2 based memory devices with rectifying capabilities

We report on the fabrication and characterization of metal/insulator/metal capacitor like devices, with both rectifying and hysteretic features. Devices are formed by two junctions, Ti/HfO2 and Co/HfO2. Each junction exhibits highly repetitive hysteretic I-V curves with a sharp transition from a high to a low resistance state (3–4 orders of magnitude jump). The opposite transition (from low to high) is induced by polarity reversal. The rectifying non-crossing characteristics of the I-V branches denote their potential use as a multifunctional device, acting as a built-in rectifier and memory cell in a single device. Based on the phenomenological model description by Zazpe et al. [Appl. Phys. Lett. 103, 073114 (2013)], we propose a circuital equivalent representation supported on switchable rectifying junctions. By exploring different electrode connections, we disentangle the role of the bulk transport in HfO2 devices.Fil: Quinteros, Cynthia Paula. Comisión Nacional de Energía Atómica. Gerencia del Área Investigaciones y Aplicaciones no Nucleares; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Zaspe, R.. CIC nanoGUNE; EspañaFil: Marlasca, F. G.. Comisión Nacional de Energía Atómica. Gerencia del Área Investigaciones y Aplicaciones no Nucleares; ArgentinaFil: Golmar, Federico. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Instituto Nacional de Tecnología Industrial; Argentina. Universidad Nacional de San Martín. Escuela de Ciencia y Tecnología; ArgentinaFil: Casanova, F.. CIC nanoGUNE; España. Fundación Vasca para la Ciencia; EspañaFil: Stoliar, Pablo Alberto. Universidad Nacional de San Martín. Escuela de Ciencia y Tecnología; Argentina. Centre National de la Recherche Scientifique; Francia. Universite de Nantes; FranciaFil: Hueso, L.. Fundación Vasca para la Ciencia; España. CIC nanoGUNE; EspañaFil: Levy, Pablo Eduardo. Comisión Nacional de Energía Atómica. Gerencia del Área Investigaciones y Aplicaciones no Nucleares; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Factors Affecting Access to Administrative Health Data for Research in Canada: A Study Protocol

In Canada, most provinces have established administrative health data repositories to facilitate access to these data for research. Anecdotally, researchers have described delays and substantial inter-provincial variations in the timeliness of data access approvals and receipt of data. Currently, the reasons for these delays and variations in timeliness are not well understood. This paper provides a study protocol for (1) identifying the factors affecting access to administrative health data for research within select Canadian provinces, and (2) comparing factors across provinces to assess whether and how they contribute to inter-provincial variations in access to administrative health data for research

Impact on follow-up strategies in patients with primary sclerosing cholangitis.

BACKGROUND & AIMS Evidence for the benefit of scheduled imaging for early detection of hepatobiliary malignancies in primary sclerosing cholangitis (PSC) is limited. We aimed to compare different follow-up strategies in PSC with the hypothesis that regular imaging improves survival. METHODS We collected retrospective data from 2975 PSC patients from 27 centres. Patients were followed from the start of scheduled imaging or in case of clinical follow-up from 1 January 2000, until death or last clinical follow-up alive. The primary endpoint was all-cause mortality. RESULTS A broad variety of different follow-up strategies were reported. All except one centre used regular imaging, ultrasound (US) and/or magnetic resonance imaging (MRI). Two centres used scheduled endoscopic retrograde cholangiopancreatography (ERCP) in addition to imaging for surveillance purposes. The overall HR (CI95%) for death, adjusted for sex, age and start year of follow-up, was 0.61 (0.47-0.80) for scheduled imaging with and without ERCP; 0.64 (0.48-0.86) for US/MRI and 0.53 (0.37-0.75) for follow-up strategies including scheduled ERCP. The lower risk of death remained for scheduled imaging with and without ERCP after adjustment for cholangiocarcinoma (CCA) or high-grade dysplasia as a time-dependent covariate, HR 0.57 (0.44-0.75). Hepatobiliary malignancy was diagnosed in 175 (5.9%) of the patients at 7.9 years of follow-up. Asymptomatic patients (25%) with CCA had better survival if scheduled imaging had been performed. CONCLUSIONS Follow-up strategies vary considerably across centres. Scheduled imaging was associated with improved survival. Multiple factors may contribute to this result including early tumour detection and increased endoscopic treatment of asymptomatic benign biliary strictures

Implications of Electronics Constraints for Solid-State Quantum Error Correction and Quantum Circuit Failure Probability

In this paper we present the impact of classical electronics constraints on a solid-state quantum dot logical qubit architecture. Constraints due to routing density, bandwidth allocation, signal timing, and thermally aware placement of classical supporting electronics significantly affect the quantum error correction circuit's error rate. We analyze one level of a quantum error correction circuit using nine data qubits in a Bacon-Shor code configured as a quantum memory. A hypothetical silicon double quantum dot quantum bit (qubit) is used as the fundamental element. A pessimistic estimate of the error probability of the quantum circuit is calculated using the total number of gates and idle time using a provably optimal schedule for the circuit operations obtained with an integer program methodology. The micro-architecture analysis provides insight about the different ways the electronics impact the circuit performance (e.g., extra idle time in the schedule), which can significantly limit the ultimate performance of any quantum circuit and therefore is a critical foundation for any future larger scale architecture analysis.Comment: 10 pages, 7 figures, 3 table

A Randomized, Controlled, Phase 2 Study of Maralixibat in the Treatment of Itching Associated With Primary Biliary Cholangitis.

Primary biliary cholangitis (PBC) is typically associated with elevated serum bile acid levels and pruritus, but pruritus is often refractory to treatment with existing therapies. This phase 2 study assessed the efficacy and safety of maralixibat, a selective, ileal, apical, sodium-dependent, bile acid transporter inhibitor, in adults with PBC and pruritus. Adults with PBC and pruritus who had received ursodeoxycholic acid (UDCA) for ≥6 months or were intolerant to UDCA were randomized 2:1 to maralixibat (10 or 20 mg/day) or placebo for 13 weeks in combination with UDCA (when tolerated). The primary outcome was change in Adult Itch Reported Outcome (ItchRO™) average weekly sum score (0, no itching; 70, maximum itching) from baseline to week 13/early termination (ET). The study enrolled 66 patients (maralixibat [both doses combined], n = 42; placebo, n = 24). Mean ItchRO™ weekly sum scores decreased from baseline to week 13/ET with maralixibat (-26.5; 95% confidence interval [CI], -31.8, -21.2) and placebo (-23.4; 95% CI, -30.3, -16.4). The difference between groups was not significant (P = 0.48). In the maralixibat and placebo groups, adverse events (AEs) were reported in 97.6% and 70.8% of patients, respectively. Gastrointestinal disorders were the most frequently reported AEs (maralixibat, 78.6%; placebo, 50.0%). Conclusion: Reductions in pruritus did not differ significantly between maralixibat and placebo. However, a large placebo effect may have confounded assessment of pruritus. Lessons learned from this rigorously designed and executed trial are indispensable for understanding how to approach trials assessing pruritus as the primary endpoint and the therapeutic window of bile acid uptake inhibition as a therapeutic strategy in PBC

Evaluating the Patient-Reported Outcomes Measurement Information System scales in acute intermittent porphyria.

PurposeAcute intermittent porphyria (AIP) is a rare inborn error of heme biosynthesis characterized by life-threatening acute attacks. Few studies have assessed quality of life (QoL) in AIP and those that have had small sample sizes and used tools that may not have captured important domains.MethodsBaseline data from the Porphyrias Consortium's Longitudinal Study were obtained for 259 patients, including detailed disease and medical history data, and the following Patient-Reported Outcomes Measurement Information System (PROMIS) scales: anxiety, depression, pain interference, fatigue, sleep disturbance, physical function, and satisfaction with social roles. Relationships between PROMIS scores and clinical and biochemical AIP features were explored.ResultsPROMIS scores were significantly worse than the general population across all domains, except depression. Each domain discriminated well between asymptomatic and symptomatic patients with symptomatic patients having worse scores. Many important clinical variables like symptom frequency were significantly associated with domain scores in univariate analyses, showing responsiveness of the scales, specifically pain interference and fatigue. However, most regression models only explained ~20% of the variability observed in domain scores.ConclusionPain interference and fatigue were the most responsive scales in measuring QoL in this AIP cohort. Future studies should assess whether these scales capture longitudinal disease progression and treatment response

The Atomic Layer Deposition Technique for the Fabrication of Memristive Devices: Impact of the Precursor on Pre-deposited Stack Materials

Atomic layer deposition (ALD) is a standard technique employed to grow thin-film oxides for a variety of applications. We describe the technique and demonstrate its use for obtaining memristive devices. The metal/insulator/metal stack is fabricated by means of ALD-grown HfO2, deposited on top of a highly doped Si substrate with an SiO2 film and a Ti electrode. Enhanced device capabilities (forming free, self-limiting current, non-crossing hysteretic current-voltage features) are presented and discussed. Careful analysis of the stack structure by means of X-ray reflectometry, atomic force microscopy, and secondary ion mass spectroscopy revealed a modification of the device stack from the intended sequence, HfO2/Ti/SiO2/Si. Analytical studies unravel an oxidation of the Ti layer which is addressed for the use of the ozone precursor in the HfO2 ALD process. A new deposition process and the model deduced from impedance measurements support our hypothesis: the role played by ozone on the previously deposited Ti layer is found to determine the overall features of the device. Besides, these ALD-tailored multifunctional devices exhibit rectification capability and long enough retention time to deserve their use as memory cells in a crossbar architecture and multibit approach, envisaging other potential applications

Gastrointestinal Kohlmeier-Degos disease: a narrative review

INTRODUCTION: Kohlmeier-Degos (K-D) disease is a rare obliterative vasculopathy that can present as a benign cutaneous form or with potentially malignant systemic involvement. The gastrointestinal tract is most frequently involved in systemic disease and mortality is often related to bowel perforations. Herein, we provide information to providers and patients regarding gastrointestinal K-D symptomology, pathology, treatment, and diagnosis, with a focus on the importance of timely diagnostic laparoscopy. We present three new cases of gastrointestinal K-D to highlight varying disease presentations and outcomes. BODY: Based on reviewed reports, perforation is preceded by at least one gastrointestinal symptom: abdominal pain/cramping, anorexia/weight loss, vomiting, diarrhea, nausea, gastrointestinal bleeding, obstipation, constipation, and abdominal fullness. Perforation most commonly occurs in the small intestine and often results in sepsis and death. Although underutilized, laparoscopy is the most sensitive and specific diagnostic technique, demonstrating serosal porcelain plaques similar to those on the skin and characteristic for K-D. The combination of eculizumab and treprostinil is presently the most effective treatment option for gastrointestinal K-D. The pathology of gastrointestinal K-D is characterized by an obliterative intimal arteriopathy eventuating in occlusive acellular deposits of mucin and collagen along with an extravascular pauci-cellular sclerosing process resembling scleroderma confined to the subserosal fat. C5b-9 and interferon-alpha are both expressed in all caliber of vessels in the affected intestine. While C5b-9 blockade does not prevent the intimal expansion, enhanced type I interferon signaling is likely a key determinant to intimal expansion by, causing an influx of monocytes which transdifferentiate into procollagen-producing myofibroblast-like cells. CONCLUSION: Prompt laparoscopic evaluation is necessary in any K-D patient with an abdominal symptom to facilitate diagnosis and treatment initiation, as well as to hopefully decrease mortality. Those with gastrointestinal K-D should start on eculizumab as soon as possible, as onset of action is immediate