Intention and Actuality in the Fiction of William Dean Howells

This study of Howells\u27 fiction is a discussion of representative novels of the author\u27s from A Foregone Conclusion in 1875 through his last novel, The Vacation of the Kelwyns, in 1920. The arrangement of the novels in chronological order is primarily for convenience; no attempt has been made to trace the literary development of the author. My purpose, rather, has been to show that Howells, throughout the greater part of his career as a novelist, was consistent in his literary method. To understand that method is to have a better understanding of meaning in the novels. Finally, in demonstrating that there exists a genuine relationship between method and meaning in the novels, I have suggested that Howells\u27 fiction embodies an attitude which, as later formulated in the philosophy of William James, came to be known as pragmatism

Executable Architectures and their Application to a Geographically Distributed Air Operations Center

Integrated Architectures and Network Centric Warfare represent two central concepts in the Department of Defense\u27s (DoD) on-going transformation. The true power of integrated architectures is brought to bear when they are combined with simulation to move beyond a static representation and create an executable architecture. This architecture can then be used to experiment with system configurations and parameter values to guide employment decisions. The process of developing and utilizing an executable architecture will be employed to assess an Air Operations Center (AOC). This thesis applies and expands upon the methodology of Dr. Alexander Levis, former Chief Scientist of the Air Force, to the static architecture representing the Aerospace Operations Center (AOC). Using Colored Petri Nets and other simulation tools, an executable architecture for the AOC\u27s Air Tasking Order (ATO) production thread was developed. These models were then used to compare the performance of a current, forward-deployed AOC configuration to three other potential configurations that utilize a network centric environment to deploy a portion of the AOC and provide reach-back capabilities to the non-deployed units. Performance was measured by the amount of time required to execute the ATO cycle under each configuration. Communication requirements were analyzed for each configuration and stochastic delays were modeled for all transactions in which requirements could not be met due to the physical configuration of the AOC elements. All four configurations were found to exhibit statistically different behavior with regard to ATO cycle time

Prospective relationships between body weight and physical activity: an observational analysis from the NAVIGATOR study

Objectives: While bidirectional relationships exist between body weight and physical activity, direction of causality remains uncertain and previous studies have been limited by self-reported activity or weight and small sample size. We investigated the prospective relationships between weight and physical activity. Design: Observational analysis of data from the Nateglinide And Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) study, a double-blinded randomised clinical trial of nateglinide and valsartan, respectively. Setting Multinational study of 9306 participants. Participants: Participants with biochemically confirmed impaired glucose tolerance had annual measurements of both weight and step count using research grade pedometers, worn for 7 days consecutively. Along with randomisation to valsartan or placebo plus nateglinide or placebo, participants took part in a lifestyle modification programme. Outcome measures: Longitudinal regression using weight as response value and physical activity as predictor value was conducted, adjusted for baseline covariates. Analysis was then repeated with physical activity as response value and weight as predictor value. Only participants with a response value preceded by at least three annual response values were included. Results: Adequate data were available for 2811 (30%) of NAVIGATOR participants. Previous weight (χ2=16.8; p<0.0001), but not change in weight (χ2=0.1; p=0.71) was inversely associated with subsequent step count, indicating lower subsequent levels of physical activity in heavier individuals. Change in step count (χ2=5.9; p=0.02) but not previous step count (χ2=0.9; p=0.34) was inversely associated with subsequent weight. However, in the context of trajectories already established for weight (χ2 for previous weight measurements 747.3; p<0.0001) and physical activity (χ2 for previous step count 432.6; p<0.0001), these effects were of limited clinical importance. Conclusions: While a prospective bidirectional relationship was observed between weight and physical activity, the magnitude of any effect was very small in the context of natural trajectories already established for these variables

Altered cellular infiltration and cytokine levels during early Mycobacterium tuberculosis sigC mutant infection are associated with late-stage disease attenuation and milder immunopathology in mice

<p>Abstract</p> <p>Background</p> <p>Mouse virulence assessments of certain <it>Mycobacterium tuberculosis </it>mutants have revealed an immunopathology defect in which high tissue CFU counts are observed but the tissue pathology and lethality are reduced. <it>M. tuberculosis </it>mutants which grow and persist in the mouse lungs, but have attenuated disease progression, have the immunopathology (<it>imp</it>) phenotype. The antigenic properties of these strains may alter the progression of disease due to a reduction in host immune cell recruitment to the lungs resulting in disease attenuation and prolonged host survival.</p> <p>Results</p> <p>In this study we focused on the mouse immune response to one such mutant; the <it>M. tuberculosis </it>Δ<it>sigC </it>mutant. Aerosol infection of DBA/2 and SCID mice with the <it>M. tuberculosis </it>Δ<it>sigC </it>mutant, complemented mutant and wild type strain showed proliferation of mutant bacilli in mouse lungs, but with decreased inflammation and mortality in DBA/2 mice. SCID mice shared the same phenotype as the DBA/2 mice in response to the Δ<it>sigC </it>mutant, however, they succumbed to the infection faster. Bronchoalveolar lavage (BAL) fluid analysis revealed elevated numbers of infiltrating neutrophils in the lungs of mice infected with wild type and complemented Δ<it>sigC </it>mutant strains but not in mice infected with the Δ<it>sigC </it>mutant. In addition, DBA/2 mice infected with the Δ<it>sigC </it>mutant had reduced levels of TNF-α, IL-1β, IL-6 and IFN-γ in the lungs. Similarly, there was a reduction in proinflammatory cytokines in the lungs of SCID mice. In contrast to the mouse model, the Δ<it>sigC </it>mutant had reduced initial growth in guinea pig lungs. A possible mechanism of attenuation in the Δ<it>sigC </it>mutant may be a reduction in neutrophilic-influx in the alveolar spaces of the lungs, and decreased proinflammatory cytokine secretion. In contrast to mouse data, the <it>M. tuberculosis </it>Δ<it>sigC </it>mutant proliferates slowly in guinea pig lungs, a setting characterized by caseating necrosis.</p> <p>Conclusion</p> <p>Our observations suggest that the immunopathology phenotype is associated with the inability to trigger a strong early immune response, resulting in disease attenuation. While macrophages and T cells have been shown to be important in containing <it>M. tuberculosis </it>disease our study has shown that neutrophils may also play an important role in the containment of this organism.</p

Efficacy of pulmonary artery pressure monitoring in patients with chronic heart failure:a meta-analysis of three randomized controlled trials

Aims Adjustment of treatment based on remote monitoring of pulmonary artery (PA) pressure may reduce the risk of hospital admission for heart failure (HF). We have conducted a meta-analysis of large randomized trials investigating this question. Methods A systematic literature search was performed for randomized clinical trials with PA pressure monitoring devices in patients and results with HF. The primary outcome of interest was the total number of HF hospitalizations. Other outcomes assessed were urgent visits leading to treatment with intravenous diuretics, all-cause mortality, and composites. Treatment effects are expressed as hazard ratios, and pooled effect estimates were obtained applying random effects meta-analyses. Three eligible randomized clinical trials were identified that included 1898 outpatients in New York Heart Association functional classes II–IV, either hospitalized for HF in the prior 12 months or with elevated plasma NT-proBNP concentrations. The mean followup was 14.7 months, 67.8% of the patients were men, and 65.8% had an ejection fraction ≤40%. Compared to patients in the control group, the hazard ratio (95% confidence interval) for total HF hospitalizations in those randomized to PA pressure monitoring was 0.70 (0.58–0.86) (P = .0005). The corresponding hazard ratio for the composite of total HF hospitalizations, urgent visits and all-cause mortality was 0.75 (0.61–0.91; P = .0037) and for all-cause mortality 0.92 (0.73–1.16). Subgroup analyses, including ejection fraction phenotype, revealed no evidence of heterogeneity in the treatment effect. Conclusion The use of remote PA pressure monitoring to guide treatment of patients with HF reduces episodes of worsening HF and subsequent hospitalizations.</p

The Impact of Mouse Passaging of Mycobacterium tuberculosis Strains prior to Virulence Testing in the Mouse and Guinea Pig Aerosol Models

It has been hypothesized that the virulence of lab-passaged Mycobacterium tuberculosis and recombinant M. tuberculosis mutants might be reduced due to multiple in vitro passages, and that virulence might be augmented by passage of these strains through mice before quantitative virulence testing in the mouse or guinea pig aerosol models.By testing three M. tuberculosis H37Rv samples, one deletion mutant, and one recent clinical isolate for survival by the quantitative organ CFU counting method in mouse or guinea pig aerosol or intravenous infection models, we could discern no increase in bacterial fitness as a result of passaging of M. tuberculosis strains in mice prior to quantitative virulence testing in two animal models. Surface lipid expression as assessed by neutral red staining and thin-layer chromatography for PDIM analysis also failed to identify virulence correlates.These results indicate that animal passaging of M. tuberculosis strains prior to quantitative virulence testing in mouse or guinea pig models does not enhance or restore potency to strains that may have lost virulence due to in vitro passaging. It is critical to verify virulence of parental strains before genetic manipulations are undertaken and comparisons are made

Radiosynthesis of (R,S)-[18 F]GE387: A Potential PET Radiotracer for Imaging Translocator Protein 18 kDa (TSPO) with Low Binding Sensitivity to the Human Gene Polymorphism rs6971.

Translocator protein (TSPO) is a biomarker of neuroinflammation, which is a hallmark of many neurodegenerative diseases and has been exploited as a positron emission tomography (PET) target. Carbon-11-labelled PK11195 remains the most applied agent for imaging TSPO, despite its short-lived isotope and low brain permeability. Second-generation radiotracers show variance in affinity amongst subjects (low-, mixed-, and high-affinity binders) caused by the genetic polymorphism (rs6971) of the TSPO gene. To overcome these limitations, a new structural scaffold was explored based on the TSPO pharmacophore, and the analogue with a low-affinity binder/high-affinity binder (LAB/HAB) ratio similar (1.2 vs. 1.3) to that of (R)-[11 C]PK11195 was investigated. The synthesis of the reference compound was accomplished in six steps and 9 % overall yield, and the precursor was prepared in eight steps and 8 % overall yield. The chiral separation of the reference and precursor compounds was performed using supercritical fluid chromatography with >95 % ee. The absolute configuration was determined by circular dichroism. Optimisation of reaction conditions for manual radiolabelling revealed acetonitrile as a preferred solvent at 100 °C. Automation of this radiolabelling method provided R and S enantiomers in respective 21.3±16.7 and 25.6±7.1 % decay-corrected yields and molar activities of 55.8±35.6 and 63.5±39.5 GBq μmol-1 (n=3). Injection of the racemic analogue into a healthy rat confirmed passage through the blood-brain barrier.This work was supported by Medical Research Council (UK) grant awards RG46503 (LM, MH, XZ) and RG70550 (EF), National Institute of Health Research (UK), Cambridge Biomedical Research Unit in Dementia (EF, NKR) and the Herchel Smith Fellowship programme (LQ)

Optimal background pharmacological therapy for heart failure patients in clinical trials: JACC review topic of the week

With the current landscape of approved therapies for heart failure (HF), there is a need to determine the role of a standard background therapy against which novel therapies are studied. The Heart Failure Collaboratory convened a multistakeholder group of clinical investigators, clinicians, patients, government representatives including U.S. Food and Drug Administration and National Institutes of Health participants, payers, and industry in March 2021 to discuss whether standardization of background drug therapy is necessary in clinical trials in patients with HF. The current paper summarizes the discussion and provides potential conceptual approaches, with a focus on therapies indicated for HF with reduced ejection fraction