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The emergency department (ED) may represent a missed opportunity to proactively intervene upon patients at "high risk" for HIV. We sought to describe characteristics of ED HIV seroconverters (individuals who screened positive in the ED for HIV who had either (1) a previous prior negative HIV test in the electronic health record (EHR) or who (2) self-reported a prior negative HIV test) to identify a "high-risk" phenotype for pre-infection engagement. A retrospective chart-review was performed of HIV seroconverters at an academic, urban ED. General demographics, mental health illness comorbidities, and Centers for Disease Control and Prevention (CDC)-identified "high risk" factors, including intravenous drug use (IVDU) and history of sexually transmitted infection (STI) were noted. One hundred thirty total patients were identified, 48 (36.9%) with prior HER-negative test and 82 (63.1%) with self-reported previous negative test. Of total seroconverters: 100 (76.9%) were male and 77 (59.2%) were between the ages of 13-34, comparable to national rates of new HIV diagnoses. Ninety-two patients (70.8%) were Black and 16 (12.3%) had a history of IVDU, significantly increased compared with regional and national new HIV rates (

This paper presents the main findings of a seismic performance assessment for mutiblock tower structures designed to store renewable energy. To perform our assessment, we deployed in tandem physical and numerical models that were developed using appropriate scaling for Newtonian systems that interact via frictional contact. The approach is novel, breaking away from continuum structures where Cauchy scaling and continuum mechanics are used to model such systems. We show that our discontinuous approach is predictive and consistent. We demonstrate predictiveness by showing that the numerical models can reproduce with high fidelity the physical models deployed across two different scales. Consistency is demonstrated by showing that our models can be seamlessly compared across scales and without regard for whether the model is physical or numerical. The integrated theoretical-numerical-experimental approach provides a robust framework to study multiblock tower structures and the results of our seismic performance assessments are promising. These findings may open the door for new analysis tools in structural mechanics, particularly those applied to gravity energy storage systems.

Motivated by the need to evaluate the seismic response of large capacity gravity energy storage systems (potential energy batteries) such as the proposed frictional Multiblock Tower Structures (MTS) recently discussed by Andrade et al. [1], we apply Buckingham’s Pi Theorem [2] to identify the most general forms of dimensionless numbers and dynamic similitude laws appropriate for scaling discontinuous multiblock structural systems involving general restoring forces resisting inertial loading. We begin by introducing the dimensionless “mu-number” (μN) appropriate for both gravitational and frictional restoring forces and then generalize by introducing the “arbitrary restoring force number” (RFN ). RFN is subsequently employed to study similitude in various types of discontinuous or discrete systems featuring frictional, gravitational, cohesive, elastic and mixed restoring forces acting at the block interfaces. In the process, we explore the additional consequences of inter and intra-block elasticity on scaling. We also formulate a model describing the mechanism of structural signal transmission for the case of rigid MTS featuring inter-block restoring forces composed of elastic springs and interfacial friction, introducing the concept of “structural speed”. Finally, we validate our results by demonstrating that dynamic time-histories of field quantities and structural speeds between MTS models at various scales are governed by our proposed similitude laws, thus demonstrating the consistency of our approach.

INTRODUCTION METHODS Background: Rigid protocols can hamper translation of evidence-based interventions (EBIs) from research to real-world settings. Nevertheless, employing principles of community-based participatory research holds potential for successful implementation. The primary aim of this investigation was to develop procedures for modifying the study protocol of a colorectal cancer screening educational intervention implemented in African American communities to fit local needs while maintaining fidelity to its core elements. Methods: To ensure sustainability of the Educational Program to Increase Colorectal Cancer Screening (EPICS), four-hour guided discussions between researchers and 15 community coalitions were undertaken to include: 1) assessing strengths, weaknesses, opportunities and threats; 2) establishing specific, measurable, achievable, realistic and timely goals; and 3) developing local action plans. Results: In the local action plans, adherence to core intervention elements (theoretical framework, educational content, and sessions) was maintained with adaptation to roles and responsibilities. For example, the coalition leader modified views to reflect local ownership of data and members accepted responsibilities for marketing, education, communication, and data management. Conclusions: Enhancing interactions between researchers and community partners and addressing weaknesses and threats ensure transition from efficacy to implementation and promote sustainability of interventions. Grant Support: NIH 1R01CA166785  Colorectal cancer (CRC) is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and in women. African Americans (AAs) have the highest over-all incidence, incidence of advanced stage at disease presentation, attributable mortality, and the lowest survival rates after diagnosis.  Although screening is an effective tool for reducing CRC mortality, differences in screening accounted for 42% of disparity in CRC incidence and 19% of disparity in CRC mortality between AAs and Whites.  EPICS is an EBI for increasing CRC screening rates among AAs. Core elements are listed in Table 1.  EPICS implementation is in partnership with community coalitions organized by the National Black Leadership Initiative on Cancer (NBLIC) in 15 communities across the United States.  Sustainability of the EBI is based on acceptability, capacity, and resources within the targeted communities, using an approach that is flexible enough for local relevance.  In the present study, investigators describe a method for enhancing dissemination by adjusting the EPICS study protocol to meet local contextual challenges. Guided by Glasgow’s Evidence Integration Triangle (EIT) [Fig. 1], a variety of issues faced at the 15 sites and the process by which the basic protocol was modified are described. 1. Discussions between investigators and leaders of each NBLIC community coalition to share information and develop action plans was completed. 2. SWOT Analysis (strengths or characteristics of community coalitions needed for delivery; weaknesses or challenges/ barriers to implementation; opportunities or elements that could be exploited; and threats or contextual risks to successful trial completion) was completed. 3. SMART (specific, measurable, actionable, realistic and timely) Goals related to facilitator and participant recruitment and retention were established. 4. Modification of the study protocol to reach SMART goals was completed. 1. Draft action plan was reviewed, revised, and distributed. 2. Final action plan was distributed.  Differences in priorities of the 15 participating communities inform challenges experienced.  Major themes emerging from the guided discussions included: 1) facilitator recruitment, training and roles 2) participant recruitment and retention  Specific challenges identified by coalitions were unique to each community, with synergy across sites.  Strategies outlined were based on the barriers identified, informed by community stakeholders [Table 2].  The community and its individual members constitute a “research participant”; it is appropriate that communities have the last word on the research approach that works best for them.  Multi-site research protocols may require adjustments.  Application of a conceptual framework (e.g., EIT model) is essential to maintaining integrity and ensuring fidelity to EBI core elements. DISCUSSION Table 2. Local EPICS Implementation Action Plan Element Approach Adaptation Option Theoretical Framework Diffusion of Innovations Theory Educational Content Guidelines for CRC (DRE*; FOBT*, Sigmoidoscopy; Colonoscopy); CRC Risk Factors (modifiable; nonmodifiable) Dietary and physical activity information adapted to fit the audience Sessions Group settings; three (3) one-hour sessions Size of group settings 3) Facilitators Public health professionals, cancer survivors and advocates, community members, church and civic leaders Other individuals interested in lowering CRC incidence and mortality Facilitator Training Training (11⁄2 day session) and TA* TA based on randomization Settings Churches, clinics and community sites Other settings Table 1. EPICS Core Elements RESULTS

Background . Stage III advanced locoregional esophageal carcinoma is frequently unresectable and inconsistently represented in therapeutic trials of esophageal cancer. Methods . From 1992 to 1998, 34 of 131 total esophageal cancer patients were designated stage III (16 T3N1, 9 T4N0, 9 T4N1) and medically fit to enter a combined modality protocol with continuous infusion 5-fluorouracil (CI5-FU, 300 to 600 mg/m 2 /day), high-dose external beam irradiation (60 Gy), and interval esophagectomy. Staging before and after induction therapy included computed tomography, endoscopy, and endoscopic ultrasound. Results . Significant toxicity from induction therapy included death (5/34; 14.7%), pneumonitis (5/34; 14.7%), mucositis (13/34; 38%), and hand-foot syndrome (3/34; 8.8%). In addition to the five deaths, 11 patients did not proceed to operation because of development of esophagorespiratory fistula in 3, distant disease in 2, persistence of T4 stage in 2, progression of comorbidities in 2, and patient refusal in 2. There was a discrepancy between clinical complete response (cCR) at restaging 56% (19/34) and pathologic CR (pCR) noted at the time of operation (8/34; 23.5%). Complete resections were possible in 16 of 18 patients explored. Complications in 4 patients included: death (1), airway injury (1), chylothorax requiring reoperation (1), anastomotic leak (1), recurrent nerve injury with vocal cord paresis (2), and ascaris infection (1). Actuarial survival analysis using the Kaplan-Meier method and log-rank testing showed a 36-month survival of 20% for the group as a whole and 27% for patients restaged cCR (cCR vs PR, p = 0.0046). Treatment failure is predominantly distant, with good local control in resected patients. N0 node status was strongly associated with survival (N0 vs N1 p = 0.0024). There is a trend towards improved survival in the resected group (resected 22% vs nonresected 10% at 3 years, p = 0.17). Conclusions . Response rates and survival are commensurate with multiple completed phase II and III trials. These are attained at a higher treatment-related mortality. T4 patients can be successfully resected in selected patients. Even in advanced disease, nodal status is a significant predictor of survival.

The GATA family of transcription factors promotes the normal development of the gastrointestinal tract during embryogenesis and determines tissue differentiation in adult gut epithelium. Loss of GATA-4 and GATA-5 has been reported in human gastric and colon cancer. We examined GATA-4,-5 and -6 gene expression in established esophageal squamous cancer cell lines and the relationship to DNA methylation in the promoter region of these genes. GATA-4 and GATA-5 expression was absent in most esophageal cancer cell lines, but was restored upon treatment with the demethylating agent 5-aza-2'-deoxycytidine. For each of the cell lines without detectable GATA gene expression, aberrant methylation of the promoter region CpG-island was detected by methylation specific PCR. We confirmed these results with genomic bisulfite sequencing. GATA-6 expression was found in each of the cell lines. GATA-4/-5 promoter methylation was not detected in normal esophageal mucosa, but GATA-4 methylation was present in 27 of 44 (61%) squamous carcinomas and 31 of 44 (71%) adenocarcinoma of the esophagus, while GATA-5 methylation was present in 14 of 44 (32%) squamous carcinomas and 24 of 44 (55%) adenocarcinoma of the esophagus. Our studies demonstrate frequent silencing of GATA-4 and GATA-5, but not GATA-6, in human esophageal neoplasia associated with gene promoter hypermethylation.

(1992). The placement of the songs in Dekker's the shoemaker's holiday. English Studies: Vol. 73, No. 2, pp. 121-123.

Seeking to determine precisely what it means to be an American, John Harmon McElroy compares the cultural history of the United States with the cultural histories of Brazil, Canada, Europe, and Spanish America.McElroy demonstrates that American culture is the least European of the four continental cultures developed after 1492. He believes the essential variance stems from the fact that the United States is populated by people and their descendants who chose the United States as home. In contrast, because immigration to Canada, Brazil, and South America was controlled by the European governments, they reflect a stronger European cultural outlook and orientation than the United States.

This report on the study of neglected languages in United States colleges and universities in 1962–63 shows that the neglect is diminishing, with enrollments of some 17,000 in foreign languages except the “big five”: French, German, Italian, Russian, and Spanish. In 168 colleges and universities in the United States, 68 “neglected” foreign languages are being taught in 270 departments by over a thousand teachers to more than eleven thousand students, a figure we reach by estimating that each student is enrolled in about one and a half courses in the language. The five languages in which the largest enrollments were reported are Hebrew, Japanese, Chinese, Portuguese, and Norwegian.

Four patients with mild to moderate obstructive sleep apnea were monitored first in the supine posture to establish a diagnosis of obstructive sleep apnea (apnea indices 33, 12, 22, 36). A second polysomnogram, obtained while the patients slept in the lateral posture, showed a dramatic decrease in apnea (apnea indices 5, 0, 0.2, and 0) and snoring. Each patient had an enlarged uvula, which moved to the side in the lateral posture. We conclude that sleeping in the lateral posture may be therapeutic in some patients with obstructive sleep apneas.

Apres quelques remarques sur l'intention de l'auteur en ecrivant History of the Life and Voyages of Christopher Colombus, l'A. decrit les materiaux et leur utilisation, et rapporte les jugements critiques ou elogieux des XIX et XXs. sur le travail accompli.

Late this past summer, my wife and I returned terize them as precise. Here again, therefore, we from a trip to the west coast to a rather startling have the Myth of Measurable Improvement. sight. We had been away for about ten days, and in that time, one of my pumpkin plants had Assumptions exploded across a large section of the back lawn. How then should we evaluate student writing if My pepper plants, too, had burst into flame, ripe our estimations seem particularly crude and red peppers like tongues of fire, licking out at the imprecise? Actually, the answer is not so much how, green stems. for many fine methods remain at our disposal, but Although I had nurtured these plants with litwhen to evaluate. I believe teachers of English, tle success throughout the summer, under benign writing instructors, should withhold judgment of neglect they had apparently thrived. Or had they? a student's progress until a suitable period of time Later, I comforted myself with the realization that has elapsed which would indeed allow for measthese peppers had indeed been growing all along; urable growth. We should not look for day-to-day I simply had to turn away for a week or so to growth, especially if our method of assessing that ascertain this growth. Prior to our holiday, I had growth is so imprecise. I base this prohibition on been estimating their growth---or lack of it-using premature evaluation of growth on three no refined tool or instrument; yet I assumed that assumptions. I could pass judgment on the state of these plants 1. The writing tasks we require of our students are so from my day-to-day evaluations. Such is the "myth varied that daily, or even weekly, evaluations ultimately of measurable improvement." become confounded with the variance of the written I borrow this phrase from Cy Knoblauch and assignments themselves. One particular student may Lil Brannon, lifting it specifically from Rhetorical perform marvelously in the descriptive mode, Traditions and the Teaching of Writing (1984). After while she languishes in her attempts to produce all, my topic is writing, not vegetables. As teachers quality exposition. Is she slipping? Has her proof English, we, too, perpetuate a fallacy if we congress fallen off? Her classmate writes an abysmal tinue to believe that we can measure growth in business letter, yet the following week he produces writing using crude estimations in a day-by-day a marvelously expressive narration. My, how he manner. That our evaluations are crude might be has improved! Few of us are duped, of course, demonstrated by simply asking twenty teachers to into making such spurious evaluations of such varrate a particular student text. These evaluations ied examples of discourse. This same spuriousness will no doubt vary considerably. Experience has exists, however, in our insistence on providing a shown that such variations will occur with any summative evaluation of business letters, or pertype of text with any group of teachers. We like to suasive essays, or literary compositions. The stuthink of our evaluations as reliable-and I think dents write each under a different context, in a they are-and valid, yet we could hardly characdifferent frame of mind, often for a different

For about 150 years, the United States pursued a policy of relatively unrestricted immigration. Since 1924, however, we have pursued a policy of drastically restricted immigration, with the restrictions based on considerations which many persons have believed to be discriminatory, unjust, and not based on facts. In the early I950's, it seemed that changes in this policy might be effected. The final result, the McCarranWalter Act,1 however, although undoubtedly a more efficient instrument than the 1924 law,2 still clashes with the democratic ideals held by most Americans and not only perpetuates most of the injustices of the earlier legislation, but adds new discriminations of its own. We shall here concern ourselves not with the entire law, but rather with the principle upon which it is based: that it is not desirable for the United States to permit more than a small amount of immigration, and that such immigration should be specifically and unequally allocated among various countries. The assumptions here embodied are that the place of birth of an immigrant is a reliable indication of his capability of becoming a desirable American, and that people from some countries are not sufficiently likely to become desirable Americans that we can afford to chance the entry of more than a hundred or two a year. It is a serious matter when a majority of Congress votes in favor of an immigration law based on the assumption that mankind is divided into fixed breeds, some superior to others. On the contrary, as Edward Corsi has said:3

T HE PRINCIPAL IDEOLOGICAL reference in Hawthorne's "Ethan Brand: A Chapter from an Abortive Romance" is to the "unpardonable sin" of the title-character; the principal event of the story is his suicide by leaping into a furnace. Hawthorne seems to connect the two, the sin and the suicide, in a peculiar way through the name Brand. Just before killing himself Brand feels that he has nothing further to seek; no more to achieve. "'My task is done, and well done!"' he thinks. What he has done is probably stated in his soliloquy of farewell