Early Manuscripts Electronic Library

Workforce productivity has become a critical factor in the strength and sustainability of a company's overall business performance. Absenteeism affects productivity; however, even when employees are physically present at their jobs, they may experience decreased productivity and below-normal work quality--a concept known as decreased presenteeism. This article describes the creation and testing of a presenteeism scale evaluating the impact of health problems on individual performance and productivity. A total of 175 county health employees completed the 34-item Stanford Presenteeism Scale (SPS-34). Using these results, we identified six key items to describe presenteeism, resulting in the SPS-6. The SPS-6 has excellent psychometric characteristics, supporting the feasibility of its use in measuring health and productivity. Further validation of the SPS-6 on actual presenteeism (work loss data) or health status (health risk assessment or utilization data) is needed.

Abstract Lakes and impoundments are important sources of greenhouse gases (GHG: i.e., CO 2 , CH 4 , N 2 O), yet global emission estimates are based on regionally biased averages and elementary upscaling. We assembled the largest global dataset to date on emission rates of all three GHGs and found they covary with lake size and trophic state. Fitted models were upscaled to estimate global emission using global lake size inventories and a remotely sensed global lake productivity distribution. Traditional upscaling approaches overestimated CO 2 and N 2 O emission but underestimated CH 4 by half. Our upscaled size‐productivity weighted estimates (1.25–2.30 Pg of CO 2 ‐equivalents annually) are nearly 20% of global CO 2 fossil fuel emission with ∼ 75% of the climate impact due to CH 4 . Moderate global increases in eutrophication could translate to 5–40% increases in the GHG effects in the atmosphere, adding the equivalent effect of another 13% of fossil fuel combustion or an effect equal to GHG emissions from current land use change.

OBJECTIVE: To examine the impact of delirium during intensive care unit stay on long-term health-related quality of life and cognitive function in intensive care unit survivors. DESIGN: Prospective 18-month follow-up study. SETTING: Four intensive care units of a university hospital. PATIENTS: A median of 18 months after intensive care discharge, questionnaires were sent to 1,292 intensive care survivors with (n = 272) and without (n = 1020) delirium during their intensive care stay. MEASUREMENTS AND MAIN RESULTS: The Short Form-36v1, checklist individual strength-fatigue, and cognitive failure questionnaire were used. Covariance analysis was performed to adjust for relevant covariates. Of the 915 responders, 171 patients were delirious during their intensive care stay (median age 65 [interquartile range 58-85], Acute Physiology and Chronic Health Evaluation II score 17 [interquartile range 14-20]), and 745 patients were not (median age 65 [interquartile range 57-72], Acute Physiology and Chronic Health Evaluation II score 13 [interquartile range 10-16]). After adjusting for covariates, no differences were found between delirium and nondelirium survivors on the Short Form-36 and checklist individual strength-fatigue. However, survivors who had suffered from delirium reported that they made significantly more social blunders, and their total cognitive failure questionnaire score was significantly higher, compared to survivors who had not been delirious. Survivors of a hypoactive delirium subtype performed significantly better on the domain mental health than mixed and hyperactive delirium patients. Duration of delirium was significantly correlated to problems with memory and names. CONCLUSIONS: Intensive care survivors with delirium during their intensive care unit stay had a similar adjusted health-related quality of life evaluation, but significantly more cognitive problems than those who did not suffer from delirium, even after adjusting for relevant covariates. In addition, the duration of delirium was related to long-term cognitive problems.

There are two ways to present this work; the most efficient is of course to start with the main syntactical definitions, and to end with semantics: this is the presentation that we follow in the body of the text: section 1, syntex; section 2, semantics. Another possibility is to follow the order of discovery of the concepts, which (as expected) starts with the semantics and ends with the syntex; we adopt this second way for our introduction, hoping that this orthogonal look at the same object will help to apprehend the concepts.

The relationship between perceived participative decision making and employee performance was examined in matched samples of employees from the Hong Kong and U.S. branches of one organization. Self-efficacy in regard to participating in decisions and idiocentrism moderated the relationship between perceived participative decision-making opportunity and individual performance. Perceptions of the participation efficacy of a work unit and allocentrism moderated the relationship between participative decision-making opportunity cuid group performance. Idiocentrism and allocentrism appeared to explain regional differences in how participative decision making and efficacy perceptions interacted to predict performance. Participative decision making, defined as joint decision making (Locke & Schweiger, 1979) or influence sharing between hierarchical superiors and their subordinates (Mitchell, 1973), has been a focus of organizational research for nearly 50 years. Whereas many researchers have examined relationships between participative decision making and employee outcomes such as task performance, job satisfaction, and turnover, only equivocal conclusions can be drawn from existing research on the relationship between participative decision making and job performance. Some quantitative reviews have reported moderately positive relationships between these variables (e.g.. Cotton, VoUrath, Froggatt, Lengnick-Hall, & Jennings, 1988; Miller & Monge, 1986). Other quantitative reviews have not found these positive effects (e.g., Wagner, 1994; Wagner & Gooding, 1987a, 1987b). Wagner and Gooding (1987a) inspected the studies cited by Miller and Monge (1986) and found that 90 percent involved percept-percept data collection techniques (that is, data collected from the same respondents using the same questionnaire at the same time). Wagner (1994) reanalyzed Cotton and his coauthors ' (1988) data using meta-analysis and

ions in hydrides at low temperatures suppresses hydrogen poisoning of the Ru surfaces. The present work demonstrates the high potential of metal hydrides as efficient promoters for low-temperature ammonia synthesis.

BACKGROUND: Hidradenitis suppurativa (HS) is a chronic recurrent inflammatory skin disease with abscess formation and scarring predominantly in the inverse areas. The disease is often difficult to treat and patients experience a decreased quality of life (QoL). It is hypothesized that depression is more common in HS patients than among other dermatological patients. OBJECTIVES: To evaluate the prevalence of depression in patients with HS. METHODS: In total 211 HS patients were included in the study and 233 were dermatological control patients. Their QoL and depression scores were assessed using the Dermatology Life Quality Index (DLQI) and the Major Depression Inventory (MDI) questionnaires. HS severity was recorded with a questionnaire and Hurley stages were extracted from the case records. RESULTS: The DLQI was significantly higher for HS patients than for the control patients, 8.4 ± 7.5 vs. 4.3 ± 5.6 (P < 0.0001) and correlated with Hurley stage severity scores. Mean MDI scores were significantly higher for HS patients, 11.0 vs. 7.2 (P < 0.0001). However, clinically defined depression rates according to the International Classification of Diseases, 10th edition (ICD-10) criteria were not significantly higher in HS patients compared to controls (9% vs. 6%). CONCLUSIONS: HS is a chronic skin disease with major impact on QoL even when compared to other dermatological diseases. MDI scores in HS patients correlate with disease severity. This correlation could indicate that the MDI represents a valid measure of disease related morbidity that may serve as an outcome measure in future studies and a relevant point of intervention for individual patients.

Addiction professionals and the public are recognizing that certain nonsubstance behaviors--such as gambling, Internet use, video-game playing, sex, eating, and shopping--bear resemblance to alcohol and drug dependence. Growing evidence suggests that these behaviors warrant consideration as nonsubstance or "behavioral" addictions and has led to the newly introduced diagnostic category "Substance-Related and Addictive Disorders" in DSM-5. At present, only gambling disorder has been placed in this category, with insufficient data for other proposed behavioral addictions to justify their inclusion. This review summarizes recent advances in our understanding of behavioral addictions, describes treatment considerations, and addresses future directions. Current evidence points to overlaps between behavioral and substance-related addictions in phenomenology, epidemiology, comorbidity, neurobiological mechanisms, genetic contributions, responses to treatments, and prevention efforts. Differences also exist. Recognizing behavioral addictions and developing appropriate diagnostic criteria are important in order to increase awareness of these disorders and to further prevention and treatment strategies.

OBJECTIVES: To determine the optimal initial ventilation mode in congenital diaphragmatic hernia. BACKGROUND: Congenital diaphragmatic hernia is a life-threatening anomaly with significant mortality and morbidity. The maldeveloped lungs have a high susceptibility for oxygen and ventilation damage resulting in a high incidence of bronchopulmonary dysplasia (BPD) and chronic respiratory morbidity. METHODS: An international, multicenter study (NTR 1310), the VICI-trial was performed in prenatally diagnosed congenital diaphragmatic hernia infants (n = 171) born between November 2008 and December 2013, who were randomized for initial ventilation strategy. RESULTS: Ninety-one (53.2%) patients initially received conventional mechanical ventilation and 80 (46.8%) high-frequency oscillation. Forty-one patients (45.1%) randomized to conventional mechanical ventilation died/ had BPD compared with 43 patients (53.8%) in the high-frequency oscillation group. An odds ratio of 0.62 [95% confidence interval (95% CI) 0.25-1.55] (P = 0.31) for death/BPD for conventional mechanical ventilation vs high-frequency oscillation was demonstrated, after adjustment for center, head-lung ratio, side of the defect, and liver position. Patients initially ventilated by conventional mechanical ventilation were ventilated for fewer days (P = 0.03), less often needed extracorporeal membrane oxygenation support (P = 0.007), inhaled nitric oxide (P = 0.045), sildenafil (P = 0.004), had a shorter duration of vasoactive drugs (P = 0.02), and less often failed treatment (P = 0.01) as compared with infants initially ventilated by high-frequency oscillation. CONCLUSIONS: Our results show no statistically significant difference in the combined outcome of mortality or BPD between the 2 ventilation groups in prenatally diagnosed congenital diaphragmatic hernia infants. Other outcomes, including shorter ventilation time and lesser need of extracorporeal membrane oxygenation, favored conventional ventilation.

To analyze morphologic and physiological properties of olfactory interneurons in the honeybee, Apis mellifera, antennal lobe (AL) neurons were intracellularly recorded and subsequently labeled with Neurobiotin. Additional focal injections were carried out with cobalt hexamine chloride and dextran fluorescent markers. Olfactory interneurons (projection neurons, PNs) project by means of five tracts, the lateral, the median, and three mediolateral antennocerebral tracts (l-, m-, and ml-ACT, respectively) to the mushroom bodies (MBs) and the protocerebral lobe (PL) of the ipsilateral protocerebrum. Uniglomerular PNs of the m- and l-ACT receiving input from a single glomerulus of the AL also arborize in different regions of the AL. The vast majority of l-ACT innervate the T1 region, whereas m-ACT neurons arborize exclusively in the T2, T3, and T4 regions (T1-4 : AL projection area of sensory cells from the antennae). In the calyces of the MB, uniglomerular PNs form varicosities in the basal ring and the lip region. Individual neurons of both types exhibit unequal innervation within and between the two calyces. In addition, m-ACT fibers ramify more densely within the lip neuropil and show a higher incidence of spine-like processes than l-ACTs. In the PL, l-ACTs arborize exclusively within the lateral horn, whereas some m-ACT neurons innervate a broader region. Multiglomerular neurons of the ml-ACT leave the AL by means of three subtracts (ml-ACT 1-3). Two different types can be distinguished according to their protocerebral target areas: ml-ACTs projecting to the lateral PL (LPL) and to the neuropil around the alpha-lobe (tracts 2 and 3) and neurons projecting only to the LPL (tract 1). Intracellular recordings indicate that both l- and m-ACT neurons respond to general odors but with different response properties, indicating that odor information is processed in parallel pathways with different functional characteristics. Just like m-ACT neurons, ml-ACT neurons respond to odors with complex activity patterns. Bilateral interneurons, originating in the suboesophageal ganglion, connect glomeruli of both AL, and send an axon through the m-ACT in each hemisphere of the brain, terminating in the lip region of the calyces. These neurons respond to contact chemical stimuli.

This paper presents a program transformation that allows languages with polymorphic typing (e.g. ML) to be implemented with unboxed, multi-word data representations. The transformation introduces coercions between various representations, based on a typing derivation. A prototype ML compiler utilizing this transformation demonstrates important speedups.

Cells of the innate and adaptive immune systems play a critical role in the host response to sepsis. Moreover, their accessibility for sampling and their capacity to respond dynamically to an acute threat increases the possibility that leukocytes might serve as a measure of a systemic state of altered responsiveness in sepsis.The working group of the 14th Acute Dialysis Quality Initiative (ADQI) conference sought to obtain consensus on the characteristic functional and phenotypic changes in cells of the innate and adaptive immune system in the setting of sepsis. Techniques for the study of circulating leukocytes were also reviewed and the impact on cellular phenotypes and leukocyte function of nonextracorporeal treatments and extracorporeal blood purification therapies proposed for sepsis was analyzed.A large number of alterations in the expression of distinct neutrophil and monocyte surface markers have been reported in septic patients. The most consistent alteration seen in septic neutrophils is their activation of a survival program that resists apoptotic death. Reduced expression of HLA-DR is a characteristic finding on septic monocytes, but monocyte antimicrobial function does not appear to be significantly altered in sepsis. Regarding adaptive immunity, sepsis-induced apoptosis leads to lymphopenia in patients with septic shock and it involves all types of T cells (CD4, CD8, and Natural Killer) except T regulatory cells, thus favoring immunosuppression. Finally, numerous promising therapies targeting the host immune response to sepsis are under investigation. These potential treatments can have an effect on the number of immune cells, the proportion of cell subtypes, and the cell function.

OBJECTIVE: To examine the epidemiologic and clinical characteristics of older persons (ie, those aged 65-74, 75-84, and > or = 85 years) hospitalized with traumatic brain injury (TBI). METHODS: Data from the 1999 CDC 15-state TBI surveillance system were analyzed. RESULTS: In 1999, there were 17,657 persons 65 years and older hospitalized with TBI in the 15 states for an age-adjusted rate of 155.9 per 100,000 population. Rates among persons aged 65 years or older increased with age and were higher for males. Most TBIs resulted from fall- or motor vehicle (MV)-traffic-related incidents. Most older persons with TBI had an initial TBI severity of mild (73.4%); however, the proportions of both moderate and severe disability for those discharged alive and of in-hospital mortality were relatively high (23.5%, 9.7%, and 12%, respectively). Persons who fell were also more likely to have had 3 or more comorbid conditions than were those who sustained a TBI from an MV-traffic incident. CONCLUSIONS: TBI is a substantial public health problem among older persons. As the population of older persons continues to increase in the United States, the need to design and implement proven and cost-effective prevention measures that focus on the leading causes of TBI (unintentional falls and MV-traffic incidents) becomes more urgent.

Different analytical techniques used on the same data set may lead to different conclusions about the existence and strength of genetic structure. Therefore, reliable interpretation of the results from different methods depends on the efficacy and reliability of different statistical methods. In this paper, we evaluated the performance of multiple analytical methods to detect the presence of a linear barrier dividing populations. We were specifically interested in determining if simulation conditions, such as dispersal ability and genetic equilibrium, affect the power of different analytical methods for detecting barriers. We evaluated two boundary detection methods (Monmonier's algorithm and WOMBLING), two spatial Bayesian clustering methods (TESS and GENELAND), an aspatial clustering approach (STRUCTURE), and two recently developed, non-Bayesian clustering methods [PSMIX and discriminant analysis of principal components (DAPC)]. We found that clustering methods had higher success rates than boundary detection methods and also detected the barrier more quickly. All methods detected the barrier more quickly when dispersal was long distance in comparison to short-distance dispersal scenarios. Bayesian clustering methods performed best overall, both in terms of highest success rates and lowest time to barrier detection, with GENELAND showing the highest power. None of the methods suggested a continuous linear barrier when the data were generated under an isolation-by-distance (IBD) model. However, the clustering methods had higher potential for leading to incorrect barrier inferences under IBD unless strict criteria for successful barrier detection were implemented. Based on our findings and those of previous simulation studies, we discuss the utility of different methods for detecting linear barriers to gene flow.

TLR have a crucial role in the detection of microbial infection in mammals. Until recently, most investigations on TLR have focused on cells of the innate immune system and on the role of TLR in the initiation of antigen-specific responses following recognition of microbial products by APC. Here, we report that murine T cells express TLR1, TLR2, TLR6, TLR7 and TLR9 mRNA. Using CD8 T cells from F5 TCR-transgenic mice, we demonstrate that the lipopeptide Pam(3)CysSK(4) (Pam), a synthetic analog of bacterial and mycoplasmal lipoproteins that recognizes TLR1/2 complex, costimulates antigen-activated T cells. Costimulation with Pam permits an increased cell proliferation and survival associated with a sustained CD25 expression and an enhanced expression of Bcl-xL anti-apoptotic protein. In addition, we show that costimulation with Pam up-regulates IFN-gamma production but also granzyme B secretion and cytotoxic activity of antigen-activated T cells, indicating that TLR2 engagement enhances the major effector functions of CD8 T cells. Finally, we demonstrate that TLR2 engagement on T cells lowers the activation threshold for costimulatory signals delivered by APC.

PURPOSE: To evaluate the effects of tear osmolarity on the repeatability of keratometry (K) measurements in patients presenting for cataract surgery. SETTING: Three clinical practices. DESIGN: Observational prospective nonrandomized study. METHODS: Subjects were prospectively recruited based on tear osmolarity (Tearlab Osmolarity System); that is, osmolarity more than 316 mOsm/L in at least 1 eye (hyperosmolar) and osmolarity less than 308 mOsm/L in both eyes (normal). The baseline K value was measured, and a second measurement was taken on the same instrument (IOLMaster) within 3 weeks of the first. Variability in average K, calculated corneal astigmatism using vector analysis, and intraocular lens (IOL) sphere power calculations were compared between groups. RESULTS: The hyperosmolar group (50 subjects) had a statistically significantly higher variability in the average K reading (P = .05) than the normal group (25 subjects) and a statistically significantly higher percentage of eyes with a 1.0 diopter (D) or greater difference in the measured corneal astigmatism (P = .02). A statistically significantly higher percentage of eyes in the hyperosmolar group had an IOL power difference of more than 0.5 D (P = .02). No statistically significant differences were present when the subjects were grouped by self-reported dry eye. CONCLUSIONS: Significantly more variability in average K and anterior corneal astigmatism was observed in the hyperosmolar group, with significant resultant differences in IOL power calculations. Variability was not significantly different when subjects were grouped by self-reported dry eye. Measurement of tear osmolarity at the time of cataract surgery planning can effectively identify patients with a higher likelihood of high unexpected refractive error resulting from inaccurate keratometry. FINANCIAL DISCLOSURE: Drs. Epitropoulos, Matossian, Berdy, and Malhotra received compensation from Tearlab for participating in the study. No author has a financial or proprietary interest in any material or method mentioned.

INTRODUCTION: There are conflicting data on the association between early exposure to pets and allergic diseases. Bias related to retrospective information on pet ownership has been addressed as a reason for distorted study results. OBJECTIVE: To elucidate how early exposure to cat and dog relates to IgE-sensitization and asthma in children at 2 and 4 years of age, in a prospective birth-cohort study. METHODS: Four thousand and eighty-nine families with children born 1994-1996 in predefined areas of Stockholm answered questionnaires on environmental factors and symptoms of allergic disease at birth, one, two and four years of age. Dust samples collected from the mothers' beds at birth were analysed for Fel d 1 and Can f 1 in a subgroup of the cohort. Blood samples taken at four years from 2614 children were analysed for allergen-specific IgE to common airborne allergens. Risk associations were calculated with a multiple logistic regression model, with adjustment for potential confounders. RESULTS: A correlation was seen between allergen levels and reported exposure to cat and dog. Exposure to cat seemed to increase the risk of cat sensitization, OR (odds ratio) 1.44 (95% confidence interval 1.03-2.01), whereas dog exposure did not have any effect on dog sensitization, OR 1.16 (0.79-1.72). Dog ownership was related to a reduced risk of sensitization to other airborne allergens, OR 0.36 (0.15-0.83), and a similar tendency was seen for cat ownership OR 0.63 (0.37-1.07). Early dog ownership seemed to be associated with a lower risk of asthma, OR 0.50 (0.24-1.03), with no corresponding effect after cat ownership, OR 0.88 (0.56-1.38). CONCLUSION: Early exposure to cat seems to increase the risk of sensitization to cat but not of asthma at 4 years of age. Dog ownership, on the other hand, appears to be associated with lowered risk of sensitization to airborne allergens and asthma. Both aetiological relationships and selection effects have to be considered in the interpretation of these findings.

PURPOSE: To compare quantitative parameters for assessing the degree of eccentric systolic blood flow in the ascending thoracic aorta (AsAo). MATERIALS AND METHODS: Forty-one patients were studied with three-dimensional (3D), cine phase-contract MRI (4D Flow). Analysis was performed at peak systole for a cross-sectional plane in the AsAo just distal to the sinotubular junction. AsAo flow was graded as normal, mildly, or markedly eccentric based on qualitative visual assessment. For quantitative analysis, flow jet angle and normalized flow displacement from the vessel center were calculated. RESULTS: Patients with normal AsAo systolic flow (n = 25) had an average flow jet angle of 13.7 degrees and flow displacement 0.04. These parameters were significantly elevated for patients with mild eccentric systolic flow (n = 6): 24.6 degrees (P = 0.012) and 0.12 (P = 0.001), respectively. However, for patients with marked eccentric flow (n = 10), only flow displacement was significantly elevated compared with the mild eccentric group (0.18; P = 0.04); flow angle was 25.7 degrees. CONCLUSION: Flow displacement is a more reliable quantitative parameter for measuring eccentric AsAo systolic flow than flow jet angle, and should be evaluated in studies investigating the role of eccentric flow in the promotion of aortic pathology.

OBJECTIVE: To determine actual five-year survival (5YS) rates associated with a strategy of upfront surgery and adjuvant therapy in pancreatic ductal adenocarcinoma (PDAC). BACKGROUND: The rate of actual 5YS in PDAC remains controversial. Available data is restricted to cohorts acquired over several decades and series of resection after patient selection by neoadjuvant therapy. METHODS: All patients undergoing upfront resection for resectable and borderline-resectable PDAC from 10/2001 to 12/2011 were identified from a prospective database. Actual overall survival was assessed after a follow-up of at least 5 years. Uni- and multivariable logistic regression analyses were performed. RESULTS: Median survival of 937 patients was 22.1 months. The actual 5YS rate was 17.0% (n = 159) including 89 (9.5%) patients without evidence of disease >5 years after resection. 5YS rates in patients with or without adjuvanttherapy were 18.8% vs. 12.2%, respectively. Tumorgrading, number of positive lymph nodes, a context of intraductal papillary mucinous neoplasia, and vascular resections were independently associated with 5YS. Patient-related parameters and CA 19-9 levels were associated with observed survival up to 3 years, but lost relevance thereafter. The extent of lymph node involvement was the strongest predictor of 5YS. Patients with pN0R0 had a 5YS rate of 38.2%. in patients with exclusively favorable factors the observed 5YS rate was above 50%. CONCLUSIONS: This is the largest series of long-term survivors with histologically confirmed PDAC. With upfront resection and adjuvant therapy an actual overall 5YS rate of 18.8% can be expected. in favorable subgroups actual 5YS is above 50%.

Shimp's (1976) recent paper on memory and the structure of behavior is discussed, as is the concept of memory itself. Radical behaviorism is distinguished from associationism, and behavioral accounts of experiments on short-term and long-term memory are provided. Unobservable theoretical quantities, such as rate of response, are distinguished from theoretical constructs such as memory. The logical inconsistency involved in the use of short-term memory as a "theoretical primitive" in the definition of units of behavior is explicated, and an alternative strategy for identifying units of behavior is presented. It is argued that the experimental analysis of behavior has ignored processes usually considered as memorial because many of the phenomena are irreversible. Methods for the study of transitions in single subjects should be developed more fully. Possible pitfalls associated with subscription to the term memory are listed, and it is concluded that the concept is neither required nor helpful in the analysis of behavior.