bluuebunny/crossref_metadata_2025_split huggingface dataset:
Multilingualism and AI: The Regimentation of Language in the Age of Digital Capitalism
Authors: Schneider Britta 
Published: November 2022

AbstractThis article examines the effects of commercial digital language technologies on the regimentation of language. Language technologies based on the exploitation of large data sets—from machine translation and automatic text generation to digital voice assistants—are a particular form of human-made sign practice in which traditional language norms interact with the affordances of digital devices and the capitalist interests of those who design them. Such sociotechnological practices construct language hierarchies within the realm of commercially based language technology and can shape both dominant discourses about language in society and epistemologies of language in linguistics. The article focuses on interrelationships between digital language technology and metasemiotic interpretations of language that pertain to multilingualism, language variation, and language prestige. It examines languages as discursive constructs and reviews the role of media technology in shaping language ideology, showing that writing and print have had a crucial impact on modern language concepts. It draws on expert discourse and qualitative interviews with programmers and users and examines ideological effects of digital language technology and the potential epistemological reconfigurations of concepts of language that may emerge as a result.
Toroidal modeling of 3D perturbations generated by current filaments in scrape-off layer in tokamak with biased divertor targets
Authors: Hao G.Z. , Dong G.Q. , Cui B.T. , Liu Y.Q. , Xu Y.H. , Sun T.F. , Ji X.Q. , Wang S. , Zhao Y.F. , Xu J.Q. , Bai X. , Zhang N. , Li C.Y. , Wang L. , He H.D. , Gao J.M. , Liu Yi , Zhong W.L. , Xu M. , Duan X.R. 
Published: November 2022

Abstract
The divertor biasing technique offers a promising alternative to control the edge localized mode (ELM) as well as the divertor heat load in tokamaks, as compared to the resonant magnetic perturbation (RMP) generated by magnetic coils. The linear resistive MHD code MARS-F (Liu et al 2000 Phys. Plasmas
7 3681) is employed to study the plasma response to the n = 2 (n is the toroidal mode number) field perturbation in HL-2A, produced by the divertor biasing current filaments flowing in the scrape-off layer region. The response field due to biasing currents is compared with the RMP field utilized for ELM control in HL-2A. The strength of the radial resonant field perturbation, produced by the biasing currents of 100 A level, is found to be comparable with RMP generated by several kA of ELM control coil currents for the reference plasma. The plasma normal displacement near the X-point and the associated neoclassical toroidal viscosity torque are also computed to be similar between these two techniques. The modeling results thus strongly suggest that the biasing technique can be applied to control ELMs. Moreover, the biasing currents produce field perturbations, including the plasma response, that are localized more near the plasma edge (compared to the RMP counterpart), thus reducing the chance of mode locking associated with core perturbations. Particle orbit tracing also reveals that the biasing current produced magnetic perturbation tends to widen the heat deposition region and induce the strike point splitting of the ion saturation flow on the outer divertor surface, consistent with experimental observations in HL-2A. These toroidal modeling results confirm the possibility of ELM control and plasma exhaust solution by the divertor biasing technique.
Allocating Blood Products During a Time of Remarkable Shortage
Authors: Dent Edward A , Hamilton Ellie , Bodeker Joy , Roback John , Sullivan H Cliff 
Published: November 2022

Abstract
The COVID-19 Pandemic adversely impacted the nation’s blood supply such that blood suppliers could not fill standing orders. To address the dwindling blood supply, the American Red Cross (ARC) implemented daily thresholds, which distributed red blood cells (RBCs) based on clients’ historical blood orders and the ARC’s inventory. The threshold system left the blood bank to devise a process to judiciously allocate the reduced RBC supply across our institution. Herein, we describe an internal RBC utilization audit, the data from which we used to devise an algorithm to predict our ability to meet transfusion requirements for operating room (OR) procedures. An OR adjudication committee used our report to prioritize elective surgical cases taking places the following day. Thirty-one non-consecutive days of blood inventory release slips were reviewed across three months of recent transfusions. Weekdays were disproportionally investigated to predict the blood utilization for days with scheduled OR procedures. For all RBCs released, the blood type requested and the final disposition (transfused vs returned to blood bank) of the units were recorded. Average use was calculated as well as interquartile range (IQR) to account for transfusion variability. Utilization data was then used to develop a worksheet-based tool to predict ability to meet RBC requirements. Overall, the hospital transfused an average of 80 RBC units each weekday (IQR: 64-92 units). Approximately 40% of all requested RBC units were released to the OR. In turn, the OR transfused only 39% of the RBCs released to them, which represented 20% of transfusions hospital-wide. The OR requested an average of 41 RBC units each weekday (IQR: 25-57 units). The OR transfused an average of 16 units of RBCs each weekday (IQR: 9-21 units). The outpatient cancer center infusion clinic used less than 15% of total RBCs. The biggest user of RBCs were inpatients, who were transfused 65% of RBCs during the week and 82% of transfusions during the weekend. These percentages and the average-to-third-quartile range were used to devise a blood allocation algorithm to inform the OR if the blood bank could support anticipated use. The data was also used to devise a blood allocation worksheet for the on-call transfusion medicine physicians to predict our ability to provide adequate blood for emergent, non-elective procedures that require transfusion support such as liver transplants and aortic repairs. The audit of RBC disposition informed blood inventory management practices during a time of remarkable shortage. Within the confines of the threshold system, the transfusion medicine service allocated the expected number of units based on historical request and transfusion data to predict whether inventory levels could support scheduled and nonscheduled OR procedures.
Lupus anticoagulant testing for patients on direct oral anticoagulants
Authors: Girton Mark , Acker Mary , Bazydlo Lindsay 
Published: November 2022

Abstract
As use of direct factor Xa inhibitor (direct oral anticoagulant; DOAC) therapy increases, a modified lupus anticoagulant (LAC) testing method was studied to remove interfering DOACs, allowing clinicians to evaluate patients for antiphospholipid syndrome (APS) without altering anticoagulation treatment.
We evaluated the use of DOAC-StopTM on our LAC testing panel with two assays: dilute Russell viper venom time (dRVVT), a factor X activator, and Silica Clotting Time (SCT), an intrinsic coagulation pathway activator. The plasma specimens were pretreated with DOAC-STOPTM beads by mixing on a rocking platform for 5 minutes and centrifugation at 5000 rpm for 5 minutes. The treated plasma supernatant was used for each step of the assay including the screen, confirm (addition of phospholipid), 50:50 mix (addition of reagent plasma with coagulation factors) and confirm 50:50 mix. The total ratio (ratio between screen and confirm ratios relative to mean of normal ranges) was calculated and used per the package insert in the positive or negative interpretation of each LAC testing panel. The study included patients with one or more of the following characteristics identified during coagulation sign-out and chart review: no evidence of a LAC (NELAC), evidence of a LAC, and whether on apixaban or rivaroxaban therapy. The effectiveness of DOAC removal was characterized with an apixaban spiking experiment for NELAC and LAC patient specimens which showed no change in LAC testing panel interpretation before and after DOAC-STOPTM treatment. A second experiment with apixaban-spiked NELAC samples demonstrated removal of anti-factor Xa activity upon comparison of pre- and post-treatment with DOAC-STOPTM. Of 10 patients taking rivaroxaban, nine had positive dRVVT interpretations; eight of these specimens changed to negative interpretations after DOAC-STOPTM treatment. For SCT, two positive interpretations remained positive, while two of the remaining eight negatives became positive after treatment. Of nine patients taking apixaban, two had positive dRVVT interpretations, one of which became negative post-treatment. Of the seven negative interpretations, one became positive post-treatment. For SCT, three were positive pre-treatment and seven were negative with no change post-treatment. Providing a LAC testing option for patients on DOACs may be of benefit to patients and clinicians in APS assessment, eliminating the risk of suspending anticoagulation therapy. Our study shows DOAC-STOPTM effectively removes DOAC interference in the majority of patient specimens studied, though LAC testing and interpretation in the setting of a high-complexity patient population on DOAC therapy remains challenging with occasional false positives and false negatives.
Making Complex Cancer Reports Easier Using Self-Built Interactive Templates
Authors: Rogers John , Cara Lukas , Hsu Jim , Christensen Paul , Long Scott 
Published: November 2022

Abstract
Surgical pathology reports are becoming increasingly complex, especially with neoplastic cases. Pathologists need to verify all elements are addressed in the CAP synoptics, order proper reflex molecular testing or immunohistochemistry depending on care standards and institutional guidelines, and address key points in the report for clinicians. For example, breast cancer cases at our institution need repeat biomarkers for all cases status post neoadjuvant therapy, oncotype reflex testing for pT2N0, estrogen receptor positive tumors, and tumor bed size with residual tumor burden calculations for all breast cancer only after neoadjuvant chemotherapy. For residents and faculty alike, these expansive reports are challenging, especially for those new to the institution’s policies and conventions. Previous workflow included using Microsoft Word documents with previously signed out cases had significant risk for errors that stem from new updates in the CAP protocols, missing or different reflex testing from the previous case, and updated institutional guidelines. We set out to create a customized library of decision support and interactive templates using a software called PhraseExpander. We created PhraseExpander templates for all cancer resections. The templates included the associated synoptics required for accreditation by CAP, implemented automated staging using logic statements, and provided conditional reminders when reflex testing was indicated. Variable labels were utilized to help clarify notes in the CAP synoptic such as how to grade specific tumors and how many high-power fields to count. The tools were distributed to all surgical pathology fellows, residents, and select faculty who expressed interest in participating. The templates were successfully implemented into the routine workflow for surgical pathology sign out. End-user feedback was overwhelmingly positive. First year and upper level residents appreciate the detailed descriptions on how to complete the report, most notably the reflex molecular testing reminders and many conditional aspects such as in our breast cancer reports. Fellows and attendings have also appreciated these aspects as well as the automated staging and reminders to do administrative tasks, such as adding the case to the Laboratory Information System tumor registry. Interactive templates with built in conditions and calculators are powerful tools that can be used for generating the increasingly complex reports in pathology. They provide pathologists real-time and non-interruptive clinical decision support, allow them to spend less time typing and reduce reliance on remembering the required reflex testing. The most notable disadvantage in coding these complex templates is the considerable build and maintenance time. We plan to expand use to flow cytometry reports, biopsy reports, and routine non-neoplastic cases while incorporating labels to assist in resident education.
Correlation of PDL1 Expression with Genomic Alterations in Non-Small Cell Lung Cancer: a 7-month retrospective analysis
Authors: Sen Siddhartha , Pratt Anna , Harley Susan , Mroz Pawel , Yohe Sophia , Thyagarajan Bharat , Schomaker Matthew , Kincaid Robyn , Michel Stephen , Li Faqian 
Published: November 2022

Abstract

Background
PD1/PDL1 inhibitors have significantly improved overall survival in non-small cell lung cancer (NSCLC). PDL1 is now a standard biomarker along with molecular testing for therapy selection. Checkpoint therapy is given front-line for patients with high PDL1 and no actionable mutations or fusions, or after progression with any PDL1 expression. Studies comparing PDL1 status in the context of actionable mutations or fusions in NSCLC are sparse.

Design
All patients undergoing molecular testing for a next-generation sequencing (NGS) lung cancer panel at our institution in a 7-month period were reviewed. This included an NGS DNA panel for actionable/driver genes: EGFR, ERBB2, BRAF, K/NRAS, PIK3CA, and IDH1/2; and a NGS RNA fusion panel for ALK, ROS1, RET, NTRK1/3, NRG1, and MET e14 skipping. PDL1 expression by IHC was scored for tumor proportion score (TPS). Statistical comparison was performed using Fisher’s Exact test.

Results
186 patients with NSCLC were included (126 adenocarcinoma, 33 squamous/adeno-squamous, 19 poorly differentiated, and 8 NSCLC-NOS); 162 of those had concurrent PDL1 IHC. 121 (65%) patients had a genomic alteration, most commonly RAS [28%], EGFR [24%], ALK [8%], MET [7%], and BRAF [5%]. Cases with genomic alterations were classified into those with and without RAS mutation/s. The prevalence of high PDL1 expression was greater in RAS-driven tumors: 47% vs 22% with non-RAS bearing genomic alterations (p=0.0173). There was no significant difference in the PDL1 expression between the genomically negative tumors and those with non-RAS bearing mutations. Recently, the FDA granted approval to sotorasib, a KRAS G12C inhibitor, in patients with locally advanced or metastatic NSCLC. However, there was no significant difference in the PDL1 expression between the tumors with RAS G12C mutation and those with other RAS mutations.

Conclusion
Our data indicate that close to half of RAS-driven NSCLC have high PDL1 expression, an important consideration for front-line therapy selection. The majority of genomically-actionable tumors have at least low-positive expression of PDL1, highlighting the potential importance of immune checkpoint therapy in the resistant-progression setting. In comparison, only about one third of genomically-negative cases have high PDL1 expression, and a significant percent are completely negative. When the actionable KRAS G12C mutation bearing cases were compared to those with other RAS mutations, no significant difference was noted in the PDL1 expression between these two subsets; further investigations and a larger cohort of patients may be helpful in this case to determine whether PDL1 levels are affected by a specific RAS mutation.
Validation of Neutrophil gelatinase associated lipocalin (NGAL), a urinary biomarker for Acute Kidney Injury and the positive interference from high leukocyturia samples
Authors: Samara Vishnu , Song Lu , Buggs Vincent 
Published: November 2022

Abstract
Acute kidney injury (AKI) is a sudden and serious kidney damage condition that affects more than 1.2 million people every year. KIDNEY DISEASE IMPROVING GLOBAL OUTCOMES (KDIGO) guidelines currently suggest measuring the increase of serum creatinine as a diagnostic marker for AKI. However, the elevation of serum creatinine levels can take up to seven days or when &gt;50% kidney function is lost. Neutrophil gelatinase-associated lipocalin (NGAL) has been identified as an early biomarker for tubular injury, which can be detected in the urine of AKI patients in as early as three hours. In the current study, we evaluated the performance of BioPorto’s (Hellerup, Denmark) NGAL assay, which uses particle enhanced turbidimetry immunoassay (PETIA) technology on the Roche (Indianapolis, USA) cobas c502 chemistry analyzer. Linearity was determined using linearity material from BioPorto and also verified by serial dilutions of a high NGAL patient sample. The limit of quantitation was determined by running urine samples with values of 20 ng/mL, 25 ng/mL, and 35 ng/mL, respectively in duplicate for 10 days. Within-run precisions were determined by running urine two samples containing 100 ng/mL and 400 ng/mL NGAL 20 times and between–run precisions were determined by running the same samples 2 times a day for 10 days. To determine the accuracy of the NGAL method on cobas 502, 40 samples were used to compare results with those measured on Siemens Atellica using the BioPorto’s NGAL assay. Reference interval was verified in 40 urine samples collected from healthy donors. A urine dipstick test was performed to confirm the normal urine samples did not contain leukocyte esterase activity. Since NGAL is also present in neutrophils, we evaluated the effect of leukocytes in urine with the NGAL assay. Results showed the sample with 75 leukocytes/µL had an NGAL of 68 ng/mL and the sample with 500 leukocytes/µL has an NGAL of 222 ng/mL. The linearity range was determined to be 0 - 3000 ng/mL with a limit of quantification of 26 ng/mL. The within-run precision mean and CV% are 121 ng/mL, 4.3% for Level 1 and 401 ng/mL, 1.8% for Level 2. Between-run precisions mean and CV% are 106 ng/mL, 4.8% for Level 1 and 399 ng/mL, 2.6% Level 2. Method comparison had a slope of 0.90 and an intercept of 32.9. The reference interval was determined to be &lt;50 ng/mL and Leukocytes in urine did cause false-positive NGAL results.
A Rare Case of Primary Cardiac T-cell Lymphoma in Immunocompetent Adult
Authors: Chen J , Jetly R , Connor E 
Published: November 2022

Abstract

Introduction/Objective
Primary cardiac lymphoma (PCL) is an extranodal lymphoma involving only the heart and/or the pericardium. It is exceedingly rare, accounting for &lt;2% of primary cardiac neoplasms in a surgical series and 0.05% of a &gt;12,000 autopsies’ series, and is often associated with an immunocompromised state. Most PCL are of B- cell lineage with T-cell lymphoma constituting &lt; 10%.

Methods/Case Report
We report a case of unexpected sudden death due to primary cardiac T-cell lymphoma in a 48-year-old immunocompetent man without significant medical history who presented in cardiopulmonary arrest following a two-week history of cold-like symptoms. Autopsy revealed an irregular, discontinuous tan plaque on the epicardial surface that extended over the right and left ventricles, and sectioning revealed that extension of the lesion throughout the subvalvular myocardium of the left ventricular wall, interventricular septum, and medial aspects of the right ventricle. The lesion had irregular areas of necrosis and hemorrhage. No lymphadenopathy or other visceral lesions were identified. Histologically, the myocardium had a regionally necrotic, angiocentric infiltrate of atypical, large, pleomorphic lymphoid cells with large, irregular nuclei, vesicular chromatin, and conspicuous nucleoli. Initial immunohistochemical work-up showed a profile of CD45+/CD20-/CD3+ suggesting a T-cell origin with CD8 predominance (CD4-/CD8+). Further work-up demonstrated a profile as CD2+/CD7+/CD25+/CD30+/EBV(EBER- ISH)+/Ki67(70-80%)/ and ALK-1-/BCL6-/CD5-/CD10-/CD56-, supporting extranodal NK/T-cell lymphoma, extranasal type with a cytotoxic T-cell subtype (perforin+/granzyme B+/TIA-1+/TCR Beta F1+).

Results (if a Case Study enter NA)
NA.

Conclusion
Primary cardiac lymphoma with cytotoxic T-cell subtype is extremely rare and fatal. This case is the third report over the past two decades, to our knowledge, of a primary cardiac T-cell lymphoma leading to acute heart failure and sudden death in an immunocompetent adult.
Papillary Renal Cell Carcinoma with Massive Hemorrhage: An Autopsy Case Report
Authors: Naik U , Amin S E , Gehris B T , Wang W , Hunter R L 
Published: November 2022

Abstract

Introduction/Objective
Spontaneous renal hemorrhage is a rare complication of various kidney pathologies. It can be due to renal artery aneurysms, arteriovenous malformations, cystic renal diseases, renal calculus, coagulation disorders, as well as neoplastic lesions like angiomyolipoma and renal cell carcinoma (RCC). Individuals present with sudden flank or scapular pain, hypovolemic shock, termed as Wunderlich syndrome (WS). 30-35% cases of WS are from spontaneously ruptured RCC, commonly clear cell variant (70%) followed by papillary (10-15%) and chromophobe variant (4-6%). We present an autopsy case of a papillary variant RCC identified as a small kidney mass with a pathogenetic correlation behind the intractable bleeding.

Methods/Case Report
An 81-year-old Caucasian man with a history of atrial fibrillation, on long-term Xarelto treatment, was found to have a 1.2 cm incidental mass in the right kidney. He started experiencing right-sided scapular pain, then rapidly became hypotensive, drowsy. CT scan revealed a large right-sided perinephric and retroperitoneal hematoma (17.5 x 5.7 x 8.9 cm) extending in the pelvis. Despite receiving blood products, other supportive treatment, and successful angio-embolization, his condition worsened to acute kidney injury, bowel ischemia, and persistent lactic acidosis leading to death. On autopsy, bloody ascites, clots on mesenteric root insertion, and bulging in retroperitoneal spaces were seen. The perinephric spaces had organized clots. The bleeding originated from a 2.0 x 2.0 cm brown mass in the middle pole of the right kidney. There was a slit-like vessel at the interface of the kidney and the mass. Microscopic examination of the mass shows trabecula of abnormal cells with abundant eosinophilic cytoplasm in the hemorrhagic and necrotic background. These cells are positive for PAX8, CK7, CD10, dim positive for CAIX, and negative for CD117, which is consistent with renal cell carcinoma, papillary variant.

Results (if a Case Study enter NA)
NA.

Conclusion
Papillary RCC is much less vascular and less aggressive than clear cell RCC. However, necrosis or bleeding into renal vessels may occur. In this case, blood-leaks and accumulation in enclosed space followed by necrosis, fibrosis, and hyalinization cause neovascularization forming a negative spiral for re-bleeding. Anticoagulants can lead to profuse sustained bleeding from even very small size RCC.