cssi/SciSciGPT-SciSciNet huggingface dataset:
Perspectives in Medical Education : 4. A "global" dimension to reform at Keio University

Keio University School of Medicine is awakening to the realization that it will achieve international recognition as a center of excellence in medical education and healthcare only by inculcating clinical skills and critical thinking in its medical graduates. A new "global" perspective identifies the traditional failure of Japanese medical education to provide its graduates with clinical skills training as the root cause of a number of deficiencies. These include (i) the reluctance of Japanese medical graduates to seek global experience; (ii) the absence of interest in the global healthcare marketplace for Japanese medical graduates as potential recruits; (iii) the failure to incorporate globally accepted innovations, like problem-based learning, in Japanese medical education; (iv) the failure to follow globally accepted standards of clinical practice in Japan; (v) the lack of instruction in general internal medicine in Japan; and (vi) the neglect of evidence-based medicine in Japanese healthcare practice. Keio University is embarking on an ambitious effort that commits both the will and resources necessary to reform medical education at Keio in accordance with global norms. The initiatives currently underway include (i) incorporating PBL into the curriculum to foster active learning, (ii) implementing measures to promote interactive teaching techniques among the faculty, and (iii) granting recognition to teachers through new promotion policies. Wider implementation of these initiatives across the country will enable Japanese healthcare and Japanese physicians to occupy their rightful place of respect in the global healthcare market, comparable to the widespread international recognition given to Japanese medical researchers.
Oral health-related quality of life in youth receiving cleft-related surgery: self-report and proxy ratings

This paper evaluated the impact of cleft-related surgery on the oral health-related quality of life (OHRQoL) of youth with cleft over time. Data were derived from a 5-year, multi-center, prospective, longitudinal study of 1196 youth with cleft lip and/or palate and their caregivers. Eligible youth were between 7.5 and 18.5 years old, spoke English or Spanish, and were non-syndromic. During each observational period, which included baseline, and 1- and 2-year post-baseline follow-up visits, youths and their caregivers completed the Child Oral Health Impact Profile, a validated measure of OHRQoL. Multilevel mixed-effects models were used to analyze the effects of receipt of craniofacial surgery on OHRQoL over time. During the course of this study a total of 516 patients (43 %) received at least one surgery. Youth in the surgery recommendation group had lower self- (β = −2.18, p < 0.05) and proxy-rated (β = −2.92, p < 0.02) OHRQoL when compared to non-surgical self- and proxy-rated OHRQoL at baseline. Both surgical and non-surgical youth (β = 3.73, p < 0.001) and caregiver (β = 1.91, p < 0.05) ratings of OHRQoL improved over time. There was significant incremental improvement (time × surgery interaction) in self-reported OHRQoL for youth postsurgery (β = 1.04, p < 0.05), but this postsurgery increment was not seen in the caregiver proxy ratings. Surgical intervention impacts OHRQoL among youth with cleft. Youth who were surgical candidates had lower baseline self- and caregiver-rated OHRQoL when compared to non-surgical youth. Youth who underwent cleft-related surgery had significant incremental improvements in self-rated but not caregiver (proxy)-rated OHRQoL after surgery.
Photonic microwave oscillator using mode-locked laser as the high Q resonator

We show that an actively mode-locked laser can serve as a high Q microwave resonator in a photonic oscillator. The high Q is due to the high regenerative gain of the optical modes which generate a beat note at a photodetector as the microwave signal. In a fiber mode-locked laser setup, we have demonstrated the generation of a 10 GHz microwave signal with phase noise of -140 dBc/Hz at the offset frequency of 10 kHz. We have also found that the effective Q of the resonator depends on the optical pulse width.
Comparative study of surface-lattice-site resolved neutralization of slow multicharged ions during large-angle quasi-binary collisions with Au(110): Simulation and experiment

In this article we extend our earlier studies of the azimuthal dependences of low energy projectiles scattered in large angle quasi-binary collisions from Au(110). Measurements are presented for 20 keV Ar{sup 9+} at normal incidence, which are compared with our earlier measurements for this ion at 5 keV and 10{sup 0} incidence angle. A deconvolution procedure based on MARLOWE simulation results carried out at both energies provides information about the energy dependence of projectile neutralization during interactions just with the atoms along the top ridge of the reconstructed Au(110) surface corrugation, in comparison to, e.g., interactions with atoms lying on the sidewalls. To test the sensitivity of the agreement between the MARLOWE results and the experimental measurements, we show simulation results obtained for a non-reconstructed Au(110) surface with 20 keV Ar projectiles, and for different scattering potentials that are intended to simulate the effects on scattering trajectory of a projectile inner shell vacancy surviving the binary collision, In addition, simulation results are shown for a number of different total scattering angles, to illustrate their utility in finding optimum values for this parameter prior to the actual measurements.
Continuity and New Directions

We look back at the ways that the lessons of this book’s resource-inclusive model are similar to those from a conventional model and how they differ. We conclude by asking what that suggests about different questions that macroeconomics should be asking and what new factors it should be taking into consideration.
Hydro-ionic microthruster for locomotion in low-Reynold'S number ionic fluids

We have demonstrated a fast, extremely power-efficient, hydro-ionic microthruster that utilizes electro-osmotic propulsion for operation in a low Reynolds-number ionic environment. Powered by an onboard power supply, the microthruster achieves speeds of up to 5.24 cm/s (131 body-lengths/s) while consuming less than 252 nW/(Bodylength/s). It is 31% faster and ∼103 times more energy-efficient than prior designs. Including the onboard Al-air battery consisting of an Al anode and an Au cathode, the microthruster measures 1400μm (H) × 1400μm (W) × 400μm (L) in dimension and contains a 1000μm-wide, 300μm-long cylindrical thruster channel in the center. With significantly improved speed and drastically higher energy-efficiency, the microthruster opens up new possibilities for various self-powered biomedical applications that can operate within the power budget of modern implantable and integrable microscale batteries and bio-fuel cells.
The Teaching of Undergraduate Health Psychology: A National Survey

We conducted an online national survey to examine how undergraduate health psychology is taught, offer information about course design and content, and provide a needs analysis. Health psychology i...
Pulsar–black hole binaries as a window on quantum gravity

Pulsars (PSRs) are some of the most accurate clocks found in nature, while black holes (BHs) offer a unique arena for the study of quantum gravity. As such, PSR–BH binaries provide ideal astrophysical systems for detecting effects of quantum gravity. With the success of aLIGO and the advent of instruments like the Square Kilometer Array (SKA) and Evolved Laser Interferometer Space Antenna (eLISA), the prospects for discovery of such PSR–BH binaries are very promising. We argue that PSR–BH binaries can serve as ready-made testing grounds for proposed resolutions to the BH information paradox. We propose using timing signals from a PSR beam passing through the region near a BH event horizon as a probe of quantum gravitational effects. In particular, we demonstrate that fluctuations of the geometry outside a BH lead to an increase in the measured root-mean-square deviation of arrival times of PSR pulsar traveling near the horizon.
How to differentiate collective variables in free energy codes: Computer-algebra code generation and automatic differentiation

Abstract The proper choice of collective variables (CVs) is central to biased-sampling free energy reconstruction methods in molecular dynamics simulations . The PLUMED 2 library, for instance, provides several sophisticated CV choices, implemented in a C++ framework; however, developing new CVs is still time consuming due to the need to provide code for the analytical derivatives of all functions with respect to atomic coordinates . We present two solutions to this problem, namely (a) symbolic differentiation and code generation, and (b) automatic code differentiation, in both cases leveraging open-source libraries (SymPy and Stan Math, respectively). The two approaches are demonstrated and discussed in detail implementing a realistic example CV, the local radius of curvature of a polymer. Users may use the code as a template to streamline the implementation of their own CVs using high-level constructs and automatic gradient computation . Program summary Program Title: Practical approaches to the differentiation of collective variables in free energy codes: computer-algebra code generation and automatic differentiation Program Files doi: http://dx.doi.org/10.17632/r4r67bvkdn.1 Licensing provisions: GNU Lesser General Public License Version 3 (LGPL-3) Programming languages: C++, Python Nature of problem: The C++ implementation of collective variables (CVs, functions of atomic coordinates to be used in biased sampling applications) in biasing libraries for atomistic simulations , such as PLUMED [1], requires computation of both the variable and its gradient with respect to the atomic coordinates; coding and testing the analytical derivatives complicate the implementation of new CVs. Solution method: The paper shows two approaches to automate the computation of CV gradients, namely, symbolic differentiation with code generation and automatic code differentiation, demonstrating their implementation entirely with open-source software (respectively, SymPy and the Stan Math Library). Additional comments: The paper’s accompanying code serves as an example and template for the methods described in the paper; it is distributed as the two modules curvature_codegen and curvature_autodiff integrated in PLUMED 2’s source tree; the latest version is available at https://github.com/tonigi/plumed2-automatic-gradients . [1] Tribello GA, Bonomi M, Branduardi D, Camilloni C, Bussi G. PLUMED 2: New feathers for an old bird. Computer Physics Communications. 2014 Feb;185(2):604-13.
Pathogenesis of Crohn's Disease- and Ulcerative Colitis-Related Strictures

Abstract The pathogenesis of stricture formation in inflammatory bowel disease is a complex process with a wide variety of clinical, genetic, and serologic risk factors. Originally thought to be a consequence of chronic inflammation, new evidence exists for noninflammatory contributors to stricture formation, suggesting an intricate interplay of cellular, molecular, and microbiologic factors. Although no specific medical treatments for fibrostenotic strictures currently exist, understanding of these newly discovered mechanisms of stricture formation will undoubtedly guide therapeutic developments in the future.
Managed Care and the Hospital Market Concentration

This paper examines the impact of managed care on the local hospital market structure. During the 1990s, managed care increased its presence rapidly in the healthcare market, and local hospital markets became more concentrated through closures and mergers. Despite the clear-cut observational correlation, the literature has not agreed on the causality. This paper analyzes the impact of managed care on two different dimensions of market concentration: the number of hospitals and the variation of the market shares of hospitals in each local market. This paper discovers that managed care reduces the number of hospitals, by driving relatively inefficient hospitals out of the market. However, it also reduces the variation of market shares, which counterbalances increased market concentration through a fall in the number of hospitals. Since market concentration indices map these two different dimensions of market concentration onto one dimension, the sum of those two conflicting effects makes managed care and market concentration indices seemingly unrelated. This explains the latest findings in the literature that the hospital market concentration and managed care market penetration have little correlation. Combined with existing findings in the literature, an excessive emphasis on the variation of market shares may lead to a failure of interpreting the market power of hospitals accurately.
The Management of Rectal Injury During Radical Retropubic Prostatectomy

From May 1982 through March 1991, 10 rectal injuries were identified in 1,000 men who underwent radical retropubic prostatectomy for clinically localized adenocarcinoma. All rectal injuries occurred in nonirradiated patients. Of these patients 9 were identified during surgery and 1 was diagnosed on postoperative day 2. The 9 patients in whom the injury was recognized at operation underwent successful primary closure without a diverting colostomy. The patient who underwent delayed closure was treated with a temporary diverting colostomy. As a preoperative routine, all patients received a Fleet enema without preoperative antibiotics. In all patients the rectal injury was closed in 2 layers, the anal sphincter was dilated, and a pedicle of omentum was mobilized through a small opening in the peritoneum and placed through the rectovesical cul-de-sac to cover the suture line. All patients received 7 to 14 days of broad-spectrum antibiotics. Postoperatively, no patient had a wound infection, pelvic abscess or urethrorectal fistula. Overall hospital stay was increased by an average of 2 days. Rectal injuries recognized during surgery in previously nonirradiated patients undergoing radical retropubic prostatectomy can be managed successfully with primary closure alone, avoiding the morbidity of a diverting colostomy.
Mesoscale Variability of the Atmosphere

Statistical measures of atmospheric variability are reviewed as they apply to the mesoscales. Horizontal spectra of kinetic energy are found to conform approximately to a −5/3 power law from a few to about 1000 km wavelengths, while the vertical spectra follow a slope of about −2.5. As measured by structure functions, humidity variables have unusually high variability in the mesoscale. Two competitive explanations for mesoscale spectra are discussed, one based on two-dimensional turbulence concepts and the other on the theory of internal gravity waves.
Clinical evaluation of platelet concentrates stored for one to five days

There are no large-scale data available describing the increments obtained with platelet concentrates stored for varying durations. Platelet concentrates prepared by standard techniques were stored at 22 degrees C with horizontal agitation in PL-732 bags and administered to clinically stable, nonalloimmunized recipients known to respond well to random donor platelet transfusions. The platelet concentrates were stored in a mean volume of 65.0 mL (range 54–80 mL) with an average yield of .72 X 10(11) platelets per unit of platelet concentrates (N = 100 consecutive units). There was no significant deterioration of pH during storage. Mean corrected count increments ranged between 16,600 (N = 146 transfusions) after 1 day of storage to 13,300 (N = 34 transfusions) after 5 days of storage. Although these differences were statistically significant (P less than .003, analysis of variance), the overall deterioration in increments was quite modest. Platelet concentrates can be stored under standard conditions for 1 to 5 days with acceptable clinical results.
Generative Design Conversion to Editable and Watertight Boundary Representation

Abstract We present the first, to our knowledge, fully automatic method for the conversion of a general generative design to a watertight B-Rep composed of the exact residual geometry of the input solids and editable T-NURCC surfaces. The design can be synthesized by any combination of both additive and subtractive in-synthesis processes, and constrained by any number of keep-in and -out solids. Our method requires only the input generative setup solids, rudimentary data from the solve, and a boundary mesh of the optimized design. Leveraging the generative solve data, we augment the boundary mesh with “incidence” attributes linking it to the input solids, and partition it into organic and incident regions. The organic regions are parameterized and approximated with T-NURCCs. Then, their boundaries are “pulled” into the adjacent input solids to construct clean intersection curves. Finally, the organic surfaces are combined with the input solids to compose a watertight solid B-Rep of the generative design. Without such an automatic conversion, users seeking to exploit generative designs in downstream workflows (e.g. setting up assembly constraints, simulation analyses, performing parametric edits) have to manually convert the design to a B-Rep, slowing down the path to manufacturing and increasing the product time to market. As a result of our work, engineers can now quickly obtain useful CAD models of any number of generative designs computed by a variety of algorithms, settings and iterations.
Assessing utility of handheld laser induced breakdown spectroscopy as a means of Dalbergia speciation.

Many species of Dalbergia are prized hardwoods, generally referred to as ‘Rosewood,’ and used in high-end products due to their distinctive hue and scent. Despite more than 58 species of Dalbergia being listed as endangered in Appendix 1 of The Convention on International Trade in Endangered Species of Fauna and Flora (CITES), the illegal logging and trade of this timber is ongoing. In this work, a handheld laser induced breakdown spectrometer (LIBS) was used to analyze seven Dalbergia species and two other exotic hardwood species to evaluate the ability of handheld LIBS for rapid classification of Dalbergia in the field. The KNN model of the classification presented 80% to 90% sensitivity for discriminating between Dalbergia species in the training set. PLS-DA models were based on a binary decision tree structure. Cumulatively, the PLS-DA decision tree model showed greater than 97% sensitivity and 99% selectivity for prediction of Dalbergia species included in the training set. The data presented in the following study are promising for the use of handheld LIBS devices and both KNN and PLS-DA models for applications in customs screenings at the port of entry of hard woods, among others.
Subunit structure and properties of two forms of adenosine triphosphatase released from Micrococcus lysodeikticus membranes.

Abstract The Ca2+-activated ATPase of M. , lysodeikticus membrane has been released in two forms: (i) a “shock wash” form which is trypsin stimulated, capable of rebinding to ATPase-depleted membranes in the presence of Mg2+ and possesses additional associated protein(s) giving rise to 1–3 minor protein bands in addition to the two major subunits detected by SDS-polyacrylamide gel electrophoresis: (ii) a form released into the aqueous phase on extracting the membranes with n -butanol (referred to as “ n -butanol type”), which is not stimulated by trypsin, dose not rebind to depleted membranes and contains only two major protein subunits. The two protein subunits of both types have molecular weights of 62, 000 and 60, 000 daltons and reduction followed by alkylation or performic oxidation does not appear to significantly alter the behavior of these subunits. It is suggested that the additional proteins(s) of the shock wash ATPase have attachment and regulatory functions.
The dynamics of maternal scaffolding vary by cumulative risk status.

Parental scaffolding, or parenting behaviors that support children's independence and competence, can foster children's self-regulation development. Children facing higher cumulative risk may experience less scaffolding and more directives from parents, but it is unclear how cumulative risk affects the dynamics of parent-child interactions in real time. We examined the role of cumulative risk in mothers' moment-to-moment use of scaffolding and directives in response to preschoolers' off- and on-task behaviors (N = 117). Mothers answered questionnaires about cumulative risk at child age 2.5 years and completed a challenging puzzle task with their preschoolers at age 3 years. Continuous-time multilevel survival analyses revealed differences by cumulative risk in the likelihood of mothers' parenting responses following children's off- and on-task behavioral transitions over the course of the interaction. Specifically, when children went off-task, higher cumulative risk was associated with a lower likelihood of maternal scaffolding, but a comparable likelihood of directives, compared to lower risk mothers. When children got on-task, mothers with higher cumulative risk were less likely to respond with scaffolding and more likely to respond with directives than lower risk mothers. These results suggest that parents at higher risk respond with less scaffolding regardless of child behavior and respond with more directive commands when they may be unnecessary. Findings provide novel, real-time descriptive information about how and when parents experiencing cumulative risk use scaffolding and directive strategies, thus informing microlevel targets for intervention. Implications for the development of self-regulation in children at risk are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
Environmental risk factors associated with pulmonary isolation of nontuberculous mycobacteria, a population-based study in the southeastern United States.

Abstract The prevalence of pulmonary nontuberculous mycobacteria (NTM) disease is increasing in the United States. Associations were evaluated among residents of central North Carolina between pulmonary isolation of NTM and environmental risk factors including: surface water, drinking water source, urbanicity, and exposures to soils favorable to NTM growth. Reports of pulmonary NTM isolation from patients residing in three counties in central North Carolina during 2006–2010 were collected from clinical laboratories and from the State Laboratory of Public Health. This analysis was restricted to patients residing in single family homes with a valid residential street address and conducted at the census block level (n = 13,495 blocks). Negative binomial regression models with thin-plate spline smoothing function of geographic coordinates were applied to assess effects of census block-level environmental characteristics on pulmonary NTM isolation count. Patients (n = 507) resided in 473 (3.4%) blocks within the study area. Blocks with >20% hydric soils had 26.8% (95% confidence interval (CI): 1.8%, 58.0%), p = 0.03, higher adjusted mean patient counts compared to blocks with ≤20% hydric soil, while blocks with >50% acidic soil had 24.8% (−2.4%, 59.6%), p = 0.08 greater mean patient count compared to blocks with ≤50% acidic soil. Isolation rates varied by county after adjusting for covariates. The effects of using disinfected public water supplies vs. private wells, and of various measures of urbanicity were not significantly associated with NTM. Our results suggest that proximity to certain soil types (hydric and acidic) could be a risk factor for pulmonary NTM isolation in central North Carolina.
Before Equal Protection: The Fall of Anti-Crossdressing Laws and the Origins of the Transgender Legal Movement 1964-1980

This article offers the most comprehensive account of the decline of anti-crossdressing regulation. Scholars are still unsure why American cities passed anti-cross dressing laws in a rash of legislation over the closing decades of the nineteenth century. By the 1960s, cities in every region of the United States had cross-dressing regulation at the municipal or state level, from major metropolitan centers like Chicago and Los Angeles, to small cities and towns like Cheyenne, Wyoming and Vermillion, South Dakota. They were used to criminalize gender non-conformity in many forms - for feminists, countercultural "hippies," cross-dressers (who often called themselves transvestites), and people we would now consider transgender. Starting in the late 1960s, however, criminal defendants began to succeed in judicial attacks on cross-dressing bans in a wide range of cities. This story invites a re-assessment of the contemporary LGBT movement’s legal history. I argue that confronting the regulation of gender non-conformity formed a crucial part of the early movement’s agenda, and presents forgotten alternatives to the legal strategy it ultimately adopted. While opening the aperture of LGBT legal history to bring gender non-conformity into view, this article also locates a trans legal movement, using different constitutional arguments from gay and lesbian counterparts, taking shape as early as the 1960s.
Sublesional Bevacizumab Injection for Recurrent Respiratory Papillomatosis: Evaluation of Utility in a Typical Clinical Practice:

Objectives:The goal of this study was to evaluate the benefit of sublesional bevacizumab injection for recurrent respiratory papillomatosis (RRP) as used in a typical clinical practice.Methods:A re...
Prevention of posterior wall puncture with a self-made needle block:

Vascular access is one of the most commonly performed invasive procedures in medicine. Ultrasound-guided vascular access has been shown to improve patient safety, decrease associated complications ...
Coating small-diameter ePTFE vascular grafts with tunable poly(diol-co-citrate-co-ascorbate) elastomers to reduce neointimal hyperplasia.

Lack of long-term patency has hindered the clinical use of small-diameter prosthetic vascular grafts with the majority of these failures due to the development of neointimal hyperplasia. Previous studies by our laboratory revealed that small-diameter expanded polytetrafluoroethylene (ePTFE) grafts coated with antioxidant elastomers are a promising localized therapy to inhibit neointimal hyperplasia. This work is focused on the development of poly(diol-co-citrate-co-ascorbate) (POCA) elastomers with tunable properties for coating ePTFE vascular grafts. A bioactive POCA elastomer (@20 : 20 : 8, [citrate] : [diol] : [ascorbate]) coating was applied on a 1.5 mm diameter ePTFE vascular graft as the most promising therapeutic candidate for reducing neointimal hyperplasia. Surface ascorbate density on the POCA elastomer was increased to 67.5 ± 7.3 ng mg−1 cm−2. The mechanical, antioxidant, biodegradable, and biocompatible properties of POCA demonstrated desirable performance for in vivo use, inhibiting human aortic smooth muscle cell proliferation, while supporting human aortic endothelial cells. POCA elastomer coating number was adjusted by a modified spin-coating method to prepare small-diameter ePTFE vascular grafts similar to natural vessels. A significant reduction in neointimal hyperplasia was observed after implanting POCA-coated ePTFE vascular grafts in a guinea pig aortic interposition bypass graft model. POCA elastomer thus offers a new avenue that shows promise for use in vascular engineering to improve long-term patency rates by coating small-diameter ePTFE vascular grafts.
126 Survey of equine pasture best management practices and soil fertility in southeast Pennsylvania

Proper pasture and grazing management can increase nutritive forage yield, decrease operational costs, and reduce nutrient and sediment runoff. However, management can be challenging in suburban areas where pastures may be small and overstocked. This study assessed pasture health and best management practices (BMPs) on suburban Pennsylvania horse farms. Participant farms (n = 28) in counties adjacent to the Philadelphia metropolitan area were recruited via social media, and 2–3 pastures/farm (72 in total; primarily used for grazing) were evaluated between November, 2019 and January, 2020 via soil testing, the USDA-NRCS Pasture Condition Score Sheet (PCSS), and the Penn State Equine Pasture Evaluation Disc (EPED). Farm managers were also surveyed about their pasture management practices. Pasture soil pH, soil nutrient, PCSS, and EPED data were transformed to normality and analyzed with linear models, with p-values adjusted for multiple comparisons by Monte Carlo simulation. Fixed effects included farm purpose (private or commercial); lime, fertilizer, and/or manure application; and whether the farm practiced rotational grazing. Covariates included total number of horses, number of hectares per farm, stocking rate, and farm. Mean ± s.e. pasture size was 0.68 ± 0.07 ha and mean stocking rate was 3.6 horses/hectare. Only 14% of farms had performed a soil test in the last 3yr, and less than 20% applied lime or fertilizer in that period. Three quarters of farm managers allowed horses to graze pastures to under 7.6 cm in height, and 54% reported using rotational grazing. Mean pasture soil pH was 6.18 ± 0.04, with 86% of pastures below optimum range. Soil pH was lower for pastures on private farms (P = 0.06), and on fields where no lime (P = 0.05) or fertilizer (P
Heterogeneous Micro LED Displays Yield Statistics

A Micro LED (μLEDs) display, a heterogeneous system, is one that integrates inorganic μLEDs and IGZO thin film transistors made on different substrates with different process flows. Millions of μLEDs are transferred from source wafers and integrated on TFT backplanes to make a display. To guarantee zero defect density, a fault tolerant design (e.g. redundancy) may be adopted. Here, we estimate the required redundancy level for a given display resolution and yields for the μLED source wafers and the transfer process of μLEDs to the backplane. This is done using a novel yield statistical model. The results may be used to assess the capital requirements and the risk involved in making such heterogeneous systems in high volume manufacturing.
Splenic injury following endoscopic drainage of a large pancreatic pseudocyst: a case report.

Background Many pancreatic pseudocysts spontaneously resolve, but larger or symptomatic pseudocysts may require procedural management. Though endoscopic ultrasound guided approaches are standard of care and have high success rates, complications can include bleeding, infection, and splenic perforation. This patient case report details an unusual series of complications of endoscopic cystogastrostomy that should encourage clinicians to evaluate for anatomic disruptions caused by mass effects of pancreatic pseudocysts prior to endoscopic pseudocyst drainage. Case presentation A 53-year-old African American male with a past medical history notable for alcohol use disorder, chronic pancreatitis, and insulin dependent diabetes presented with a 4-day history of left upper quadrant abdominal pain. Computed tomography imaging with contrast revealed enlargement of a known pancreatic pseudocyst to 15.9 × 10.4 cm. Due to pseudocyst size and the patient's symptoms, endoscopic cystogastrostomy stent placement was performed. However, postprocedurally, he developed leukocytosis to 19,800 cells/m3 (from 14,100 cells/m3 preoperatively) as well as acute hypoxemic respiratory failure with a large left pleural effusion. Postprocedural computed tomography with contrast demonstrated a new large subcapsular splenic hematoma in communication with a new subdiaphragmatic fluid collection. Due to suspicion of endoscopic procedural complication, he underwent open laparotomy which revealed grade 4 splenic laceration, septic splenic hematoma, and a subdiaphragmatic abscess. Conclusions While endoscopic drainage of pancreatic pseudocyst was technically successful, this case demonstrates complications from mass effect of a large pancreatic pseudocyst which putatively tore the splenorenal ligament, leading to excessive separation of the left kidney and spleen. If anatomic disruptions caused by mass effect from a pancreatic pseudocyst are recognized through preprocedural abdominal imaging, such cases may be considered for early open repair versus cystogastrostomy.
Stories from the Pandemic: A Spatial Survey of Stay-at-home Stress

Stay-at-home Stress is a spatial survey narrating the pandemic stories of sixteen households in Houston, Texas. By translating lockdown experiences of sixteen participants into comparative annotate...
Use of animal-assisted interventions in relieving pain in healthcare settings: A systematic review

Abstract Background and objective Therapeutic interaction with animals for patients coping with physical and mental health conditions is a growing interest among healthcare providers and researchers. We aimed to comprehensively summarize and evaluate the current state of evidence examining the use of animal-assisted interventions [AAI] for pain relief in healthcare settings. Design Systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Methods Two researchers independently assessed publications dated before February 5, 2021 in OVID Medline, CINAHL, and PsychINFO databases, and used the Delphi list to evaluate the quality of the evidence. Results Of the 109 studies screened, a total of 24 studies totaling 1,950 participants were ultimately included. Studies varied in design, including single group trials (8), controlled trials with at least two groups (6), and randomized controlled trials (10). The most common form of pain measurement was the visual or numeric rating scale. For the 18 studies that reported data on changes in pain severity from pre-to-post-test, 13 reported a significant reduction; using the converted common metric we created, these reductions ranged from 0.20 to 3.33 points on a 10-point numeric rating scale. Conclusions AAI may be considered a promising approach in need of further, more rigorous research. Available evidence supporting AAI remains weak due to issues of study quality and design, thereby impeding our ability to draw reliable conclusions on the utility of AAI in relieving pain. Given the rapidly increasing availability of these interventions in hospitals, it is important to better understand its effectiveness.
The Sense of Sight in Rabbinic Culture: Jewish Ways of Seeing in Late Antiquity

Introduction 1. Visual theory 2. God-gazing and homovisuality 3. Heterovisuality, face-bread and cherubs 4. Visual eros 5. Eyeing idols 6. Seeing sages Conclusion.
31 Laparoscopic Gastric Bypass: Nutritional Management After Surgery

Patients who chose to have Roux-en-Y gastric bypass (RYGB) surgery need to be able to make long-term lifestyle changes and commit to lifelong vitamin and mineral supplementation. Because the amount of food that can be eaten is limited and nutrients are not fully absorbed, patients are at risk for developing a variety of macro- and micronutrient deficiencies. Nutrition guidelines should be explained at the onset of surgery consideration and reiterated at every phase of the process. This chapter will outline postoperative nutrition and supplementation requirements as well as review possible nutrient deficiencies, symptoms, and treatment for deficiencies should they occur. In addition, this chapter will address postoperative nutrition evaluation and follow-up protocols. It is important to provide continuous monitoring and adequate support to patients after surgery to ensure that they understand and are following program guidelines in order to achieve maximal weight loss and acquire skills to maintain a healthy weight.
Theory of Unipolar Politics: Competition in the Post–Cold War Era

The theory I laid out in the previous chapter yields two central empirical implications for contemporary world politics. First, for as long as the United States pursues a grand strategy of defensive accommodation, major powers, all of which today possess survivable nuclear arsenals, are unlikely to pursue further balancing against it. Second, in the event that the United States does shift toward any other strategy, major powers in the region in which U.S. strategy has shifted are likely to initiate a balancing effort – increasing the rate at which they convert their latent power into military capabilities, pooling those capabilities together through the formation of alliances, and eventually shifting the systemic balance of power and putting an end to unipolarity. Regarding today's major powers – which include all nuclear states – most of the literature focuses on the potential for rapidly growing economic powers, such as China, to launch a military challenge to U.S. power preponderance. Therefore, although I touch briefly on the prospects that other potential U.S. challengers will emerge, my analysis focuses on the past trajectory and likely future behavior of China.
Carbon Nanotube Membranes for Use in the Transdermal Treatment of Nicotine Addiction and Opioid Withdrawal Symptoms

Transdermal systems are attractive methods of drug administration specifi cally when treating patients for drug addiction. Current systems however are defi cient in therapies that allow variable fl ux values of drug, such as nicotine for smoking cessation or complex dosing regimens using clonidine when treating opioid withdrawal symptoms. Through the use of functionalized carbon nanotube (CNT) membranes, drug delivery to the skin can be controlled by applying a small electrical bias to create a programmable drug delivery system. Clearly, a transdermal patch system that can be tailored to an individual's needs will increase patient compliance as well as provide much more effi cient therapy. The purpose of this paper is to discuss the applicability of using carbon nanotube membranes in transdermal systems for treatment of drug abuse. Introductionabuse, whether alcohol, tobacco, prescription or illicit, continues to burden society, economics, medical care systems, and the family dynamic. The World Health Organization (WHO) estimates that globally 185 million people are illicit drug users and an astounding 1.3 billion individuals are smokers. 1 Smoking related deaths, estimated at nearly 5 million worldwide, continue to be the leading preventable cause of death. Additionally, in the United States alone, $167 billion in annual health-related economic loss can be attributed to smoking. 2 Although there are roughly only 200,000 deaths reported to be directly associated with illicit drug use, the detriment to family and society, and the economic costs associated with crime, law enforcement, medical care, and drug treatment and rehabilitation, are immense. 3,4 While current treatments for cigarette smoking and opioid addiction do aid in successful abstinence from the individual's vice, there is great need and room for improvement. The best of smok- ing cessation therapies reports a mere 19% success after one year, while only 50% of individuals who enter clinics for opioid addiction remain for the duration of the treatment, of which 65% return to using within 4 weeks. 3,5 Clearly, a therapy that better controls cravings or abates withdrawal symptoms to decrease the likelihood of relapse is needed. Carbon nanotube (CNT) membranes present the opportu- nity to create a transdermal patch that can vary its rate of delivery throughout its application to the skin to attain therapeutic plasma levels and plasma profi les of a specifi c drug. The purpose of this report is to discuss the use of carbon nanotube membranes in a transdermal system to aid in abstinence from cigarettes and withdrawal from opioids.
Ion transport in free and supported nitrobenzene aliquat nitrate liquid membrane ion-selective electrodes : II. Interfacial kinetics and time-dependent phenomena

Abstract Impedances for reversibly-contacted liquid ion exchanger membranes consisting of Aliquat nitrate dissolved in nitrobenzene were measured from 0.01 Hz to 0.5 MHz. Support-dependent impedances were observed as a second arc in the impedance plane diagrams. A slow rate for nitrate transport from aqueous solution to nitrobenzene was discovered and a kinetic rate constant for the reaction was estimated. Transient potential responses to ion steps from nitrate to chloride were studied empirically and simulated using a computer model. Non-monotonic potential responses showed good agreement with the model. The time course of hydration layer formation, at a supported liquid membrane, was studied by impedance methods and the effect of this layer on potentiometric time response was followed by measuring sequential concentration-step responses. Extensive hydration was found to occur in PVC-acrylonitrile supports, which suggested criteria for wettability by membrane solvent and for hydrophobicity for support materials.
Letter from the U.S.: Exclusive Rights, Exceptions, and Uncertain Compliance with International Norms – Part II (Fair Use)

This survey of recent U.S. fair use decisions examines the domestic evolution of the doctrine, particularly in light of the significant expansion of noninfringing “transformative” uses. The article also considers the U.S.’ compliance with its international obligations under the Berne Convention and the TRIPs Accord, and inquires whether the substantial enlargement of the application of the U.S. fair use exception exceeds the leeway that the Berne Convention, art. 9(2), WCT art. 10, and TRIPs art. 13 grant to member states to provide for exceptions and limitations to copyright.
Alteration of the rat cecal microbiome during colonization with the helminth Hymenolepis diminuta

The microbiome is now widely recognized as being important in health and disease, and makes up a substantial subset of the biome within the ecosystem of the vertebrate body. At the same time, multicellular, eukaryotic organisms such as helminths are being recognized as an important component of the biome that shaped the evolution of our genes. The absence of these macroscopic organisms during the early development and life of humans in Western culture probably leads to a wide range of human immunological diseases. However, the interaction between the microbiome and macroscopic components of the biome remains poorly characterized. In this study, the microbiome of the cecum in rats colonized for 2 generations with the small intestinal helminth Hymenolepis diminuta was evaluated. The introduction of this benign helminth, which is of considerable therapeutic interest, led to several changes in the cecal microbiome. Most of the changes were within the Firmicutes phylum, involved about 20% of the total bacteria, and generally entailed a shift from Bacilli to Clostridia species in the presence of the helminth. The results point toward ecological relationships between various components of the biome, with the observed shifts in the microbiome suggesting potential mechanisms by which this helminth might exert therapeutic effects.
Adaptive response to hydrogen peroxide in yeast: induction, time course, and relationship to dose-response models.

The assay for trp5 gene conversion and ilv1-92 reversion in Saccharomyces cerevisiae strain D7 was used to characterize the induction of an adaptive response by hydrogen peroxide (H2O2). Effects of a small priming dose on the genotoxic effects of a larger challenge dose were measured in exponential cultures and in early stationary phase. An adaptive response, indicated by smaller convertant and revertant frequencies after the priming dose, occurred at lower priming and challenge doses in young, well-aerated cultures. Closely spaced priming doses from 0.000975 to 2 mM, followed by a 1 mM challenge, showed that the induction of the adaptive response is biphasic. In exponential cultures it was maximal with a priming dose of 0.125–0.25 mM. Very small priming doses were insufficient to induce the adaptive response, whereas higher doses contributed to damage. A significant adaptive response was detected when the challenge dose was administered 10–20 min after the priming exposure. It was fully expressed within 45 min, and the yeast began to return to the nonadapted state after 4–6 hr. Because of the similarity of the biphasic induction to hormetic curves and the proposal that adaptive responses are a manifestation of hormesis, we evaluated whether the low doses of H2O2 that induce the adaptive response show a clear hormetic response without a subsequent challenge dose. Hormesis was not evident, but there was an apparent threshold for genotoxicity at or slightly below 0.125 mM. The results are discussed with respect to linear, threshold, and hormesis dose–response models. Environ. Mol. Mutagen. 54:384–396, 2013. © 2013 Wiley Periodicals, Inc.
MCM standard packaging for thermal performance

This presentation addresses the standard MCM packaging solutions proposed in the JEDEC JC- 13 and IC- 13.5 committees and the task groups within these committees associated with packaging and KGD. As a member of these committees and Lask groups I propose to present a test case utilizing work performed on programs at Motorola relative to an open tooled 60 millimeter CQFP package and the thermal studies an high power applications of this package. The thermal analysis results that will be presented involve the use of finite element techniques for the analysis. The 60 millimeter COFF package is one of the JEDEC standard MCM packages. The analysis results will be used to demonstrate the influence that material selection and packaging philosophy have in the design of MCM devices.
Using structured reporting templates in staging pancreatic malignancies

Our clinical colleagues prefer structured or template reporting over conventional reports. The most commonly used type of conventional or free style reporting, tends to either “bury” the pertinent information needed for patient management in lengthy reports including unimportant incidental findings or fail to mention critical aspects of the findings that are crucial to the treatment and management of the current clinical problem. Structured or template reports on the other hand offer, the opportunity through the use of specific entry fields, to organize relevant information in an easily readable format and ensure completeness of the required information that is essential for patient management. For these reports to be practically helpful to the referring and treating physicians, they should be 1) concise, 2) use standardized terms and 3) easy to understand. Several radiology societies and societies and organizations in other medical disciplines have started to provide examples of such templates to their members for use in clinical practice for ex. on their websites etc. (Radiological Society of North America, Society of Abdominal Radiology etc.). Usually the structured templates use standardized terms and avoid the use of ambiguous, vague and imprecise wording. To take these reporting templates to the next level of being useful to the intended customer i.e. the referring medical specialist, it is essential that these reporting templates be developed in conjunction with physicians from the various disciplines that are involved in the care and management of the appropriate patient populations. This will ensure the use of mutually agreed upon terminology between the radiologist and the referring clinicians, eliminating any potential source of confusion. For these reasons, we decided to formulate a working template for pancreatic adenocarcinoma, through a national effort. Working with the Society of Abdominal Radiology and the American Pancreatic Association, we put forth a consensus statement in 2014 which has been published simultaneously in two major journals: the American Journal of Gastroenterology and Radiology. This workshop will illustrate the working template that we and others have developed with and are utilizing in patients with pancreatic adenocarcinoma using examples. We and others will be starting to work on developing a similar working reporting template with SAR as well gastroenterologists and surgeons for cystic pancreatic lesions later this year. Templates developed at other institutions will be shown and illustrated with examples.