cssi/SciSciGPT-SciSciNet huggingface dataset:
Methods and Outcomes for the Remediation of Clinical Reasoning

There is no widely accepted structured, evidence based strategy for the remediation of clinical reasoning skills. To assess the effectiveness of a standardized clinical reasoning remediation plan for medical learners at various stages of training. Learners enrolled in the University of Colorado School of Medicine Remediation Program. From 2006 to 2012, the learner remediation program received 151 referrals. Referrals were made by medical student clerkship directors, residency and fellowship program directors, and through self-referrals. Each learner’s deficiencies were identified using a standardized assessment process; 53 were noted to have clinical reasoning deficits. The authors developed and implemented a ten-step clinical reasoning remediation plan for each of these individuals, whose subsequent performance was independently assessed by unbiased faculty and senior trainees. Participant demographics, faculty time invested, and learner outcomes were tracked. Prevalence of clinical reasoning deficits did not differ by level of training of the remediating individual (p = 0.49). Overall, the mean amount of faculty time required for remediation was 29.6 h (SD = 29.3), with a median of 18 h (IQR 5–39) and a range of 2–100 h. Fifty-one of the 53 (96 %) passed the post remediation reassessment. Thirty-eight (72 %) learners either graduated from their original program or continue to practice in good standing. Four (8 %) additional residents who were placed on probation and five (9 %) who transferred to another program have since graduated. The ten-step remediation plan proved to be successful for the majority of learners struggling with clinical reasoning based on reassessment and limited subsequent educational outcomes. Next steps include implementing the program at other institutions to assess generalizability and tracking long-term outcomes on clinical care.
LINEAR STABILITY ANALYSIS OF MODEL ERROR CONTROL SYNTHESIS

Recently, a new approach for the robust control of nonlinear systems was presented. This approach, called Model Error Control Synthesis, employs an optimal real-time nonlinear estimator to determine model error corrections to the control input of a sliding mode controller using a one time-step ahead technique. Control compensation is achieved by using the estimated model error as a signal synthesis adaptive correction to the nominal control input so that maximum performance is achieved in the face of extreme model uncertainty and disturbance inputs. In this paper Model Error Control Synthesis is applied to a simple second order linear mass-spring-damper system and a higher order benchmark problem. A robustness analysis is performed for the mass-spring-damper system. The proof of the closed loop stability is derived using
Distributed control of glucose uptake by working muscles of conscious mice: roles of transport and phosphorylation.

Muscle glucose uptake (MGU) is determined by glucose delivery, transport, and phosphorylation. C57Bl/6J mice overexpressing GLUT4, hexokinase II (HK II), or both were used to determine the barriers...
IDIOPATHIC MUSCULAR SUBVALVULAR AORTIC STENOSIS WITH ASSOCIATED CONGENITAL CARDIOVASCULAR LESIONS.

Abstract Two patients with idiopathic muscular subvalvular aortic stenosis are described. In one case there was an associated secundum atrial septal defect and in the other, complete situs inversus. This combination of lesions has not been previously reported. The incidence and genetics of these three entities are briefly discussed.
Optimizing combined modality therapy for Hodgkin's disease.

cured of their Hodgkin’s disease. Of the 20%–25% who do relapse, the majority of these are cured with subsequent salvage programs employing either chemotherapy alone or combined modality therapy. The problem, of course, is what happens beyond 10 years. Patients treated with full-dose subtotal nodal radiotherapy, i.e., doses in the range of 40 Gy, will experience an increased frequency of both cardiac disease and second malignancies, the relative risk for each of these entities being approximately 4. In actuarial terms, the risk of any second malignancy is approximately 1% per year. When one examines survival curves for Hodgkin’s disease patients treated with subtotal nodal radiotherapy beyond 10 years, death due to causes other than Hodgkin’s disease becomes predominant.
Genotypic diversity and spatial-temporal distribution of Symbiodinium clones in an abundant reef coral.

Genetic data are rapidly advancing our understanding of various biological systems including the ecology and evolution of coral–algal symbioses. The fine-scale interactions between individual genotypes of host and symbiont remain largely unstudied and constitute a major gap in knowledge. By applying microsatellite markers developed for both host and symbiont, we investigated the intracolony diversity, prevalence and stability of Symbiodinium glynni (type D1) multilocus genotypes in association with dense populations of Pocillopora at two sites in the Gulf of California. The genetic diversity and allelic frequencies in reef populations of S. glynni remained stable over 3 years. Common clone genotypes persisted over this period, and no temporal population subdivision (FPT = 0.021 and )0.003) was detected. Collections from circular plots showed no statistical correlation between related Pocillopora individuals and their associations with particular S. glynni genotypes, with no spatial structuring or clonal aggregation across a reef for the symbiont. From permanent linear transects, samples were analysed from multiple locations within a colony and some were resampled approximately 1 year later. Many of these multisampled colonies (approximately 53%) were dominated by a single S. glynni genotype and tended to associate with the same symbiont genotype(s) over time, while colony ramets often possessed unrelated symbiont genotypes. In contrast to the species level, associations between genotypes of Pocillopora and S. glynni are apparently more flexible over space and time. The abundance of sexually recombinant genotypes of S. glynni combined with greater flexibility might provide adaptive mechanisms for these symbioses to evolve rapidly to changes in environmental conditions and allow particular symbiont genotypes to spread through a host population.
Opium Alkaloids III: Isolation of α-Allocryptopine

Allocryptopine has been isolated from opium in approximately 0.01 per cent yield as the α -form. The alkaloid has been identified by NMR and mass spectrometry and by comparison of its infrared spectrum with that of its allotropic modification, β -allocryptopine. The biosynthetic pathway leading to allocryptopine is discussed briefly.
Winter movements of burbot (Lota lota) during an extreme drawdown in Bull Lake, Wyoming, USA

Winter movements of burbot (Lota lota) were monitored in Bull Lake, Wyoming during a record low water storage period in the winter of 1985–1986. Burbot with surgically implanted ultrasonic transmitters were commonly sedentary during the drawdown. The fish that did move were most active during dusk and at night in winter and during the day in spring. Burbot did not appear to occupy well defined home ranges or show discernible movement patterns. Movement into shallow water during winter was attributed to colder water temperatures and the onset of the spawning season. Burbot were always found associated with silt substrates during the drawdown. Aerial photographs of the exposed bottom revealed that virtually all suitable spawning and nursery habitat for burbot was eliminated by the 13.4-m drawdown.
T Cell Transcriptomes Describe Patient Subtypes in Systemic Lupus Erythematosus.

Background T cells regulate the adaptive immune response and have altered function in autoimmunity. Systemic Lupus Erythematosus (SLE) has great diversity of presentation and treatment response. Peripheral blood component gene expression affords an efficient platform to investigate SLE immune dysfunction and help guide diagnostic biomarker development for patient stratification. Methods Gene expression in peripheral blood T cell samples for 14 SLE patients and 4 controls was analyzed by high depth sequencing. Unbiased clustering of genes and samples revealed novel patterns related to disease etiology. Functional annotation of these genes highlights pathways and protein domains involved in SLE manifestation. Results We found transcripts for hundreds of genes consistently altered in SLE T cell samples, for which DAVID analysis highlights induction of pathways related to mitochondria, nucleotide metabolism and DNA replication. Fewer genes had reduced mRNA expression, and these were linked to signaling, splicing and transcriptional activity. Gene signatures associated with the presence of dsDNA antibodies, low complement levels and nephritis were detected. T cell gene expression also indicates the presence of several patient subtypes, such as having only a minimal expression phenotype, male type, or severe with or without induction of genes related to membrane protein production. Conclusions Unbiased transcriptome analysis of a peripheral blood component provides insight on autoimmune pathophysiology and patient variability. We present an open source workflow and richly annotated dataset to support investigation of T cell biology, develop biomarkers for patient stratification and perhaps help indicate a source of SLE immune dysfunction.
Pro-Act: Sex Strategies for Organizing Peer Interaction in Elementary Classrooms

One of the continuing instructional dilemmas faced by elementary bilingual education and English as a Second Language (ESL) teachers has been that of providing students with adequate and appropriate second language input and opportunities for practice. While recent research has shown that the use of peer language models is one potential solution to this problem, few bilingual educators have suggested the specific means by which peer models may be used to facilitate such input and practice. This article outlines six major (or “macro”) strategies for facilitating peer interaction in English used by two teachers who were observed and videotaped in a study of a summer English Enrichment program. When combined, the first letters of each of the macrostrategies used by these teachers spell the word “PRO-ACT,” a term which describes a crucial attribute of each of these teachers’ macrostrategies- -that of being pro-active rather than re-active in the use of peer language models in the daily life of the classroom.
Social Influence History and Theories

Social influence is an umbrella concept encompassing the work of many theorists such as Paul Lazarsfeld famous for social communication theory and E.M. Rogers known for diffusion of innovation theory. Theories are useful for structuring thought and knowledge about consumer behavior such as how an innovation is communicated through channels over time to members of a social network. Researchers have found that certain people, opinion leaders whether online or offline, are more central and influential than others in a group. The Two-Step Flow Model illustrates that ability and access are crucial to gaining successful influence.
The Feasibility of Using Cattails from Constructed Wetlands to Produce Bioethanol

This project investigates the feasibility of harvesting the cattails in the constructed wetlands of the North Carolina A&T Farm to be converted into ethanol. Using the cattails to produce renewable energy will add value to the land as well as reduce emissions of greenhouse gases by replacing petroleum products. Pretreatment of the dried cattails with dilute NaOH was followed by solid-liquid separation and enzymatic hydrolysis and fermentation of the solids. Two trials gave an average conversion efficiency of 43.4% for the pretreated solids alone which, in conjunction with the crop yield for the cattails, would give up to 4,012 L ethanol/ha, a favorable comparison with corn stover’s 1,665 L/ha at a 60% conversion rate. Given the high potential – 9,680 L/ha at 60% conversion efficiency for solid and liquid streams – and the social and environmental benefits gained by adding value to the waste management system and reducing carbon emissions otherwise made by gasoline, it is recommended that further studies be made using cattails as a feedstock for bioethanol.
Applied Linguistics and Language Teacher Education: What We Know

The research reviewed in this chapter shows knowledge of applied linguistics can have a positive impact on language teachers and has potential for a much greater impact if problems of transfer can be addressed. Therefore, when designing applied linguistics courses for language teacher education programs, it is not enough to simply provide a short apprenticeship in applied linguistics and hope for the best because the knowledge that teachers use in their practice is more complicated that just knowing facts and general conceptions of language and language learning. In order to produce better learning experiences for novice teachers we need to move more away from folk psychology conceptions of the mind (Strauss, 2001) to a more sophisticated and complex view of language teachers’ knowledge, knowledge acquisition, and knowledge use which takes into account the insights from research in these areas. We need to take into account what kind of knowledge language teachers need (as opposed using what knowledge we can offer as a starting point) and what kinds of learning experiences will help them acquire such knowledge. We also need to have a deeper, more sophisticated understanding of how our course designs, materials and activities effect teachers’ knowledge growth, which provides a whole series of research questions which need to be investigated in the coming decade.
The Phenogrammar of Coordination

Linear Categorial Grammar (LinCG) is a sign-based, Curryesque, relational, logical categorial grammar (CG) whose central architecture is based on linear logic. Curryesque grammars separate the abstract combinatorics (tectogrammar) of linguistic expressions from their concrete, audible representations (phenogrammar). Most of these grammars encode linear order in string-based lambda terms, in which there is no obvious way to distinguish right from left. Without some notion of directionality, grammars are unable to differentiate, say, subject and object for purposes of building functorial coordinate structures. We introduce the notion of a phenominator as a way to encode the term structure of a functor separately from its “string support”. This technology is then employed to analyze a range of coordination phenomena typically left unaddressed by Linear Logic-based Curryesque frameworks.
CAMEL to CAMELS: The risk of sensitivity

Most bank regulatory regimes added interest rate risk or sensitivity to their examination focus in the mid-1990s. Interest rate risk significantly contributed to the demise of the US savings and loan industry in the 1980s and 1990s and that episode alone warranted additional focus on sensitivity. However, interest rate risk is not as important as asset quality to remaining a profitable and well-capitalized institution. We find that most US banks are liability-sensitive and that exposure has increased despite regulatory warnings to the contrary. The Basel Committee on Banking Supervision has also expressed renewed concern with interest rate risk. We find that small and community bank net interest margins are affected by interest rates, mortgage prepayment and loan demand. By contrast, large banks hedge much of their interest rate risk but are adversely affected by basis risk. Even if the regulatory agencies had not added ‘S’ to CAMEL two decades ago, the equity market would force management to monitor, measure and control interest rate risk.
Alternatives to Helium-3 for neutron multiplicity counters

Multiplicity counters are an example of a neutron detection system affected by the shortage of 3He. Efforts are underway to identify potential 3He neutron detector replacements for use in multiplicity counters. Boron-10 and 6Li based systems are two of the options being explored as near-term 3He alternatives for neutron multiplicity counters. Simulations of BF3 filled proportional counters, 10B-lined proportional counters and 6Li/ZnS(Ag) sheets in various configurations have been performed with the Monte Carlo particle transport code MCNPX and compared to simulations of existing 3He counters. The system performances are being compared using figure of merits that are the square or cube of the total system efficiency divided by the die-away time (the average lifetime of neutrons in the counter). Design considerations include developing a system with enough neutron detection material to achieve the highest possible efficiency, while simultaneously minimizing system size. Adequate moderation is required to thermalize the incident neutrons for increased counting efficiency, but as the system size increases so will the die-away time. The optimal moderator configuration is one for which the increase in neutron detection efficiency is not off-set by an increase in die-away time. Thus, the entire system performance must be evaluated with every configuration change. The simulation results will be validated against a bench-top demonstrator unit design based on the system identified through simulations as having the highest performance potential. Presented here are the simulation results with various configurations of BF3 filled proportional counters, 10B lined proportional counters and 6Li/ZnS(Ag) sheets, and preliminary measurements with the initial bench-top system.
Suppression of G-CSF-mediated Stat signalling by IL-3

G-CSF-induced myeloid differentiation of 32Dcl3 murine myeloblast cells is antagonized by concurrent exposure to interleukin-3 (IL-3) or by oncogenic transformation of 32Dcl3 by src- or abl-oncogenes which render the cells IL-3-independent. Recent reports have linked G-CSF-mediated differentiation to the ability of G-CSF to activate Stat3. We hypothesized that IL-3 suppresses 32Dcl3 differentiation in part through disruption of G-CSF-Stat signalling. We report that IL-3 inhibited the ability of G-CSF to induce Stat3 DNA binding. Moreover, we find that G-CSF activation of Stat3 binding to DNA is biphasic, peaking at 15–30 min and again at 6–8 h; both peaks are inhibited by IL-3. Transformation of 32Dcl3 cells by the v-abl oncogene leads to constitutive Stat3 activation and distinctive Stat-DNA-binding patterns which are not affected by G-CSF. Cross- modulation of Stat pathway signalling could be a physiologic mechanism for establishing a hierarchy of growth factor effects upon a cell exposed at once to multiple cytokines.
Mid-IR Colloidal Nanocrystals

Colloidal quantum dots presenting optoelectronic properties into the mid-infrared are reviewed with an emphasis on HgTe. Interband transitions with narrow band gap material and intraband transition...
Use of a desk-top calculator to interpret acid-base data.

A computer program for interpretation of acid-base data was developed for a desk-top calculator. Computer diagnosis showed good correlation with clinical diagnosis. It is concluded that the desk-top calculator can generate accurate laboratory interpretations with ease and relatively low cost.
A Rellich Compactness Theorem for Sets of Finite Volume

(1976). A Rellich Compactness Theorem for Sets of Finite Volume. The American Mathematical Monthly: Vol. 83, No. 5, pp. 350-351.
Chemotherapy of solid tumors.

In the majority of solid malignant tumors, chemotherapy and hormonal therapy are only palliative. Nonetheless, drugs or hormones can bring worthwhile subjective and objective improvement. Every patient with a recurrent malignant process should be considered for chemotherapy, but strict guidelines must be followed in selection of patients. Those whose tumors are not responsive to chemotherapy should be considered candidates for investigational programs.
Bit loading-based irregular LDPC coded-modulation for high-speed optical communications

In state-of-the-art fibre-optics communication systems, the forward error correction (FEC) and high-order constellation formats are employed. It is important to approach the Shannon limit by using turbo product codes (TPC) and low-density parity-check (LDPC) codes with soft-decision decoding (SDD) algorithms. In this paper, we first study the rate-adaptive irregular LDPC coding technique in wide range of code rates enabling the flexible adjustment according to channel conditions and the simulation results show an improved SNR gain of 0.15 ∼ 0.44 dB compared with regular LDPC codes under BPSK transmission. Then we propose a bit-loading rule for irregular LDPC codes combined with 16QAM and demonstrate additional 0.3 dB SNR improvements in low code rate regime, making it a viable solution for next generation high-speed optical communication systems.
A model for head/tape friction for smooth media

We present a model for calculating the friction at the head/tape interface as a function of wrap angle, tape speed, tension and head dimensions. The model is based on the Euler–Bernoulli beam equation and the Reynolds equation. Several refinements relative to previous implementations are introduced: specifically a multi-coefficient slip-flow correction is implemented to deal with the reduction of spacing, the skiving-edge profile is modeled using interferometer microscope measurements to account for edge rounding, and the tension asymmetry due to friction is accounted for. Results from the model are compared with experimental measurements of friction versus wrap angle and tape velocity. The model and the experiment show excellent agreement under the range of conditions studied.
Discoveries of Novel Biological Means of Controlling HIV and HIV Disease

We will be focusing this presentation on a few selected aspects regarding novel biological means of conrolling HIV disease with an emphasis on research that we have been conducting in our laboratory.
Evidence for intermolecular domain exchange in the Fab domains of dimer and oligomers of an IgG1 monoclonal antibody.

ABSTRACTRecombinant protein therapeutics have become increasingly useful in combating human diseases, such as cancer and those of genetic origin. One quality concern for protein therapeutics is the content and the structure of the aggregated proteins in the product, due to the potential immunogenicity of these aggregates. Collective efforts have led to a better understanding of some types of protein aggregates, and have revealed the diversity in the structure and cause of protein aggregation. In this work we used a broad range of analytical techniques to characterize the quinary structure (complexes in which each composing unit maintains native quaternary structure) of the stable non-covalent dimer and oligomers of a monoclonal IgG1λ antibody. The results supported a mechanism of intermolecular domain exchange involving the Fab domains of 2 or more IgG molecules. This mechanism can account for the native-like higher order (secondary, tertiary and disulfide bonding) structure, the stability of the non-cova...
Hospitalization in the Year Preceding Major Oncologic Surgery Increases Risk for Adverse Postoperative Events.

Hospitalization is associated with negative clinical effects that last beyond discharge. This study aimed to determine whether hospitalization in the year before major oncologic surgery is associated with adverse outcomes. Patients 18 years of age or older with stomach, pancreas, colon, or rectal cancer who underwent resection in California and New York (2008–2010) were included in the study. Patients with hospitalization in the year prior to oncologic resection (HYPOR) were identified. Multivariable logistic regression was used to examine the association of prior hospitalization with the following adverse outcomes: inpatient mortality, complications, complex discharge needs, and 90-day readmission. Subset analysis by cancer type was performed. Outcomes based on temporal proximity of hospitalization to month of surgical admission were evaluated. Of 32,292 patients, 16.3% (n = 5276) were HYPOR. Patients with prior hospitalization were older (median age, 72 vs 67 years; p < 0.001) and had more comorbidities (Elixhauser Index ≥3, 86.5 vs 75.3%; p < 0.001). In the multivariable analysis, HYPOR was associated with complications (odds ratio [OR], 1.28; 95% confidence interval [CI] 1.18–1.40), complex discharge (OR, 1.44; 95% CI 1.34–1.55), and 90-day readmission (OR, 1.45; 95% CI 1.35–1.56). The interval from HYPOR to resection was not associated with adverse outcomes. Patients hospitalized in the year before oncologic resection are at increased risk for postoperative adverse events. Recent hospitalization is a risk factor that is easily ascertainable and should be used by clinicians to identify patients who may need additional support around the time of oncologic resection.
Basal Ganglia Control of Substantia Nigra Dopaminergic Neurons

Although substantia nigra dopaminergic neurons are spontaneously active both in vivo and in vitro, this activity does not depend on afferent input as these neurons express an endogenous calcium-dependent oscillatory mechanism sufficient to drive action potential generation. However, afferents to these neurons, a large proportion of them GABAergic and arising from other nuclei in the basal ganglia, play a crucial role in modulating the activity of dopaminergic neurons. In the absence of afferent activity or when in brain slices, dopaminergic neurons fire in a very regular, pacemaker-like mode. Phasic activity in GABAergic, glutamatergic, and cholinergic inputs modulates the pacemaker activity into two other modes. The most common is a random firing pattern in which interspike intervals assume a Poisson-like distribution, and a less common pattern, often in response to a conditioned stimulus or a reward in which the neurons fire bursts of 2-8 spikes time-locked to the stimulus. Typically in vivo, all three firing patterns are observed, intermixed, in single nigrostriatal neurons varying over time. Although the precise mechanism(s) underlying the burst are currently the focus of intensive study, it is obvious that bursting must be triggered by afferent inputs. Most of the afferents to substantia nigra pars compacta dopaminergic neurons comprise monosynaptic inputs from GABAergic projection neurons in the ipsilateral neostriatum, the globus pallidus, and the substantia nigra pars reticulata. A smaller fraction of the basal ganglia inputs, something less than 30%, are glutamatergic and arise principally from the ipsilateral subthalamic nucleus and pedunculopontine nucleus. The pedunculopontine nucleus also sends a cholinergic input to nigral dopaminergic neurons. The GABAergic pars reticulata projection neurons also receive inputs from all of these sources, in some cases relaying them disynaptically to the dopaminergic neurons, thereby playing a particularly significant role in setting and/or modulating the firing pattern of the nigrostriatal neurons.
A methodology for estimation of ground phenomena propagation

In this paper, a methodology for estimating the periphery of propagating phenomena is presented. The methodology utilizes a Quantized Estimation to improve the predicted spread of a periphery and decrease the uncertainty of its current state. A procedure to construct the boundary and estimate the rate of spread is discussed. After the Quantized Estimator is determined, the algorithm is incorporated in a multi-UAV dynamic simulation to prove the concept of uncertainty suppression with various schemes for fleet deployment. The paper presents a detailed numerical analysis of the proposed algorithm and extensive simulation results.
Fundus Color Code

Many years ago, Dr. Charles Schepens devised a system of sketching the fundus as a way of recording the findings on indirect ophthalmoscopy with scleral depression. This technique has served as an invaluable aid in improving our comprehension and overall understanding of retinal diseases as well as planning vitreoretinal surgery in specific patients.
Fecal microbiota transplantation: great potential with many challenges

In January of 2019, Samuel P. Costello and colleagues published a wonderfully executed, double blind placebo-controlled trial on fecal microbiota transplantation (FMT) versus autologous stool as placebo in mild to moderately active adult ulcerative colitis [UC: one type of inflammatory bowel disease (IBD)] patients. This review-commentary examines the current state of knowledge on human gut microbiome (live microbiota + their products and surrounding environment, i.e., fecal matter) and microbial therapeutics from a gastrointestinal (GI) clinician’s standpoint. The varied forms of dysbiosis as the target of FMT, recipient donor and placebo considerations are also discussed in respect to randomized control trials in IBD [and the lack thereof in Crohn’s disease (CD)] with this unconventional treatment modality.
Shear resistance of an auxetic chiral mechanical metamaterial

Abstract The shear resistance of 3D printed periodic auxetic chiral mechanical metamaterial was quantified via a picture-frame apparatus. The experimental set-up allowed the accurate measurement of the effective shear modulus of the material. Also, a rigid-rod-rotational spring model shows that the effective shear modulus of the material is directly related to the chiral geometry and the rotational rigidity of the center joints and the corner joints in the chiral cell. To facilitate practical design, design guidelines were developed through an integrated analytical, numerical and experimental approach. The influences of the chiral geometry and the joint rigidity on the shear resistance of the periodic auxetic chiral mechanical metamaterial were quantified. The design guidelines were verified by systematic finite element (FE) simulations.
The Moderating Effect of Education on the Venture Performance of Serial Entrepreneurs

The market for serial entrepreneurship is a market for lemons. Studies have investigated different external factors that influence the expected performance change of serial entrepreneurs, which is ...
Powerful Substances Because of Powerless Powers

I argue that the debate between proponents of substance causation and proponents of causation by powers, as to whether substances or their powers are causes, hinges on whether or not powers (as properties) are self-exemplifying or non-self-exemplifying properties. Substance causation is committed to powers being non-self-exemplifying properties while causation by powers is committed to powers being self-exemplifying properties. I then argue that powers are non-self-exemplifying properties, in support of substance causation.
From Pallets to Puppies: Using Insights from Logistics to Save Animals

The Kentucky Humane Society (KHS) is a private, nonprofit organization dedicated to saving every healthy, behaviorally sound animal that they take in. They are also the largest no-kill animal shelter in Kentucky, USA. Due to limited resources, the KHS has a great need for an optimized methodology for allocating available animals to their adoption facilities. Workers at the KHS believe that a capacity constraint is their most limiting factor. The purpose of this work is to develop an allocation model that will improve the throughput rate of the animals to be adopted, thereby freeing up extra capacity more quickly than current practices. The allocation model presented here assigns animals to adoption locations based on their expected length of stay at all available locations. The resulting allocation minimizes the expected length of stay for these animals. In order to make the model easy to use, we have implemented a software with a user-friendly interface.
Rate of Progression in Activity and Participation Outcomes in Exercisers with Parkinson's Disease: A Five-Year Prospective Longitudinal Study.

Background. Rates of progression of motor symptoms and physical performance show declines between 2% and 7% annually in community samples with Parkinson’s disease (PD). However, the effects of ongoing exercise behaviors on progression rates have not been considered. Objective. The primary purpose of this prospective, longitudinal study was to examine the annual rates of progression in activity and participation measures over five years in community-based exercisers with PD. Methods. A cohort of 55 regular exercisers with idiopathic PD was assessed at baseline and 1, 2, and 5 years. Regular exercise was defined as scores of 4-5 on the Stages for Readiness to Exercise Scale and a self-reported average of at least 60 minutes of exercise/week within six months of each testing session. Unadjusted and adjusted annual progression rates for activity and participation measures were calculated with a standardized equation of change from baseline. A linear mixed model with covariates of age at PD diagnosis and PD subtype was used to determine adjusted change scores. Results. Annual progression rates for unadjusted and adjusted variables were similar, and none exceeded 1.7% across time points for this group of exercisers with PD. Older age at PD diagnosis significantly contributed to faster progression of walking and balance functions. A nonlinear trajectory of the PD progression was demonstrated across most activity and participation outcomes. Conclusions. Annual progression rates demonstrated by this sample of exercisers were lower than those previously reported for motor decline in general samples with PD. Assessing activity and participation outcomes longitudinally at interim time points was important for understanding the trajectory of change over time. The lower rates of progression in this study warrant further investigation into the long-term effects of exercise in PD.
The impact of program-driven wellness initiatives on burnout and depression among surgical trainees.

Abstract Background The prevalence of burnout and depression are high among surgical trainees. This study examined the impact of program-driven initiatives to improve surgical trainee wellness. Methods A survey was administered to residents and fellows at all surgical training programs across an urban academic health system. The survey measured burnout, depressive symptoms, and perceptions of program-driven wellness initiatives. Results The response rate was 44% among 369 residents. Of these, 63.2% screened positively for burnout, and 36.7% for depression. Residents who were burned out were more likely to work >80 h per week, have greater clerical duties, and miss educational activities more frequently. Conversely, having opportunities for wellness activities, dedicated faculty and housestaff wellness champions, and assistance with clerical burden were all associated with lower rates of burnout and depression. Conclusion The presence of wellness support was associated with better outcomes, suggesting the value of initiatives to manage workload and support the well-being of surgical resident physicians.
Use of the rat as a model in regenerative medicine

Abstract Regenerative medicine is a branch of medicine aimed at the repair, replacement, and functional restoration of tissues or organs that have been damaged due to disease, injury, or congenital defects. Specific therapeutic strategies involve the use of stem cells, tissue engineering, medical devices, and/or creation of artificial organs. Due to their size, ease of handling, relatively low cost, and similar anatomy and physiology to humans, rats are an ideal model to study regenerative-based therapies for the repair and treatment of a wide variety of diseases or injuries, most notably those affecting the liver, heart, bone, and central nervous system. This chapter provides an overview of rat models used to investigate regenerative medicine strategies and how the laboratory rat has contributed to progress in this exciting and rapidly growing field.
Implementation of a pre- and in-scan system to minimize head motion in pediatric participants undergoing fMRI scans

Background: Performing fMRI scans of children can be a difficult task, as participants tend to move while being scanned. Head motion represents a significant confound in functional magnetic resonance imaging (fMRI) connectivity analyses, and methods to limit the impact of movement on data quality are needed. One approach has been to use shorter MRI protocols, though this potentially reduces the reliability of the results. Objective: Here we describe steps we have taken to limit head motion in an ongoing fMRI study of children undergoing a 60 minute MRI scan protocol. Specifically, we have used a mock scan protocol that trains participants to lie still while being scanned. We provide a detailed protocol and describe other in-scanner measures we have implemented, including an incentive system and the use of a weighted blanket. Materials and methods: Participants who received a formal mock scan (n = 12) were compared to participants who had an informal mock scan (n = 7). A replication group of participants (n = 16), including five with autism spectrum disorder, who received a formal mock scan were also compared to the informal mock scan group. The primary measure of interest was the mean frame-to-frame displacement across eight functional runs during the fMRI protocol. Results: Participants in the formal mock scan and replication group tended to exhibit more low-motion functional scans than the informal mock scan group (P 0.8). Conclusion: Results indicate that with appropriate measures, it is possible to achieve low-motion fMRI data in younger participants undergoing a long scan protocol.
The role of pharmacotherapy in the treatment of endometriosis across the lifespan

Endometriosis is estimated to affect 10% of reproductive-aged women. The gold standard for treatment is surgery; however, surgery carries a significant morbidity and cost burden. There is an ongoin...
Transgender and gender diverse health education for future nurses: Students' knowledge and attitudes.

Abstract Background Compared to cisgender peers, transgender and gender diverse (TGD) people experience significant health disparities associated with discrimination and limited access to appropriate care in healthcare settings. Nurses represent the largest segment of the United States (US) healthcare workforce; however, US nursing programs only dedicate approximately 2.12 h to Lesbian, Gay, Bisexual, and TGD (LGBT)-related content. Objectives/design/setting/participants To fill the gap in TGD-related nursing education, the Transgender Curriculum Integration Project (TCIP) developed and integrated an evidence-based curriculum specific to TGD health into the pre-licensure accelerated Bachelor's in Nursing Science (BSN) program at Johns Hopkins School of Nursing. The purpose of this study was to assess the preliminary efficacy and feasibility (i.e., attrition, engagement, acceptability) of the TCIP in improving the TGD-related health knowledge and attitudes among a sample of pre-licensure nursing students. Methods TCIP utilized a self-administered online survey to assess students' knowledge and attitudes about TGD health prior to (time point 1) and following (time points 2 and 3) the integration of TGD-specific content into five nursing pre-licensure courses. Rank-based nonparametric testing using Kruskal-Wallis H and Mann-Whitney U were conducted to determine if there were statistically significant differences in responses between the three time points. Thematic content analysis was used to determine themes present among short answers. Results Findings indicate TGD-specific content improved student's gender sensitivity overtime, with improvements in self-reported skills in providing care for TGD people and knowledge of additional TGD-specific resources. However, gender sensitivity remains low among student's and students requested more TGD content suggesting room for further improvement. Conclusions Findings support the efficacy of TCIP and highlight complexities of curricular change that can guide future curricular integration and evaluation in nursing programs nation-wide.
Pediatric orthopedic mythbusters: the truth about flexible flatfeet, tibial and femoral torsion, W-sitting, and idiopathic toe-walking.

Purpose of review Myths, widely held but false or unproven beliefs, exist in pediatric orthopedics, with the most common examples related to flexible flatfeet, in-toeing/out-toeing, W-sitting, and toe-walking. Concerns regarding these findings and suggested treatments, unfounded in science, may be passed along verbally or published through various media, without citation. The current review investigates these myths and provides up to date recommendations on diagnosis and treatment (or lack of necessary treatment) for these common pediatric orthopedic findings. Recent findings Orthotics used in childhood do not alter foot development for flexible flatfeet. W-sitting is not associated with developmental dysplasia of the hip, and there is no scientific evidence to support that it leads to contractures, hip dislocations, or functional deficits. Summary Misinformation about normal variants of growth in childhood and suggested treatments are rampant and can be found published through various media without citation, as supportive scientific studies do not exist or existing studies refute the claims. Flexible flatfeet, in-toeing/out-toeing, W-sitting, and toe-walking typically improve throughout childhood without intervention. Physical therapy, orthotics and bracing have not been proven effective. Treatment is required in rare scenarios and should be directed by the orthopedic surgeon.
Research on Influencing Factors of Very Fast Transient Overvoltage in EHV GIS

The influence factors of VFTO when the disconnector operating of GIS are obtained, the methods of suppressor VFTO of UHV GIS are put forward. based on construction and operating mode of 550kV GIS VFTO at different operating mode are calculated, the effects of VFTO on transformer insulation, the breaker capacitance, residual charge voltage and bus wave impedance on VFTO are analyzed. Aiming at the transmission and transformation system, measures to suppress VFTO are proposed, thus providing a reference for the production and operation of EHV GIS equipment.
A Review of the History, Pharmacology, and Legal Regulation of Vaporizers and Vape Products

Vaping has gained incredible popularity in the United States and in the United Kingdom over the last decade. Likely, this is due to the confluence of certain conditions that, together, bolstered an environment conducive for explosive growth. These conditions include the long existence of vaporizer technology, the growth of the legal cannabis industry, the continued marketing efforts of the tobacco industry, intense marketing campaigns of alternative and safer nicotine delivery systems, and youth culture in a hyper-connected broadband/Internet era. Tangentially, emerging “gray market” industries that are largely unregulated or under-regulated have also contributed to a broader vape culture. This includes the manufacture of alternative cannabis products, such as cannabidiol (CBD), that have expanded wildly since the passage of the Agriculture Improvement Act of 2018. While the U.S. Food & Drug Administration and the U.K. Home Office continue to create clear and comprehensive guidelines, a regulatory vacuum continues to exist in both countries allowing products to flourish in stores and online. Facets of the legal/illegal cannabis and CBD markets continue to exploit the broadening vape culture. In all, the following products are available in vape form: cannabis oil and other concentrates (e.g., wax, butter, “shatter,” or butane-extracted compounds—all containing THC), CBD and “cannabis alternatives,” nicotine and nicotine/ tobacco alternatives, and essential oils (or “herbal vape” products that can include “flavor” combinations such as jasmine, lime, and patchouli; orange, frankincense, and ylangylang; fennel, thyme, and vanilla). The following sections describe this emerging vaping trend in these ways: its history, the known and unknown pharmacology (including toxicity), legal considerations, and regulatory concerns. It does so while focusing on both the products of consumption (e.g., the vape “juice,” salts, or organic matter) as well as the devices used to produce the aerosol for their consumption.
Pay (Be)for(e) Performance: The Signing Bonus as an Incentive Device

This paper investigates the use of a signing bonus as a tool for …rms to signal their quality to prospective employees. It is the …rst to provide a theoretical basis for the signing bonus, one of the most common elements of compensation packages for white collar employees. It also shows that low performance incentives can serve a complementary purpose, implying that within a job/industry pair we should expect higher quality …rms to employ higher signing bonuses and lower performance pay. This runs contrary to previous literature relating …rm quality to incentive intensity and calls into question the use by empiricists of low performance pay as an indicator of poor corporate governance. The paper makes a number of empirically testable predictions and provides precise guidance on how
Association of Generic Competition With Price Decreases in Physician-Administered Drugs and Estimated Price Decreases for Biosimilar Competition.

Importance Price decreases of biologic and biosimilar products in Medicare Part B have been minimal, even with biosimilar competition. Medicare reimburses clinicians for biologics and biosimilars differently than for brand-name and generic drugs, which has generated greater price reductions. Objective To characterize the nature of price competition among brand-name and generic drugs under Medicare Part B and to estimate the cost savings to the program of subjecting biologic and biosimilar therapies to a similar price competition. Design, Setting, and Participants This cohort study analyzed all brand-name drugs and their approved generic versions as well as biologics and biosimilars that were reimbursed under Medicare Part B from quarter 1 of 2005 to quarter 2 of 2021. Two separate data sets were created: brand-name and generic drugs as well as biologics and biosimilars data sets. Brand-name products with generic versions that were introduced before 2005 were excluded, and so were vaccines. Exposures Number of generic and biosimilar competitors over time. Main Outcomes and Measures Price change as a percentage of the brand-name drug or biologic price in the quarter before generic or biosimilar competition. Price change was modeled using a linear, fixed-effects time series regression, with the number of generic or biosimilar competitors as the main covariate. Time was expressed as the number of quarters since the first generic or biosimilar competitor entered the market. Savings were estimated by projecting the regression model of brand-name and generic drug competition to observed biologic and biosimilar competition and by applying the estimated price reduction to actual Medicare spending for those products from 2015 to 2019. Results Of the 988 Healthcare Common Procedure Coding System codes identified, 50 (5.0%) met the inclusion criteria for the brand-name and generic drug data set and 28 (2.8%) met the criteria for the biologic and biosimilar data set. The first generic competitor was associated with reduced drug prices by 17.0%, the second competitor with a 39.5% decrease, the third competitor with a 52.5% decrease, and the fourth and more competitors with a 70.2% decrease (price decline was measured from brand-name drug price before the first generic competitor rather than from price established with fewer competitors). If biologics and biosimilars were subject to the same Medicare reimbursement framework as brand-name and generic drugs, Medicare spending on these products was estimated to have been 26.6% lower ($1.6 billion) from 2015 to 2019. Conclusions and Relevance This study found minimal uptake of biosimilars and limited price reductions for biologics and biosimilars under the current Medicare Part B reimbursement policy. Adopting the bundled biosimilar reimbursement structure for biologic and biosimilar therapies may be associated with substantial savings and encourage greater biosimilar market entry.