cssi/SciSciGPT-SciSciNet huggingface dataset:
Liver transplantation at the Cleveland Clinic. Early results.

Seventeen patients received 19 orthotopic liver transplants at the Cleveland Clinic in the initial clinical phase of the liver transplantation program developed by a team of surgeons, gastroenterologists, anesthesiologists, psychiatrists, and social workers. The survival rate of 71% after a mean follow-up of six months is equal to that seen in other centers. The technical demands are high, and postoperative complications are many. The demands on limited resources, such as blood for transfusion, are modest. The quality of life among survivors has been, with two exceptions, excellent. The indications for liver transplantation are evolving. It is anticipated that this operation will be performed more often. Patients to be considered for transplantation need to be referred before they have deteriorated too much to be operated on.
A study of separation on airfoils undergoing pitch, surge and combined motions

Vertical axis wind turbine blades undergo a large angle of attack and velocity variation during every turbine rotation. The flow over a NACA 0018 airfoil undergoing sinusoidal pitch, surge and combined motions at similar frequency, amplitude and Reynolds number as a commercial turbine was measured to investigate the effect of the different motions on the flow field. Two-dimensional, time resolved velocity fields were acquired using particle image velocimetry. Vorticity contours of the phase-averaged flow were used to visualize the separation process and shear layer development. The pitch-only ease is seen to separate earlier and at a lower angle of attack than the combined case. Results for surging airfoils at two angles of attack are presented, one fully separated, and one partially separated. Surge forward is shown to move the separation point toward the leading edge, while surge back moved it aft. The dynamics of the leading edge vortex in the combined pitch/surge and pitch motions are discussed.
Fragmented Regionalism: Why Metropolitan America Continues to Splinter

This article addresses the extent to which metropolitan regions have continued to fragment and grown more disparate. We ask, why have comprehensive institutions not taken root to mitigate metropoli...
Decreased survival, chronic inflammation and tumor susceptibility of irradiated DR5-null mice

779 The long-term tissue response following ionizing irradiation (IR) involves molecular events in different cell types that regulate tissue homeostasis that has implications for inflammation, tissue damage and cancer. We have previously shown that loss of DR5/Killer/MK, the receptor to the cytokine Tumor necrosis factor Related Apoptosis Inducing Ligand (TRAIL) in mice confers resistance to acute cell death inflicted by IR in several lymphoid and also to some extent in non-lymphoid organs (Finnberg N et al. Mol. Cell. Biol. 25:2000-2013, 2005). In the present study we explored the long-term effects (17 months) of IR in mice treated with a single sub-lethal dose of whole-body irradiation (4 Gy) at the age of 4-5 weeks. Wild-type (wt, N = 11) mice, mice heterozygous for the DR5 receptor (DR5, N = 10) and mice completely lacking the DR5-receptor (DR5-/-, N = 21) were subjected to irradiation. Increased lethality was observed in the DR5-/- group at 8 months following IR. Necropsy showed “tissue damage” (i.e., infiltrating lymphocytes, fibrosis and distorted tissue architecture) in the lungs (consistent with bronchopneumonia), small intestine and the colon of moribund DR5-/- mice. Immunohistochemistry identified infiltrating lymphocytes as CD3-positive, deposition of fibronectin and increased numbers of TUNEL-positive epithelial cells in damaged tissue. A limited number of tumors were detected in the lungs and the lymphoid tissues of DR5-/- mice and DR5 mice (but not wt mice) that survived 17 months. We propose a model wherein DR5 functions as a negative regulator of late tissue-damage involving inflammation and fibrosis following IR primarily in the lungs. In addition, TRAIL might be useful in modulating the tissue toxicity following anti-cancer therapy. Thus DR5 appears to suppress chronic inflammation and cancer following exposure to IR.
The Hospitalized Child

Today the pediatrician must know the course of the emotional response to hospitalization just as he must know the usual course of a disease process to maximize the response to treatment. This article describes the reactions of children of various ages to hospitalization and offers suggestions for making the experience less traumatic.
Gastrin effects on isolated rat enterochromaffin-like cells in primary culture

The hormone gastrin stimulates acid secretion by releasing histamine from gastric enterochromaffin-like (ECL) cells and induces ECL cell proliferation in vivo. This study uses a > 90% pure ECL cell...
Commentary: Assessment: The Pros and Cons of this Necessary “Evil”

Attempting to provide a summarizing commentary that unified the three chapters in this section initially seemed like a daunting task. After all, the two chapters by Cheung and Fortus are clearly about, with Cheung focusing on assessment of students’ practical skills in Hong Kong and Fortus taking on the broader issue of assessing Israeli students’ knowledge in science. The latter uses the issues with assessment to address issues related to policy and practice, while Cheung is more focused on specific practical skills within the science curriculum. Nevertheless, the two chapters are both clearly related to assessment. However, the third chapter written by Teleshov and Zhilin addresses the history of didactics of chemistry and how it has been viewed in Russia from the eighteenth century to now.
Effects of a Peer-Delivered Corrective Reading Program

The effects of a peer-delivered Corrective Reading program (CRP) (Engelmann, Hanner, & Johnson, 1989) with repeated reading on the reading performance of at-risk high school students were examined. High school peer instructors and students in need of reading remediation were randomly assigned to dyads or triads. Peer instructors presented the CRP, conducted repeated reading trials, and took rate and accuracy measures. Pre to post test data were collected on vocabulary and comprehension subtests of the Gates–MacGinitie Reading Tests, oral reading fluency (words read per minute) and accuracy, number of repeated readings on initial and final lessons, and lessons completed. Results indicated that students' performance on the standardized reading assessment increased as did their oral reading fluency. In general, the number of repeated readings decreased from the initial lesson to the final lesson. Implications for further research are discussed.
States of emergence: Writing African female same-sex sexuality

ABSTRACTTracing a series of intertextually linked short stories from the 1990s to the present by women writers from Nigeria and its diaspora—Chimamanda Ngozi Adichie, Unoma Azuah, Chinelo Okparanta, and Lola Shoneyin—I suggest that although the figure of the African lesbian appears “new” in the context of heightened contemporary attention to the issue of homosexuality, this figure has a literary history. Ghanaian Ama Ata Aidoo's novel Our Sister Killjoy: Or, Reflections From A Black-Eyed Squint (1977) inaugurates this formation, in which the imagining of female same-sex desire is entangled with articulating the experience of migration under the shadow of imperial histories. In these short stories, the emphasis on the difficulties of love in puritanical times and transnational places produces the figure of the African lesbian as a symbol of appealingly human vulnerability, resilience, and complexity.
Impact of Negative Message Framing on Security Adoption

This article examines the impact of negative message framing on security technology adoption. Based on previous studies, it was hypothesized that negatively-framed messages would have a greater effect on the adoption of security technologies which detect system abuse than on technologies for prevention. To test this hypothesis, two security technologies were selected: one to represent preventative technologies and one to represent detective technologies. Undergraduate business students at a major southeastern university were first introduced to both security technologies, then exposed to negatively-framed messages and asked to complete a survey regarding their attitudes and intentions toward adopting each. In line with previous studies, it was determined that negatively-framed messages are better suited for detection technologies than for prevention technologies, and that IS managers should become more sensitive to the manner in which new security technologies are introduced and to the factors that help s...
Pre-operative walking activity in youth with cerebral palsy.

Abstract Background No data are available regarding level of walking activity for youth with cerebral palsy (CP) before undergoing orthopeadic surgery. The goals of this study were to quantify pre-operative walking activity, and determine whether pre-operative values are different from previously defined levels of walking activity in youth with CP. Procedures This study retrospectively evaluated pre-operative walking activity in youth with spastic CP, GMFCS levels I–IV. Walking activity was monitored using the StepWatch™. Outcome variables included mean daily strides, percent of day active, and percent of active time at high activity. Differences between GMFCS levels were examined and comparisons were made to published data. Results Pre-operative walking activity data from 126 youth with CP were included. All variables demonstrated higher walking activity in youth at GMFCS levels I/II compared to those at GMFCS levels III/IV. When compared to previously defined walking activity levels, pre-operative walking activity was lower. Conclusions Walking activity among pre-operative youth with CP is significantly lower than published data for ambulatory youth with CP. Results suggest that youth with CP who are surgical candidates have less walking activity than youth with CP without surgical needs. Therefore this study should encourage the effort to collect and analyze individual pre-operative data for comparison and evaluation of post-operative functional recovery.
Birth of a New Perspective? A Call for Biopsychosocial Research on Childbirth:

Childbirth is a major life event with implications for family health, but it has been understudied by psychological scientists. The biopsychosocial model, which posits that health is shaped by biol...
Prospective Review of Mesenchymal Stem Cells Differentiation into Osteoblasts

Stem cell research has been a popular topic in the past few decades. This review aims to discuss factors that help regulate, induce, and enhance mesenchymal stem cell (MSC) differentiation into osteoblasts for bone regeneration. The factors analyzed include bone morphogenic protein (BMP), transforming growth factor β (TGF-β), stromal cell-derived factor 1 (SDF-1), insulin-like growth factor type 1 (IGF-1), histone demethylase JMJD3, cyclin dependent kinase 1 (CDK1), fucoidan, Runx2 transcription factor, and TAZ transcriptional coactivator. Methods promoting bone healing are also evaluated in this review that have shown promise in previous studies. Methods tested using animal models include low intensity pulsed ultrasound (LIPUS) with MSC, micro motion, AMD3100 injections, BMP delivery, MSC transplantation, tissue engineering utilizing scaffolds, anti-IL-20 monoclonal antibody, low dose photodynamic therapy, and bone marrow stromal cell transplants. Human clinical trial methods analyzed include osteoblast injections, bone marrow grafts, bone marrow and platelet rich plasma transplantation, tissue engineering using scaffolds, and recombinant human BMP-2. These methods have been shown to promote and accelerate new bone formation. These various methods for enhanced bone regeneration have the potential to be used, following further research, in clinical practice.
Abstract 292: Isoform-Specific Expression of Estrogen-Related Receptors Regulates Cardiomyocyte Metabolic Adaptation to Oxidative Stress

In the ischemic heart, metabolic adaptation of cardiomyocytes exposed to prolonged hypoxia is critical to sustain myocardial energy production. Metabolic gene expression is regulated by Estrogen-Related Receptor (ERR) transcription factors and Peroxisome Proliferator-Activated Receptor γ Coactivator-1 (PGC-1) co-activators. ERRs do not require ligand to achieve an active conformation and regulate an array of target genes involved in myocardial energy metabolism. These studies aim to determine the regulatory mechanisms governing expression of ERR isoforms (ERRα and ERRβ) in cardiomyocytes undergoing oxidative stress. We hypothesize that metabolic energy production in myocardium initially adapts to hypoxia by inducing transient ERRβ expression, and maintains this compensatory expression through induction of sustained ERRα expression. Adult feline cardiomyocytes in primary culture were electrically stimulated to contract continuously at 1 Hz under normoxia (21% [O2]), hypoxia (0.5% [O2]), or hypoxia followed by reoxygenation. Expression of ERR, PGC-1 and target genes was measured by QRT-PCR (n≥5). QRT-PCR arrays were used to screen for prospective target genes. In response to 24 hours of hypoxia, mRNA levels increased for ERRα (3-fold by 24 hours), ERRβ (11-fold by 12 hours), PGC-1α (16-fold by 24 hours) and PGC-1β (8-fold by 24 hours). Subsequent reoxygenation for 24 hours decreased ERRβ, PGC-1α and PGC-1β mRNA levels to that of normoxia controls. However, reoxygenation did not markedly decrease (∼25%; 0.7 of 3.0-fold) ERRα mRNA levels. Cytochrome C Oxidase Subunit VIc (Cox6c) and Fatty Acid Binding Protein 3 (Fabp3) were identified as potential ERRα target genes in adult cardiomyocytes based on correlation of expression. Moreover, hypoxia-induced increases in Cox6c and Fabp3 mRNA levels were partially blocked by treatment with XCT-790, an inhibitor of ERRα activity. We conclude that hypoxia and subsequent reoxygenation elicit isoform-specific changes in ERR and PGC-1 mRNA expression in adult cardiomyocytes. This observed regulation of expression for ERR isoforms and their target genes may play a critical role in metabolic adaptation to oxidative stress.
U.S. AGRICULTURE IN AN INCREASINGLY COMPETITIVE GLOBAL MARKET

Dramatic changes are occurring in the agricultural sector today. These changes provide opportunities for some, but threats for others. Longer-term, four fundamental forces or drivers will shape the business climate that the industry faces. These forces include expanded global production; expanded and diversified global demand; technology and in particular simplification technology; and changes in competitive metrics and expectations as to the acceptable returns to contributed resources. The interaction among these four fundamental forces will determine whether the future business climate for US agriculture is characterized as one of opportunity or one of challenge/threat. These four fundamental forces have the potential to shape a very different agricultural industry compared to that of the 20th century. Twenty-first century agriculture is likely to be characterized by the following: increased concentration and consolidation; expansion of industrialized agriculture; production of differentiated products; precision (information intensive) production and distribution; emergence of ecological agriculture; formation of food supply chains; increasing risk; and more diversity. In this new agriculture of the future, successful companies will need to be better, faster, and cheaper to have a sustainable competitive advantage
Towards Collaborative Trust Management

Current technologies to include cloud computing, social networking, mobile applications and crowd and synthetic intelligence, coupled with the explosion in storage and processing power, are evolving massive-scale marketplaces for a wide variety of resources and services. They are also enabling unprecedented forms and levels of collaborations among human and machine entities. In this new era, trust remains the keystone of success in any relationship between two or more parties. A primary challenge is to establish and manage trust in environments where massive numbers of consumers, providers and brokers are largely autonomous with vastly diverse requirements, capabilities, and trust profiles. Most contemporary trust management solutions are oblivious to diversities in trustors' requirements and contexts, utilize direct or indirect experiences as the only form of trust computations, employ hardcoded trust computations and marginally consider collaboration in trust management. We surmise the need for reference architecture for trust management to guide the development of a wide spectrum of trust management systems. In our previous work, we presented a preliminary reference architecture for trust management which provides customizable and reconfigurable trust management operations to accommodate varying levels of diversity and trust personalization. In this paper, we present a comprehensive taxonomy for trust management and extend our reference architecture to feature collaboration as a first-class object. Our goal is to promote the development of new collaborative trust management systems, where various trust management operations would involve collaborating entities. Using the proposed architecture, we implemented a collaborative personalized trust management system. Simulation results demonstrate the effectiveness and efficiency of our system.
Reflections on Commentaries on “Issues in Human–Automation Interaction Modeling”:

This “reflections” piece identifies major themes emerging from the commentaries in the issue. I discuss how some existing issues with the levels of automation (LOAs) approach may be further resolve...
Excitation spectra of retinal by multiconfiguration pair-density functional theory

Retinal is the chromophore in proteins responsible for vision. The absorption maximum of retinal is sensitive to mutations of the protein. However, it is not easy to predict the absorption spectrum of retinal accurately, and questions remain even after intensive investigation. Retinal poses a challenge for Kohn–Sham density functional theory (KS-DFT) because of the charge transfer character in its excitations, and it poses a challenge for wave function theory because the large size of the molecule makes multiconfigurational perturbation theory methods expensive. In this study, we demonstrate that multiconfiguration pair-density functional theory (MC-PDFT) provides an efficient way to predict the vertical excitation energies of 11-Z retinal, and it reproduces the experimentally determined absorption band widths and peak positions better than complete active space second-order perturbation theory (CASPT2). The consistency between complete active space self-consistent field (CASSCF) and KS-DFT dipole moments is demonstrated to be a useful criterion in selecting the active space. We also found that the nature of the terminal groups and the conformations of retinal play a significant role in the absorption spectrum. By considering a thermal distribution of conformations, we predict an absorption spectrum of retinal that is consistent with the experimental gas-phase spectrum. The location of the absorption peak and the spectral broadening based on MC-PDFT calculations agree better with experiments than those of CASPT2.
On numerical study of coupled plasma-wall instability

A rather simple approach to the numerical study of instabilities, associated with coupled plasma and wall-related transport processes, is suggested. It allows coupling of different plasma and wall-related transport models without performing additional simulations.
Management of neuromas in the hand

Injury to a peripheral nerve in the hand can result in loss of motor and sensory function. In addition, incomplete or abnormal regeneration can cause painful sequelae. The approach to neuromas in the hand requires familiarity with the basic aspects of nerve regeneration as well as the neurophysiology of pain mechanisms.
Psychology and the Health Care System

The purpose of this chapter is to delineate the challenges and opportunities confronting psychology as a health care science and profession that arise from the transactions of psychologists with medical settings. These transactions are considered from the perspective of the unique characteristics and contributions of psychologists and the characteristics of a health care system that is currently undergoing unprecedented changes.
Multiple Resource Modeling of Task Interference in Vehicle Control, Hazard Awareness and In-vehicle Task Performance

The authors describe a computational model of multiple task performance used to predict task interference and subsequent decrements in performance, based on the resource demands of a particular task (i.e., the difficulty) as well as the competition between tasks over limited and overlapping resources. They describe the model components, the computational aspects, and further validate it with data from a simulated driving study.
Association of Target Volume Margins With Locoregional Control and Acute Toxicities for Non-small cell lung cancer Treated With Concurrent Chemoradiation Therapy

Abstract Purpose This study aimed to investigate the association between target volume margins and clinical outcomes for patients with inoperable non-small cell lung cancer (NSCLC) treated with concurrent chemoradiation therapy. Methods and materials We reviewed the records of 82 patients with inoperable NSCLC treated between 2009 and 2016 with concurrent chemoradiation. All patients received positron emission tomography–based treatment planning, 4-dimensional computed tomography simulation to define an internal target volume, and daily cone beam computed tomography. We quantified variations in target volume margins with a margin deviation index (MDI), calculated as the percentage change in equivalent uniform dose between the original planning target volume (PTV) and a standard reference PTV 10 mm beyond the original gross tumor volume, consistent with the minimum margins mandated by recent NSCLC trials. Greater MDIs equated to smaller effective target volume margins. We dichotomized patients by the upper tercile MDI value (5.8%). Endpoints included time to locoregional progression and time to grade ≥ 3 radiation esophagitis (RE3) or radiation pneumonitis (RP3), modelled with the Fine-Gray method. Results Median follow-up was 37.8 months (range, 5.9-58.1 months). Larger MDIs correlated with smaller clinical target volume (CTV) + PTV margins, larger gross tumor volumes, later treatment year, and intensity modulated radiation therapy use. The risk of locoregional progression did not differ for MDI ≥5.8% versus Conclusions Smaller margins were used for larger tumors but were not associated with an increase in locoregional failures. Additional studies could clarify whether smaller margins, when used alongside modern radiation therapy techniques, decrease treatment-related toxicity for inoperable NSCLC.
Sticky Platelet Syndrome

Sticky platelet syndrome (SDS) is a rare form of an inherited platelet disorder characterized by thrombotic platelet aggregation. Complications of hypercoagulability may develop with arterial thrombosis being the most common clinical manifestation of the syndrome, especially in coronary and cerebral arteries. Deep venous thrombosis and pulmonary embolism may also occur. Fetal effects from placental vascular thrombosis include intrauterine growth restriction and fetal demise. This syndrome may be an underappreciated cause of adverse pregnancy outcomes.
Conducting rights-based short-term study abroad experiences

The number of short-term study abroad trips has been increasing and the majority of social work programs conduct them, often including service learning experiences. These trips can help students le...
THE USE OF IMPELLA HEART PUMP FOR MANAGEMENT OF WOMEN WITH PERIPARTUM CARDIOGENIC SHOCK

Peripartum cardiomyopathy (PPCM) is a pregnancy associated cardiomyopathy presenting with heart failure. Although the majority of women recover, continued deterioration of cardiac function occurs leading to mortality. Early unloading of the LV may prevent death and allow better recovery.
Changes in Tobacco Product Advertising at Point of Sale: 2015–2018

OBJECTIVES: Tobacco point-of-sale advertising, particularly in retailers surrounding schools, is associated with youth tobacco use and must be monitored. This study examines how the point-of-sale environment surrounding youth changed over time with regard to diverse tobacco products. METHODS: Each spring from 2015 to 2018, research staff visited the same tobacco retailers (n = 141) within a half-mile of New Jersey high schools. For cigarettes, cigars, electronic cigarettes, and smokeless tobacco, advertisement presence, volume, and share of advertising voice (SAV) were measured for both the exterior and interior of the store. Analyses examined changes over time by product, controlling for store type and poverty. RESULTS: Over time, exterior cigarette advertisements declined in presence (61% to 49%) and SAV (50% to 40%), whereas interior advertisements maintained stable presence, volume, and SAV. In contrast, cigar advertisements increased in presence (exterior 11% to 23%; interior 19% to 30%) and volume (exterior mean 0.2 to 0.5; interior 0.3 to 0.8). For electronic cigarettes, exterior and interior advertising presence, volume, and SAV decreased from 2015 to 2017 but increased in 2018. Smokeless tobacco advertising was infrequent and stayed consistent except in volume in the interior of stores (mean 0.2 to 0.3). When there were any differences by store type, chain convenience stores had the most exterior and interior advertising for all products. CONCLUSIONS: The longitudinal changes observed for each product’s advertising reflect national youth use rates of the corresponding products. The point-of-sale environment around schools may be influencing youth tobacco use and must be monitored and regulated.
Does Referral Bias Impact Outcomes of Surgery for Degenerative Mitral Valve Disease

Background Geographic origin is cited as a possible factor influencing outcomes of operation for repair or replacement of degenerative mitral valve (MV) disease. Our study aimed to identify the potential impact of referral bias on clinical outcomes of MV surgery. Methods We analyzed clinical and echocardiographic information of 2353 patients undergoing primary or secondary MV surgery for degenerative MV disease. Patients were grouped as local (in-state), regional (5 surrounding states), or national referrals. Results The number of patients (local, 827; regional, 809; national, 717) and median follow-up time (9.1 years) were similar between geographic groups. More comorbidities were found in the local patient group. Overall operative risk was 0.7% and was greater in local and regional patients compared with national patients (0.7% and 1.1% vs 0.1%, P = .05). Valve repair was performed in 97% of isolated MV surgeries, and repair rate was similar in the 3 geographic groups. The 3 groups had similar incidences of major morbidity, but local and regional groups had higher 30-day readmissions. In univariate analysis, survival was improved in national and regional patients compared with local patients; however in multivariable analysis this difference was no longer significant. Conclusions There were important variations in baseline demographic and clinical characteristics between referral groups; local and regional patients presented with more comorbid conditions compared with national referrals. Aside from a small difference in perioperative mortality, early outcomes were generally similar. Late survival, however, was superior in national patients, and this referral bias is explained by fewer associated medical illnesses.
Impact of AMI Data Time Granularity on Quasi-Static Time-Series Load Flow Simulation

AMI data allows highly detailed representation of distribution system loads in quasi-static time-series load flow (QSTS) simulations but requires managing large data volumes. Reducing the time granularity of AMI data reduces the data volume but can harm the detail and accuracy of QSTS simulations. This paper analyzes the accuracy of QSTS simulations with different time granularities of AMI load profiles. Three time granularities (5-min, 15-min, and 60-min) common to today's AMI deployments are compared against a higher 1-min time granularity. The QSTS simulation results show that while lower time granularities of AMI data may capture feeder operation in general at the medium-voltage level, AMI data with high granularity is necessary to accurately capture feeder maximum element loadings and minimum node voltages particularly in the low-voltage secondary circuits.
FITTING STATISTICAL DISTRIBUTION MODELS TO MOE AND MOR IN MILL-RUN SPRUCE AND RED PINE LUMBER POPULATIONS

It has been mathematically demonstrated that the distribution of modulus of rupture (MOR) in a graded lumber subpopulation does not have the same theoretical form as the distribution of the mill-run population from which the subpopulation is drawn. However, the distributional form of the graded lumber subpopulation does depend heavily on the distributional form of the full mill-run population, and thus it is important to characterize the distributions of full mill-run lumber populations. Previous studies presented evidence suggesting that commonly-used distributions such as normal, lognormal, and Weibull distributions might not be suitable for modeling mill-run modulus of elasticity (MOE) and MOR; rather, nontraditional distributions such as skew-normal and mixed normal seem to be more appropriate models for the MOE and MOR of mill-run populations across mills and time. Previous studies of this kind have been carried out using only southern pine ( Pinus spp.) lumber. In this study, we extend this work by investigating whether the distributional forms found to adequately fit southern pine mill-run lumber populations also adequately fit other species (or species groups). The objective of this study is to identify statistical models that fit MOE and MOR distributions in mill-run spruce ( Picea spp.) and red pine ( Pinus resinosa ) lumber populations. Mill-run samples of 200 spruce 2 × 4 specimens and 200 red pine 2 × 4 specimens (for a total of 400 test pieces) were collected, and the MOE and MOR for each specimen were assessed. Various distributions were fit to the MOE and MOR mill-run data and evaluated for goodness-of-fit. In addition to further demonstrating that traditional distributions such as normal, lognormal, and Weibull may not be adequate to model mill run MOE and MOR populations, the results suggested that mixed normal and skew normal distributions might perform well across species.
Integration of clinical anatomical sciences in medical education: Design, development and implementation strategies

For the last 20 years, undergraduate medical education has seen a major curricular reform movement toward integration of basic and clinical sciences. The rationale for integrated medical school curricula focuses on the application of knowledge in a clinical context and the early ability to practice key skills such as critical thinking and clinical problem-solving. The method and extent of discipline integration can vary widely from single sessions to entire programs. A challenge for integrated curricula is the design of appropriate assessments. The goal of this review is to provide a framework for clinical anatomy educators with definitions of integration, examples of existing integration models, strategies, and instructional methods that promote integration of basic and clinical sciences.
Injury-associated levator ani muscle and anal sphincter ooedema following vaginal birth: a secondary analysis of the EMRLD study.

OBJECTIVE To determine whether all three components of the levator ani muscle (pubovisceral [= pubococcygeal], puborectal and iliococcygeal) and the external anal sphincter are equally affected by oedema associated with muscle injury after vaginal birth. DESIGN Observational cross-sectional study. SETTING Michigan Medicine, University of Michigan. POPULATION Primiparous women classified as high risk for levator ani muscle injury during childbirth. METHOD MRI scans obtained 6-8 weeks postpartum were analysed. Muscle oedema was assessed on axial and coronal fluid-sensitive magnetic resonance (MRI) scans. Presence of oedema was separately determined in each levator ani muscle component and in the external anal sphincter for all subjects. Descriptive statistics and correlation with obstetric variables were obtained. MAIN OUTCOME MEASURES Oedema score on fluid-sensitive MRI scans. RESULTS Of the 78 women included in this cohort, 51.3% (n = 40/78) showed muscle oedema in the pubovisceral (one bilateral avulsion excluded), 5.1% (n = 4/78) in the puborectal and 5.1% (n = 4/78) in the iliococcygeal muscle. No subject showed definite oedema on external anal sphincter. Incidence of oedema on the pubovisceral muscle was seven times higher than on any of the other analysed muscles (all paired comparisons, P < 0.001). CONCLUSIONS Even in the absence of muscle tearing, the pubovisceral muscle shows by far the highest incidence of injury, establishing that levator components are not equally affected by childbirth. External anal sphincter did not show oedema-even in women with sphincter laceration- suggesting a different injury mechanism. Developing a databased map of injured areas helps understand injury mechanisms that can guide us in honing research on treatment and prevention. TWEETABLE ABSTRACT Injury-associated levator ani muscle and anal sphincter oedema mapping on MRI reveals vulnerable muscle components after childbirth.
Microstructural evolution of polyurea under hydrostatic pressure

Abstract Polyurea (PU) is a versatile high strain rate elastomeric polymer that has attracted significant interest due to its utility as a blast and ballistic resistant coating. Predictive design of PU materials, particularly with a focus on structure, is complicated by the occurrence of both high pressure and high strain rate effects in response to blast and ballistic impact. To help elucidate the behavior of PU under such conditions, we sought to characterize the microstructural evolution of PU under hydrostatic compression. To this end, we utilized a diamond anvil cell with in-situ X-ray scattering to monitor the compression-induced microstructural changes of two PU materials differing in their soft segment length. We found that regardless of soft segment length, the initially phase separated structure becomes increasingly mixed during hydrostatic compression up to ~1 GPa. Despite this increase in phase mixing, the interchain network between urea linkages formed through hydrogen bonds remains apparent at pressures well above 1 GPa. The mean spacing associated with the interchain hydrogen-bonded network within the hard segment domains contracts under hydrostatic compression and in some cases recovers upon load removal. Furthermore, the extent of both deformation and recovery depends upon the degree of microphase separation as dictated by the length of the soft segment, wherein PU with a longer soft segment deforms less and recovers more.
On the modified least action principle with dissipation

Abstract The principle of least action is a variational principle that states an object will always take the path of least action as compared to any other conceivable path. This principle can be used to derive the equations of motion of many systems, and therefore provides a unifying equation that has been applied in many fields of physics and mathematics. Hamilton’s formulation of the principle of least action typically only accounts for conservative forces, but can be reformulated to include non-conservative forces such as friction by using the approach suggested by Wang and co-workers (Lin and Wang, 2014; Wang, 2015). However, it turns out that this modified action is dependent upon the nature and amount of damping in the system and the optimality argument fails to hold for sufficiently large values of the damping coefficient. In this paper, we specifically investigate the modified action principle for the cases of a linearly and cubically damped, nonlinear pendulum.
Population health management of low-density lipoprotein cholesterol via a remote, algorithmic, navigator-executed program.

BACKGROUND Implementation of guideline-directed cholesterol management remains low despite definitive evidence establishing such measures reduce cardiovascular (CV) events, especially in high atherosclerotic CV disease (ASCVD) risk patients. Modern electronic resources now exist that may help improve health care delivery. While electronic medical records (EMR) allow for population health screening, the potential for coupling EMR screening to remotely delivered algorithmic population-based management has been less studied as a way of overcoming barriers to optimal cholesterol management. METHODS In an academically affiliated healthcare system, using EMR screening, we sought to identify 1,000 high ASCVD risk patients not meeting guideline-directed low-density lipoprotein-cholesterol (LDL-C) goals within specific system-affiliated primary care practices. Contacted patients received cholesterol education and were offered a remote, guideline-directed, algorithmic cholesterol management program executed by trained but non-licensed "navigators" under professional supervision. Navigators used telephone, proprietary software and internet resources to facilitate algorithm-driven, guideline-based medication initiation/titration, and laboratory testing until patients achieved LDL-C goals or exited the program. As a clinical effectiveness program for cholesterol guideline implementation, comparison was made to those contacted patients who declined program-based medication management, and received education only, along with their usual care. RESULTS 1021 patients falling into guideline-defined high ASCVD risk groups warranting statin therapy (ASCVD, type 2 diabetes, LDL ≥ 190 mg/dL, calculated 10-year ASCVD risk ≥7.5%) and not achieving guideline-defined target LDL-C levels and/or therapy were identified and contacted. Among the 698 such patients who opted for program medication management, significant LDL-C reductions occurred in the total cohort (mean -65.4 mg/dL, 45% decrease), and each high ASCVD risk subgroup: ASCVD (-57.2 mg/dL, -48.0%); diabetes mellitus (-53.1 mg/dL, -40.0%); severe hypercholesterolemia (-76.3 mg/dL, -45.7%); elevated ASCVD 10-year risk (-62.8 mg/dL, -41.1%) (P<0.001 for all), without any significant complications. Among 20% of participants with reported statin intolerance, average LDL-C decreased from baseline 143 mg/dL to 85 mg/dL using mainly statins and ezetimibe, with limited PCSK9 inhibitor use. In comparison, eligible high ASCVD risk patients who were contacted but opted for education only, a 17% LDL-C decrease occurred over a similar timeframe, with 80% remaining with an LDL-C over 100 mg/dL. CONCLUSIONS A remote, algorithm-driven, navigator-executed cholesterol management program successfully identified high ASCVD risk undertreated patients using EMR screening and was associated with significantly improved guideline-directed LDL-C control, supporting this approach as a novel strategy for improving health care access and delivery.
On the origins of trapped helium, neon and argon isotopic variations in meteorites. I - Gas-rich meteorites, lunar soil and breccia. II - Carbonaceous meteorites.

Data are presented from stepwise heating experiments and total extractions on five meteorites: Kapoeta, Fayetteville, Holman Island, Cee Vee, and Pultusk. These data reveal the presence of four isotopically distinct trapped neon components. A comparison of trapped neon with trapped helium and argon in bulk analyses indicates the existence of correlated helium, neon and argon isotopic structures. Component B is attributed primarily to direct implantation of rare gas ions by the present day solar wind. Component C is identified with directly implanted low energy (1-10 Mev/n) solar flare rare gases. Component D is associated with rare gas ions implanted in meteoritic material by the primitive, pre-main sequence, solar wind. A fourth component, observed only in Kapoeta and the lunar fines and breccia, is tentatively attributed to parent body 'atmospheric' ions implanted in surface material by a solar wind induced electric field.
Scrutinizing the Right Not to Know

There is an important ongoing debate about how best to incorporate individual choice into the management of clinically significant findings generated by large-scale genomic sequencing. While patien...
Sex Differences in Patients With CAM Deformities With Femoroacetabular Impingement: 3-Dimensional Computed Tomographic Quantification.

Purpose To determine if significant differences exist between male and female CAM deformities using quantitative 3-dimensional (3D) volume and location analysis. Methods Retrospective analysis of preoperative computed tomographic (CT) scans for 138 femurs (69 from male patients and 69 from female patients) diagnosed with impingement from November 2009 to November 2011 was completed. Those patients who presented with hip complaints and had a history, physical examination (limited range of motion, positive impingement signs), plain radiographs (anteroposterior pelvis, 90° Dunn view, false profile view), and magnetic resonance images consistent with femoroacetabular impingement (FAI) and in whom a minimum of 6 months of conservative therapy (oral anti-inflammatory agents, physical therapy, and activity modification) had failed were indicated for arthroscopic surgery and had a preoperative CT scan. Scans were segmented, converted to point cloud data, and analyzed with a custom-written computer program. Analysis included mean CAM height and volume, head radius, and femoral version. Differences were analyzed using an unpaired t test with significance set at P Results Female patients had greater femoral anteversion compared with male patients (female patients, 15.5° ± 8.3°; male patients, 11.3° ± 9.0°; P = .06). Male femoral head radii were significantly larger than female femoral heads (female patients, 22.0 ± 1.3 mm; male patients, 25.4 ± 1.3 mm; P P 3 ; female patients, 89 ± 124 mm 3 ; P P P P = .60) or anterior ( P = .14) extent of CAM deformities. However, the span on the clock face of the CAM deformities varied when comparing men with women (male patients, the 3:43 o'clock position ± the 1:29 o'clock position; female patients, the 2:54 o'clock position ± the 1:09 o'clock position; P = .02). Conclusions Our data show that female CAM deformities are shallower and of smaller volume than male lesions. Further studies will allow further characterization of the 3D geometry of the proximal femur and provide more precise guidance for femoral osteochondroplasty for the treatment of CAM deformities. Clinical Relevance Female CAM deformities may not be detectable using current 2D nonquantitative methods. These findings should raise the clinician's index of suspicion when diagnosing a symptomatic CAM lesion in female patients.
Class of Canonical Equations K50 for the Entries of Random S-Matrices

The canonical equations of the spectral theory of random matrices can be used for the analysis of quantum scattering problems in open chaotic systems. As a result, it is possible to find equation for the entries of the so-called stochastic scattering matrix. The main application of the analysis of array of random matrices is a Random Matrix Physics, in particular, stochastic S-matrices are used in statistics of resonance poles, phase shifts and time delays in quantum chaotic scattering.
Startups & the Patent System: A Narrative

In 2008, a team at the University of California, Berkeley, School of Law conducted the most comprehensive study to date on startup companies and the patent system. The study consisted of a survey, which led to primarily quantitative data, as well as more in-depth pre- and post-survey interviews and case studies. Following upon articles broadly reporting the quantitative survey results, this chapter recounts the qualitative interviews and case studies in order to provide a richer overall account. Like the quantitative results, the qualitative results vary widely depending upon company industry, age, sophistication, and a variety of other factors. As such, this chapter reinforces the study’s original finding that there is no overriding characterization of how startups use and are affected by the patent system.
Design of robust flight control systems for advanced technology vehicles

Innovative approaches for analysis, design and modeling of advanced flight vehicles are demanded in response to requirements toward substantial performance improvements. Although control theory is thoroughly developed, the calculus of variations and Pontryagin's principle are not well suited because these methods exhibit rather poor robustness and are hampered by the limited time available for computations. This paper explores the robust control technology for uncertain nonlinear systems and presents innovative design procedures to enhance the robustness for open-loop unstable systems with constraints. Utilizing the Hamilton-Jacobi theory, the developed procedures allow one to find a straightforward avenue to design the robust controllers. A new control methodology is less conservative than the known results and allows us to solve the nonlinear control problem for uncertain systems. The explored time-optimal and antiwindup techniques are studied for a highly-manoeuvrable missile. The longitudinal and rolling flight control, as well as the guidance problem, are treated and solved. To evaluate the robustness, analytical and simulation results are performed.
Galvanizing medical students in the administration of influenza vaccines: the Stanford Flu Crew

Many national organizations call for medical students to receive more public health education in medical school. Nonetheless, limited evidence exists about successful servicelearning programs that administer preventive health services in nonclinical settings. The Flu Crew program, started in 2001 at the Stanford University School of Medicine, provides preclinical medical students with opportunities to administer influenza immunizations in the local community. Medical students consider Flu Crew to be an important part of their medical education that cannot be learned in the classroom. Through delivering vaccines to where people live, eat, work, and pray, Flu Crew teaches medical students about patient care, preventive medicine, and population health needs. Additionally, Flu Crew allows students to work with several partners in the community in order to understand how various stakeholders improve the delivery of population health services. Flu Crew teaches students how to address common vaccination myths and provides insights into implementing public health interventions. This article describes the Stanford Flu Crew curriculum, outlines the planning needed to organize immunization events, shares findings from medical students’ attitudes about population health, highlights the program’s outcomes, and summarizes the lessons learned. This article suggests that Flu Crew is an example of one viable service-learning modality that supports influenza vaccinations in nonclinical settings while simultaneously benefiting future clinicians.