cssi/SciSciGPT-SciSciNet huggingface dataset:
Severe aortic stenosis with low systolic gradient:the good and bad news.

Severe calcific aortic stenosis (AS) is an important clinical entity because (1) it is the most common valve lesion being considered for valve replacement in the United States,1 especially in older people. (2) More people are living longer. In 1996, 36 million people in the United States were ≥65 years old, and by 2020, this number is expected to increase by 75%. (3) Aortic valve replacement (AVR) improves the survival of symptomatic patients.1 2 The relative survival of those ≥65 years old is better than those <65 years old.1 2 (4) The symptomatic state and abnormal LV function improve or normalize in most patients.1 2 Patients with a mean aortic valve gradient (AVG) ≤30 mm Hg have been of concern. They may have severe AS even if left ventricular (LV) ejection fraction (EF) is normal. The clinical problem is magnified in those in whom LVEF is severely reduced because of uncertainty about the cause of low LVEF and patient outcome after AVR. In this issue of Circulation , Connolly and coworkers3 from the Mayo Clinic present important data that clarify several issues but also raise other issues that need to be addressed. Of 52 patients 71±11 years old (mean±SD) with aortic valve area (AVA) of 0.7±0.2 cm2, mean AVG <30 mm Hg, and LVEF <0.35, 86% were in NYHA functional classes III and IV. The good news is that after AVR, (1) the 3-year survival was 62%; (2) of the survivors, 47% were asymptomatic and 30% were minimally symptomatic (the improvement in symptomatic state is impressive); and (3) LVEF improved by 0.10±0.14. Most patients were in clinical heart failure (HF) (LVEF <0.35; 86% were in clinical classes III/IV3 ), and their survival was not significantly different from that of previously described patients …
Highly scalable and accurate seeds for subsequence alignment

We propose a method for finding seeds for the local alignment of two nucleotide sequences. Our method uses randomized algorithms to find approximate seeds. We present a dynamic index to store the fingerprints of k-grams and a highly scalable and accurate (HSA) algorithm to incorporate randomization into process of seed generation. Experimental results show that our method produces better quality seeds with improved running time and memory usage compared to traditional non-spaced and spaced seeds. The presented algorithm scales very well with higher seed lengths while maintaining the quality and performance.
Database programming using Java

Focuses on database programming using Java. Java provides a very good approach to working with different database. A discussion is provided about database programming using Java for the Microsoft Access DBMS. Some concepts are reviewed along the way, like relational databases, components of databases, Open Database Connectivity (ODBC) data sources, the Java SQL package and methods. The Java programming language has the potential of working with different databases like SQL Server, Oracle, Informix, Sybase, Microsoft Access and others. Java uses the JDBC (Java Database Connectivity) tool to work with the database. Programs developed with the Java programming language and JDBC are platform- and vendor-independent. This paper introduces the concept of a JDBC-ODBC bridge for Microsoft Access, which is a useful system for understanding and teaching database programming. Examples of simple Java programs for Microsoft Access are provided as illustrations of the concept of database programming.
Do Genetic Factors Influence Religious Life? Findings from a Behavior Genetic Analysis of Twin Siblings

Social scientific research assumes that religious involvement is primarily, if not exclusively, the product of social-environmental influences. There is growing evidence, however, that genetic or other biological factors also play a role. Analyzing twin sibling data from the National Survey of Midlife Development in the United States (MIDUS), this study addresses this issue by showing that individual-level variation on four different aspects of religious life-organizational involvement, personal religiosity and spirituality, conservative ideologies, and transformations and commitments-is indeed the product of both genetic and environmental influences. Specifically, genetic factors explain 19-65 percent of the variation, while environmental influences account for the remaining 35-81 percent depending upon the aspect of religion under investigation. Research of this type enhances contemporary social science by providing a new perspective that nicely supplements existing ones, but it also highlights potential implications, including explanatory power deficiencies and potentially bias.
Mating in Heliothis virescens: transfer of juvenile hormone during copulation by male to female and stimulation of biosynthesis of endogenous juvenile hormone.

Studies were undertaken to determine whether adult males of Heliothis virescens transfer juvenile hormone (JH) to females during copulation, and an in vitro radiochemical assay was used to determine whether mating causes an allatotropic effect, i.e., stimulation of JH biosynthesis by corpora allata (CA). In vitro, CA from 3-day-old mated females synthesized and released approximately 2.5 times total JH as that of CA from comparably aged virgin females. Of the homologues, JH II exhibited significant increase in mated females; JH I also increased but not significantly. JH III remained similar to that of virgin females. This is the first demonstration of an allatotropic effect of mating in moths. In contrast to the female, CA of virgin males did not produce any JH, but accessory sex glands (ASG) in 3-day-old males synthesized small amounts of JH. Immediately after adult emergence, male ASG contained approximately 1.5 ng JH I and II, which increased by 12 h after emergence and remained at this high level up to 54 h after emergence. JH III was barely detected in ASG. JH in ASG of mated male immediately after uncoupling was depleted almost completely, and 24 h later recovered to levels comparable to that of 54-h-old virgin male. Virgin female bursa copulatrix did not contain any JH, but mated female bursa, immediately after uncoupling, had JH at levels comparable to that observed in virgin male ASG. By 6 h after uncoupling, JH levels decreased dramatically in mated female bursa. These data suggest the transfer of JH to females by the male.
Innovation Through Tradition: Rediscovering the “Humanist” in the Medical Humanities

Throughout its fifty-year history, the role of the medical humanist and even the name "medical humanities" has remained raw, dynamic and contested. What do we mean when we call ourselves "humanists" and our practice "medical humanities?" To address these questions, we turn to the concept of origin narratives. After explaining the value of these stories, we focus on one particularly rich origin narrative of the medical humanities by telling the story of how a group of educators, ethicists, and scholars struggling to define their relatively new field rediscovered the studia humanitatis, a Renaissance curriculum for learning and teaching. Our origin narrative is composed of two intertwined stories-the history of the studia humanitatis itself and the story of the scholars who rediscovered it. We argue that as an origin narrative the studia humanitatis grounds the medical humanities as both an engaged moral practice and pedagogical project. In the latter part of the paper, we use this origin narrative to show how medical humanists working in translational science can use their understanding of their historical roots to do meaningful work in the world.
Oldest record of peduncular attachment of brachiopods to crinoid stems, Upper Ordovician, Ohio, U.S.A. (Brachiopoda; Atrypida: Echinodermata; Crinoidea)

A hand-specimen, bedding-plane sample of limestone (wackestone) from the Upper Ordovician Waynesville Formation has numerous brachiopod specimens (at least 60) exposed on its surface (Figure 1). The brachiopods have been identified as members of the atrypid species Zygospira modesta (Say in Hall) 1847 (the type species of the genus Zygospira Hall, 1862) and are concentrated in an area measuring approximately 9 cm x 2 cm. A wide range of specimen sizes from juvenile to adult are present and are believed to represent a brachiopod life-assemblage (Figure 2).
Factors Affecting Care in Non-English-Speaking Patients and Families

Objective. Identify concerns in non-English-speaking patients to improve patient care and communication. Misunderstandings due to language barriers can impose undue hardship possibly leading to adverse outcomes. Information from this study may identify ways of improving care. Methods. A 31-question survey was administered in the patients’ native language using certified medical interpreters. Surveys were collected anonymously during clinic visits. Results. Thirty-eight surveys were completed and compiled. Most were happy with their provider. Half indicated that they did not know why they were seeing that provider, did not understand the tests, or had difficulty with interpreters. Many indicated they would like medical information written in their native language. Conclusion. Barriers to communication can lead to adverse medical outcomes, poor compliance with therapy, and poor understanding of medical conditions. Providing written information in the patient’s native language has the potential to complement...
Contested Convergence and the Politics of Play on GameTrailers.com

As a hobby and as an industry, gaming is growing. The impetus for this growth is convergence, specifically technological, content, and market convergence. But gamers might contest this convergence, insofar as it blends “genres of participation.” Gaming has long been dominated by the “hardcore” who “geek out” over their favorite titles. However, a recent influx of “casual” games, which encourage “hanging out” means a split in resources. In order to investigate the contestation this might inspire, I analyzed discussions on the site GameTrailers.com. The site features both producer and fan discourse on the state of the videogame industry. On GameTrailers, the debate over convergence comes down to its driving focus: audience convergence. The industry’s goal is to create products that bring together a wider range of consumers. Differing perspectives on the worth and outcome of this audience convergence lead to political contestation.
Domain Names and Websites as Collateral: Managing Uncertainty in Secured Financing Transactions

It is no secret that the growth of online commerce has surged in the 21st Century. Accompanying that growth has been an increased level of awareness that Internet-related “cyberassets” have become critically important in the field of secured financing. There is no reason to believe that this trend will change any time soon. Indeed, interest in these assets as collateral in commercial financing transactions appears to be getting stronger each year. One of the problems financers face, however, is that while the pace of cyberasset-based financing accelerates, the law governing those transactions seems to fall further behind. This paper attempts to identify and clarify some of the most fundamental legal doctrines that are likely to be most important to lenders operating in this field. It begins with a discussion of how these assets are classified for the purpose of creditors asserting claims to them — are they even “personal property” at all and subject to creditor’s claims and within the scope of Article 9? If they are property subject to Article 9, what unique attributes and characteristics of these assets are important for creditors to understand in creating a security interest in them, perfecting that interest, and enforcing the interest upon the debtor’s default?
Epitaxial Growth of Thick Ag/Si(111) Films

600~4000A thick Ag films grown on 3~4° misoriented Si(111) substrates by molecular beam epitaxy (MBE) technique have been studied by using x-ray pole-figure analysis and MeV He+ Rutherford Backscattering Spectrometry (RBS)/channeling technique. X-ray pole-figure measurements revealed that despite the large lattice mismatch (~25%) between Ag and Si, Ag films with epitaxial relationship were grown with a small quantity (15~20%) of twin structure. The axial channeling minimum yield (Xmin) is reduced at the Ag surface as the Ag film thickness increases. These films were thermally stable up to 500 °C annealing but the twinning disappeared after annealing.
Epilepsy and sleep

A sleep history should be taken routinely in patients with epilepsy. Treatment of sleep disorders and improvement in sleep hygiene may improve seizure control, daytime cognitive functioning, and quality of life. Patients with recurrent sleepiness interfering with daily activities or an Epworth Sleepiness Scale score more than 10 should be considered for additional evaluation by a sleep specialist. Treatment options for insomnia include improvements in sleep hygiene, cognitive behavior therapies, and sedative or hypnotic drugs. Alterations in the timing or type of antiepileptic drugs (AEDs) may be helpful (for example, using sedating medications before bedtime and avoiding evening use of drugs that may exacerbate insomnia ). Improvements in sleep hygiene alone are less effective than cognitive behavioral therapy or pharmacologic therapy. Cognitive behavioral therapy is more efficacious and its effects longer lasting than pharmacologic treatments. Sedative and hypnotic drugs may exacerbate AED cognitive adverse effects during the day and should be used only after other therapies have failed. Excessive daytime sleepiness (EDS) in patients with epilepsy may be secondary to AEDs, nocturnal seizures, or a concomitant sleep disorder such as sleep apnea or restless leg syndrome. Sedating AEDs should be minimized during the day, and activating AEDs should be used as appropriate. Video electroencephalogram polysomnography should be performed when EDS interferes with daily activities and the etiology of sleepiness is unclear. AEDs that are associated with weight gain should be avoided in patients with sleep apnea. AEDs that may promote weight loss should be considered for obese patients with sleep apnea. Continuous positive airway pressure is the treatment of choice for sleep apnea.
The heritability of foreign policy preferences

Attitudes towards foreign policy have typically been explained by ideological and demographic factors. We approach this study from a different perspective and ex amine the extent to which foreign policy preferences correspond to genetic variation. Using data from the Minnesota Twin Family Study, we show that a moderate share of individual differences in the degree to which one's foreign policy preferences are hawkish or dovish can be attributed to genetic variation. We also show, based on a bivariate twin model, that foreign policy preferences share a common genetic source of variation with political ideology. This result presents the possibility that ideology may be the causal pathway through which genes affect foreign policy preferences.
Safety and Efficacy of Electrohydraulic Lithotripsy By Ureteroscopy

AbstractElectrohydraulic lithotripsy, when performed blindly for ureteral calculi in the past, resulted in frequent ureteral perforation and, therefore, it was considered to be unsafe. A total of 33 patients from 5 institutions underwent electrohydraulic lithotripsy for ureteral calculi under direct vision. There were only 3 minor ureteral perforations treated by ureteral catheter drainage. All patients were free of stones after treatment and there were no long-term complications. Electrohydraulic lithotripsy by ureteroscopy is considered to be a safe and effective method for fragmentation and removal of large ureteral calculi. (J. Urol., 140: 957–958, 1988)
SU-F-T-425: Head-Scatter Off-Axis for FFF Megavoltage Photon Beams

Purpose: Head-scatter photons inside a clinical accelerator cause the output to change with collimator setting. On the central-axis, this contribution is well-described by output factor in air (or head-scatter factor). However, a few studies have examined this component at off-axis points. Methods: We define the head-scatter off-axis ratio, HOA, as the ratio of the water kerma in air due to head-scatter photons at the off-axis position x to the water kerma from direct primary photons on the central axis: HOA(cx,cy,xy) = (Q(cx,cy,x) – QP(cx,cy,x))/QP(cx,cy,0), where Q(cx, cy,x), QP(cx,cy,x) are charges measured by an ionization chamber in a miniphantom for collimator setting cx × cy and cx × 3 cm, respectively, at off-axis point x. “Direct primary” is those photons that come from the source without interactions in the intervening structures. Results: We measured HOA for two energies (6XFFF and 6X) along X and Y jaw directions for various collimator settings. The shape of HOA has well defined penumbra for collimator setting larger than 10 × 10 cm2. Conclusion: The narrow gaussian component is interpreted as the source of photons scattered in the flattening filter and the primary collimator. The broad component is attributed to photons scattered in the secondary (variable) collimators. By a direct comparison between 6X and 6XFFF beams, we can confirm that the second component is indeed coming from collimator jaws and identify the parts coming from the primary collimator and the flattening filter, respectively.
Next-Generation Access Control for Distributed Control Systems

With the rapid integration of wired and wireless internetworking technologies, distributed control systems (DCS) are increasingly susceptible to cyberattacks. A well-designed access control framework could potentially contain and mitigate the impact of cyberattacks. However, existing solutions often fail to cover and protect all connected devices, leaving holes that are sufficient to undermine the security and safety of a plant. Further, in current DCS environments, it's hard to adhere to the least-privilege principle because access control policies are distributed among many heterogeneous systems. In this article, the authors identify key challenges in moving toward a more complete and manageable access control framework for DCS, and present a model architecture that can be adapted by the industrial control system community to ensure that every access is checked against policies that adhere to the least-privilege principle. Their proposed architecture facilitates centralized (plant-wide) policy management and protection of every connected field device.
Rethinking Concept Mapping for Youth Participatory Evaluation in the Context of Youth Development Programs

As a mixed-methods participatory approach, concept mapping (Trochim, 1989) provides unique opportunities for engaging youth in evaluating the contexts and environments in which they develop. Youth development programs, by definition, seek to fully engage youth as partners and provide them with opportunities to effect positive change. This includes encouraging youth to be involved in the process of designing, implementing, and evaluating the programs and activities in which they participate. Concept mapping has been used successfully with adult populations; however its utility with adolescents in the context of youth development programming has yet to be explored. This paper explores both the obstacles and successes associated with utilizing this participatory approach with youth.
On Sensor Networking and Signal Processing for Smart and Safe Buildings

The monitoring and control of indoor environments has become an increasingly important concern, with multiple objectives including maximizing the comfort and minimizing health risks of occupants, in everyday operating conditions as well as emergency situations. The deployment of many networked sensors, equipped with reasoning and communicating abilities, can significantly contribute towards these objectives. This chapter discusses a framework for sensor networking in smart and safe buildings, and considers various issues relevant in the development of such networks and effective use of the information obtained by sensors in these networks. A hierarchical decision model is envisaged spanning multiple reasoning levels. Examples of control and response planning applications are discussed.
Authority and Freedom in the Ancient Asian World

This is one of the four papers on man’s ideas of society. My assigned topic is “Authority and Freedom in the Ancient Asiatic World.” It should include the ancient empires of Babylonia and Assyria, of the Medes and the Persians, India and China.
The Comprehensive Counseling Center Model

ABSTRACTThe authors outline a four-factor model and philosophy for college mental health services that addresses the loss of comprehensiveness in some centers due to changes in organizational structure. Given research on demand for services and retention of those seen in centers, emphasis is placed in particular upon the value of consultation, outreach, and training work across the entire campus community. The model challenges some assumptions made by proponents of integrated care, including its definition, and illustrates the benefits of establishing and maintaining a fully comprehensive college counseling service.
Chapter 4 – Reactive Oxygen Species, Oxidative Damage and Cell Death

Abstract Reactive Oxygen Species (ROS) are small and highly reactive oxygen-containing molecules. ROS, when maintained at proper cellular concentrations, may function as “redox messengers” and play a significant role in intracellular signaling and regulation. On the other hand, when concentrations are higher than the physiological concentration, these radicals may be deleterious resulting in oxidative stress which may cause cell damage and cell death. This chapter elaborates the processes of ROS production, its physiological role, and the role of oxidative stress in cell death.
Weight gain after treatment of Graves' disease in children.

SummaryObjective The frequency of and risk factors for weight gain in children treated for Graves disease have not been described. We evaluated change in BMI Z score and predictors of weight gain in this population. Design Retrospective review of data from January 2000 to July 2011. Patients 222 children and adolescents with Graves’ disease (ages 2-18 years) evaluated following radioactive iodine administration (RAI) (n=101), thyroidectomy (n=9), and initiation of medical therapy (n=112). Measurements Changes in body mass index Z score over 12 months (ΔBMI-Z0-12). Results All treatment groups in each gender and race increased BMI-Z (median ΔBMI-Z0-12 was positive). T3 levels following RAI (p=.04) and weight lost at time of administration (p=.02) in the RAI group, and free T4 levels in the medical therapy group (p=.03) were positively correlated with ΔBMI-Z0-12. Race was a significant predictor only in the medical therapy group (p=.01). Age negatively correlated with ΔBMI-Z0-12 in both the RAI (p<.001) and medical therapy groups (p=.003). Gender, maximum TSH in the 12 months after RAI, and initial dose of LT4 replacement did not correlate with ΔBMI-Z0-12. The prevalence of overweight and obesity in our cohort was similar to US children. Conclusions Weight gain during treatment for Graves’ disease is common in children, and many children become overweight or obese during treatment. Risk factors include greater degree of hyperthyroidism at presentation and time of RAI and younger age. Weight lost upon presentation may also predict greater weight gain. Control of subsequent hypothyroidism does not appear to affect weight gain. This article is protected by copyright. All rights reserved.
Manhattan's Koreatown as a Transclave: The Emergence of a New Ethnic Enclave in a Global City:

This article critically challenges scholarship on ethnic enclaves, from Chicago School scholars to the ethnic enclave debates of the 1980s and 1990s, and introduces a new type of ethnic enclave in ...
Aerodynamics and Other Efficiencies in Transporting Goods

Recognizing both the pollution effects of fuel use and the likely increases of fuel cost in coming decades puts high priority on alternative energy for trucks, buses and trains. There are still gains available in decreasing aerodynamic drag and rolling friction, using efficient engines, and minimizing fuel waste, but it is appropriate to explore decisions that would be suitable if fossil fuel were deemed unattractive. One then would consider utilizing natural energy (sunlight, wind, wave), getting energy from braking, employing hydrogen, putting different priorities on trucks vs. buses vs. trains, exploring integration with water deliveries and automatic local air transport, etc. Such an investigation might illuminate early alternatives that would at least permit partial improvements.
Older female (55+) consumers' apparel shopping and life satisfaction: an application of activity theory

ix CHAPTER 1 : INTRODUCTION l Older Population and Consumption Power 1 Activity Theory 1 Older Consumers' Apparel Shopping Behavior 2 Purpose 4 Constitutive Definitions for Terms 6 Dissertation Organization 6 CHAPTER 2: LITERATURE REVIEW 8 Activity Theory 8 Life satisfaction 10 Consumers' characteristics and activities 12 Apparel Shopping Orientations 13 Consumer characteristics and apparel shopping orientations 15 Activities and apparel shopping orientations 17 Older Consumers' Apparel Shopping Activities 18 Consumer characteristics, apparel expenditures, and patronage behavior 18 Activities and apparel shopping activities 21 Apparel shopping orientations and apparel shopping activities 22 Hypotheses 23 CHAPTER 3: METHOD 28 Questionnaire Development 28 Activities 29 Life satisfaction 29 Apparel shopping activities 29 Types of apparel shipping location 31 Hours spent on apparel shopping 32 Frequencies of apparel shopping 32 Times of apparel purchase 32 Amount of money spent on apparel 32 Apparel shopping information sources 33 Apparel shopping orientations 33 Community information 34 Consumer characteristics 35
Original Research: Being Young, Female, and BRCA Positive

ObjectiveWomen who carry a BRCA1 or BRCA2 gene mutation face a risk of developing breast or ovarian cancer at an earlier age than women without such a mutation. Relatively little is known about the psychosocial consequences—especially regarding marriage and childbearing—in young women who test posit
Modified AC Magnetic Bridge Scanning Patterns of Samples Simulating Flaws in Aircraft Seams

Hidden corrosion in the seams or below the skin of an aluminum aircraft results in the loss of material and therefore affects the net conductance as measured at the seam or skin surface. This loss of conductance has been detected through the use of electromagnetic techniques, for example, eddy-current techniques [1].
Wages for Intern Work: Denormalizing Unpaid Positions in Archives and Libraries

While no comprehensive studies have yet been published quantifying the extent of unpaid internships within archives and libraries, their prevalence is easily recognized as widespread. Unpaid internships are offered and facilitated based on the implication that they correlate positively to future job prospects, although recent studies point to evidence that complicates this idea. Instead, the prevalence of unpaid internships may negatively impact efforts for diversity and inclusion among information workers while contributing to greater precarity of labor throughout the workforce. Meanwhile, professional organizations and academic programs often do not discuss the realities of unpaid internships, and some MLIS programs require or encourage students to work without remuneration for course credit at their own expense. Situating unpaid internships within larger questions of economic access, labor laws, indebtedness, and neoliberalization, this paper advocates for the denormalization of unpaid internships within archives and libraries, especially for those institutions that articulate social justice as part of their institutional values. Although rendering these positions obsolete is likely beyond the power of any one entity, this paper identify strategies that can be taken at the individual- and institutional-level to advance economic justice and the dignity of all work that occurs in our respective fields. Pre-print first published online11/25/2018
Development and ex vivo validation of novel force-sensing neochordae for measuring chordae tendineae tension in the mitral valve apparatus using optical fibers with embedded Bragg gratings.

Few technologies exist that can provide quantitative data on forces within the mitral valve apparatus. Marker-based strain measurements can be performed, but chordal geometry and restricted optical access are limitations. Foil-based strain sensors have been described and work well, but the sensor footprint limits the number of chordae that can be measured. We instead utilized fiber Bragg grating (FBG) sensors-optical strain gauges made of 125 μm diameter silica fibers-to overcome some limitations of previous methods of measuring chordae tendineae forces. Using FBG sensors, we created a force-sensing neochord (FSN) that mimics the natural shape and movement of native chordae. FBG sensors reflect a specific wavelength of light depending on the spatial period of gratings. When force is applied, the gratings move relative to one another, shifting the wavelength of reflected light. This shift is directly proportional to force applied. The FBG sensors were housed in a protective sheath fashioned from a 0.025 in. flat coil, and attached to the chordae using polytetrafluoroethylene suture. The function of the force-sensing neochordae was validated in a three-dimensional (3D)-printed left heart simulator, which demonstrated that FBG sensors provide highly sensitive force measurements of mitral valve chordae at a temporal resolution of 1000 Hz. As ventricular pressures increased, such as in hypertension, chordae forces also increased. Overall, FBG sensors are a viable, durable, and high-fidelity sensing technology that can be effectively used to measure mitral valve chordae forces and overcome some limitations of other such technologies.
Hürthle cell lesions on thyroid fine needle aspiration cytology: Molecular and histologic correlation

Background Hurthle cell lesions often pose diagnostic challenges, despite their common occurrence on thyroid fine-needle aspiration cytology (FNAC). The associated molecular alterations are also not well understood. Therefore, our study aimed to delineate the molecular profile of Hurthle cell lesions classified as Bethesda Categories III or IV (atypia of undetermined significance (AUS) or suspicious for follicular neoplasm (SFN)) on FNAC and to correlate this molecular profile with surgical resection findings. Methods This study consisted of 188 Hurthle cell lesions with indeterminate cytology and ThyroSeq® v2/v3 molecular testing results. Surgical follow-up was available for 33 cases. Results The majority of indeterminate Hurthle cell lesions had negative ThyroSeq® results (61%) and were benign on available surgical follow-up. The most prevalent mutations involved the RAS gene (21%), which were associated with benign lesions, non-invasive follicular thyroid neoplasms with papillary-like nuclear features (NIFTP), and malignancy. The remaining mutations involved less than 18% of the cases, including PAX8/PPARG (3.7%), TSHR (3.7%), EIF1AX (2.7%), MET (2.1%), PTEN (1.6%), clonal copy number alteration (1.6%), TERT (1.1%), and 0.5% each of GNAS, PIK3CA, and TP53 mutations. On follow-up, 45% were benign, 24% were NIFTP, and 30% were malignant. The malignant cases had different molecular alterations. Conclusion No single molecular alteration defines cytologically indeterminate Hurthle cell lesions; the majority of cases have low-risk or no molecular alterations and are benign on follow-up. These findings suggest that molecular testing may be useful, but is not definitive, in determining which cases may be managed conservatively; additional studies are needed to fully determine the negative predictive value in ruling out malignancy.
In the Crosshairs: Defending Market-Allocation in the Blue Cross Blue Shield Conspiracy

Insurance has long been governed by the states, which has led to a general hands-off approach by the federal government, but with costs rising faster than inflation over the past decade Washington was recently intervened. Recent legislation may have championed regulatory competition policy, but questions remain as to whether the new regulations will effectively correct a failing market. Certainly, the conventional practice of health insurance is partially to blame for rising costs, even absent anticompetitive practices; however when insurance companies are circumventing antitrust laws to set prices or define markets, consumers are forced take to the courts to rectify the abuse. Presently, two groups of plaintiffs have adopted such an approach. Suspicious of the longstanding operations of the Blue Cross Blue Shield Association (BCBSA) and its members, consumers and health care providers alike recently filed comparative complaints against the Blues. Plaintiffs of both the Provider Track Complaint and the Subscriber Track Complaint allege that Blue Cross Blue Shield members are engaging in concerted action to divide the market geographically, thus resulting in reduced competition, lower reimbursement rates for providers, and higher rates charged to subscribers. The concerted action in question comes in the form of licensing agreements between Blue Cross Blue Shield Association and aligned “Blue” insurers. Plaintiffs allege these agreements to be a blatant, per se violation of Section 1 of the Sherman Act. Further, the Plaintiffs believe that the agreements present unreasonable restraints of trade, the effects of which are emphasized by the dominant market power of each licensed insure, as well as the diminishing payments to providers and increasing cost to consumers for fewer benefits. The fundamental reasons for defending conglomerate insurer activity like the Blues exhibit is that in order to do battle with such large controlling providers, an insurer must also be large and dominate; a clash of titans, battling over costs and coverage. The argument for massive insurers continues: large insurers mean larger insurer pools and thus larger cost sharing among insureds. But at what point does an insurer become so dominant that it hurts consumers and providers alike, providing and paving less respectively, all in the name of a larger profit? Further, does it allow insurers to split up territory in a manner that essentially allocates regions to a single provider powerhouse?
A Mind-Body Physical Activity Program for Chronic Pain With or Without a Digital Monitoring Device: Proof-of-Concept Feasibility Randomized Controlled Trial.

Background: Chronic pain is associated with poor physical and emotional functioning. Nonpharmacological interventions can help, but improvements are small and not sustained. Previous clinical trials do not follow recommendations to comprehensively target objectively measured and performance-based physical function in addition to self-reported physical function. Objective: This study aimed to establish feasibility benchmarks and explore improvements in physical (self-reported, performance based, and objectively measured) and emotional function, pain outcomes, and coping through a pilot randomized controlled trial of a mind-body physical activity program (GetActive) with and without a digital monitoring device (GetActive-Fitbit), which were iteratively refined through mixed methods. Methods: Patients with chronic pain were randomized to the GetActive (n=41) or GetActive-Fitbit (n=41) programs, which combine relaxation, cognitive behavioral, and physical restoration skills and were delivered in person. They completed in-person assessments before and after the intervention. Performance-based function was assessed with the 6-min walk test, and step count was measured with an ActiGraph. Results: Feasibility benchmarks (eg, recruitment, acceptability, credibility, therapist adherence, adherence to practice at home, ActiGraph wear, and client satisfaction) were good to excellent and similar in both programs. Within each program, we observed improvement in the 6-min walk test (mean increase=+41 m, SD 41.15; P<.001; effect size of 0.99 SD units for the GetActive group and mean increase=+50 m, SD 58.63; P<.001; effect size of 0.85 SD units for the GetActive-Fitbit group) and self-reported physical function (P=.001; effect size of 0.62 SD units for the GetActive group and P=.02; effect size of 0.38 SD units for the GetActive-Fitbit group). The mean step count increased only among sedentary patients (mean increase=+874 steps for the GetActive group and +867 steps for the GetActive-Fitbit group). Emotional function, pain intensity, pain coping, and mindfulness also improved in both groups. Participants rated themselves as much improved at the end of the program, and those in the GetActive-Fitbit group noted that Fitbit greatly helped with increasing their activity. Conclusions: These preliminary findings support a fully powered efficacy trial of the two programs against an education control group. We present a model for successfully using the Initiative on the Methods, Measurement, and Pain Assessment in Clinical Trials criteria for a comprehensive assessment of physical function and following evidence-based models to maximize feasibility before formal efficacy testing. Trial Registration: ClinicalTrial.gov NCT03412916; https://clinicaltrials.gov/ct2/show/NCT03412916
The Importance of Community Colleges in Students' Choice to Major in STEM.

This article investigates whether attending a community college is related to an increase in the number of students majoring and graduating with degrees in science, technology, engineering and math...
Interacting User-Generated Content Technologies: How Questions and Answers Affect Consumer Reviews

We study the question and answer (QA answers convey fit-specific information in a predominantly sentiment-freeway. Based on these observations, we hypothesize that Q&As mitigate product fit uncertainty, leading to better matches between products and consumers, and therefore improved product ratings. We find that when products suffering from fit mismatch start receiving Q&As, their subsequent ratings improve by approximately 0.1 to 0.5 stars and the fraction of negative reviews that discuss fit-related issues declines. The extent of the rating increase due to Q&As is proportional to the probability that purchasers will experience fit mismatch without Q&A. Our findings suggest that, by resolving product fit uncertainty in an e-commerce setting, the addition of Q&As can be a viable way for retailers to improve ratings of products that have incurred low ratings due to customer-product fit mismatch.
Phase-Dependent Effects of Closed-Loop Tactile Feedback on Gait Stability in Parkinson’s Disease

Gait disturbances in people with Parkinson’s disease (PD) are a major cause for functional dependence and have recently been shown to be the largest risk factor for falls, institutionalization and death in PD. The use of external cues has been successful at improving gait in people with PD, but the effect of external cues on gait stability is unclear. We examined whether different forms of cueing, open-loop and closed-loop, influenced the local dynamic stability of three critical phases of gait. Forty-three adults with PD completed six, two-minute long walking trials in the following cued conditions: no cue (B), open-loop cueing, fixed auditory cue (OL), closed-loop cueing, tactile feedback delivered to wrist when the ipsilateral foot contacted with the ground (CL). Conditions were performed with and without a cognitive task. Kinematic data were recorded with inertial sensors. Only CL cueing was associated with changes in trunk stability, and these changes were only evident during the weight transfer phase of gait. Both OL and CL caused reductions in overall gait speed, stride length, and an increase in stride time. While CL cueing significantly influenced local dynamic stability during weight transfer, it remains unknown whether these changes are associated with more or less global stability. Future research will explore the clinical implications.
430-P: Macrovascular Complications and the Diabetes Early Readmission Risk Indicator (DERRI) Predict Risk for Hospital Readmission at 90 Days

Several risk factors for hospital readmission in patients with diabetes (DM) have been identified. The Diabetes Early Readmission Risk Indicator (DERRITM) is a tool that identifies patients at high risk for readmission within 30 days of hospital discharge, but does not incorporate several DM specific factors such as type of DM and pre-discharge glycemic measures. The purpose of this investigation was to prospectively examine DM specific factors and DERRI scores as predictors of readmission risk at 90 days in participants in the Readmission and Comprehension of Discharge Education in Diabetes (RECODED) study. Among the 126 patients, (age mean (STD) 61(12) yrs, BMI 32.9 (9.6) kg/m2, A1c 8.0 (2.2%), 45% women, 22% Black, 85% type 2 DM), readmission occurred in 54 (42.9%) of patients within 90 days of discharge. Factors identified as predicting risk for hospital readmission included the presence of known macrovascular (CAD, p = 0.039; CHF, p = 0.029; CVA, p = 0.054) but not microvascular complications. DERRI scores were higher in those with a readmission compared to those without (27 ± 12% vs. 20 ± 11%, p = 0.006).No differences were observed for age, BMI, type of diabetes, eGFR, history of DM self-management education, inpatient DM service consultation, education level, employment history, A1c, pre-discharge hypoglycemia, hyperglycemia or glycemic variability, or hospital length of stay among those with and without a readmission. In summary, these results reinforce the complexity of identifying risk factors for hospital readmission in DM patients. Certain macrovascular complications, which are collectively components of the DERRI, individually demonstrate an association with readmission risk at 90 days, as does DERRI. This is the first demonstration of DM related macrovascular complications and DERRI score as a predictor of readmission beyond 30 days of hospital discharge. Disclosure D. Pinkhasova: None. J. Swami: None. N. Patel: None. A. Donihi: None. L.M. Siminerio: Research Support; Self; Becton, Dickinson and Company. K. Delisi: None. D.S. Hlasnik: None. D.J. Rubin: None. M.T. Korytkowski: None. Funding National Institutes of Health (UL1TR001857)
Nanoceria distribution and effects are mouse-strain dependent

Prior studies showed nanoparticle clearance was different in C57BL/6 versus BALB/c mice, strains prone to Th1 and Th2 immune responses, respectively. Objective: Assess nanoceria (cerium oxide, CeO2...
The performance of the commissioned Notre Dame multi-reflection time-of-flight mass spectrometer

Abstract The future N = 126 factory at Argonne National Laboratory is aimed to produce neutron-rich elements around the N = 126 peak of the rapid-neutron capture process using multi-nucleon transfer reactions. However, this radioactive ion beam production method will entail the delivery of contaminant ions. To remove the isobar contaminants from the beam, a multi-reflection time-of-flight mass spectrometer has been built and successfully commissioned at the University of Notre Dame, reaching a resolving power of 70,000, with an efficiency of 10%. According to stability study conducted, the resolving power is potentially limited to 83,000 by the power supply stability, however it can be mitigated by the addition of RC filtration as done for other MR-TOFs. The commissioned MR-TOF has been transported to Argonne National Laboratory to be used in the N = 126 factory.
Comparison of Instantaneous Effect of Speed Change on Invasive Hemodynamics and Echocardiographic Parameters Between Heartware and Heartmate 3 LVADs

Introduction Left ventricular assist device (LVAD) has shown to improve hemodynamics (HD). Right heart catheterization (RHC) and echocardiogram (ECHO) are used to define the optimal LVAD speed. This study evaluates the instantaneous effect of speed change on the HD and ECHO parameters in HeartWare (HVAD) and HeartMate 3 (HM3). Methods Patients with LVAD between January 2016 to March 2020, who had undergone speed optimization using RHC and ECHO, were included in this study. Generalized estimating equation or multilevel ordered logistic regression models were used to examine the effect of speed on all parameters to account for the correlation within conditions. Speed was standardized using the mean and standard deviation for HVAD and HM3. The estimated slope or odds ratio showed the effect on the parameters when standardized speed increased one standard deviation from its mean. Results Forty-two patients (13 HVAD and 29 HM3) were included. With increasing the speed, both devices similarly decreased pulmonary capillary wedge pressure, pulmonary artery systolic pressure, pulmonary artery diastolic pressure, mean pulmonary artery pressure, and improved cardiac index calculated by Fick method. Increasing the speed also had a similar decrement on left ventricular end-diastolic diameter and right ventricular systolic pressure. Worsening right ventricular (RV) function with the increasing speed only occurred in HVAD. At any given standardized speed, HVAD had a higher chance of having worse aortic valve regurgitation (AVR), worse tricuspid regurgitation (TR), and less frequent aortic valve opening compared to HM3 (Table 1). Conclusion HVAD and HM3 overall have a similar instantaneous hemodynamic effect with speed change; however, increasing speed had a higher chance of worsening AVR, TR, and RV function in HVAD compared to HM3.
Understanding intestinal health in nursery pigs and the relevant nutritional strategies

In the modern pig production, pigs are weaned at early age with immature intestine. Dietary and environmental factors challenge the intestine, specifically the jejunum, causing inflammation and oxidative stress followed by destruction of epithelial barrier and villus structures in the jejunum. Crypt cell proliferation increases to repair damages in the jejunum. Challenges to maintain the intestinal health have been shown to be related to changes in the profile of mucosa-associated microbiota in the jejunum of nursery pigs. All these processes can be quantified as biomarkers to determine status of intestinal health related to growth potential of nursery pigs. Nursery pigs with impaired intestinal health show reduced ability of nutrient digestion and thus reduced growth. A tremendous amount of research effort has been made to determine nutritional strategies to maintain or improve intestinal health and microbiota in nursery pigs. A large number of feed additives have been evaluated for their effectiveness on improving intestinal health and balancing intestinal microbiota in nursery pigs. Selected prebiotics, probiotics, postbiotics, and other bioactive compounds can be used in feeds to handle issues with intestinal health. Selection of these feed additives should aim modulating biomarkers indicating intestinal health. This review aims to define intestinal health and introduce examples of nutritional approaches to handle intestinal health in nursery pigs.