cssi/SciSciGPT-SciSciNet huggingface dataset:
The Kidney Transplant Evaluation Process in the Elderly: Reasons for Being Turned down and Opportunities to Improve Cost-Effectiveness in a Single Center

Background. The kidney transplant evaluation process for older candidates is complex due to the presence of multiple comorbid conditions. Methods. We retrospectively reviewed patients ≥60 years referred to our center for kidney transplantation over a 3-year period. Variables were collected to identify reasons for patients being turned down and to determine the number of unnecessary tests performed. Statistical analysis was performed to estimate the association between clinical predictors and listing status. Results. 345 patients were included in the statistical analysis. 31.6% of patients were turned down: 44% due to coronary artery disease (CAD), peripheral vascular disease (PVD), or both. After adjustment for patient demographics and comorbid conditions, history of CAD, PVD, or both (OR = 1.75, 95% CI (1.20, 2.56), p = 0.004), chronic obstructive pulmonary disease (OR = 8.75, 95% CI (2.81, 27.20), p = 0.0002), and cancer (OR 2.59, 95% CI (1.18, 5.67), p = 0.02) were associated with a higher risk of being turned down. 14.8% of patients underwent unnecessary basic testing and 9.6% underwent unnecessary supplementary testing with the charges over a 3-year period estimated at $304,337. Conclusion. A significant number of older candidates are deemed unacceptable for kidney transplantation with primary reasons cited as CAD and PVD. The overall burden of unnecessary testing is substantial and potentially avoidable.
Validation of high throughput screening of human sera for detection of anti-PA IgG by Enzyme-Linked Immunosorbent Assay (ELISA) as an emergency response to an anthrax incident.

To improve surge testing capability for a response to a release of Bacillus anthracis, the CDC anti-Protective Antigen (PA) IgG Enzyme-Linked Immunosorbent Assay (ELISA) was re-designed into a high throughput screening format. The following assay performance parameters were evaluated: goodness of fit (measured as the mean reference standard r2), accuracy (measured as percent error), precision (measured as coefficient of variance (CV)), lower limit of detection (LLOD), lower limit of quantification (LLOQ), dilutional linearity, diagnostic sensitivity (DSN) and diagnostic specificity (DSP). The paired sets of data for each sample were evaluated by Concordance Correlation Coefficient (CCC) analysis. The goodness of fit was 0.999; percent error between the expected and observed concentration for each sample ranged from −4.6% to 14.4%. The coefficient of variance ranged from 9.0% to 21.2%. The assay LLOQ was 2.6 μg/mL. The regression analysis results for dilutional linearity data were r2 = 0.952, slope = 1.02 and intercept = −0.03. CCC between assays was 0.974 for the median concentration of serum samples. The accuracy and precision components of CCC were 0.997 and 0.977, respectively. This high throughput screening assay is precise, accurate, sensitive and specific. Anti-PA IgG concentrations determined using two different assays proved high levels of agreement. The method will improve surge testing capability 18-fold from 4 to 72 sera per assay plate.
The Gentleman Vanishes: Dementia, Caretaking and the Life of the Mind

This essay recounts the author's journey with her father during his prolonged decline due to dementia. The experience pushed her to break out of the confines of conventional scholarly research in her academic field of architectural history to a multi-disciplinary consideration of nineteenth-century environmental, sensory and horticultural therapies for the mentally ill. During her father's illness, she discovered the tangible therapeutic benefits of momentary engagements with his environment through his five senses and through the emotional filter of poetry. This reorientation to sensory and poetic experience had a beneficial impact on the caretaker as well.
Rhodotorula Endogenous Endophthalmitis: A Novel Harbinger of the Injection Drug Epidemic in the United States

Endogenous endophthalmitis is a rare but feared infectious ocular complication of injection drug use (IDU). The recent opioid epidemic in the United States threatens to increase the incidence of this disease. We report the first case of endogenous endophthalmitis in the United States caused by the emerging fungal pathogen Rhodotorula in an injection drug user which led to no light perception vision (NLP). Worldwide experience with Rhodotorula endogenous endophthalmitis is limited, but existing cases suggest infection by this particular fungal genus has a grim prognosis.
Historical patterns of acidification and increasing CO2 flux associated with Florida springs

Florida has one of the highest concentrations of springs in the world, with many discharging into rivers and predominantly into eastern Gulf of Mexico coast, and they likely influence the hydrochemistry of these adjacent waters; however, temporal and spatial trends have not been well studied. We present over 20 yr of hydrochemical, seasonally sampled data to identify temporal and spatial trends of pH, alkalinity, partial pressure of carbon dioxide (pCO2), and CO2 flux from five first-order-magnitude (springs that discharge greater than 2.83 m3 s−1) coastal spring groups fed by the Floridan Aquifer System that ultimately discharge into the Gulf of Mexico. All spring groups had pCO2 levels (averages 3174.3–6773.2 μatm) that were much higher than atmospheric levels of CO2 and demonstrated statistically significant temporal decreases in pH and increases in CO2 flux, pCO2, and alkalinity. Total carbon flux emissions increased from each of the spring groups by between 3.48 × 107 and 2.856 × 108 kg C yr−1 over the time period. By 2013 the Springs Groups in total emitted more than 1.1739 × 109 kg C yr−1. Increases in alkalinity and pCO2 varied from 90.9 to 347.6 μmol kg−1 and 1262.3 to 2666.7 μatm, respectively. Coastal data show higher CO2 evasion than the open Gulf of Mexico, which suggests spring water influences nearshore waters. The results of this study have important implications for spring water quality, dissolution of the Florida carbonate platform, and identification of the effect and partitioning of carbon fluxes to and within coastal and marine ecosystems.
BUILDING A BETTER GLUTEAL BRIDGE: ELECTROMYOGRAPHIC ANALYSIS OF HIP MUSCLE ACTIVITY DURING MODIFIED SINGLE-LEG BRIDGES

BACKGROUND Gluteal strength plays a role in injury prevention, normal gait patterns, eliminating pain, and enhancing athletic performance. Research shows high gluteal muscle activity during a single-leg bridge compared to other gluteal strengthening exercises; however, prior studies have primarily measured muscle activity with the active lower extremity starting in 90 ° of knee flexion with an extended contralateral knee. This standard position has caused reports of hamstring cramping, which may impede optimal gluteal strengthening. HYPOTHESIS/PURPOSE The purpose of this study was to determine which modified position for the single-leg bridge is best for preferentially activating the gluteus maximus and medius. STUDY DESIGN Cross-Sectional. METHODS Twenty-eight healthy males and females aged 18-30 years were tested in five different, randomized single-leg bridge positions. Electromyography (EMG) electrodes were placed on subjects' gluteus maximus, gluteus medius, rectus femoris, and biceps femoris of their bridge leg (i.e., dominant or kicking leg), as well as the rectus femoris of their contralateral leg. Subjects performed a maximal voluntary isometric contraction (MVIC) for each tested muscle prior to performing five different bridge positions in randomized order. All bridge EMG data were normalized to the corresponding muscle MVIC data. RESULTS A modified bridge position with the knee of the bridge leg flexed to 135 ° versus the traditional 90 ° of knee flexion demonstrated preferential activation of the gluteus maximus and gluteus medius compared to the traditional single-leg bridge. Hamstring activation significantly decreased (p < 0.05) when the dominant knee was flexed to 135 ° (23.49% MVIC) versus the traditional 90 ° (75.34% MVIC), while gluteal activation remained similarly high (51.01% and 57.81% MVIC in the traditional position, versus 47.35% and 57.23% MVIC in the modified position for the gluteus maximus and medius, respectively). CONCLUSION Modifying the traditional single-leg bridge by flexing the active knee to 135 ° instead of 90 ° minimizes hamstring activity while maintaining high levels of gluteal activation, effectively building a bridge better suited for preferential gluteal activation. LEVEL OF EVIDENCE 3.
Predisposing factors to autoimmune disease.

There are many factors that predispose women to autoimmune disease. The protective effect of testosterone during development prevents most males from getting autoimmune disease, although in some instances this protective effect can be bypassed by either genetic anomalies or endocrinopathies. Autoimmunity is defined as the development of symptoms and antibodies referable to one or another autoimmune disease. Some of the factors that predispose young women to autoimmunity also directly involve the endocrine system and indirectly, disorders of gonadal development. Altered sex steroid metabolism is one endogenous factor that predisposes a young woman to autoimmunity. The metabolism of estrone which can be directed to either the 16- or the 2-metabolites by diet, thyroid function, or certain drugs has a major influence on immune function and possibly gonadal pathology. Attempts to shift the metabolism of estrone to the 2-compounds with a variety of agents actually decreases the predisposition to autoimmunity. Other predisposing factors are all related to hormone metabolism and include hyperprolactinemia, the use of exogenous estrogenic agents, or compounds that change basic steroid metabolism. Most of these conditions are reversible.
PENERAPAN INTREPRETATIVE STRUCTURAL MODELING(ISM) DALAM PENENTUAN ELEMEN PELAKU DALAM PENGEMBANGAN KELEMBAGAAN SISTEM BAGI HASIL PETANI KOPI DAN AGROINDUSTRI KOPI

Coffee farmer and agroindustry facebankcruptcy riskif they operate separately. This research aim to designa key actor in profit sharing institutional development. There are ten actor in coffee value chain resulted by Interpretative Structural Modelling (ISM)methode, consisted of facilitator, coffee agroindustry, local government, intermediary, financial institution, farmer organization, R&D,central government, eksportir and coffee farmer
De Novo Synthesis of Phosphorylated Triblock Copolymers with Pathogen Virulence-Suppressing Properties That Prevent Infection-Related Mortality.

Phosphate is a key and universal “cue” in response to which bacteria either enhance their virulence when local phosphate is scarce or downregulate it when phosphate is adundant. Phosphate becomes depleted in the mammalian gut following physiologic stress and serves as a major trigger for colonizing bacteria to express virulence. This process cannot be reversed with oral supplementation of inorganic phosphate because it is nearly completely absorbed in the proximal small intestine. In the present study, we describe the de novo synthesis of phosphorylated polyethylene glycol compounds with three defined ABA (hydrophilic/-phobic/-philic) structures, ABA-PEG10k-Pi10, ABA-PEG16k-Pi14, and ABA-PEG20k-Pi20, and linear polymer PEG20k-Pi20 absent of the hydrophobic block. The 10k, 16k, and 20k demonstrate the molecular weights of the poly(ethylene glycol) block, and Pi10, Pi14, and Pi20 represent the repeating units of phosphate. Polymers were tested for their efficacy against Pseudomonas aeruginosa virulence in v...
Differential Equations and Reaction Kinetics

In this chapter we will show how to numerically solve the kinetic rate equations of the sort that describe biochemical metabolism, microbial growth, and similar biological phenomena. These equations are called differential equations, and generally describe the change of concentrations or numbers of organisms (the dependent variables) as a function of time (the independent variable). Since there is only one independent variable (time), these are “ordinary differential equations”, or ODEs. If there were two or more independent variables (e.g., time and positional coordinates), we would have “partial differential equations”, or PDEs. In this book we’ll deal mainly with ODEs.
Insights into CKD from Metabolite GWAS.

Under steady state, blood levels of human metabolites are determined by their baseline rates of production and clearance. These physiologic processes, in turn, are influenced by various environmental factors ( e.g. , diet and medication exposure), genetic variation ( e.g. , in genes encoding
Non-operative Treatment of Gastroesophageal Reflux Disease

Gastrointestinal reflux disease (GERD) is the most prevalent gastrointestinal disorder in the United States with considerable morbidity. It is typically characterized by the classic symptoms of heartburn and regurgitation. The management of GERD includes assessment for alarm features which should prompt further investigation. However, in most cases GERD is a presumptive diagnosis that can be treated empirically with proton pump inhibitor (PPI) therapy without extensive diagnostic evaluation. This chapter will review the non-operative management of GERD, including medical therapy as well as the additional diagnostic for patients at risk for complications of GERD.
Wine Industry Campaign Contributions and Wine Excise Taxes: Evidence from U.S. States

Given the growing importance of the wine industry in the United States, wine special interests are on the rise. Data shows that campaign contributions from the wine industry to officials running for state offices have increased over time. Given this reality, one can expect wine excise tax to remain low in states that receive higher campaign contributions. In addition, there are theoretical and empirical reasons to believe that these tax rates are interdependent based on Tiebout competition and yardstick competition. Based on this reasoning, one can hypothesize wine excise tax rates to be spatially dependent. In this study, I test this hypothesis using state-level campaign contributions data from the National Institute on Money in State Politics and Distilled Spirits Council of the United States, Inc. and find that there is strong statistical evidence of spatial dependence between state wine excise tax rates. (JEL Classifications: C12, C23, H71)
A FRAMEWORK FOR ASSESSING THE IMPACT OF INFORMATION SYSTEMS INFRASTRUCTURE ON BUSINESS EFFECTIVENESS

Information systems infrastructure (ISI) was ranked as the most important issue in a 1994-1995 study of key issues in IS management (Brancheau et al. 1996). Yet, to date, little theoretical and empirical work has been done in this area. This study attempts to reconceptualize the ISI construct and its measures. Drawing from the literature, this study envisions ISI as a base of shared technological, human, and organizational capabilities that provide the foundation for business application systems in the form of services to a range of users. A measure of ISI capability was developed and operationalized through a self-administered mail survey sent to IS executives across the country. A factor analysis revealed that ISI was a multidimensional construct consisting of three underlying dimensions: technological, human, and organizational. A research model was proposed to assess the main impact of ISI on business effectiveness and the moderating effect of information intensity. Five selected business effectiveness variables were time and cost reduction in systems development, system availability, user satisfaction, improved financial performance, and outstanding financial performance. The results of hypotheses testing revealed that human capability was significantly related to system availability and user satisfaction, and organizational capability significantly influenced all business effectiveness, except system availability. Surprisingly, no significant impact of technological capability on any business effectiveness variables was detected. For the moderating effect, the more information intensive the organization, the greater the impact of ISI on time and cost reduction in systems development and outstanding financial performance. This study concluded that ISI capabilities contribute to business effectiveness. Future research should focus on refining the proposed research model using additional data or different data collection techniques.
Sonographic Estimated Fetal Weight among Diabetics at ≥ 34 Weeks and Composite Neonatal Morbidity

Objectives The objective was to assess the composite neonatal morbidity (CNM) among diabetic women with sonographic estimated fetal weight (SEFW) at 10 to 90th versus >90th percentile for gestational age (GA). Study Design The inclusion criteria for this retrospective study were singleton pregnancies at 34 to 41 weeks, complicated by diabetes, and that had SEFW within 4 weeks of delivery. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Results Among the 140 cohorts that met the inclusion criteria, 72% had SEFW at 10th to 90th percentile for GA, and 28% at >90th percentile. Compared with women with diabetes with last SEFW at 10th to 90th percentile, those with estimate > 90th percentile for GA had a significantly higher rate of CNM (13 vs. 28%; OR, 2.65; 95% CI, 1.07–6.59). Among 109 diabetic women who labored, the rate of shoulder dystocia was significantly higher with SEFW at >90th percentile for GA than those at 10th to 90th percentile (25 vs. 2%; p = 0.002); the corresponding rate of CNM was 29 versus 10% (p = 0.02). Conclusion Among diabetic women with SEFW > 90th percentile for GA, CNM was significantly higher than in women with estimate at 10 to 90th percentile. Despite the increased risk of CNM, these newborns did not have long-term morbid sequela.
Dendrimer-Encapsulated Metal Nanoparticles: Synthesis and Application in Catalysis

This review discusses the most recent advancements in understanding the structure of nanoparticles encapsulated in polyamidoamine (PAMAM) dendrimers. After a brief discussion of different synthesis techniques used to prepare dendrimer-encapsulated nanoparticles (DENs), we focus on the structure parameters that are fundamentally important for the application of DENs in catalysis, such as the oxidation state of Pt ions inside PAMAM dendrimers after reduction treatment. We also discuss several recently developed applications of DENs in catalysis, including the conversion of a homogeneous catalytic reaction to a heterogeneous one. This change allows the application of these nanoparticles in a liquid-phase continuous flow reactor. We also discuss two recent examples using Au and Cu DENs to enhance the diastereoselectivity and chemoselectivity of chemical reactions, respectively. A deep understanding of DEN structures is vitally important for the design of superior catalysts based on DENs for important chemical conversions.
Breast Cancer Gene Expression Analysis

Cancer is a complicated disease with each individual tumor exhibiting to a variable degree a set of overlapping phenotypes that include abnormal proliferation and cell survival, genetic instability, tissue invasion, metastasis and angiogenesis. Each of these pathophysiological functions requires abnormal signaling that fails to respect the normal restraints imposed on healthy cells through homeostatic regulation. Understanding of deregulated gene expression is therefore an essential goal for cancer research because unraveling this problem will provide insights into the fundamental nature of cancer as well as provide opportunities for therapeutic intervention. Gene expression profiling is a remarkable technique that addresses this complexity by documenting the expression of thousands of genes at the level of mRNA abundance. From the standpoint of clinical investigation, the initial focus of gene profiling experiments has been on screening primary tumors for markers of poor prognosis. However this is only a first step in demonstrating the utility of this technique. Future advances will focus on understanding the evolution of an organ confined primary cancer to a treatment resistant lethal systemic disease through repeated tumor sampling and analysis, an approach termed in this paper “dynamic profiling”. Using breast cancer endocrine therapy as an example our initial approaches to dynamic profiling will be described.
Cognition in a Social Context: A Social-Interactionist Approach to Emergent Phenomena:

The formation of collective memories, emotions, and beliefs is a fundamental characteristic of human communities. These emergent outcomes are thought to be the result of a dynamical system of commu...
Navy Beans Impact the Stool Metabolome and Metabolic Pathways for Colon Health in Cancer Survivors

Colorectal cancer (CRC) is the third leading cause of cancer-related death in the United States and emerging evidence supports that increased consumption of legumes, such as navy beans, can reduce risk. Navy bean consumption was previously shown to modulate host and microbiome metabolism, and this investigation was performed to assess the impact on the human stool metabolome, which includes the presence of navy bean metabolites. This 4-week, randomized-controlled trial with overweight and obese CRC survivors involved consumption of 1 meal and 1 snack daily. The intervention contained 35 g of cooked navy bean or macronutrient matched meals and snacks with 0 g of navy beans for the control group (n = 18). There were 30 statistically significant metabolite differences in the stool of participants that consumed navy bean at day 28 compared to the participants’ baseline (p ≤ 0.05) and 26 significantly different metabolites when compared to the control group. Of the 560 total metabolites identified from the cooked navy beans, there were 237 possible navy bean-derived metabolites that were identified in the stool of participants consuming navy beans, such as N-methylpipecolate, 2-aminoadipate, piperidine, and vanillate. The microbial metabolism of amino acids and fatty acids were also identified in stool after 4 weeks of navy bean intake including cadaverine, hydantoin-5 propionic acid, 4-hydroxyphenylacetate, and caprylate. The stool relative abundance of ophthalmate increased 5.25-fold for navy bean consumers that can indicate glutathione regulation, and involving cancer control mechanisms such as detoxification of xenobiotics, antioxidant defense, proliferation, and apoptosis. Metabolic pathways involving lysine, and phytochemicals were also modulated by navy bean intake in CRC survivors. These metabolites and metabolic pathways represent an acute response to increased navy bean intake, which merit further investigation for improving colonic health after long-term consumption.
Balancing I/Q data in radar range-Doppler images.

Modern high-performance radar systems’ data is often rendered to distinguish between positive and negative frequencies necessitating complex data values, with real and imaginary constituents typically termed In-phase (I) and Quadrature (Q) elements respectively. Processing this data generally assumes well-balanced I/Q data, which may often be problematic due to non-ideal component and circuit behavior. We offer a number of techniques to mitigate the effects of I/Q imbalance.
Musculoskeletal Symptomatic Areas After Total Knee Replacement for Osteoarthritis.

Objective The objective of this study was to measure cumulative incidence and incidence rate and identify factors associated with new musculoskeletal (MSK) symptomatic areas after total knee replacement (TKR) for osteoarthritis (OA). Methods Using data from a randomized controlled trial of patients undergoing elective TKR for OA, we assessed for MSK symptomatic areas by region (neck, hands/wrists/arms/shoulders, back, hips, nonindex knee, and ankles/feet) at baseline (pre-TKR), and at 3, 6, 12, 24, 36, and 48 months post-TKR. Cumulative incidence and incidence rates were calculated for each region. Factors associated with incident MSK symptomatic areas were identified using generalized linear mixed models. Time to incident symptomatic area was assessed using Cox proportional hazards regression. Results Among 293 subjects, the cumulative incidence of any new MSK symptomatic area over 4 years was 45%; the incidence rate was 19.2 per 100 person-years. Body site-specific cumulative incidence and incidence rates were highest for nonindex knee and back. Predictors of incident MSK symptomatic areas included female sex (relative risk [RR] 1.64; 95% confidence interval [CI] 1.15-2.34), body mass index of 35 or higher (RR 1.27; 95% CI 0.88-1.85), Charlson Comorbidity Index 2 or more (RR 1.28; 95% CI 0.92-1.78), baseline index knee Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score greater than 40 (RR 1.39; 95% CI 0.99-1.95), and anxiety/depression (measured by the five-item Mental Health Index) (RR 1.70; 95% CI 1.20-2.40). Conclusion Incident MSK symptomatic areas occurred in roughly half of recipients of TKR in the 4 years after the operation. Further study is needed to examine the long-term impact of MSK symptomatic areas on postoperative pain, function, and quality of life.
Inhibition of PRMT1 Mediated FLT3 Arginine Methylation As a Potent Therapeutic Strategy for MLL-r ALL

Abstract Mixed-lineage leukemia-rearranged (MLL-r) ALL, seen in 70% of infant ALL, has a dismal prognosis compared to those with wild type MLL1 gene. Transcriptional profiling has identified Fms-like receptor tyrosine kinase 3 (FLT3) as one of the most significantly upregulated genes in MLL-r ALL. The highly expressed FLT3 protein is activated by the autocrine ligand, making the kinase a therapeutic target. FLT3 tyrosine kinase inhibitors (TKIs) such as PKC412, although effective in kinase inhibition, partially impair survival of MLL-r ALL cells and clinical trial results are not promising, promoting us to ask whether FLT3 regulates the ALL cells survival also through a kinase-independent mechanism. Herein, we report the finding of dimethylated arginines on FLT3, detected through mass spectrometry analysis of a MLL-r ALL specimen and a MLL-r ALL line SEM. The most conserved and enriched of dimethylated arginines are residues R972/R973. Using home-made arginine methylation (R-Me) antibody, we found that PRMT1, which is responsible for most type I arginine methyltransferases activity, catalyzes FLT3 methylation. Immunoblot (IB) analysis validated the expression of FLT3 R-Me in MLL-r ALL samples (6 out of 6) and MLL-r ALL lines (4 out of 4). Analysis of the GEO dataset (GSE13204) revealed that PRMT1 mRNA levels are increased in MLL-r ALL relative to normal cells (MLL-r, n=70 vs. normal, n=73, p 1% in peripheral blood, mice were subdivided into four groups and treated with vehicle, PKC412 (100 mg/kg, i.g.), MS023 (80 mg/kg, i.p, bid), or the combination (n=7/group) for 4 weeks. The BM tumor burden of CD45+ CD19+ cells was reduced in single drug-treated mice cohorts, with further reduction after combination treatment (vehicle, 94.4±0.5%, PKC412, 50.2±6.3%, MS023, 55.6±4.5%, combination, 30.7±4.9%, PKC412 vs. combination, p Our results support further exploring the molecular function of FLT3 R-Me. We will determine whether PRMT1 and FLT3 methylation are potential druggable targets in MLL-r ALL. Disclosures Konopleva: Stemline Therapeutics: Research Funding.
The Ban on US Government Funding Research Using Human Fetal Tissues: How Does This Fit with the NIH Mission to Advance Medical Science for the Benefit of the Citizenry?

Some have argued that human fetal tissue research is unnecessary and/or immoral. Recently, the Trump administration has taken the drastic––and we believe misguided––step to effectively ban government-funded research on fetal tissue altogether. In this article, we show that entire lines of research and their clinical outcomes would not have progressed had fetal tissue been unavailable. We argue that this research has been carried out in a manner that is ethical and legal, and that it has provided knowledge that has saved lives, particularly those of pregnant women, their unborn fetuses, and newborns. We believe that those who support a ban on the use of fetal tissue are halting medical progress and therefore endangering the health and lives of many, and for this they should accept responsibility. At the very least, we challenge them to be true to their beliefs: if they wish to short-circuit a scientific process that has led to medical advances, they should pledge to not accept for themselves the health benefits that such advances provide.
The effects of antihypertensive class on gout in older adults: secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial.

Objectives Gout is a common complication of blood pressure management and a frequently cited cause of medication nonadherence. Little trial evidence exists to inform antihypertensive selection with regard to gout risk. Methods The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) was a randomized clinical trial on the effects of first-step hypertension therapy with amlodipine, chlorthalidone, or lisinopril on fatal coronary heart disease or nonfatal myocardial infarction (1994-2002). Trial participants were linked to CMS and VA gout claims (ICD9 274.XX). We determined the effect of drug assignment on gout with Cox regression models. We also determined the adjusted association of self-reported atenolol use (ascertained at the 1-month visit for indications other than hypertension) with gout. Results Claims were linked to 23 964 participants (mean age 69.8 ± 6.8 years, 45% women, 31% black). Atenolol use was reported by 928 participants at the 1-month visit. Over a mean follow-up of 4.9 years, we documented 597 gout claims. Amlodipine reduced the risk of gout by 37% (hazard ratio 0.63; 95% CI 0.51--0.78) compared with chlorthalidone and by 26% (hazard ratio 0.74; 95% CI 0.58--0.94) compared with lisinopril. Lisinopril nonsignificantly lowered gout risk compared with chlorthalidone (hazard ratio 0.85; 95% CI 0.70--1.03). Atenolol use was not associated with gout risk (adjusted hazard ratio 1.18; 95% CI 0.78--1.80). Gout risk reduction was primarily observed after 1 year of follow-up. Conclusion Amlodipine lowered long-term gout risk compared with lisinopril or chlorthalidone. This finding may be useful in cases where gout risk is a principal concern among patients being treated for hypertension.This trial is registered at clinicaltrials.gov, number: NCT00000542.
Impaired Pentose Phosphate Shunt and Decreased Glycolytic Activity in Lymphocytes of Chronic Lymphocytic Leukemia. Metabolic Pathway . . .

The purpose of this study was to determine whether proportional alterations in the hexose monophosphate shunt or Embden-Meyerhof pathways of leukemic lymphocyte glycolysis might provide a biochemical explanation for excess glycogen stored in these neoplastic cells in addition to delineating a possible cause for the decreased glucose tolerance shown by a large number of patients with chronic lymphocytic leukemia (CLL). The experimental technic consisted of incubating leukemic lymphocytes separately in Krebs-bicarbonate buffer, and autologous and paired homologous normal plasma, along with glucose-1-14C. Normal, control lymphocytes were similarly handled except that corresponding leukemic plasma became the homologous substitute. Evolved 14CO2, trapped by sodium hydroxide, and collective glycolytic intermediates, isolated by anion exchange chromatography, were assayed by scintillation spectrometry. Compared to normal lymphocytes, the leukemic cells not only consumed less total sugar but also metabolized proportionately less carbohydrate via the hexose monophosphate shunt pathway as indicated by the diminished quantity of generated 14CO2. Although autologous normal plasma significantly increased all facets of normal lymphocyte glycolysis, autologous leukemic plasma failed to stimulate leukemic lymphocytes in a similar manner. In certain instances, this plasma further depressed neoplastic lymphocyte glucose utilization. These observations are consistent with the hypothesis that leukemic lymphocyte glycogenosis may be a consequence of an augmented pool of one or several glycolytic intermediates ultimately available for glycogen synthesis, and with the idea that leukemic plasma restricts in vivo glucose utilization leading to clinically detected abnormal carbohydrate metabolism in many patients with CLL.
Differential Contribution of the Retrotrapezoid Nucleus and C1 Neurons to Active Expiration and Arousal in Rats.

Collectively, the retrotrapezoid nucleus (RTN) and adjacent C1 neurons regulate breathing, circulation and the state of vigilance, but previous methods to manipulate the activity of these neurons have been insufficiently selective to parse out their relative roles. We hypothesize that RTN and C1 neurons regulate distinct aspects of breathing (e.g., frequency, amplitude, active expiration, sighing) and differ in their ability to produce arousal from sleep. Here we use optogenetics and a combination of viral vectors in adult male and female Th-Cre rats to transduce selectively RTN (Phox2b+/Nmb+) or C1 neurons (Phox2b+/Th+) with Channelrhodopsin-2. RTN photostimulation modestly increased the probability of arousal. RTN stimulation robustly increased breathing frequency and amplitude; it also triggered strong active expiration but not sighs. Consistent with these responses, RTN innervates the entire pontomedullary respiratory network, including expiratory premotor neurons in the caudal ventral respiratory group, but RTN has very limited projections to brainstem regions that regulate arousal (locus ceruleus, CGRP+ parabrachial neurons). C1 neuron stimulation produced robust arousals and similar increases in breathing frequency and amplitude compared with RTN stimulation, but sighs were elicited and active expiration was absent. Unlike RTN, C1 neurons innervate the locus ceruleus, CGRP+ processes within the parabrachial complex, and lack projections to caudal ventral respiratory group. In sum, stimulating C1 or RTN activates breathing robustly, but only RTN neuron stimulation produces active expiration, consistent with their role as central respiratory chemoreceptors. Conversely, C1 stimulation strongly stimulates ascending arousal systems and sighs, consistent with their postulated role in acute stress responses. SIGNIFICANCE STATEMENT The C1 neurons and the retrotrapezoid nucleus (RTN) reside in the rostral ventrolateral medulla. Both regulate breathing and the cardiovascular system but in ways that are unclear because of technical limitations (anesthesia, nonselective neuronal actuators). Using optogenetics in unanesthetized rats, we found that selective stimulation of either RTN or C1 neurons activates breathing. However, only RTN triggers active expiration, presumably because RTN, unlike C1, has direct excitatory projections to abdominal premotor neurons. The arousal potential of the C1 neurons is far greater than that of the RTN, however, consistent with C19s projections to brainstem wake-promoting structures. In short, C1 neurons orchestrate cardiorespiratory and arousal responses to somatic stresses, whereas RTN selectively controls lung ventilation and arterial Pco2 stability.
Avoiding Death by Meeting: An Interactive Workshop for Academic Faculty Highlighting Strategies to Facilitate Effective Team Meetings.

Introduction Effective meetings are a key marker of team function and are critical for task management. While important, the skill set for running an effective meeting is poorly understood. Methods...
The Role of Impulsivity in Major Depression: A Systematic Review

The goal of the current review was to examine recent (within the past 5 years) evidence of impulsivity, broadly defined to include both (a) self-report and (b) behavioral measures including measures of decision-making, inhibition, and inattention, as a feature of Major Depressive Disorder in terms of (a) differences between MDD groups compared to controls and (b) associations between impulsivity and self-reported depressive symptomatology. Of the 3304 studies screened, 21 met the inclusion criteria. Findings support higher levels of impulsivity in individuals with MDD compared to controls and an association between various facets of impulsivity and MDD. There is consistent evidence for impulsivity as a transdisease process influencing MDD. This evidence may be dependent on the facet of impulsivity being measured.
Reduction of surgical site infections in pediatric patients with complicated appendicitis: Utilization of antibiotic stewardship principles and quality improvement methodology.

Abstract Background The rate of surgical site infection (SSI) after appendectomy for complicated appendicitis (CA) was high at our children's hospital. We hypothesized that practice standardization, including obtaining intra-operative cultures of abdominal fluid in patients with CA, would improve outcomes and reduce healthcare utilization after appendectomy. Methods A quality improvement team designed and implemented a clinical practice guideline for CA that included obtaining intra-operative culture of purulent fluid, administering piperacillin/tazobactam for at least 72 h post-operatively, and transitioning to oral antibiotics based on intraoperative culture data. We compared outcomes before and after guideline implementation. Results From July 2018-October 2019, 63 children underwent appendectomy for CA compared to 41 children from January-December 2020. Compliance with our process measures are as follows: Intra-operative culture was obtained in 98% of patients post-implementation; 95% received at least 72 h of piperacillin-tazobactam; and culture results were checked on all patients. Culture results altered the choice of discharge antibiotics in 12 (29%) of patients. All-cause morbidity (SSI, emergency department visit, readmission to hospital, percutaneous drain, unplanned return to operating room) decreased significantly from 35% to 15% (p=0.02). Surgical site infections became less frequent, occurring on average every 27 days pre-implementation and every 60 days after care pathway implementation (p=0.03). Conclusions Utilization of a clinical practice guideline was associated with reduced morbidity after appendectomy for CA. Intra-operative fluid culture during appendectomy for CA appears to facilitate the selection of appropriate post-operative antibiotics and, thus, minimize SSIs and overall morbidity.
In Vitro Motions of the Medial and Lateral Proximal Sesamoid Bones under Mid-Stance Load Conditions are Consistent with Racehorse Fracture Configurations

Abstract Proximal sesamoid bone (PSB) fractures in racehorses are likely fatigue fractures that occur due to repetitive loads and stress remodeling. The loading circumstances that may induce damage in the PSBs are not well understood. The goal of this study was to determine in three-dimensions, PSB motions relative to the opposing metacarpal condyle during simulated mid-stance loads. Seven equine cadaveric forelimbs were axially loaded in a material testing system to simulate standing and mid-stance walk, trot, and gallop load conditions (1.8-10.5 kN). Joint angles were determined by tracking the positions of bone-fixed kinematic markers. Internal-external rotation, abduction-adduction, and flexion-extension of each PSB relative to the third metacarpal condyle were compared between loads and between PSBs using an ANOVA with Tukey-Kramer post hoc tests for pairwise comparisons. The medial PSB rotated externally and the lateral PSB apex abducted during limb loading. Medial PSB external rotation was significantly greater at the gallop load condition than at the walk or trot load conditions. The medial and lateral PSB motions observed in this study are consistent with location of fatigue damage and fracture configurations frequently seen in medial and lateral PSBs from Thoroughbred racehorses. Specifically, medial PSB external rotation is consistent with the development of an abaxial subchondral medial PSB lesion that is reported in association with medial PSB transverse fracture and lateral PSB abduction is consistent with axial longitudinal fracture of the lateral PSB.
Sanctified Sexism: Religious Beliefs and the Gender Harassment of Academic Women.

The present study explored gender harassment in the context of Christian higher education. Specifically, we examined ways in which the theologically based gender schemas in these settings might affect the experiences of harassment among male and female faculty. A questionnaire containing measures of harassment and two aspects of institutional climate (the degree to which the participant feels he or she has influence in the academic unit and perceived access to information about academic life and advancement) was sent to all faculty at a single university; 138 responses (a 65% response rate) were received. Of these, 89 (68%) were male and 42 (32%) female, closely resembling the gender distribution of the faculty. Results indicated that attributing discrimination to the Christian beliefs of the perpetrator moderated the effects of harassment on the two organizational climate variables, potentiating the negative effects at higher levels of harassment. These results suggest that the religious context of insti...
Peripheral Nerve Blocks for Pregnant Patients with Headache (P7.202)

OBJECTIVE: Though peripheral nerve blocks (PNBs) are an established and safe treatment option for headache, we describe their use for the first time in a case series of pregnant women. BACKGROUND: Headache therapies in pregnancy are limited because of maternal and fetal safety concerns. PNBs for headache are generally a safe and efficacious treatment in non-pregnant patients. DESIGN/METHODS: A retrospective review of all pregnant patients treated with PNBs between 7/2009 and 4/2013 was performed, including greater occipital, auriculotemporal, supraorbital and supratrochlear injections with local anesthetics. RESULTS: PNBs were performed 24 times in 11 pregnant women, either in isolation (n=5) or repetitively (n=6). Mean gestational age of the patients was 24.0 weeks (range 7-37 weeks), and 81.8% (n=9) had a migraine history. PNBs were performed for status migrainosus (n=11, 45.8%) or transitional/bridge therapy (for high headache attack frequency) (n=13, 54.1%), in both inpatient (n=10, 41.6%) and ambulatory (n=14, 58.3%) settings. Average pre-procedure pain was 8.3 (range 5-10) and post-procedure pain was 4.7 (range 0-10) for status migrainosus patients, and for transitional treatment average pre-procedure pain was 3.5 (range 0-7) and post-procedure pain was 0.8 (range 0-5). All patients failed standard acute and/or prophylactic treatments. For visits with this data recorded, 90.9% (n=11) did not have any obstetrical complaints following the procedure. The 2 patients that did not respond to PNBs were ultimately diagnosed with preeclampsia and delivered. Of the 11 patients, 4 (36.3%) delivered after 37 weeks, 3 (27.2%) delivered after 35 weeks and before 37 weeks for PPROM and poorly controlled diabetes, 2 (18.1%) delivered preterm at 29 weeks for (n=1) preeclampsia and (n=1) placental abruption, and 2 (18.1%) patients delivered in different hospitals and were lost to follow up. CONCLUSIONS: In our experience PNBs for headache can be performed safely during pregnancy for patients with debilitating headaches, who failed oral or intravenous regimens, as most patients experienced rapid pain relief or attack frequency reduction. Further prospective studies are warranted. Disclosure: Dr. Govindappagari has nothing to disclose. Dr. Grossman has nothing to disclose. Dr. Dayal has nothing to disclose. Dr. Grosberg has received personal compensation for activities with Tribute Pharmaceutical as an advisory board member, and Zogenix as a speaker. Dr. Grosberg has received research support from Allergan Inc., Electrocore, and Novartis. Dr. Vollbracht9s family owns stock and/or stock options in Allergan, Inc. Dr. Robbins has received personal compensation for activities with Medlink.
Shallow water tomography

The tomogaphic approach with reciprocal transmission has been applied to a shallow water area in the Florida Straits to give a direct observation of range and depth averaged currents and temperatures. Such spatial averages are not easily obtained with conventional current measurement methods. The propagation models and inversion methods of deep ocean tomography cannot be directly applied to shallow water locations since the spread in arrival times amongst paths is inherently limited in shallow propagation channels and the interaction with the rough ocean bottom can cause further uncertainty in path identification and travel time measurements. Nevertheless, acoustic reciprocal transmission experiments have been successful in the Florida Straits. Acoustic measures are interpreted with ray theory and parabolic equation propagation models to give averaged currents and temperatures which are in good agreement with measurements with current meter arrays. The experimental approach, inversion methods and equipment requirement are considered for the Florida Straits experiment and for applictions to other shallow water areas. The precision and limitations of the method are discussed.
Chapter 9 Narrative threads of metaphor

Publisher Summary This chapter addresses aspects of the interpretation of metaphors in lengthier contexts, specifically those found in passages of published fiction, where metaphors are numerous and important. Metaphor is a rhetorical device by which words are used to refer to concepts that may never have been called by that name before and, as such, is problematic for many theories of meaning. To interpret a metaphor is to clarify or represent its meaning. Scholars have frequently used the word interpretation to denote a brief statement of understanding. Some scholars also use interpretation to mean, roughly, “putting something into words” but it is quite possible that subjects could claim to understand a line of poetry, for example, though they could also find it difficult to write down what exactly they understand. Interpretation might well be related to such aspects of a metaphor as its quality, the ease with which readers form an image of it, the pre-existing similarity of the concepts it compares, or its memorability. Interpretation of metaphors, at least in some past work, has been found to relate to metaphoric quality, imageability, and conceptual similarity, if not to memory.
Necrotizing Enterocolitis is associated with Ureaplasma Colonization in Preterm Infants

The study objective was to determine whether Ureaplasma respiratory tract colonization of preterm infants <33 wk gestation is associated with an increased risk for necrotizing enterocolitis (NEC). One or more tracheal or nasopharyngeal aspirates for Ureaplasma culture and PCR were obtained during the first week of life from 368 infants <33 wk gestation enrolled from 1999 to 2003 or from 2007 to 2009. NEC Bell stage ≥ 2 was confirmed by radiological criteria, and pathology, if available. Cord serum samples were analyzed for IL-6 and IL-1β concentrations, and placentas were reviewed for histological chorioamnionitis in the first cohort. NEC was confirmed in 29 of 368 (7.9%) of the combined cohorts. The incidence of NEC was 2.2-fold higher in Ureaplasma-positive (12.3%) than Ureaplasma-negative (5.5%) infants <33 wk (OR, 2.43; 95% CI, 1.13-5.2; p = 0.023) and 3.3-fold higher in Ureaplasma-positive (14.6%) than Ureaplasma-negative (4.4%) infants ≤ 28 wk (OR, 3.67; 95% CI, 1.36-9.93; p = 0.01). Age of onset, hematologic parameters at onset, and NEC severity were similar between Ureaplasma-positive and negative infants. Cord serum IL-6 and IL-1β concentrations were significantly higher in Ureaplasma-positive than in Ureaplasma-negative NEC-affected infants. Ureaplasma may be a factor in NEC pathogenesis in preterm infants by contributing to intestinal mucosal injury and/or altering systemic or local immune responses.