cssi/SciSciGPT-SciSciNet huggingface dataset:
Architecture, Medicalization, and the Aesthetics of Hygiene at the Écoles maternelles.

This article examines the focus on hygiene, medical surveillance, and physical regeneration in late 19th and early 20th century French nursery schools (ecoles maternelles) and its impact on their architecture. Administrators had originally charged maternelles with providing education and motherly care to young children. But bureaucratic anxieties about physical degeneration and disease among French schoolchildren led to new practices focused on the body, which ultimately led to changes in the schools' architectural program and aesthetics. Supposedly at stake was nothing less than the biological, political, and economic future of France.
A randomized phase II study of ipilimumab induction in patients with melanoma brain metastases receiving stereotactic radiosurgery.

TPS9079 Background: Despite recent advances in the treatment of metastatic melanoma, survival remains poor in patients who develop brain metastases. Radiation therapy continues to be the backbone o...
Death or Nourishment in Robert Frost's BLUE-BUTTERFLY DAY?

Butterflies appear in six of Robert Frost's poems, but only in “Blue-Butterfly Day” do they appear in early spring. Some authors have inferred that the blue butterflies are dead in the “April mire”...
Proton-induced production and radiochemical isolation of 44Ti from scandium metal targets for 44Ti/44Sc generator development

Scandium-44g (half-life 3.97h) shows promise for application in positron emission tomography (PET), due to favorable decay parameters. One of the sources of 44gSc is the 44Ti/44gSc generator, which can conveniently provide this radioisotope on a daily basis at a diagnostic facility. Titanium-44 (half-life 60.0 a), in turn, can be obtained via proton irradiation of scandium metal targets. A substantial 44Ti product batch, however, requires high beam currents, long irradiation times and an elaborate chemical procedure for 44Ti isolation and purification. This study describes the production of a combined 175MBq (4.7mCi) batch yield of 44Ti in week long proton irradiations at the Los Alamos Isotope Production Facility (LANL-IPF) and the Brookhaven Linac Isotope Producer (BNL-BLIP). A two-step ion exchange chromatography based chemical separation method is introduced: first, a coarse separation of 44Ti via anion exchange sorption in concentrated HCl results in a 44Tc/Sc separation factor of 102-103. A second, cation exchange based step in HCl media is then applied for 44Ti fine purification from residual Sc mass. In summary, this method yields a 90-97% 44Ti recovery with an overall Ti/Sc separation factor of ≥106.
Analytical and Numerical Methods in Determining the Combined Effects of Iontophoresis and Chemical Penetration Enhancers

Techniques were proposed to measure the effects of design parameters on the flux enhancement ratios of controlled release systems induced by chemical agents and/or iontophoresis. The lag time method facilitated the computation of diffusion and vehicle/membrane partition coefficients for passive transport studies performed in Franz diffusion cells. After exposing the system to an electric field, the parameters, affecting the process, were calculated assuming inappreciable changes in the drug diffusivity through the biological membrane. Closed-form expressions were given for the effective time constant, a measure of the time it takes to reach a steady-state delivery rate. The flux enhancement ratios were related to properties of controlled release devices making it possible to explain the specific mechanisms governing the effects of iontophoresis and chemical penetration enhancers on drug permeation.
Force and Contact Transition Control via Nonlinear Feedback and Event-based Planning

Abstract In this paper, a new sensor-referenced control method using positive acceleration feedback together with a switching control strategy is developed for robot impact control and force regulation. The robot dynamic model is feedback linearized and decoupled for the free motion mode, and the phase transition mode, as well as the constrained motion mode. Stable contact can be made with a nonzero impact velocity and large impact forces can be avoided. Consider the detection of the impact as an event. The event driven switching control strategy is used to deal with the inadvertent loss of contact of the robotic manipulator. Bouncing can be eliminated after finite switches. A stable transition can be achieved and the output force can be regulated after contact is established. Stability analysis based on the Liapunov-like method is given for the proposed system. The scheme was implemented and tested on a 6 DOF PUMA 560 robot arm.
Sustained Response to Thymosin Therapy in Patients with Chronic Active Hepatitis B

Chronic hepatitis B (CHB) is a widespread disease associated with significant morbidity and mortality. At least 300 million people worldwide are chronically infected with the hepatitis B virus (HBV) with carrier rates as high as 20% in some populations (1).
Oxidation-induced changes in microrheologic properties of the red blood cell membrane

It has been hypothesized that some of the irreversible microrheologic abnormalities of sickle red blood cell (RBC) membranes could result from autoxidative perturbation. To model this possibility, we used micromechanical manipulation to examine the static extensional rigidity and inelastic or plastic behavior of normal RBCs exposed to phenazine methosulfate (PMS), an agent that generates superoxide from within the cell. In response to this stress, RBC membranes became stiff as evidenced by increasing extensional rigidity. At 50 mumol/L PMS they were as stiff as the membranes of most dense, dehydrated sickle RBCs; and at 25 mumols/L PMS the membranes were similar to somewhat less dense sickle RBCs. When examined for inelastic behavior, RBCs exposed to PMS even at 10 mumols/L showed hysteresis in loading and unloading phases of the curve relating aspiration length to suction pressure, and they developed membrane bumps that persisted after RBC release from the pipette. Examination of single cells in both isotonic and hypotonic buffers showed that the effect of PMS on RBC microheology is not mediated by cellular dehydration. Independent confirmation of the membrane stiffening effect of PMS was obtained by ektacytometric analysis of resealed RBC ghosts, with sickle-like increases in membrane rigidity observed between 50 and 100 mumol/L PMS. The rigidity of these ghosts was partially ameliorated by exposure to a thiol reductant. In terms of biochemical abnormalities, treated RBCs became significantly different from control RBCs at 25 mumol/L PMS, at which point they just began to enter the sickle range for amounts of membrane thiol oxidation and membrane-associated heme. The sickle average was achieved at 50 mumol/L PMS (for thiol oxidation) to 100 mumol/L PMS (for membrane heme). Thus, micromolar concentrations of PMS induce abnormalities of membrane microrheology that closely mimic those of unmanipulated sickle RBCs while reproducing similar degrees of oxidative biochemical change. We conclude that membrane protein oxidation could explain existence of an irreversible component to the abnormal rheology of the sickle membrane.
CO2 Detection at 2 µm Using Quartz Enhanced Photoacoustic Spectroscopy

Sensitive carbon dioxide detection and analysis of CO2 relaxation process is performed using quartz enhanced photoacoustic spectroscopy and a diode laser operating at 2µm as the spectroscopic source. Sensor performance and optimization will be reported.
Pulmonary Complications of Rheumatologic Disorders

Rheumatologic diseases are a heterogeneous group of more than 100 immunologically mediated chronic systemic inflammatory disorders. Although they are not specific to the respiratory system (in fact one of their characteristics is that they affect multiple tissues/organs in the body), these disorders invariably involve the respiratory system, but the extent and severity of the pulmonary complications as well as their onset and clinical course vary significantly among them. The following chapter discusses the pathophysiology of these disorders as they relate to the different components of the respiratory system as well as on the various diagnostic modalities that clinicians should consider in making the diagnosis and monitoring of the disease.
Let's Talk About It: Supporting Family Communication during End-of-Life Care of Pediatric Patients.

Abstract Background: Communication is key in optimizing medical care when a child is approaching end of life (EOL). Research is yet to establish best practices for how medical teams can guide intrafamily communication (including surviving siblings) when EOL care is underway or anticipated for a pediatric patient. While recommendations regarding how medical teams can facilitate communication between the medical team and the family exist, various barriers may prevent the implementation of these recommendations. Objective: This review aims to provide a summary of research-to-date on family and medical provider perceptions of communication during pediatric EOL care. Design: Systematic review. Results: Findings from a review of 65 studies suggest that when a child enters EOL care, many parents try to protect their child and/or themselves by avoiding discussions about death. Despite current recommendations, medical teams often refrain from discussing EOL care with pediatric patients until death is imminent for ...
COBOTS - A Cognitive Multi-Bot Conversational Framework for Technical Support

Human technical support agents spend significant time interacting with customers via various channels of voice, email and chat. There is a massive incentive to automate support with autonomous agents with the goal of reducing manual effort and time taken for problem resolution. As technical support questions are complex and diverse, building a generic agent capable of solving multiple domains is implausible. In this paper, we describe a scalable conversational framework that automates the process of guided troubleshooting called COBOTS (COgnitive BOts for Technical Support). Our underlying premise is that scalability in such frameworks can be achieved by control and co-ordination across multiple domain expert bots. These bots co-ordinate to (a) understand user problems from natural language queries (b) engage in conversation and (c) provide assistance with troubleshooting. All of the above is done with minimum human assistance. COBOTS framework comprises of User Bots that monitor customer infrastructure for issues, the Orchestrator bot which co-ordinates and controls various request-response pairs and Domain Expert bots which handle issues pertaining to their domains, respectively. In a real environment, we have deployed an implementation of our COBOTS framework which can co-ordinate and control user queries across 11 different technical support domains. When evaluated by two different teams of expert support users, it was observed that more than 75% of the time our application was able to provide relevant solutions for their queries.
A Geometric Approach to Second and Higher Order Kinematic Analysis

There is extensive literature on using screw theory to study the first order kinematic properties of robot manipulators. In this paper, we focus on screw theory and its relationship to second and higher order kinematic properties. We start with the geometry of the Lie group S E (3), the special Euclidean group in three dimensions. It is well known that the set of all twists can be identified with the tangent vectors at the identity element to form a Lie algebra. We argue that in order to describe second order kinematic properties, it is necessary to endow S E(3) with an affine connection. The connection allows us to differentiate twists to obtain higher order derivatives. To get correct expressions for the rigid body acceleration and jerk, it is necessary to use a suitable affine connection. We show that there is a unique symmetric connection with this property. We also prove that there is a unique invariant, symmetric connection that leads to the definition of the acceleration screw.
11.19 – Ovarian Toxicology

In the mammalian ovary, the development of follicles is a complex process that begins with the formation of primordial follicles and culminates either in a normal atretic degradation process or in the release of an oocyte for fertilization. Female reproduction depends, in part, on successful development of follicles. However, large numbers of toxicants target the follicles compromising female reproduction. This chapter describes the processes occurring and factors controlling primordial follicle formation, activation, growth, and development to the ovulatory stage. Further, this chapter provides information about deleterious effects and mechanisms that some environmental chemicals use to damage the follicle and thereby impair ovarian function. Although many mechanisms of ovotoxicity have been elucidated, knowledge of factors that control follicle development may allow the design of studies that evaluate new potential endpoints of toxicity. This may help to develop new strategies of prevention or treatment of toxicant-induced ovotoxicity.
Immobilization following Distal Radius Fractures: A Randomized Clinical Trial.

Background No consensus exists regarding postoperative splinting position following volar plate fixation of distal radius fractures. Purpose The purpose of this study was to determine whether immobilization in supination would result in superior outcomes compared with no restriction of forearm range of motion. Patients and Methods All patients >18 years of age with distal radius fractures indicated for volar plate fixation were eligible. Exclusion criteria were open fracture and concomitant injury to, or functional deficit of, either upper extremity. Patients were randomized to immobilization in (1) maximal supination with a sugar-tong splint or (2) no restriction of supination with a volar splint. Patient-Rated Wrist Evaluation (PRWE), Disabilities of the Arm, Shoulder, and Hand (DASH) score, and visual analog scale (VAS) score; wrist range of motion; and grip strength were recorded at 2 and 6 weeks postoperatively. A Student's t-test was used to compare mean values of all outcome measures at each time point. Results A total of 46 patients enrolled in the study; 28 were immobilized with a volar splint and 18 were immobilized with a sugar-tong splint. Six-week follow-up data were obtained for 32 patients. There was no significant difference in PRWE, DASH, and VAS scores; or range of motion; or grip strength between the two groups postoperatively. Conclusion Range of motion, grip strength, and patient-rated outcome measures were similar regardless of postoperative immobilization technique in patients with a distal radius fractures stabilized with a volar plate. Surgeons can elect to use the standard-of-care postoperative immobilization modality of their preference following volar plate fixation without compromising short-term return to function. Level of Evidence This is a Level II, therapeutic study.
Active spectroscopy measurements of the deuterium temperature, rotation, and density from the core to scrape off layer on the DIII-D tokamak (invited).

Main-ion charge exchange recombination spectroscopy (MICER) uses the neutral beam induced Dα spectrum to measure the local deuterium ion (D+) temperature, rotation, and density, as well as parameters related to the neutral beams, fast ions, and magnetic field. An edge MICER system consisting of 16 densely packed chords was recently installed on DIII-D, extending the MICER technique from the core to the pedestal and steep gradient region of H-mode plasmas where the D+ and commonly measured impurity ion properties can differ significantly. A combination of iterative collisional radiative modeling techniques and greatly accelerated spectral fitting allowed the extension of this diagnostic technique to the plasma edge where the steep gradients introduce significant diagnostic challenges. The importance of including the fast ion Dα emission in the fit to the spectrum for the edge system is investigated showing that it is typically not important except for cases which can have significant fast ion fractions near the plasma edge such as QH-mode. Example profiles from an Ohmic L-mode and a high power ITER baseline case show large differences in the toroidal rotation of the two species near the separatrix including a strong co-current D+ edge rotation. The measurements and analysis demonstrate the state of the art in active spectroscopy and integrated modeling for diagnosing fusion plasmas and the importance of direct main ion measurements.
rfDemons: Resting fMRI-Based Cortical Surface Registration Using the BrainSync Transform

Cross subject functional studies of cerebral cortex require cortical registration that aligns functional brain regions. While cortical folding patterns are approximate indicators of the underlying cytoarchitecture, coregistration based on these features alone does not accurately align functional regions in cerebral cortex. This paper presents a method for cortical surface registration (rfDemons) based on resting fMRI (rfMRI) data that uses curvature-based anatomical registration as an initialization. In contrast to existing techniques that use connectivity-based features derived from rfMRI, the proposed method uses ‘synchronized’ resting rfMRI time series directly. The synchronization of rfMRI data is performed using the BrainSync transform which applies an orthogonal transform to the rfMRI time series to temporally align them across subjects. The rfDemons method was applied to rfMRI from the Human Connectome Project and evaluated using task fMRI data to explore the impact of cortical registration performed using resting fMRI data on functional alignment of the cerebral cortex.
The Imaginary Framing and the Lived Experience of Technologies: Interview with Laura Forlano:

In this interview conducted by Stan Ruecker, Laura Forlano gives some clues of what designers can learn from the critical thinking the social sciences have developed for decades: challenging key terms, overturning narratives, and being critical about the way new technologies are being framed and presented. She asks for designers to commit to a position. She points out that because each new technology will inevitably fail, designers might be more effective if they think of people not only using technology, but also having to take care of it.
Energy Balance in Medium-Scale Methanol, Ethanol, and Acetone Pool Fires.

Abstract Several series of measurements were made to characterize medium-scale pool fires steadily burning in a well-ventilated, quiescent, open environment. Time-averaged local measurements of radiative and total heat flux were made in steadily burning methyl alcohol (methanol; CH3OH), ethyl alcohol (ethanol; C2H5OH), and acetone ((CH3)2 CO) pool fires. The fuel lip height in a water-cooled stainless-steel burner was maintained at 10 mm. Schmidt-Boelter heat flux gauges were used to measure the radiative emission to the surroundings. The total heat flux directed towards the pool surface was measured using a Gardon gauge positioned just above the pool surface. A previously developed method was used to calculate the convective heat flux to the pool surface, allowing estimation of the radiative flux, which agreed within experimental uncertainty with a previous measurement in the methanol pool fire. The steady-state mass burning rate was measured using a load cell, and the heat release rate was measured in the exhaust using calorimetry. The energy balance for each of the fires was determined. The results showed that both radiation and convection play significant roles in these pool fires. Radiation was the dominant mechanism of heat feedback to the fuel surface accounting for 68% to 88% of the energy, while enthalpy convected in the plume represented 68% to 78% of the fire's total energy, far exceeding radiative emission to the surroundings.
The Present Value of Corporate Profits: A Forecasters' Survey Perspective

This paper presents and discusses the estimates of the present value of corporate profits in the United States from 1984 to 2018. To value the expected income stream, it uses the long-range forecasts of professional forecasters for pre-tax corporate earnings and long-term Treasury note yields, sourced from the Blue Chip Economic Indicators survey. The appraised value of corporate earnings can point in real time at periods where market prices are deviating from valuations implied by expected earnings and interest rates. Market participants' forecasts seem to interpret most of the earnings fluctuations as permanent, underestimating the cyclical fluctuations The over-reaction to transitory shocks and changes in long-term outlook leads to swings in the valuation, in line with swings in the observed market prices.
Multi-wavelength erbium-doped fiber ring lasers based on an optical fiber tip interferometer

Rare earth-doped fiber lasers are interesting in the field of optical fiber lasing and sensing. One of the interesting topics is the tunable/switched multi-wavelength lasers. However, due to the homogeneous broadening gain, it is difficult to generate multiple wavelengths in the fiber lasers based on erbium-doped fibers. Here, we propose a tunable multiwavelength erbium-doped fiber ring laser based on an optical fiber tip Fabry-Perot (FP) interferometer, which acts a wavelength filter and a reflector of the fiber ring laser. With the purpose to propose a method for switch multiwavelength spectra, the strain and thermal variations around the modal interferometers are investigated. The spectra are symmetric with a maximal power difference about 25 dB between the lasing modes and the average of the side mode suppression ratio, which is tuned into the C-band with a resolution of 0.02 nm. This laser offers low wavelength drift, good signal to noise ratio and high-power stability, and can therefore be used for sensing applications.
An investigation into the impact of applying systems engineering life-cycle processes during new product development and the economic growth of the diversified industrial sector

Systems engineering rigor has been used successfully in the aerospace and defense industries where the development cycles tend to be rather long. However, the practice of using a traditional waterf...
Integrated analysis of miRNAs expression in breast cancer patients to detect genes deregulation involved in malignant transformation.

e12560 Background: Outcomes of breast cancer patients depend on a number of phenotypic and molecular markers present in the malignancy. MicroRNAs dysregulation, often inhibiting gene expression, ar...
Delay discounting and reward sensitivity in a 2 × 2 study of bipolar disorder and alcohol dependence.

Background and aims Separate studies have shown increased delay discounting in people with bipolar disorder (BD) and people with alcohol dependence (AD) relative to people without mental health problems. Delay discounting was compared in people with no mental health problems, AD, BD and AD plus BD. Associations of delay discounting with self-reported impulsivity and reward sensitivity were also assessed. Design The study was a two-by-two factorial comparative observational design. Setting Data were collected at baseline diagnostic visits as part of a neuroimaging study at a medical university in South Carolina, USA. Participants Twenty-two BD + AD, 33 BD, 28 AD and 27 people without mental health problems participated. Measurements Diagnostic and clinician-rated symptom measures, self-report questionnaires and a computerized delay discounting task were administered. Two-by-two general linear univariate models were tested to examine between-group differences on discounting rates, and bivariate correlations and hierarchical regression analyses were performed to examine associations between discounting rates and self-reported reward sensitivity and impulsivity. Findings There was a significant main effect of AD (P = 0.006, η2 = 0.068). The main effect of BD and the BD × AD interaction terms were non-significant (P ≥ 0.293, η2 ≤ 0.010). Reward sensitivity and impulsivity were not significantly associated with discounting rates after adjustment for the other (P ≥ 0.089). Conclusions People with alcohol dependence appear to have higher delay discounting, while previously found associations between bipolar disorder and delay discounting may be secondary to alcohol use disorder.
Seed longevity and dormancy state in an invasive tree species: Ailanthus altissima (Simaroubaceae)

Successional tree species often form soil seedbanks, suggesting that extended seed dormancy may also facilitate regeneration in nonnative species. We examined seed dormancy in Ailanthus altissima, which is currently spreading into long-established forests of Europe and eastern North America. Ailanthus seeds were sewn into replicated nylon mesh bags and buried in 10 second-growth stands in southeast Ohio, USA. North- and south-facing slopes were included as a coarse-grained test for environmental control. Bags were recovered at 2-mo intervals and seeds were tested for viability and germination. Fifty percent of Ailanthus seeds survived the full length of the study (24 mo) after an initial phase of partial germination (51–79% of viable seeds). Remaining seeds returned to a state of induced dormancy, allowing a second flush of germination (3–28%) after 18 mo. After the first 5 mo no further decline in seed number was observed, suggesting persistence in the soil well beyond the 2-yr length of this study. No slope-aspect effect was observed. Long-term seed dormancy potentially facilitates Ailanthus invasion by buffering against extended canopy closure or allowing passive dispersal with movement of soil. Complete eradication of a population will depend on elimination of the soil seed bank, which may require many years. Management should avoid creating canopy openings near existing populations with the goal of suppressing sexual reproduction and seedling establishment.
Three Paradoxes of Climate Truth for the Anthropocene Social Scientist

Climate change has been one of the most contested truths for the past two decades. Many social scientists within the academy and this volume have spent years discerning the nature of this truth and...
The GEBCO and NOAA Chart Adequacy Workshop

Abstract. On July 23, NOAA Coast Survey hosted a three-day Chart Adequacy Workshop that included participants from 13 countries. This is the fourth Chart Adequacy Workshop held at National Oceanic and Atmospheric Administration’s (NOAA) Silver Spring, Maryland campus. This was the fourth workshop hosted by NOAA and Nippon Foundation / General Bathymetric Chart of the Oceans (GEBCO) Training Program at the Center for Coastal and Ocean Mapping, UNH. Unlike previous years (2017, 2016, 2015), the focus of this week was on networking and support for the upcoming International Cartographic Association (ICA) Working Group on Marine Cartography meeting held on July 26 and in preparation for next year’s International Cartographic Conference (ICC). The main goal of the workshop is to provide training for professional cartographers and hydrographers on techniques for assessing nautical chart adequacy using publicly-available information, such as satellite images and maritime automatic identification system (AIS) data. . The participants received an overview on Coast Survey datasets, processes, and requirements for nautical charts. They also learned about pre-processing hydrographic data, such as loading charts, uploading imagery, and applying electronic navigation charts (ENCs) and AIS point data. Through a series of lab units, the attendees practiced performing the concepts they learned. The 2018 participants were from Australia, Greece, Ireland, Japan, Latvia, Madagascar, Mexico, Nigeria, Peru, Poland, St. Vincent and the Grenadines, Taiwan, and Trinidad and Tobago. The international nature of the event allows the participants to meet and learn from cartographers from a variety of backgrounds and expertises. Thee individuals include Nippon Foundation / GEBCO training program students and those nominated by their home hydrographic offices and their travel was sponsored through funds secured by the workshop organizers. The workshop was developed in part too address the need to improve the collection, quality, and availability of hydrographic data world-wide, and increase the standardization of chart adequacy evaluations across the globe. Coast Survey is currently working with the International Hydrographic Organization (IHO) to recommend participants for next year’s workshop towards the end of July, 2019.
Higher-dimensional generalizations of Berry curvature

A family of finite-dimensional quantum systems with a nondegenerate ground state gives rise to a closed two-form on the parameter space, the curvature of the Berry connection. Its integral over a surface detects the presence of degeneracy points inside the volume enclosed by the surface. We seek generalizations of the Berry curvature to gapped many-body systems in $D$ spatial dimensions which can detect gapless or degenerate points in the phase diagram of a system. Field theory predicts that in spatial dimension $D$ the analog of the Berry curvature is a closed $(D+2)$-form on the parameter space (the Wess-Zumino-Witten form). We construct such closed forms for arbitrary families of gapped interacting lattice systems in all dimensions. We show that whenever the integral of the Wess-Zumino-Witten form over a $(D+2)$-dimensional surface in the parameter space is nonzero, there must be gapless edge modes for at least one value of the parameters. These edge modes arise even when the bulk system is in a trivial phase for all values of the parameters and are protected by the nontrivial topology of the phase diagram.
A qualitative study of physician perspectives on adaptation to electronic health records

Electronic Health Records (EHRs) have the potential to improve many aspects of care and their use has increased in the last decade. Because of this, acceptance and adoption of EHRs is less of a concern than adaptation to use. To understand this issue more deeply, we conducted a qualitative study of physician perspectives on EHR use to identify factors that facilitate adaptation. We conducted semi-structured interviews with 9 physicians across a range of inpatient disciplines at a large Academic Medical Center. Interviews were conducted by phone, lasting approximately 30 min, and were transcribed verbatim for analysis. We utilized inductive and deductive methods in our analysis. We identified 4 major themes related to EHR adaptation: impact of EHR changes on physicians, how physicians managed these changes, factors that facilitated adaptation to using the EHR and adapting to using the EHR in the patient encounter. Within these themes, physicians felt that a positive mindset toward change, providing upgrade training that was tailored to their role, and the opportunity to learn from colleagues were important facilitators of adaptation. As EHR use moves beyond implementation, physicians continue to be required to adapt to the technology and to its frequent changes. Our study provides actionable findings that allow healthcare systems to focus on factors that facilitate the adaptation process for physicians.
Refractory thrombotic thrombocytopenic purpura related to checkpoint inhibitor immunotherapy.

Background Checkpoint inhibitors enhance T-lymphocyte-mediated antitumor responses, resulting in increased survival for patients with neoplastic disease. However, a subset of patients receiving checkpoint inhibitor therapy may experience adverse complications that include the development of autoimmune conditions, such as thrombotic thrombocytopenic purpura (TTP). Given the potential etiologic differences of checkpoint inhibitor-related autoimmunity, TTP that develops in the presence of checkpoint inhibitors may be refractory to current treatment methods and therefore may require additional treatment and prognostic consideration. Case report Herein, we describe the unique clinical course of a patient who was treated with the combined checkpoint inhibitors nivolumab and ipilimumab for Stage IV malignant melanoma, who subsequently developed TTP. Unlike many patients with TTP, this patient failed to develop a sustained response to therapeutic plasma exchange. Additional use of steroids, anti-CD20, and plasma cell-targeting therapy (bortezomib) also failed to substantially reverse thrombocytopenia in a sustainable fashion. During this time, her melanoma progressed, and she ultimately succumbed. Conclusion This case illustrates not only that TTP may be a potential complication of checkpoint inhibitor therapy, but also that TTP developing in this setting may result in an unpredictable response to commonly employed TTP treatment modalities. Ultimately, checkpoint inhibitor-related TTP may require distinct management approaches and prognostic considerations.
The Velvet Glove: Union Avoidance and Union Substitution, 1919 Through 1935

The nineteenth century strategy of union avoidance was almost universally to fire, arrest, beat, and use military methods against organizers and strikers. However, World War I labor turnover and the post-war industrial warfare caused corporate management to reconsider the efficacy of autocratic control of all power and authority in the workplace. While in practice brutality continued, some employers sought stabilization of the employment relationship through corporate welfare and employee representation plans. Union avoidance was supplemented by substituting non-adversarial company-controlled organizations. By the end of 1919, “roundtables” including capital, labor, management and communities were introduced Standard Oil and General Electric; welfare capitalism was implemented at Goodyear and Endicott-Johnson. Two of the most long lasting and effective were the Employee Representation Plan at U.S. Steel, and the International Harvester Works Council. Each of these for decades successfully channeled grievances and discontent into company-controlled venues. In the end, however, both were swept away by the late 1930s by CIO activists. The Farm Equipment Workers Union became the bargaining representative at International Harvester; William Z. Foster, later to play a central role in devising the organizing strategy for the 1930s CIO Steel Workers Organizing Committee, advocated taking over the ERP as early as the 1919 national steel strike. In this paper, I analyze why company unions in these industries were effective for so long, and why they ultimately failed. A deeper understanding of the strength and interplay of class forces, the role of the government, and the vitality of working class upsurges helps put in perspective reasons for the long-standing success of some of the more sophisticated union avoidance and substitution strategies that are being implemented today, most notably at the Toyota Motor Company and other foreign-owned “transplants” in the US.
Detailed Assessment of Left Ventricular Function in Multisystem Inflammatory Syndrome in Children Using Strain Analysis.

Background Cardiac manifestations in multisystem inflammatory syndrome in children (MIS-C) occur in ∼80% of patients. Left ventricular (LV) systolic dysfunction is the most frequent cardiac finding. Methods In this single-centre, retrospective cohort study, we report on detailed assessment of LV function in MIS-C patients using strain and strain rate analysis. We compare those with normal peak systolic strain z-scores (both longitudinal and circumferential strain) to those with abnormal peak systolic strain z-scores (decreased circumferential and/or longitudinal strain). Results Among 25 patients, 14 (56%) were male, 20 (80%) were Black or Hispanic, 13 (52%) were overweight/obese, and the median age was 11.4 years (interquartile range: 7.5 to 16). Median ejection fraction (EF) was 55.2% (interquartile range: 48.3% to 58%), with the abnormal strain patients having a lower EF (P < 0.01). Demographics were similar between groups. The abnormal strain patients had more organ systems involved and were more likely to require inotropic support. In a comparison of MIS-C patients with normal EF (n = 15) to controls, MIS-C patients had lower peak systolic strain as well as lower early diastolic strain rates. In patients with initially depressed function, EF normalized in 8 of 10 (80%), but 4 of 11 (36%) patients had persistently abnormal systolic strain after discharge. Conclusions LV systolic dysfunction is common in the acute phase of MIS-C, and detection may be improved with strain imaging. Longitudinal cardiac follow-up is imperative, as some patients may be at risk for persistent LV dysfunction.
Perioperative Pain Management in Ambulatory and Inpatient Shoulder Surgery.

» Acetaminophen is an effective addition to a multimodal pain regimen; however, evidence to support intravenous versus oral administration requires further evaluation. » While nonsteroidal anti-inflammatory drugs are a valuable addition to a multimodal pain strategy, concerns regarding their effect on healing after certain procedures (i.e., rotator cuff repair) in select patients may preclude their use. » The use of perioperative gabapentinoids have varied results for pain control, and additional research is warranted to support their use after certain shoulder procedures. » Opioid-prescribing should be limited and reserved for severe postoperative pain. When prescribed, opioids should be taken at the lowest possible dose and for the shortest period. » Centrally acting analgesics such as tramadol have been shown to be as effective as opioids and have a lower risk of complications. » Nerve blocks are an excellent addition to multimodal pain management strategies. Longer-lasting formulations of perioperative single-shot injections and indwelling catheters may reduce rebound pain.
Meeting the Information Needs of Constitutionalists Patrons: A Guide for Reference Librarians

This paper attempts to illustrate the challenges that a reference librarian might face when meeting the information needs of Constitutionalist patrons. Constitutionalist patrons are defined here as members of a diverse community of groups that challenge the validity of the mainstream legal system in a variety of ways. The paper provides background on the different types of patrons who fit the generic category of Constitutionalist, explains the theories that these patrons use to view the legal system, and discusses sources and materials that are of interest to them. The intention of the paper is to provide the reference librarian with the necessary background information to understand the perspective from which these patrons approach the law library.
Oceanic Crust and Mantle

The Nd isotopic data provide an important addition to petrogenetic modeling studies of igneous rocks because they provide previously unavailable information about the chemical composition of magma sources. Oceanic basalts present the possibility of applying the isotopic data for this purpose in a relatively straightforward way because there is little likelihood that the magmas are modified by contamination with old continental crust between the time they are generated in the mantle and when they are erupted at the surface. The Nd isotopic ratio (eNd value) measured on a lava can therefore be safely assumed to represent the ratio in the mantle where the magma originated. Using an appropriate model the eNd value can be used to infer some of the trace element characteristics of the mantle magma source, in particular the Sm/Nd ratio. This can, in turn, be compared to the Sm/Nd ratios of the lavas to evaluate petrogenetic models (Chap. 5). This approach requires assumptions, but is valuable because it allows the internal consistency of the models to be evaluated. The trace element partitioning models provide the basis for evaluating the relationship between the Sm/Nd ratio of a basalt magma and its source in the mantle. A sampling of data for oceanic basalts is shown in Fig. 8.1.
Positions of extragalactic radio sources from very long baseline interferometry

The positions of extragalactic radio sources have been determined by very-long-baseline interferometry with uncertainties smaller than 0″.1, and fundamental limits on the accuracy of VLBI astrometry have not yet been reached. Technical improvements within the next five years may enable positions to be determined by VLBI with uncertainties of 0″.005.
The Role of Plant Rapidly Induced Responses in Asymmetric Interspecific Interactions Among Insect Herbivores

The role of induced responses of tomato, Lycopersicon esculentum, in interspecific interactions between two polyphagous herbivores, the silver- leaf whitefly, Bemisia argentifolii (WF), and the vegetable leafminer, Lirio- myza trifolii (LM), was characterized in laboratory and field experiments. Feeding by LMs and WFs induced local and systemic production of puta- tive defensive proteins, i.e., chitinases, peroxidases, B-1,3-glucanases, and lysozymes. The magnitude of the induction for each defensive protein varied between species. Unlike WFs, LMs caused a 33% local reduction in total foliar protein content. In a whole-plant choice experiment, adult LM feeding, oviposition, and larval survival were reduced by 47.7%, 30.7%, and 26.5%, respectively, for the WF-infested host compared with the controls. Early WF infestations also had negative systemic (plant-mediated) effects on LMs. Adult LMs preferred leaves from control plants to leaves of plants that had been previously infested with WFs; no reciprocal effect of LMs on WFs were found. Feeding by Helicoverpa zea larvae, which has been shown previously to affect LM performance, had no effect on WF survival and development. LM natural population dynamics were monitored on WF-preinfested and control plants in a field experiment. WF-infested plants were less suitable for LM development with an overall 41% reduction in LM population density. These results demonstrate asymmetric direct and plant-mediated interspecific interactions between generalist herbivores feeding simultaneously on the
Organizations as Complex, Dynamic Design Problems

The ACTION organization design and analysis system is a research and development effort designed to assist business re-engineering and organizational or technology change by helping to improve the integration of technology, organizations, and people (”TOP-integration”) in manufacturing enterprises. ACTION uses a multi-level constraintbased representation of organizational features including business objectives, unit structure, skills needed, performance monitoring/reward systems, decisionmaking discretion, employee values, coordination attributes, etc. to both evaluate existing organization designs and to help users develop new ones. ACTION'S core software is domain-independent, theory-driven architecture designed for application to a wide range of design and analysis problems.
A Review of “The Romans in the Age of Augustus”: Lintott, Andrew New York: Wiley-Blackwell, 216 pp., $89.95, ISBN 978-1405176552 Publication Date: March 2010

Professor Andrew Lintott's The Romans in the Age of Augustus is an excellent examination of a people whose influence on Western civilization and the world is still with us today. This short work ad...
Finite Element Model with Nonviscous Damping

A constitutive law by which structural damping is modeled as a relationship between stress, strain, and strain rate in a material is used in conjunction with the finite element method to develop general integral expressions for viscous and nonviscous damping matrices. To solve the set of nonlinear equations resulting from the presence of nonviscous damping, a solution technique is developed by modifying the Newmark method to accommodate an iterative solution and treat the nonviscous damping as a pseudo-force. The technique is then checked for accuracy and convergence in single- and multi-degree-of-freedom problems, and is found to be accurate and efficient for initial-condition problems with small nonviscous damping.
Trimethoprim-sulfamethoxazole therapy for ocular toxoplasmosis.

Background: Toxoplasmosis is a leading cause of retinochoroiditis. Conventional multidrug therapy using sulfadiazine, pyrimethamine, and folinic acid is increasingly difficult to procure and administer safely. Methods: To evaluate the efficacy of trimethoprim-sulfamethoxazole, a fixed-combination antibiotic, patients with active toxoplasmosis were treated with trimethoprimsulfamethoxazole (Bactrim DS) with or without adjunctive clindamycin and prednisone for 4 to 6 weeks. Results: All patients in this study (n = 16) had resolution of active retinochoroiditis and had improved vision, with an average gain of 5.2 lines of vision. Two patients developed a drug allergy. Conclusion: Trimethoprim-sulfamethoxazole appears to be a safe and effective substitute for sulfadiazine, pyrimethamine, and folinic acid (Leucovorin) in treating ocular toxoplasmosis.
Postoperative urinary retention following vaginal mesh procedures for the treatment of pelvic organ prolapse.

The objective of the study was to assess vaginal mesh procedures and patient characteristics that are associated with postoperative urinary retention (PUR) following pelvic reconstructive surgery. The charts of 142 patients who underwent transvaginal reconstructive surgery with mesh were included in the analysis. Primary outcome was the incidence of PUR following surgery with mesh. Patients were grouped according to discharge from the hospital with or without a catheter based on a standardized voiding trial. Forty-eight patients (34%) developed PUR after surgery. Of those, 30 patients (62.5%) had a combined anterior and posterior repair (p = 0.033). Mean preoperative anterior stage prolapse for patients with PUR compared with no PUR was 2.31 vs. 1.80 (p = 0.002). There was a greater association of PUR among patients with concomitant retropubic slings compared with transobturator slings (OR = 3.6, 95% confidence interval = 1.3–9.8). A higher preoperative anterior stage prolapse, combined anterior and posterior compartment repairs, and retropubic sling procedures appear to be associated with PUR.
Experimental bilateral bundle branch block.

Abstract Surgical production of bilateral bundle branch block resulted in complete heart block in fourteen dogs. In eight dogs, left bundle branch block resulted from the initial bundle branch section. In six animals, right bundle branch block was produced at first. In either circumstance, section of the opposite bundle branch resulted in complete heart block. Limited correlation between the electrical and mechanical events of the cardiac cycle under these circumstances was demonstrated. The data indicate that complete right and complete left bundle branch block were produced by surgical section of the respective bundle branches.
Sex-related functional asymmetry of the amygdala: preliminary evidence using a case-matched lesion approach

We have reported previously that there appears to be an intriguing sex-related functional asymmetry of the prefrontal cortices, especially the ventromedial sector, in regard to social conduct, emotional processing, and decision-making, whereby the right-sided sector is important in men but not women and the left-sided sector is important in women but not men. The amygdala is another structure that has been widely implicated in emotion processing and social decision-making, and the question arises as to whether the amygdala, in a manner akin to what has been observed for the prefrontal cortex, might have sex-related functional asymmetry in regard to social and emotional functions. A preliminary test of this question was carried out in the current study, where we used a case-matched lesion approach and contrasted a pair of men cases and a pair of women cases, where in each pair one patient had left amygdala damage and the other had right amygdala damage. We investigated the domains of social conduct, emotio...