cssi/SciSciGPT-SciSciNet huggingface dataset:
An Event-Based Approach to Design a Teamwork Training Scenario and Assessment Tool in Surgery.

Objective Simulation is a technique recommended for teaching and measuring teamwork, but few published methodologies are available on how best to design simulation for teamwork training in surgery and health care in general. The purpose of this article is to describe a general methodology, called event-based approach to training (EBAT), to guide the design of simulation for teamwork training and discuss its application to surgery. Design The EBAT methodology draws on the science of training by systematically introducing training exercise events that are linked to training requirements (i.e., competencies being trained and learning objectives) and performance assessment. The EBAT process involves: 1. selecting a teamwork competency for training and assessment; 2. defining a list of measureable learning objectives that are rooted in the teamwork competency; 3. selecting a clinical context to frame the scenario development; 4. defining a set of targeted knowledge, skills, and attitudes (KSAs) or behaviors that capture the predefined learning objectives; 5. choosing clinical events to allow learners the opportunity to demonstrate the targeted KSAs or behaviors; 6. identifying targeted responses to the events; and 7. developing an evaluation tool to assess learners’ performance. Results Of the 4 teamwork competencies endorsed by the Agency for Healthcare Research Quality and Department of Defense, “communication” was chosen to be the focus of our training efforts. A total of 5 learning objectives were defined based on 5 validated teamwork and communication techniques. Diagnostic laparoscopy was chosen as the clinical context to frame the training scenario, and 29 KSAs were defined based on review of published literature on patient safety and input from subject matter experts. Critical events included those that correspond to a specific phase in the normal flow of a surgical procedure as well as clinical events that may occur when performing the operation. Similar to the targeted KSAs, targeted responses to the critical events were developed based on existing literature and gathering input from content experts. Finally, a 29-item EBAT-derived checklist was created to assess communication performance. Conclusion Like any instructional tool, simulation is only effective if it is designed and implemented appropriately. It is recognized that the effectiveness of simulation depends on whether (1) it is built upon a theoretical framework, (2) it uses preplanned structured exercises or events to allow learners the opportunity to exhibit the targeted KSAs, (3) it assesses performance, and (4) it provides formative and constructive feedback to bridge the gap between the learners’ KSAs and the targeted KSAs. The EBAT methodology guides the design of simulation that incorporates these 4 features and, thus, enhances training effectiveness with simulation.
Unit Hydrograph Characteristics for Sewered Areas

Hydrographs of measured storm sewer outflow from urban areas up to 7. 5 sq mi in size are analyzed; their characteristics are correlated with properties of sewers and drainage basins in order to permit construction of synthetic unit hydrographs for other unmeasured sewered areas; applicability of derived relationships is tested against measured outflow hydrograph for complex storm.
Seasonal change in phosphorus content of Pinus strobus- Cenococcum geophilum ectomycorrhizae

1057 Abstract: An important function of the ectomycor- rhizal sheath may be the storage and delayed trans- location of nutrients to the host. In order to deter- mine whether there are such phases, we quantified seasonal change in phosphorus content in sheaths of Cenococcum geophilum-Pinus strobus (white pine) ec- tomycorrhizae. Our field site was a mixed deciduous forest in northern, lower Michigan. White pine nee- dle and root growth, and density of C. geophilum scle- rotia were determined weekly. Ectomycorrhizae were collected biweekly, as were buried meshes that served to index hyphal growth. Phosphorus content of sheaths of ectomycorrhizae was measured by energy- dispersive X-ray analysis of planed, frozen material. From May to Jun 1994, sheath P content declined 0.9%/d. From Jul to Oct sheath P content was low and varied little; C. geophilum hyphae grew, but nee- dles and roots did not. The following spring from Mar to May 1995, sheath P content increased 1.2%/ d. We suggest, on the basis of synchrony of changes
Research progress in macrosomia growth

The incidence of macrosomia was increasing year by year, which may be associated with gestational diabetes, obesity and pregnancy weight gain. The study showed that macrosomia was prone to obesity in childhood, and diabetes, hypertension and cardiovascular disease in adulthood. The growth and development status of macrosomia in childhood is worthy of attention.
Lightning monitoring for Anhui Power Grid and application of lightning information

The positioning and monitoring principles,main functions,and technical indices of the lightning monitoring system for Anhui Power Grid were presented.Based on large amount of lightning information obtained,the fundamental data and practical method for guiding anti-lightning design,technical retrofits,and operation were achieved.
Genotoxic effects of low dose ionizing radiation occupationally exposed in industrial flaw detection workers

OBJECTIVE: To assess the genetic damage of low dose ionizing radiation(LDIR) occupationally exposed in flaw detection workers. METHODS:We used the Thermo-luminescent Dosimeter(TLD) to measure the individual exposure dose. Thirty-one flaw detection workers and forty-nine people without such exposure were enrolled. The cytokinesis-block micronucleus(CBMN) assay was performed to detect the chromosome damage in peripheral blood lymphocytes. Real-time PCR was used to analyze the mtDNA copy number and supercoiling formation change. Long-PCR was applied to analyze mtDNA integrity. qRT-PCR was applied to analyze mRNA levels of TFAM and PGC-1α. RESULTS:The mean annual effect dose in flaw detection workers was(0.15±0.03) mSv/a,range in(0.12-0.21) mSv/a. The MN and NBUDs rate in flaw detection worker group were obviously elevated compared with controls(P0.01). In our study,the mtDNA copy number of flaw detection workers(40.04±24.99) was higher than controls(24.86±19.14)(P0.01),and the supercoiling formation was also evidently changed(P0.05). The mtDNA integrity of flaw detection workers(95.10±9.54) was decreased compared to controls(313.51±14.58)(P0.01). The mRNA levels of TFAM and PGC-1α was found to be higher than controls(P0.01). CONCLUSION:We found all of the annual effect dose of flaw detection workers are conforming the state radiological protection standards. However,the induction of chromosome damage and mtDNA damage caused by LDIR were evident,the health of flaw detection workers are at risk.
STUDY OF THE ANTISERUM TO THE PLAGUE BACTERIOPHAGE

The author utilized the agglutinating reaction between the antiphage serum and the brothfiltrate from lysed culture containing high titre phage as an indication of the titre of theantiserum.It was found to correspond to the neutralization test on agar,and the authorconsidered the method to be reliable and much more simple.Having obtained a high titreserum,it was applied in the diagnosis of plague with decayed materials,with clinical materials,and with ectoparasites with success.
3D Segmentation of Glial Cells Using Fully Convolutional Networks and k-Terminal Cut

Glial cells play an important role in regulating synaptogenesis, development of blood-brain barrier, and brain tumor metastasis. Quantitative analysis of glial cells can offer new insights to many studies. However, the complicated morphology of the protrusions of glial cells and the entangled cell-to-cell network cause significant difficulties to extracting quantitative information in images. In this paper, we present a new method for instance-level segmentation of glial cells in 3D images. First, we obtain accurate voxel-level segmentation by leveraging the recent advances of fully convolutional networks (FCN). Then we develop a k-terminal cut algorithm to disentangle the complex cell-to-cell connections. During the cell cutting process, to better capture the nature of glial cells, a shape prior computed based on a multiplicative Voronoi diagram is exploited. Extensive experiments using real 3D images show that our method has superior performance over the state-of-the-art methods.
In vitro Detection of S-acylation on Recombinant Proteins via the Biotin-Switch Technique

Protein palmitoylation is the post-translational modification of proteins via the attachment of palmitate through acyl linkages. The nucleophile sulfhydryl group of cysteines is the common palmitoylation site. Covalent attachment of palmitate occurs on numerous proteins and is usually associated with directing protein localization to the endomembrane system. Detection of protein palmitoylation by in vivo labeling with tritium-labeled palmitic acid typically requires an autoradiographic exposure time of several months, and, thus is not suitable for rapid analyses. Here, we described an easy protocol for quick in vitro detection of protein S-acylation using the Arabidopsis protein kinase, PBS1, as an example. To determine whether PBS1 is modified through thioester linkage to acyl groups, we employed a "biotin switch" assay (Hemsley et al., 2008). This work was first published in Qi et al. (2014), but we expand on the method here. PBS1 functions within the basal immune system of plants, and is a target of the bacterial cysteine protease, AvrPphB (Shao et al., 2002; Zhang et al., 2010). It contains a predicted N-terminal S-acylation motif (MGCFSCFDS), with both Cys-3 and Cys-6 residues predicted to be palmitoylated by CSS-Palm 3.0 (http://csspalm.biocuckoo.org/; Ren et al., 2008). Our method utilizes hydroxylamine-induced cleavage of thioester bonds, which results in free sulfhydryl groups that can then be conjugated to a biotin derivative, 1-biotinamido-4-[4'-(maleimidomethyl) cyclohexanecarboxamido]-butane (Biotin-BMCC). The conjugates are detectable by Western blot with streptavidin-horseradish peroxidase. The whole process of in vitro labelling and detection took less than 3 days, allowing the fast detection of protein modifications via thioester bonds such as palmitoylation.
AHCA meets BCRA; timeline, context, and future directions

This past decade has brought important change to the delivery of healthcare in the United States. In 2010, President Barack Obama signed the Patient Protection and Affordable Care Act (PPACA, also referred to as ACA or Obamacare) into law.1 The ACA sought to provide insurance for millions of additional Americans while simultaneously bending the cost curve down.2 Beyond that, the far-ranging law imposed new taxes, developed new independent agencies with heightened power in shaping healthcare policy and regulations, and advanced the implementation of accountable care.3–5 In response to the Congressional vote passing the ACA along strict party lines, Republicans have repeatedly emphasized their desire to undo the legislation and replace it with something they considered better. The Republican Congress subsequently undertook multiple votes to repeal the ACA throughout the remainder of the Obama administration. Nonetheless, even if successful in passing Congress, all such efforts were guaranteed to be vetoed by the President. In January 2015, Secretary of Health and Human Services Sylvia Burwell described the administration’s priority of transitioning volume-based care to a system providing greater value,6 7 and a whole new industry was formed to manage this transition.8 9 Throughout this period, a legion of other regulatory issues was confronting healthcare practitioners, ranging from ICD-10 implementation to meaningful use.10 One such perennial issue was the need to implement a fix to prevent enormous cuts to Medicare payments resulting from the sustainable growth rate formula for Part B services.11 12 In April 2015, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was passed, permanently ending the sustainable growth rate.13 14 However, MACRA, which has been described in numerous dedicated reviews,15 16 introduced an array of new challenges for providers, beneficiaries, and payers alike.17 18 It is generally agreed …
A handheld 1D transparent CMUT array probe for photoacoustic imaging: Preliminary results

A transparent transducer array is desired in backward-mode photoacoustic imaging (PAI). CMUT technology is especially suitable for this application because of its wide bandwidth and a wide selection of processing materials. We have previously demonstrated a single-element CMUT with an ITO bottom electrode for improved transparency. The device showed 40% to 70% optical transmission from 700 nm to 900 nm, which is the wavelength range commonly used for in-vivo PAI. In this work, we present a 1D PAI probe that integrates a 1D CMUT array, a fiber bundle, in-probe optics, and low-noise amplifiers which interface with a real-time imaging system. We also demonstrate the PAI capability of a single transparent CMUT element. In this experiment, the phantom was a polyethylene tube filled with indocyanine green (ICG) solution embedded in a tissue-mimicking material. In this setup, the light introduced from the back side of the CMUT enabled direct illumination of the imaging field. We are currently developing 1D arrays for use in PAI with high Vis-NIR transmission. As a proof of principle, we built a 128-channel handheld probe which integrates light from the back side and allows for in-probe front-end amplifiers. The center of the probe houses a compact optical design for the illuminator based on cylindrical lenses. The probe electronics consists of two printed circuit boards, each with 64 channels of low-noise amplifiers with integrated transmit/receive switching and biasing circuitry. This handheld probe has been used in initial tests with a standard nontransparent 1D CMUT array to show the basic electrical functionality.
The Serum Lactobacillus casei Folate Clearance Test in Various Hematologic Disorders

Serum folic acid clearance curves using Lactobacillus casei were determined on 10 normal individuals, 5 patients with hemolytic anemias and active hemolysis, 15 patients with myeloid metaplasia, and 12 patients with miscellaneous hematologic disorders. In general, there was a correlation between the initial serum folate value and the subsequent serum folate clearance curve. Both values were determined by L. casei . In many instances of initial serum folate values classified as indeterminate, the serum folate clearance clarified the initial impression. Patients with active hemolytic anemia showed rapid folate clearance curves following injection with a test dose of folic acid. In eight of 15 patients with myeloid metaplasia, the serum folate clearance was rapid; in 5 of these patients the serum folate clearance was consistent with marked folic acid deficiency. Several possible mechanisms for the folic acid deficiency in myeloid metaplasia are discussed, but the cause of the deficiency has not been established.
The Welfare Effects of Rising Imported Food Prices in Iran

Food products account for a significant amount of the Iranian imports. Despite the rising prices of food products over the last two decades, their imports have been increasing too. In this study import demand of the main imported food products is empirically analyzed using Quadratic AIDS. Welfare impacts are measured using compensated variation. The results indicate that all products, except tea and cheese are own price inelastic. In general, price response of food imports is found low. Rising prices of the products as high as their trend over the last two decades has resulted in an annual welfare loss of 2.2 percent.
Uncovering HTTP Header Inconsistencies and the Impact on Desktop/Mobile Websites

The paradigm shift to a mobile-first economy has seen a drastic increase in mobile-optimized websites that in many cases are derived from their desktop counterparts. Mobile website design is often focused on performance optimization rather than security, and possibly developed by different teams of developers. This has resulted in a number of subtle but critical inconsistencies in terms of security guarantees provided on the web platform, such as protection mechanisms against common web attacks. In this work, we have conducted the first systematic measurement study of inconsistencies between mobile and desktop HTTP security response configuration in the top 70,000 websites. We show that HTTP security configuration inconsistencies between mobile and desktop versions of the same website can lead to vulnerabilities. Our study compares data snapshots collected one year apart to garner insights into the longitudinal trends of mobile versus desktop inconsistencies in websites. To complement our measurement study, we present a threat analysis that explores some possible attack scenarios that can leverage the inconsistencies found on real websites. We systematically analyze the security impact of the inconsistent implementations between the mobile and desktop versions of a website and show how it can lead to real-world exploits. We present several case studies of popular websites to show real-world impact of how these inconsistencies are leveraged to compromise security and privacy of web users. Our results show little to no improvements across our datasets, which highlight the continued pervasiveness of subtle inconsistencies affecting even some high profile websites.
An empirical analysis of entry and location decisions by bars and liquor stores

We analyze the entry and location decisions of bars and liquor stores using a spatial game-theoretical framework. We first estimate a one-industry location game where we model bars and liquor stores separately. We then estimate a two-industry location game where we model bars and liquor stores jointly. The model allows for two contradictory effects: a competition effect and a spillover effect. Estimation results reveal a strong negative competition effect for both bars and liquor stores. However, bars appear to benefit from a substantially positive spillover effect. We also find that bars and liquor stores compete with each other. For example, an additional liquor store in a location decreases the probability of a new bar opening in that location and vice versa.
Partial sequence of the NH2-terminal segment of Glycera hemoglobin. Homology with sperm whale myoglobin.

Abstract The partial sequence of the first 45 amino acid residues from the NH 2 -terminus of the hemoglobin from Glycera dibranchiata has been determined. A considerable homology between this sequence and the corresponding sequence of sperm whale myoglobin was found.
The Application and Potential of Ion Mobility Mass Spectrometry in Imaging MS with a Focus on Lipids

Tissue profiling and imaging by MALDI mass spectrometry has allowed the direct analysis and localization of biomolecules in tissue. However, due to the in situ nature of this technique, the complexity of tissue, and the need for a chemical matrix in MALDI, the signal recorded can be extremely complex and difficult to assign. Combining ion mobility with matrix-assisted laser desorption/ionization is a very powerful technique for fast separation and analysis of biomolecules in complex mixtures (such as tissue and cells), as isobaric lipid, peptide, and oligonucleotide molecular ions are pre-separated in the mobility cell before mass analysis. Differences in drift time of as much as 30% are obtained in a timescale of hundreds of microseconds. Molecular ions of the same biochemical family fall along trend lines when plotted in 2D plots of mobility drift time as a function of m/z. In this chapter ion mobility MALDI-MS ability to analyze various biomolecules in tissue, that is, lipids and proteins, as well as its ability to separate species from all of the major phospholipid classes from tissue and extracts, the effects that radyl chain length, degree of unsaturation, head group composition have upon their ion’s cross section in the gas phase, and how it can be used not only to distinguish them from other biochemical groups in a mixture but also to differentiate them from other lipid species will be illustrated.
A Teleological Conception of Government

In Politics as a Vocation, Max Weber provided a seminal definition of the state in terms of its distinctive means, not its ends. This paper examines the implications and development of that idea and provides an alternative, teleological, conception of the state.
Beyond Chrismukkah: The Christian-Jewish Interfaith Family in the United States, by Samira K. Mehta, Chapel Hill, University of North Carolina Press, 2018, xii + 260pp., US$29.95 (paperback), ISBN 978 1 4696 3636 8

Using an historical and ethnographical methodology, Mehta gives a nice romp through the history of intermarriage in the United States, relating her narrative at each juncture to the larger social a...
Determination of legal responsibility in shared airway management between anesthesiology and otolaryngology.

Background Malpractice litigation remains an important point of contention in the United States. Airway management often sees multidisciplinary teams of anesthesiologists and otolaryngologists. This report analyzes lawsuits affecting both teams in airway management. Methods The Westlaw legal database (West Publishing Co., St. Paul, MN) was used to search for malpractice cases involving failed airway management, where both anesthesiology and otolaryngology were involved. Results Among the 28 cases analyzed, otolaryngology and anesthesiology were most commonly sued together (46.4%). When sued together, defendants were less likely to win and average award amounts ($4, 558 716) were higher. These cases most commonly occurred in the operating room (78.6%), involved a difficult/improper intubation (39.3%), alleged a failure to follow standard of care (57%), and resulted in death (60.7%). Conclusion These cases primarily cited failure to follow standard of care and communication failures. Efforts should be directed toward multidisciplinary airway management protocols and effective communication.
Formal methods and software development: work in progress

I am exploring the use of Formal Methods in Software Development. The need for high-integrity and safety-critical software is increasing, and formal methods hold out the promise of progress in that direction. Program derivation, and program verification are widely regarded as impractical in most situations, and a semi-formal or hybrid model-based approach, based on formal specification is attractive, especially if the specification is executable, providing rapid-prototyping and easy validation of the model.
Editorial Commentary: Resident Education: At What Cost?

Abstract Arthroscopic trainees may struggle to learn basic skills, resulting in slower and more expensive surgical procedures. However, the reward of resident involvement includes the satisfaction and benefit to society associated with medical mentorship, and the learning—clinical and otherwise—that is associated with teaching.
Identification of Stem Cells from Large Cell Populations with Topological Scoring

Abstract Machine learning and topological analysis methods are becoming increasingly used on various large-scale omics datasets. Modern high dimensional flow cytometry data sets share many features with other omics datasets like genomics and proteomics. For example, genomics or proteomics datasets can be sparse and have high dimensionality, and flow cytometry datasets can also share these features. This makes flow cytometry data potentially a suitable candidate for employing machine learning and topological scoring strategies, for example, to gain novel insights into patterns within the data. We have previously developed the Topological Score (TopS) and implemented it for the analysis of quantitative protein interaction network datasets. Here we show that the TopS approach for large scale data analysis is applicable to the analysis of a previously described flow cytometry sorted human hematopoietic stem cell dataset. We demonstrate that TopS is capable of effectively sorting this dataset into cell populations and identify rare cell populations. We demonstrate the utility of TopS when coupled with multiple approaches including topological data analysis, X-shift clustering, and t-Distributed Stochastic Neighbor Embedding (t-SNE). Our results suggest that TopS could be effectively used to analyze large scale flow cytometry datasets to find rare cell populations.
Safety of diagnostic spinal angiography in children.

Background Spinal angiography (SA) is associated with low complications in adults but its safety in children has not been properly analyzed. The goal of our study is to assess the safety of pediatric SA. Methods This study is the retrospective analysis of a series of 36 consecutive SA procedures performed in 27 children over a 5-year period. Parameters including neurological complications, non-neurological complications requiring additional management, contrast volume, and radiation exposure were analyzed via univariate and bivariate methods. Results Our cohort included 24 diagnostic and 12 combined therapeutic cases in children with an average age of 11.1 years. No neurological or non-neurological complication requiring additional management was recorded. The average volume of contrast administered was 1.6 mL/kg in the diagnostic group and 0.9 mL/kg in the combined group. The average air kerma was 186.9mGy for an average of 36.8 exposures in the diagnostic group, and 264.5mGy for an average of 21 exposures in the combined group. Patients in the combined group had lower contrast load (45% lower on average) and higher air kerma (1.6 times higher on average). The difference in air kerma was due to a higher live fluoroscopy-related exposure. Conclusions This study reports the largest pediatric SA cohort analyzed to date and the only one including radiation dose and contrast load. It confirms that pediatric SA is a safe imaging modality with low risk of complications, and demonstrates that SA can be performed in children with low radiation exposure and contrast load.
Transfusion-Related Hypocalcemia After Trauma.

Hypocalcemia is cited as a complication of massive transfusion. However, this is not well studied as a primary outcome in trauma patients. Our primary outcome was to determine if transfusion of packed red blood cells (pRBC) was an independent predictor of severe hypocalcemia (ionized calcium ≤ 3.6 mg/dL). Retrospective, single-center study (01/2004–12/2014) including all trauma patients ≥ 18 yo presenting to the ED with an ionized calcium (iCa) level drawn. Variables extracted included demographics, interventions, outcomes, and iCa. Regression models identified independent risk factors for severe hypocalcemia (SH). Seven thousand four hundred and thirty-one included subjects, 716 (9.8%) developed SH within 48 h of admission. Median age: 39 (Range: 18–102), systolic blood pressure: 131 (IQR: 114–150), median Glasgow Coma Scale (GCS): 15 (IQR: 10–15), Injury Severity Score (ISS): 14 (IQR: 9–24). SH patients were more likely to have depressed GCS (13 vs 15, p < 0.0001), hypotension (23.2% vs 5.1%, p < 0.0001) and tachycardia (57.0% vs 41.9%, p < 0.0001) compared to non-SH patients. They also had higher emergency operative rate (71.8% vs 29%, p < 0.0001) and higher blood administration prior to minimum iCa [pRBC: (8 vs 0, p < 0.0001), FFP: (4 vs 0, p < 0.0001), platelet: (1 vs 0, p < 0.0001)]. Multivariable analysis revealed penetrating mechanism (AOR: 1.706), increased ISS (AOR: 1.029), and higher pRBC (AOR: 1.343) or FFP administered (AOR: 1.097) were independent predictors of SH. SH was an independent predictor of mortality (AOR: 2.658). Regression analysis identified a significantly higher risk of SH at pRBC + FFP administration of 4 units (AOR: 18.706, AUC:. 897 (0.884–0.909). Transfusion of pRBC is an independent predictor of SH and is associated with increased mortality. The predicted probability of SH increases as pRBC + FFP administration increases.
Control of Spacecraft Subject to Actuator Failures: State-of-the-Art and Open Problems

In this paper we review the main results in the area of active control of spacecraft with one actuator failure. We emphasize the qualitative characteristics that make this a challenging control problem. We present a series of new results that solve the problem of detumbling with simultaneous attitude stabilization about the unactuated axis, the complete attitude stabilization problem, and the feasible trajectory generation problem for a spacecraft with one actuator failure. We present several numerical examples that demonstrate the efficacy of the proposed control algorithms. We conclude with a brief review of some open problems in the general area of spacecraft control subject to actuator and/or sensor failures.
Genome Sequence of Bacillus megaterium O1, a Saponin-Degrading Bacterium.

ABSTRACT Bacillus megaterium strain O1 was isolated from a soapnut (Sapindus saponaria) surface and degrades Quillaja saponin as a sole carbon source. We report the draft genome sequence of B. megaterium O1, which has an estimated size of 5.1 Mb. Study of this isolate will provide insight into mechanisms of saponin degradation.
Evaluation of the Maternal-Fetal Triage Index in a tertiary care labor and delivery unit.

BACKGROUND The Maternal-Fetal Triage Index is a 5-level system to facilitate the care of pregnant women seeking care in an obstetrical triage unit (priority 1 being the highest acuity and priority 5 being the lowest acuity). Although the American College of Obstetricians and Gynecologists recommends implementing labor and delivery triage tools, it remains unclear whether the Maternal-Fetal Triage Index facilitates the timely evaluation of high-acuity pregnant women. OBJECTIVE We sought to examine the duration of a labor and delivery triage evaluation before and after the implementation of the Maternal-Fetal Triage Index. We also sought to examine the duration of a labor and delivery triage evaluation according to priority levels by the Maternal-Fetal Triage Index. STUDY DESIGN This was a retrospective quality improvement study of all women presenting to an urban, tertiary labor and delivery triage unit at 16 weeks’ gestation or later from December 2017 to February 2018 (historical cohort) and December 2018 to February 2019 (study cohort). As part of a quality improvement initiative, the Maternal-Fetal Triage Index was implemented in the labor and delivery unit in May 2018. All registered nurses who worked in the labor and delivery unit completed a formal education course and assigned the priority levels at the time of triage presentation. The primary outcome was the duration of a labor and delivery triage evaluation, which was defined as the time interval from triage presentation to the completion of history and physical examination in the electronic medical record. Secondary outcomes included the rates of labor and delivery unit admissions. RESULTS There were 1305 and 1374 women in the historical cohort and study cohort, respectively. The duration of labor and delivery triage evaluation was longer for the study cohort than for the historical cohort (64 minutes vs 61 minutes; P=.02). Of the 1374 women in the study cohort, there were 28 (2%), 290 (21%), 459 (33%), 462 (34%), and 135 (10%) women with priority levels 1, 2, 3, 4, and 5 assigned, respectively. Women with a higher priority according to the Maternal-Fetal Triage Index had a shorter labor and delivery triage evaluation (priority 1, 57 minutes; priority 2, 66 minutes; priority 3, 63 minutes; priority 4, 62 minutes; and priority 5, 83 minutes; P CONCLUSION Compared with the historical cohort, the duration of labor and delivery triage evaluation was longer in the study cohort. However, in the study cohort, women classified as higher priority according to the Maternal-Fetal Triage Index had a shorter labor and delivery triage evaluation. Our study supports the American College of Obstetricians and Gynecologists’ recommendation on the implementation and utilization of labor and delivery triage tools such as the Maternal-Fetal Triage Index.
0047 Investigating the feasibility and acceptability of firearm safety counseling and distribution of safe storage devices in the pediatric emergency department

Statement of purpose To assess feasibility and caregiver acceptability of providing firearm safety education and free safe-storage devices in the ED. Methods/Approach Prospective feasibility study of caregivers in a pediatric ED. Participants completed electronic surveys on firearm safe-storage knowledge and practices, and received video-based firearm-safety education. We offered those with firearm access free cable locks and device education. We contacted subjects two weeks post-ED visit to assess firearm safety practices, cable lock use, and acceptability of the intervention. Results We enrolled 307 participants. 43 participants (14%) reported a firearm in the home at some point during the week. 16/43 (37%) of families with guns had never received safe-storage information prior to this ED visit. Among those with handguns, 17% reported not using a safety device and 17% reported storing the gun loaded. 47 (15%) of all participants received one or more cable locks from the study team. 240 (78%) subjects completed the 2-week follow-up survey. 182 (75%) participants had shared the firearm-safety information they received with others, 213 (89%) felt the ED was an appropriate place to discuss firearm safety, and two participants had removed a firearm from their home. Of the 163 participants who had the opportunity to ask about firearms in the homes where their children visit, 111 (68%) did ask, compared to only 61/163 (37%) at time of ED intervention, (p Conclusions It is feasible to provide firearm-safety education and cable locks to caretakers in the ED. Caretakers considered these practices acceptable and appropriate. The education and device distribution led to a change in intended and actual practices of firearm safety. Significance Providing firearm safety education in the ED can lead to improved firearm safety practices.
Is there a doctor on the plane? A review of in-flight emergencies for the on-board radiologist.

Abstract In-flight medical emergencies (IFME) are the acute on-service events involving illness or injury to a passenger with the potential for long-term health compromise. With the continuously rising number of flights available, both domestically and internationally, it is conceivable that the number of IFMEs will similarly continue to rise. Although most of these instances are relatively self-limited, the rare instance of a severe occurrence justifies preparation, both from in-flight staff and healthcare providers traveling on these flights. Given these events' sporadic nature and the variable availability of medical support, all physicians need to understand their in-flight ethical and legal capabilities, the available medical supplies, and the most likely etiologies to manage such situations successfully. Most radiologists rarely utilize the hands-on, clinical skills developed in medical school or internship for emergencies beyond allergic contrast reactions. Therefore, they may not be adept in caring for patients during an IFME. As such, we present a thorough overview and literature review for the radiologist regarding the management of various acute IFMEs, with consideration for ethical and legal precedence and a review of medical equipment available on-board.
The Positive Implications of Intentional Feedback

Positive and constructive feedback is a high leverage practice that can be learned and practiced through scaffolded and structured experiences. Teaching preservice candidates to provide effective feedback is an efficient way to increase P-12 students’ learning and behavioral outcomes. Teacher educators can craft experiences for their preservice teachers that offer rich coursework experiences, practice-based opportunities, and aligned clinical placement. Using the scaffolded approach provided in this article, teacher educators can ensure these experiences are robust and aligned with evidence-based pedagogy.
Real-Time Simultaneous Imaging of Acidification and Proteolysis in Single Phagosomes Using Bifunctional Janus-Particle Probes

The digestion of pathogens inside phagosomes by immune cells occurs through a sequence of reactions including acidification and proteolysis, but how the reactions are orchestrated in the right order is unclear due to a lack of methods to simultaneously measure more than one reaction in phagosomes. Here we report a bifunctional Janus particle probe to simultaneously monitor acidification and proteolysis in single phagosomes in live cells. Each probe consists of a pH reporter and a proteolysis reporter that are spatially separated but function concurrently. Using the Janus probes, we found the acidic pH needed to initiate and maintain proteolysis, revealing the mechanism for the sequential occurrence of both reactions during pathogen digestion. We showed how bacterium-derived lipopolysaccharide alters the acidification and proteolysis in phagosomes. This study showcases the Janus particle probes as a generally applicable tool for monitoring multiple reactions in intracellular vesicles.
Acute Echocardiographic Effects of Exogenous Ketone Administration in Healthy Participants.

ABSTRACT (word count = 276) Background Interest in therapeutic applications of exogenous ketones has grown significantly, spanning heart failure patients to endurance athletes. Exogenous ketones engender significant effects on cardiac function in heart failure and provide an ergogenic benefit in athletes. We assessed the effects of exogenous ketones on cardiac function in healthy participants. Methods In a single-arm intervention study, twenty fasting, healthy participants underwent comprehensive echocardiography (2D/Doppler/strain) before and 30 minutes after weight-based oral ketone ester (KE) administration. The relationship between change in log-transformed biomarker levels with change in absolute global longitudinal strain (GLS) was assessed using linear regression. Results Mean age was 30 ± 7 years, 50% were female, 45% were non-white, and average BMI was 24.3 ± 3.1 kg/m2. Ketone ingestion acutely elevated beta-hydroxybutyrate levels (median, 25th-75th percentile) from 0.13 (0.10-0.37) to 3.23 (2.40-4.97) mmol/L (p Conclusions In a single-arm study, systolic blood pressure, heart rate, biventricular function, and LV/LA strain acutely augmented after KE ingestion in healthy, fasting participants, similar to several effects observed in the failing heart. These data may provide supporting data for the ergogenic benefits observed in athletes, and may become increasingly relevant with exogenous ketone consumption across a variety of cardiovascular and non-cardiovascular applications.
Comment: Repeat Infringement in the DMCA

The DMCA creates safe harbors for internet service providers that shield them from liability for copyright infringement that takes place on their services. Those safe harbors are conditional on ISPs maintaining a policy that terminates internet access for repeat infringers. The DMCA does not, however, define some key terms regarding what an ISP must do in order to qualify for the safe harbor. In this comment, I first provide a theoretical grounding for defining those terms, rooted in the incentives facing copyright holders, infringers, and ISPs. I then argue that individuals who infringe as part of their own creative endeavors should be excluded from the scope of an ISP's "repeat infringer" policy. Next, I argue that a "repeat infringer" is someone who has been identified as an infringer on multiple occasions, not someone who has committed multiple acts of infringement. Finally, I argue that ISPs should not alone bear the burden of identifying infringers; instead, the statute is best read to require a joint effort between copyright holders and ISPs.
Factoring univariate integral polynomial in polynomial average time

Let A be a primitive squarefree univariate integral polynomial of degree n. An irreducible factor of A can be found by forming products of lifted modulo p factors of A for a suitable small prime p. One can either form first the products consisting of the smallest numbers of lifted factors (cardinality procedure) or form first the products with smallest degrees (degree procedure). Let ∏ be the partition of n consisting of the degrees of the irreducible factors of A. The average number of products formed before finding an irreducible factor of A is a function of ∏, C(∏) or D(∏) respectively. Let C*(n) (D*(n)) be the maximum of C(∏) (D(∏)) for all partitions, ∏, of n. Subject to the validity of two conjectures, for which considerable evidence is presented, it is proved that C*(n) is dominated by n2 whereas D*(n) is exponential. If the conjectures are true then the cardinality procedure results in a complete factorization algorithm for primitive univariate integral polynomials whose average computing time, in a very strong sense, is dominated by a polynomial function of its degree n.
Poisson brackets for densities of functionals

In the theory of integrable systems and in other field theories one usually deals with Poisson brackets between functionals. The latter are integrals of densities. Densities are defined up to divergence (boundary) terms. A question arises, is it possible to define a reasonable Poisson bracket for densities themselves? A general theory was suggested by Barnich, Fulp, Lada, Markl and Stasheff which has led them to the notion of a strong homotopy Lie group, (sh Lie). We are giving a few concrete examples.
Lightcone Quantization of String Theory Duals of Free Field Theories

We quantize in light cone gauge the bosonic sector of string theory on Anti-de Sitter space in the zero curvature radius limit. We find that the worldsheet falls apart into a theory of free partons and map the Hilbert space of the string theory to the Hilbert space of a free scalar in light-front description. We outline how the string worldsheet reproduces the field theory at weak coupling.
SMS-Watchdog: Profiling Social Behaviors of SMS Users for Anomaly Detection

With more than one trillion mobile messages delivered worldwide every year, SMS has been a lucrative playground for various attacks and frauds such as spamming, phishing and spoofing. These SMS-based attacks pose serious security threats to both mobile users and cellular network operators, such as information stealing, overcharging, battery exhaustion, and network congestion. Against the backdrop that approaches to protecting SMS security are lagging behind, we propose a lightweight scheme called SMS-Watchdog that can detect anomalous SMS behaviors with high accuracy. Our key contributions are summarized as follows: (1) After analyzing an SMS trace collected within a five-month period, we conclude that for the majority of SMS users, there are window-based regularities regarding whom she sends messages to and how frequently she sends messages to each recipient. (2) With these regularities, we accordingly propose four detection schemes that build normal social behavior profiles for each SMS user and then use them to detect SMS anomalies in an online and streaming fashion. Each of these schemes stores only a few states (typically, at most 12 states) in memory for each SMS user, thereby imposing very low overhead for online anomaly detection. (3) We evaluate these four schemes and also two hybrid approaches with realistic SMS traces. The results show that the hybrid approaches can detect more than 92% of SMS-based attacks with false alarm rate 8.5%, or about two thirds of the attacks without any false alarm, depending on their parameter settings.
Parallel implementation of WAP-tree mining algorithm

In this paper, we present parallel algorithms for Web log mining and the performance prediction model. The algorithm, based on WAP-tree, scans dataset only twice and avoids candidate generation process. We parallelized mining part of WAP tree. To balance the workload among processors, we developed a task scheduling strategy. A performance model of parallel Web mining algorithm is also developed to predict the performance of parallel implementation. This model shows that we can get linear speedup for a small number of processors, and a slow down of speedup as the number of processors increases. Using the performance model, we can also estimate the maximum speed up. We implemented the algorithm on a Pittsburg Super Computer Center Lemieux using up to 48 processors. Our benchmark results showed that the performance model correctly predicts the performance of the parallel implementation. We have achieved a good speedup as the size of the dataset is increased.
INFORMATION AND EFFICIENCY IN TENDER OFFERS

We analyze tender offers where privately informed shareholders are uncertain about the raider's ability to improve firm value. The raider suffers a "lemons problem" in that, for any price offered, only shareholders who are relatively pessimistic about the value of the firm tender their shares. Consequently, the raider finds it too costly to induce shareholders to tender when their information is positive. In the limit as the number of shareholders gets arbitrarily large, when private benefits are relatively low, the tender offer is unsuccessful if the takeover has the potential to create value. The takeover market is therefore inefficient. In contrast, when private benefits of control are high, the tender offer allocates the firm to any value-increasing raider, but may also allow inefficient takeovers to occur. Unlike the case where all information is symmetric, shareholders cannot always extract the entire surplus from the acquisition.
Bedside diagnosis of myocardial ischemia with ST-segment monitoring technology: Measurement issues for real-time clinical decision making and trial designs*

Monitoring of the ST segment is a valuable tool for guiding clinical decision making and evaluating anti-ischemia interventions in clinical trials; however, measurement issues hamper its diagnostic accuracy. This study reports the frequency and type of false positives and other measurement issues we have encountered during 12-lead ST-segment monitoring of patients in a cardiac care unit. Of 292 patients, 117 (40%) had one or more false positive events during an average of 41 hours of ST-segment monitoring, for a total of 506 false positive events. The 506 false positive events included 167 (36%) due to body positional change; 132 (26%) due to sudden increase in QRS complex/ST-segment voltage; 96 (19%) due to transient arrhythmia or pacing; 80 (16%) due to heart rate change in steeply sloped ST-segment contours; 26 (5%) due to a noisy signal; and 5 (1%) due to lead misplacement. It is concluded that many conditions in addition to myocardial ischemia can cause transient ST-segment deviation in patients with unstable coronary syndromes. Accurate ST-segment monitoring requires expertise in electrocardiogram interpretation, an understanding of the patient's clinical situation, and knowledge of the functions and limitations of the ST-segment monitoring system.