cssi/SciSciGPT-SciSciNet huggingface dataset:
Comorbidities and Overall Survival In Myelodysplastic Syndromes (MDS): Development of a Prognostic Model Incorporating IPSS and Age with ACE-27 Comorbidity Index

Abstract Abstract 605 Background: Cancer patients often experience comorbidities that may affect their therapeutic options, prognosis, and outcome. Limited studies have evaluated the characteristics and impact of comorbidities in MDS. The aim of this study was to determine the effect of comorbidities on the survival of patients with MDS. Methods: We reviewed the medical records of 600 consecutive MDS patients who presented to MD Anderson Cancer Center from 01–2002 to 06–2004. The Adult Comorbidity Evaluation-27 (ACE-27), a validated 27-item comorbidity index for cancer patients, was used to assess the severity of comorbid conditions. Data on demographic characteristics, International Prognostic Scoring System (IPSS), stem cell transplant (SCT) and outcomes (leukemic transformation and survival) was collected. Kaplan-Meier methods and log-rank tests were used to assess survival. Multivariate analysis was performed using the Cox Proportional Hazards Model. A prognostic model incorporating baseline comorbidities with age and IPSS was developed to predict survival. A score point for each significant factor (age, IPSS and ACE-27 comorbidity score) was obtained by dividing respective coefficients from the multivariate model by 0.3 and rounding to the nearest integer. Results: Of the 600 patients included in this study, 400 (65.7%) were male, and 518 (87.1%) were white; median age at presentation was 66.6 years (range 17.3 – 93.5); median duration of follow-up was 14.8 months (range 0–88). The ACE-27 comorbidity scores were as follows: none, 137 patients (28.8%); mild, 254 (42.3%); moderate, 127 (21.2%); and severe, 82 (13.7%). Four hundred and fifty six (76.0%) patients died, 123 (20.5%) suffered leukemic transformation and 51 (8.5%) patients underwent SCT. Overall median survival using the Kaplan-Meier method was 18.6 months. Median survival according to ACE-27 scores was: 31.8, 16.8, 15.2 and 9.7 months for none, mild, moderate and severe comorbidity scores respectively (p 65 years=2; IPSS of Intermediate-2= 2 and High= 3; ACE-27 score of mild or moderate= 1 and Severe= 3. Based upon their risk scores, patients were categorized into 3 groups: low (0 - 1), intermediate (2 - 4) and high (5 – 8). Almost 50% of the patients in our study were noted to be in the intermediate category with a median survival of 23 months. The model confirmed a better survival in patients in low risk group of 43 months versus 9 months in the high risk group (p Conclusion: Comorbidities had a significant impact on the survival of patients with myelodysplastic syndrome. Patients with higher ACE-27 comorbidity scores had a shorter survival than those with no comorbidity, independent of their age and the IPSS risk group. A comprehensive assessment of comorbidity is therefore needed to determine the prognosis in patients with MDS. Our newly developed prognostic model helps predict survival in such patients based on their comorbidities. Disclosures: No relevant conflicts of interest to declare.
Factor X/Xa Elicits Protective Signaling Responses In Endothelial Cells Directly Via PAR-2 and Indirectly Via EPCR-Dependent Recruitment of PAR-1

Abstract Abstract 2115 We recently demonstrated that the Gla-domain-dependent interaction of protein C with endothelial protein C receptor (EPCR) leads to dissociation of the receptor from caveolin-1 and recruitment of PAR-1 to a protective signaling pathway. Thus, the activation of PAR-1 by either thrombin or PAR-1 agonist peptide elicited a barrier protective response if endothelial cells were pre-incubated with protein C. In this study, we examined whether other vitamin K-dependent coagulation protease zymogens can modulate PAR-dependent signaling responses in endothelial cells. We discovered that the activation of both PAR-1 and PAR-2 in endothelial cells pretreated with factor FX (FX)-S195A, but not other procoagulant protease zymogens, also results in initiation of protective intracellular responses. Interestingly, similar to protein C, FX interaction with endothelial cells leads to dissociation of EPCR from caveolin-1 and recruitment of PAR-1 to a protective pathway. Further studies revealed that, FX activated by factor VIIa on tissue factor bearing endothelial cells, also initiates protective signaling responses through the activation of PAR-2 independent of EPCR mobilization. All results could be recapitulated by the receptor agonist peptides to both PAR-1 and PAR-2. These results suggest that a crosstalk between EPCR and an unknown FX/FXa receptor, which does not require interaction with the Gla-domain of FX, recruits PAR-1 to protective signaling pathways in endothelial cells. Disclosures: No relevant conflicts of interest to declare.
Advances in Technology and Policing: 21st Century America

The significance of technology in the development of the policing role cannot be denied, nor can it be overstated. Technology has provided the tools needed to better understand the criminal act, and to better protect the community now and in the future. This chapter provides an introduction and appraisal to many of the most common and emerging technologies in policing today. The authors hope that this chapter provides readers a basic foundation for law enforcement’s use and adoption of technologies, and how they forge the way in which policing is conducted in modern day America.
Effect of interfacial preheating on welded joints during ultrasonic composite welding

Abstract Due to the low welding energy efficiency of ultrasonic composite welding, preheating is proposed to concentrate the welding energy to joining interface. By analyzing the maximum shear load, fracture surface, and microstructure of the joint cross-sections, it is found that preheating can localize welding pressure because of the softening of the welding layers, which can further concentrate weld area and reduce the generation of welded edges. Preheating enhances the welding energy efficiency, reflected by improved weld attributes (weld area and the degree of bonding) and joint quality as preheating temperature increased. With extended preheating time, the maximum shear load increases, and then drops owing to the porosity generated in the weld layer when the joints are over-heated.
Abstract TP240: Simulation-Based Learning Improves Neurology Resident Training in Acute Stroke Care

Introduction: Acute “stroke codes” are stressful for the new neurology resident who must lead a multi-disciplinary team and quickly integrate information to make high risk time-sensitive decisions....
IL-21 RECEPTOR SIGNALING IS ESSENTIAL FOR OPTIMAL CD4+ T-CELL FUNCTION AND CONTROL OF Mycobacterium tuberculosis INFECTION IN MICE

In this study, we determined the role of IL-21R signaling in Mycobacterium tuberculosis infection, using IL-21R knockout (KO) mice. A total of 50% of M. tuberculosis H37Rv-infected IL-21R KO mice died in 6 mo compared with no deaths in infected wild type (WT) mice. M. tuberculosis-infected IL-21R KO mice had enhanced bacterial burden and reduced infiltration of Ag-specific T cells in lungs compared with M. tuberculosis-infected WT mice. Ag-specific T cells from the lungs of M. tuberculosis-infected IL-21R KO mice had increased expression of T cell inhibitory receptors, reduced expression of chemokine receptors, proliferated less, and produced less IFN- γ, compared with Ag-specific T cells from the lungs of M. tuberculosis-infected WT mice. T cells from M. tuberculosis-infected IL-21R KO mice were unable to induce optimal macrophage responses to M. tuberculosis. This may be due to a decrease in the Ag-specific T cell population. We also found that IL-21R signaling is associated with reduced expression of a transcriptional factor Eomesodermin and enhanced functional capacity of Ag-specific T cells of M. tuberculosis-infected mice. The sum of our findings suggests that IL-21R signaling is essential for the optimal control of M. tuberculosis infection.
Queueing or Creaming? Will or Lose

A review of the Work Incentive Program (WIN) provides insight into some of the issues and options confronting manpower planners and administrators. It becomes apparent that the strategies regularly utilized and reinforced by federal funding practices can clearly be labelled as "creaming." The "queueing" model is presented as an alternative decisionmaking process that appears more likely to lead to rational and purposive outcomes for manpower programs.
Outcomes of immediate versus delayed breast reconstruction: Results of a multicenter prospective study.

Abstract Background Previous studies suggest that immediate reconstruction following mastectomy produces superior results over delayed procedures. However, for medical or oncological reasons, some patients may be poor candidates for immediate reconstruction. We compared complications and patient-reported outcomes between immediate and delayed breast reconstructions in a prospective, multicenter study. Methods 1957 patients (1806 immediate, 151 delayed) met eligibility criteria. Demographic data, major complications, infections, and reconstructive failure rates were evaluated. Patient-reported outcomes were assessed with BREAST-Q, PROMIS, and EORTC QLQ-BR23 surveys, pre- and two years post-operatively. Subscale scores were compared across cohorts using mixed-effects regression models, controlling for patient characteristics and hospitals. Findings Complete data were available in 1639 immediate and 147 delayed reconstruction patients. There were significant baseline differences between immediate and delayed cohorts in age, BMI, prevalence of diabetes, lymph node management, use of radiation, and chemotherapy. Controlling for clinical covariates, the delayed group had lower odds of any (OR 0.38, p Conclusions Compared with immediate techniques, delayed reconstruction following mastectomy was associated with lower rates of overall and major complication, while providing equivalent patient satisfaction and quality of life benefits. Although immediate reconstruction is still the preferred choice of most patients and surgeons, delaying reconstruction does not appear to compromise clinical or patient-reported outcomes.
Mediation Models, Theories and Approaches

This chapter identifies some of the major approaches used by professional mediators – working independently or in teams – in the United States. It also identifies some of the theoretical underpinnings of those approaches, identifies models that can be used by those with different approaches, provides a rationale for understanding the approaches and includes some information about mediation in other countries.
Real-Time Fire Monitoring and Visualization for the Post-Ignition Fire State in a Building

During a fire event, environmental threats to building occupants and first responders include extreme temperatures, toxic gases, disorientation due to poor visibility coupled with unfamiliar surroundings, and a changing indoor environment. In addition to these hazards, firefighters often lack critical information for making decisions once on the scene. The lack of information coupled with the dynamics of natural fire events leads to several near-misses, injuries, and deaths each year. Additionally, these challenges slow the rescue time of building occupants and prolong the suppression of the fire. Integrating real-time measurements from sensors into the fire intervention strategy may provide an opportunity for a new technological advancement to improve the practice of firefighting. In this study, a computational framework using Lightweight Communications and Marshalling was developed for connecting real-time fire data to an event detection sub-model to demonstrate how computing can be used for fire monitoring and sensor-assisted firefighting. A post-processed example using these monitoring computations in conjunction with a building information model is provided as a demonstration for presenting real-time data in the field. This work serves as a step towards an intelligent firefighting system based on real-time computing tools.
Botulinum Toxin: Techniques Within Pediatric Physiatry.

Abstract Background Intramuscular botulinum toxin injections are used for treatment of focal spasticity in children, particularly in those with a diagnosis of cerebral palsy. There are a variety of techniques used when performing botulinum toxin injections without clear standards for pediatric providers. Objective To describe current practice techniques for botulinum toxin injections among pediatric physiatrists. Design Cross-sectional survey using RedCap Software. Setting Pediatric physiatrists who perform botulinum toxin injections. Participants Survey of 307 pediatric physiatrists. Methods Analysis of data from the 2017 practice survey of pediatric physiatrists in the United States. Main Outcome Measurements Physicians were asked the primary botulinum toxin used, common dosing information, the role of localization, and the role of sedation and distraction in their practice. Results Nearly all pediatric physiatrists use OnabotulinumtoxinA as the primary formulation of botulinum toxin. The maximum dose per body weight used per injection series had a median of 15 units/kilogram and a median maximum total dose of 500 units. Sixty-five percent of pediatric physiatrists report using sedation, of any type, for botulinum toxin injections. When using sedation, the most common primary method was general anesthesia (38.9%), followed by enteral or nasal anxiolytic with the patient awake (26.2%). The most common reported intended injection site for botulinum toxin was “in multiple sites spread throughout the muscle” (67.9%), and then “one site of the muscle at the motor point” (17.1%). Large muscles were injected using primarily anatomic guidance (75.6%) and electromyography (50.8%), and small muscles were primarily completed with electromyography (73.6%) and anatomic guidance (49.2%). Conclusion There is considerable variability present in one common procedure performed by pediatric physiatrists. Level of Evidence Level IV
Studies on the Behavior of Fish in Relation to Power Station Operation in the U.K.

Abstract The behavior and movement patterns of fishes in their natural environment may be key factors determining whether an effluent or any other ecological disturbance has a significant effect on the populations. Alterations in migration, dispersal, feeding or breeding movements may, in the long term, cause adverse effects. Since 1973, ultrasonic tracking has been used to study the movements and behavior of freshwater and estuarine fishes in relation to water-use by British electricity generating stations. Three major areas of research are summarized below. Studies in rivers heated by thermal discharges are evaluating the effects of effluent plumes on the natural homing, movement and aggregation patterns of non-diadromous (coarse) fishes. Residence times in relation to temperature suggest that the strict constraints on discharges suggested by the E.E.C. may not be ecologically necessary. Avoidance behavior has been noted in field studies. At Dinorwic in North Wales, the construction and operation of an 1800 MW pumped storage scheme may affect a lake and small river system which carry migratory salmonids. The rate of migration of these fish is being investigated in relation to patterns of flow and suspended solids. Small automatic bankside recording stations are used to monitor the passage of sonic-tagged fish. Future thermal or tidal-barrage based generation may affect at least one large estuary in Britain. To prevent ingress of migrating salmonids at water intakes and to plan locations of barrage fish passes, the routes which salmon take through an estuary are being investigated using sonic-tracking techniques. The possible ‘thermal barrier’ effects on migration are being studied. Problems in analysis of tracking data are discussed.
Germ cell tumors: staging, prognosis, and outcome.

Germ cell tumors (GCT) remain the model for solid tumor therapy. Until 1997, GCT staging was based on individual institution systems, which limited comparison of data and collaboration between GCT groups. GCT staging is based on four basic criteria: disease site of origin, histology, secretion of serum tumor markers (STM), and bulk of disease. Within most staging systems developed by investigators, clinical stage I disease is confined to the testis based on radiographic imaging and STM or pathological stage I based on lack of histological disease at retroperitoneal lymphadenectomy. Stages II and III are considered to be disease outside the testis categorized by lymphatic spread to the retroperitoneal lymph nodes or hematological spread to lungs and visceral organs, respectively. The major staging systems previously used include the Indiana University Staging System; Modified Samuels' Classification (M.D. Anderson Cancer Center); Memorial Sloan Kettering Cancer Center Mathematical Model; and the Tumor, Nodal, Metastases (TNM) Staging System (American Joint Committee on Cancer). The most recent evolution in staging systems is the 1997 International Germ Cell Consensus Classification, which is based on prognosis and outcomes. This system allows for comparison of data and collaboration between Germ Cell Tumor Groups.
Thioacyl Functions Linked to a Metalloid (Si, Ge, or B) or Metal; and Their Seleno and Telluro Analogs

Recent advances in the preparation of thioacylsilanes are described, together with leading references to the chemistry of these interesting molecules. Members of the family of thioacyl, selenoacyl, or telluroacyl species bonded to a metal or metalloid other than silicon still remain poorly described in the literature.
Cyclic bisphosphonate therapy reduces pain and improves physical functioning in children with osteogenesis imperfecta.

Children with osteogenesis imperfecta (OI) experience pain and impaired physical functioning. The longitudinal effect of cyclic bisphosphonate treatment on these symptoms has not been described. We serially evaluated pain and functioning in pediatric patients with OI treated with intravenous bisphosphonate therapy. Pain and physical functioning were assessed at multiple time-points over two infusion cycles in 22 OI patients (median age 10 years [range 2–21 years]; 8 girls) receiving cyclic intravenous bisphosphonate therapy. Pain was assessed using the FACES® visual analogue scale; physical functioning, including self-care, was assessed using the PedsQL™ Generic Core inventory. Pain scores decreased significantly immediately following infusion and remained reduced at 4 weeks post-infusion, increasing before and decreasing again after subsequent infusion (F = 25.00, p < 0.001). Physical functioning scaled scores improved 4 weeks after infusion and declined before subsequent infusion across patients (F = 10.87, p = 0.007). Exploratory analyses indicated significantly different effects between mild and moderate-severe OI types for pain, but not for physical functioning. No fractures occurred during the study. In children with OI, cyclic intravenous bisphosphonate therapy transiently reduces pain and improves functional abilities. Pain relief occurs immediately following infusion with functional improvements observed 4 weeks later. Both pain and physical functioning return to pretreatment levels by the subsequent infusion.
Fecal incontinence, anal skin irritation, and metabolic concerns associated with pelvic pouches

Abstract Mechanical and inflammatory complications of pelvic pouch surgery have been well described but there has been limited recognition of problems such as fecal incontinence, anal skin irritation and metabolic changes that may develop after surgery. Reported rates of daytime and nighttime fecal incontinence rates are 29% and 47% respectively. We discuss strategies for managing fecal incontinence and associated anal skin irritation that can develop. Metabolic consequences of pelvic pouch surgery are also increasingly being recognized. Patients with IPAA who are doing well with no evidence of pouch inflammation have low rates of nutrient deficiencies but should be monitored for vitamin B12, vitamin D and zinc deficiencies. In contrast, patients with IPAA who develop pouchitis, diarrhea, and/or rectal bleeding are more susceptible to nutrient deficiencies and should have a broader assessment of nutrient status. In additions, there appears to be an increased risk of bone loss among patients with IPAA and thus these patients should undergo appropriate risk screening and testing. Finally, patients with IPAA have physiologic changes that predispose to formation of calcium oxalate and uric acid renal stones.
Comparison of surgical margins for lentigo maligna versus melanoma in situ.

Background Multiple studies have shown a 5-mm surgical margin to be inadequate for excision of melanoma in situ. Some have suggested that a wider margin is needed only for the lentigo maligna subtype. Objective To compare subclinical extension of lentigo maligna with that of melanoma in situ. The secondary objective was to investigate the effect of other factors on extent of subclinical extension. Methods A prospectively collected series of noninvasive melanomas was studied. Original pathology reports were used to identify lentigo maligna and compare data for that subtype with data for the remaining melanomas in situ. Results A total of 1506 lentigo maligna cases and 829 melanomas in situ were included. To obtain a 97% clearance rate, both lentigo maligna and melanoma in situ required a 12-mm margin on the head and neck and a 9-mm margin on the trunk and extremities. Only 79% of lentigo maligna and 83% of melanoma in situ were successfully excised with a 6-mm margin (P = .12). Local recurrence was identified in 0.26% (5 facial, 1 scalp, and 1 acral), with a mean follow-up time of 5.7 years. Limitations Margins less than 6 mm were not studied. The use of lentigo maligna diagnosis was not used by all dermatopathologists consistently. The degree of surrounding photodamage was not assessed. Conclusion Subclinical extension of lentigo maligna and melanoma in situ are similar. Standard surgical excision of all melanoma in situ subtypes, including lentigo maligna, should include at least 9 mm of normal-appearing skin, which is similar to the amount recommended for early invasive melanoma. Lesions on the head and neck or those with a diameter greater than 1 cm may require even wider margins and are best treated with Mohs micrographic surgery. The perception that lentigo maligna has wider subclinical extension may be related to its frequent location on the head and neck, where photodamage can camouflage the clinical border.
Canaanite Genocide and Palestinian Nakba in Conversation: A Postcolonial Exercise in Bi-directional Hermeneutics

David Ben-Gurion's attempt to forge a collective Israeli identity rooted in the biblical conquest myth adopted a bi-directional hermeneutic: biblical text and modern reality were mutually illuminat...
Use of minimally invasive surgery in emergency general surgery procedures

Minimally invasive surgery (MIS) has demonstrated superior outcomes in many elective procedures. However, its use in emergency general surgery (EGS) procedures is not well characterized. The purpose of this study was to examine the trends in utilization and outcomes of MIS techniques in EGS over the past decade. The 2007–2016 ACS-NSQIP database was utilized to identify patients undergoing emergency surgery for four common EGS diagnoses: appendicitis, cholecystitis/cholangitis, peptic ulcer disease, and small bowel obstruction. Trends over time were described. Preoperative risk factors, operative characteristics, outcomes, morbidity, and trends were compared between MIS and open approaches using univariate and multivariate analysis. During the 10-year study period, 190,264 patients were identified. The appendicitis group was the largest (166,559 patients) followed by gallbladder disease (9994), bowel obstruction (6256), and peptic ulcer disease (366). Utilization of MIS increased over time in all groups (p < 0.001). There was a concurrent decrease in mean days of hospitalization in each group: appendectomy (2.4 to 2.0), cholecystectomy (5.7 to 3.2), peptic ulcer disease (20.3 to 11.7), and bowel obstruction (12.9 to 10.5); p < 0.001 for all. On multivariate analysis, use of MIS techniques was associated with decreased odds of 30-day mortality, surgical site infection, and length of hospital stay in all groups (p < 0.001). Use of MIS techniques in these four EGS diagnoses has increased in frequency over the past 10 years. When adjusted for preoperative risk factors, use of MIS was associated with decreased odds of wound infection, death, and length of stay. Further studies are needed to determine if increased access to MIS techniques among EGS patients may improve outcomes.
Pancreatic Intraductal Papillary Mucinous Neoplasm With Elevated Pre-Operative Cystic Carcinoembryonic Antigen Level: A Histopathologic Correlation

Background To study the relationship between carcinoembryonic antigen (CEA) level, intraductal papillary mucinous neoplasm (IPMN) subtype, and the presence of invasive carcinoma. Methods Cystic CEA level and the following pathologic variables: subtypes of IPMN, size of cystic lesion, presence of dysplasia or carcinoma, and main or branch duct involvement from 45 IPMN cases were analyzed. Results There was a significant correlation between pre-operative cystic fluid CEA level and the intensity of luminal CEA staining. However, there was no correlation between CEA level and cystic mucinous secretions or mucinous epithelial cytoplasm CEA staining, mucin glycoprotein expression, size of lesion, grade of dysplasia or presence of invasive carcinoma. CEA level was neither sensitive nor specific for the presence of invasive carcinoma. Conclusions Cystic CEA level may not be a reliable determinant of the presence or absence of invasive carcinoma in IPMNs, and its use to assess risk of malignancy may be limited.
Dysfunctional adaptive immune response in adolescents and young adults with suicide behavior

Abstract Background Immune system dysfunction has been implicated in the pathophysiology of suicide behavior. Here, we conducted an exploratory analysis of immune profile differences of three groups of adolescents and young adults (ages 10–25 years): healthy controls (n = 39), at risk of major depressive disorder (MDD; at-risk, n = 33), and MDD with recent suicide behavior/ ideation (suicide behavior, n = 37). Methods Plasma samples were assayed for chemokines and cytokines using Bio-Plex Pro Human Chemokine 40-plex assay. Log-transformed cytokine and chemokine levels were compared after controlling for age, gender, body mass index, race, ethnicity, and C-reactive protein (CRP) levels. In post-hoc analyses to understand the effect of dysregulated immune markers identified in this exploratory analysis, their association with autoantibodies was tested in an unrelated sample (n = 166). Results Only levels of interleukin 4 (IL-4) differed significantly among the three groups [false discovery rate (FDR) adjusted p = 0.0007]. Participants with suicide behavior had lower IL-4 [median = 16.8 pg/ml, interquartile range (IQR) = 7.9] levels than healthy controls (median = 29.1 pg/ml, IQR = 16.1, effect size [ES] = 1.30) and those at-risk (median = 24.4 pg/ml, IQR = 16.3, ES = 1.03). IL-4 levels were negatively correlated with depression severity (r= −0.38, p = 0.024). In an unrelated sample of outpatients with MDD, levels of IL-4 were negatively correlated (all FDR p Conclusions Adolescent and young adult patients with recent suicide behavior exhibit lower IL-4 levels. One biological consequence of reduced IL-4 levels may be increased risk of autoimmunity.
Demoralization and chronic illness in rural Australia: A cross-sectional survey

ObjectiveDemoralization is prevalent in patients with life-limiting chronic illnesses, many of whom reside in rural areas. These patients also have an increased risk of disease-related psychosocial burden due to the unique health barriers in this population. However, the factors affecting demoralization in this cohort are currently unknown. This study aimed to examine demoralization amongst the chronically ill in Lithgow, a town in rural New South Wales, Australia, and identify any correlated demographic, physical, and psychosocial factors in this population.MethodA cross-sectional survey of 73 participants drawn from Lithgow Hospital, the adjoining retirement village and nursing home, assessing correlating demographic, physical, psychiatric, and psychosocial factors.ResultsThe total mean score of the DS-II was 7.8 (SD 26.4), and high demoralization scores were associated with the level of education (p = 0.01), comorbid condition (p = 0.04), severity of symptom burden (p = <0.001), depression (p = <0.001), and psychological distress (p = <0.001). Prevalence of serious demoralization in this population was 27.4% according to a cutoff of a DS-II score ≥11. Of those, 11 (15%) met the criteria for clinical depression, leaving 9 (12.3%) of the cohort demoralized but not depressed.Significance of resultsPrevalence of demoralization was high in this population. In line with the existing literature, demoralization was associated with the level of education, symptom burden, and psychological distress, demonstrating that demoralization is a relevant psychometric factor in rural populations. Further stratification of the unique biopsychosocial factors at play in this population would contribute to better understanding the burdens experienced by people with chronic illness in this population and the nature of demoralization.
The Egyptian Muslim Brotherhood and Ikhwanweb: Deliberative Ethic/Voice in a Counterpublic’s Rhetoric?

Using counterpublic theory as framework and situating the Egyptian Muslim Brotherhood (MB) as a counterpublic, counterpublics being alternative, non-dominant publics who voice their oppositional needs and values through diverse discursive practices, the goal of this study is to: (a) Examine, in the context of the years preceding the 2011 Egyptian uprising, whether the Egyptian MB, as a counterpublic, portrays a deliberative ethic/voice in its cyber rhetoric; (b) Explore whether traditional/Western ideas of deliberation are upheld or challenged in the cyber rhetoric of the Egyptian MB; and (c) Comment on the role of Ikhwanweb, as a counterpublic sphere, in providing the Egyptian MB a space to demonstrate its deliberative potential. By looking for traits and evidences of deliberative ethic in the Egyptian MB’s cyber rhetoric—in a ‘text’ produced by an Islamist organization functioning within a secular/authoritarian socio-political ‘context’—the overarching purpose of this analysis is to make sense of : (a) an Islamist organization’s role as a counterpublic and its deliberative potential in a non-democratic setting; (b) the implications of this for thinking about deliberation between diverse groups of social agents in non-democratic cultures; and (c) the role of the Internet in facilitating counterpublics’ deliberative potential in authoritarian contexts. Thus, from a heuristic standpoint, this study is an endeavor towards contributing to a key question that animates public deliberation: how can we engage/engage with voices that hold (or are assumed to hold) anti-deliberative attitudes and/or those that operate within non-democratic socio-political contexts?
Adverse event rate during inpatient sotalol initiation for the management of supraventricular and ventricular tachycardia in the pediatric and young adult population.

Background Sotalol is an important antiarrhythmic drug in the pediatric population. Given the risk of proarrhythmia, sotalol is initiated in inpatient settings, with adult studies as recent as 2015 supporting this practice. Objective The purpose of this study was to determine the frequency of adverse events (AEs) during sotalol initiation for the management of atrial, supraventricular, or ventricular arrhythmias in pediatric patients. Methods A retrospective cohort analysis of pediatric patients 21 years or younger initiated on oral sotalol for supraventricular tachycardia or ventricular tachycardia (VT) at Boston Children's Hospital from January 1, 2007, through July 1, 2016, was performed. The primary end point was an AE defined as significant bradycardia, new or increased ventricular arrhythmias, conduction block, or corrected QT interval (QTc) prolongation, resulting in dose reduction or cessation. Results There were 190 patients who met inclusion criteria, with 110 patients (58%) 6 months or younger. A total of 115 patients (60%) had congenital heart disease. Arrhythmias for which sotalol was initiated included atrioventricular reciprocating tachycardia/atrioventricular nodal reciprocating tachycardia (n = 105 [55%]), atrial flutter (n = 31 [16%]), ectopic atrial tachycardia (n = 26 [14%]), VT (n = 21 [11%]), and atrial fibrillation (n = 7 [4%]). The median pre-sotalol QTc was 438 ms (interquartile range 348–530 ms). Five patients (3%) (aged 0.1–18 years) had AEs including bradycardia Conclusion The incidence of AEs in pediatric patients initiating sotalol for atrial tachycardia, supraventricular tachycardia, or VT is low (3%), with no deaths or malignant rhythms reported in this series.
Screening Intrathecal Baclofen Pump Systems for Catheter Patency via Catheter Access Port Aspiration.

Objectives To screen all of our patients being treated with intrathecal baclofen (ITB) therapy for catheter patency. Method Catheter patency was examined by performing a catheter access port study in 91 pediatric and adult patients undergoing ITB therapy at our institution. Results Despite no preoperative clinical suspicion of a problem with the ITB system in all but one case, 16.5% of the catheters in our patient population were not patent. After replacement, prerevision and stable postrevision dosage was examined to determine the impact system replacement had on the daily dosage. There was a significant 65% reduction in the daily ITB dosage from before catheter exploration (M = 823.8 mcg/day, SD = 390.51) to stable post replacement/revision dosage after catheter replacement or revision (M = 289.43 mcg/day, SD = 187.76), t11 = 4.09, p = .002, 95% CI [246.80, 822.00]. Conclusions These results suggest that catheters need to be routinely screened for patency. Routine maintenance and screening can minimize or more quickly detect nonpatent systems and ensure proper functioning of the ITB system.
Immigrant policies as health policies: State immigrant policy climates and health provider visits among U.S. immigrants

The geographic dispersion of the U.S. immigrant population has occurred alongside a dramatic increase in state-level immigration laws that has unfolded unevenly across states, creating markedly different state immigrant policy climates. Although not all such laws are health-related, they have potential implications for immigrants' health care utilization. Using data from the 2014 Survey of Income and Program Participation, we leverage the geographic variation in the restrictiveness of state immigrant policy climates to examine the association between state-level immigrant policies and health provider visits-a fundamental indicator of health care utilization-among immigrant adults. Results indicate that restrictive immigrant policy climates exacerbate nativity gaps in health provider visits among working-age adults and, to a lesser extent, among older adults. Our findings suggest that even immigrant policies not directly related to health have consequences for immigrants' health care utilization.
Electric Contact Material Selection for Medium and High Voltage DC Circuit Breakers

Medium and high voltage DC grids are increasingly proposed for terrestrial, shipboard and aircraft power systems. However, multi terminal DC networks can only be realized with the development of a DC circuit breaker. Due to the difficulty in breaking DC currents, hybrid circuit breakers—which consist of a non-arcing fast mechanical disconnect switch (FMS) in parallel with a solid state switch—is the most promising solution. The stresses experienced by the electric contacts of FMS are different from those of AC and low voltage DC breakers and disconnect switches. The choice of contact material has a significant impact on the performance of the DC circuit breaker. The Ashby method is used to systematically identify the best suited contact materials by translating the requirements of FMS contacts into objectives and constraints and deriving material indices for each objective. Minimizing power loss, wear and overheating of contacts are identified as the key objectives. The results suggest that copper-based alloys and compounds are more suitable than silver based alloys and compounds and other contact materials.
Combining deep and hand-crafted MRI features for identifying sex-specific differences in autism spectrum disorder versus controls

Autism spectrum disorder (ASD) is a collection of neuro-developmental disorders with many symptoms, most prominently social impairment. It is known that there is a significant prevalence (4:1) of ASD in males compared to females. This suggests that there will likely be distinct neuro-anatomical structures across males and females that contribute to the distinct disease etiologies across the two sexes. Hence, in this work, we seek to develop “sex- specific" machine learning models that attempt to capture neuroanatomical differences in brain morphometry across ASD versus normal controls using structural MRI scans. Specifically, we train two different machine- learning models (one for male and one for female cohorts) consisting of hand-crafted" morphometric features such as shape and surface area of brain parcellations from T1w MRI, with deep" features learned from a Dense Convolutional Network (DenseNet). Our methodology consists of first computing morphometric hand-crafted features (i.e. volume and surface features of different brain parcellations) from the training cohort obtained from the ABIDE-II dataset consisting of 210 males and 98 females from structural T1w MRI scans. We then employ feed-forward feature selection within a linear discriminant analysis classifier trained separately for the male and female cohorts, to distinguish ASD from normal controls. Additionally, we train a DenseNet model with 4 dense blocks (with 2 layers each) to extract deep features from T1w MRI scans to distinguish ASD versus controls, separately for males and females. The deep features allow for capturing complementary data-driven feature differences in brain morphometry specific to male and female ASD cohort (versus normal controls). Finally, we combine the top morphometric and DenseNet features obtained from the training model and test them on the ABIDE I dataset for the male (n=85) and female (n=19) cohort separately, to distinguish ASD from normal controls. Our results demonstrated training and testing accuracies of 78% and 79% using hand-crafted features alone, 68% and 57% using DenseNet features alone, and 87% and 79% respectively using integrated hand-crafted and deep features for the male cohort. For the female cohort, we obtained accuracies of 81% and 84% with hand-crafted features alone, 71% and 62% for DenseNet features alone, and 81% and 84% with integrated hand- crafted and deep features, on training and testing sets respectively. With further optimization of deep features along with inclusion of a large multi-site cohort, our presented sex-specific ML approach could allow for improved diagnosis of ASD from controls, across males and females, using structural MRI scans.
Automated Bug Detection and Replay for COTS Linux Kernel Modules with Concolic Execution

Linux kernel is pervasive in the cloud, on mobile platforms, and on supercomputers. To support these diverse computing environments, the Linux kernel provides extensibility and modularity through Loadable Kernel Modules (LKM), while featuring a monolithic architecture for execution efficiency. This architecture design brings a major challenge to the security of Linux kernel. Having LKMs run in the same memory space as the base kernel on Ring 0, a single flaw from LKMs may compromise the entire system, e.g., gaining root access. However, validation and debugging of LKMs are inherently challenging, because of its special interface buried deeply in the kernel, and non-determinism from interrupts. Also, LKMs are shipped by various vendors and the public may not have access to their source code, making the validation even harder. In this paper, we propose a framework for efficient bug detection and replay of commercial off-the-shelf (COTS) Linux kernel modules based on concolic execution. Our framework automatically generates compact sets of test cases for COTS LKMs, proactively checks for common kernel bugs, and allows to reproduce reported bugs repeatedly with actionable test cases. We evaluate our approach on over 20 LKMs covering major modules from the network and sound subsystems of Linux kernel. The results show that our approach can effectively detect various kernel bugs, and reports 5 new vulnerabilities including an unknown flaw that allows non-privileged users to trigger a kernel panic. By leveraging the replay capability of our framework, we patched all the reported bugs in the Linux kernel upstream, including 3 patches that were selected to the stable release of Linux kernel and back-ported to numerous production kernel versions. We also compare our prototype with kAFL, the state-of-the-art kernel fuzzer, and demonstrate the effectiveness of concolic execution over fuzzing on the kernel level.
Abstract A44: Functional models of chromosome arm-level aneuploidies in cancer

Aneuploidy, whole-chromosome or chromosome arm copy number imbalance, is a near-universal characteristic of human cancers. We previously applied methods that define chromosome arm-level aneuploidy and a global cancer aneuploidy score to 10,522 tumors of 33 types in The Cancer Genome Atlas (TCGA). Aneuploidy level was correlated with TP53 mutation, somatic mutation rate, and expression of proliferation genes. Overall aneuploidy was anti-correlated with expression of immune signaling genes, due to decreased leukocyte infiltrates in high-aneuploidy samples. In contrast, some individual chromosome arm alterations correlated with higher expression of immune signaling genes, including deletion of chromosome 3p, 8p, and 17p. Cancer subtypes are often characterized by tumor specific patterns of arm-level copy number alterations; for example, squamous cell carcinomas (SCCs) from different tissues of origin (including lung, esophagus, and bladder) have a pattern of chromosome 3p loss and chromosome 3q gain. Although yeast and mammalian models of whole-chromosome aneuploidies have been extensively investigated, chromosome arm-level aneuploidies have rarely been modeled. However, recent advances in genome engineering and targeting of endonucleases allow generation of large chromosomal alterations. We used the CRISPR-Cas9 system to delete one copy of chromosome 3p in human immortalized lung epithelial cells, validated in 8 clones by whole-genome sequencing. Consistent with patient data, expression of 3p genes was decreased upon deletion, as well as increased expression of interferon response genes. Phenotypic characterization revealed that cells with chromosome 3p deletion initially proliferated more slowly than their siblings. These chromosome 3p-deleted cells had increased G1 arrest but did not undergo increased apoptosis or cell death. Interestingly, after several passages in culture, the proliferation defect was rescued in chromosome 3p-deleted cells; genome sequencing and karyotype analyses suggested that this was partially the result of chromosome 3 duplication. With our cellular model of chromosome arm-level aneuploidy, we uncovered a selection mechanism that allowed aneuploidy tolerance in vitro. We have also grown these cells in spheroid and organoid culture systems to assess the effects of chromosome 3 arm-level aneuploidies on cytokine production and squamous differentiation and are using these systems to identify how chromosome 3p deletion affects drug sensitivity. In conclusion, our genome engineering approach to model chromosome arm-level deletions provides a robust model that will address a gap in our understanding of aneuploidy in cancer. Citation Format: Alison M. Taylor, Sejal Jain, Juliann Shih, Andrew D. Cherniack, Rameen Beroukhim, Matthew Meyerson. Functional models of chromosome arm-level aneuploidies in cancer [abstract]. In: Proceedings of the AACR Special Conference on the Evolving Landscape of Cancer Modeling; 2020 Mar 2-5; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2020;80(11 Suppl):Abstract nr A44.
An A* Curriculum Approach to Reinforcement Learning for RGBD Indoor Robot Navigation.

Training robots to navigate diverse environments is a challenging problem as it involves the confluence of several different perception tasks such as mapping and localization, followed by optimal path-planning and control. Recently released photo-realistic simulators such as Habitat allow for the training of networks that output control actions directly from perception: agents use Deep Reinforcement Learning (DRL) to regress directly from the camera image to a control output in an end-to-end fashion. This is data-inefficient and can take several days to train on a GPU. Our paper tries to overcome this problem by separating the training of the perception and control neural nets and increasing the path complexity gradually using a curriculum approach. Specifically, a pre-trained twin Variational AutoEncoder (VAE) is used to compress RGBD (RGB & depth) sensing from an environment into a latent embedding, which is then used to train a DRL-based control policy. A*, a traditional path-planner is used as a guide for the policy and the distance between start and target locations is incrementally increased along the A* route, as training progresses. We demonstrate the efficacy of the proposed approach, both in terms of increased performance and decreased training times for the PointNav task in the Habitat simulation environment. This strategy of improving the training of direct-perception based DRL navigation policies is expected to hasten the deployment of robots of particular interest to industry such as co-bots on the factory floor and last-mile delivery robots.
Effect of Saving Motives and Horizon on Saving Behavior

The purpose of this research is to explore saving motives and saving horizon using a large, nationally representative dataset, the Survey of Consumer Finances. The framework is based on prospect theory, in which consumption and saving decisions are based on a reference point rather than on lifetime income. Prospect theory also posits that individuals construct various mental accounts, thereby allowing for households to have multiple saving motives. Since prospect theory does not assume that saving decisions are based on lifetime income, saving horizons are allowed to vary. The emergency and retirement saving motives are found to significantly increase the likelihood of saving regularly. Longer saving horizons are also found to have a highly significant effect on the likelihood of saving, while poor health is shown to have a significantly negative effect on the likelihood of saving. The results show that the saving motives held by households differ by saving horizon, but the exact relationships are unclear. Further research on the link between saving motives, saving horizon, and saving behaviors is needed. It is important for financial professionals and educators to consider a household’s saving goals, saving horizon, and health status when making recommendations or developing financial plans.