cssi/SciSciGPT-SciSciNet huggingface dataset:
LGR5 is associated with tumor aggressiveness in papillary thyroid cancer

// Gregory Michelotti 1 , Xiaoyin Jiang 2 , Julie Ann Sosa 3 , Anna Mae Diehl 1 , Brittany Bohinc Henderson 4 1 Division of Gastroenterology, Duke University Medical Center, Durham, North Carolina, USA 2 Department of Pathology, Duke University Medical Center, Durham, North Carolina, USA 3 Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA 4 Division of Endocrinology, Diabetes and Metabolism, Wake Forest University, Winston-Salem, North Carolina, USA Correspondence to: Brittany Bohinc Henderson, e-mail: bbhender@wakehealth.edu Keywords: R-spondin, Wnt, β-catenin, metastasis, BRAFV600E Received: May 07, 2015 Accepted: September 14, 2015 Published: September 25, 2015 ABSTRACT PURPOSE: Leucine-rich repeat-containing G-protein-coupled receptor 5 (LGR5) is a cancer stem cell marker and a down-stream target in Wnt/β-catenin signaling. In human papillary thyroid cancer (PTC), over activation of Wnt/β-catenin has been associated with tumor aggressiveness. PATIENTS AND METHODS: Using established human cell lines (TPC-1, KTC-1, Nthy-ori-3–1), we report LGR5 and R-spondin (RSPO1–3) overexpression in PTC and manipulate LGR5 and Wnt/β-catenin signaling via both pharmacologic and genetic interventions. We test the association of LGR5 tumor expression with markers of PTC aggressiveness using a Discovery Cohort ( n = 26 patients) and a Validation Cohort ( n = 157 patients). Lastly, we explore the association between LGR5 and the BRAFV600E mutation ( n = 33 patients). RESULTS: Our results reveal that LGR5 and its ligand, RSPO, are overexpressed in human PTC, whereby Wnt/β-catenin signaling regulates LGR5 expression and promotes cellular migration. In two separate cohorts of patients, LGR5 and RSPO2 were associated with markers of tumor aggressiveness including: lymph node metastases, vascular invasion, increased tumor size, aggressive histology, advanced AJCC TNM stage, microscopic extra thyroidal extension, capsular invasion, and macroscopic invasion. As a biomarker, LGR5 positivity predicts lymph node metastasis with 95.5% sensitivity (95% CI 88.8%-98.7%) and 61% specificity (95% CI: 48.4%–72.4%) and has a negative predictive value (NPV) of 91.3% (95% CI 79.2%–97.5%) for lymph node metastatic disease. In human PTC, LGR5 is also strongly associated with the BRAFV600E mutation ( p = 0.005). CONCLUSION: We conclude that overexpression of LGR5 is associated with markers of tumor aggressiveness in human PTC. LGR5 may serve as a future potential biomarker for patient risk stratification and loco regional metastases in PTC.
Learning instance specific distance for multi-instance classification

Multi-Instance Learning (MIL) deals with problems where each training example is a bag, and each bag contains a set of instances. Multi-instance representation is useful in many real world applications, because it is able to capture more structural information than traditional flat single-instance representation. However, it also brings new challenges. Specifically, the distance between data objects in MIL is a set-to-set distance, which is harder to estimate than vector distances used in single-instance data. Moreover, because in MIL labels are assigned to bags instead of instances, although a bag belongs to a class, some, or even most, of its instances may not be truly related to the class. In order to address these difficulties, in this paper we propose a novel Instance Specific Distance (ISD) method for MIL, which computes the Class-to-Bag (C2B) distance by further considering the relevances of training instances with respect to their labeled classes. Taking into account the outliers caused by the weak label association in MIL, we learn ISD by solving an l0+ -norm minimization problem. An efficient algorithm to solve the optimization problem is presented, together with the rigorous proof of its convergence. The promising results on five benchmark multi-instance data sets and two real world multi-instance applications validate the effectiveness of the proposed method.
Self-Concept and Significant Others:

Over the past ten years many researchers and theoreticians have studied self-theory as a partial foundation for consumer behavior. Their efforts have been positive in that a theoretical base has been well established, substantive empirical data have been generated, and the need for further research has been emphasized [1, 3, 4, 5, 10]. The strength of the approach is in the incorporation of two substantive phenomena, social interaction and expressive meaning, wherein a person uses symbols to express something about himself [6, p. 83]. One conceptual model incorporates product use as a symbol of consumers' interaction with significant others [4]. A test of this model by Grubb and Hupp showed that consumers of a specific brand have self-concepts similar to those they attribute to other consumers of the same brand, and these self-concepts are significantly different from those attributed to consumers of a competing brand. The results supported the relationship of selfperception to consumption and indicated that these individuals matched brand image with self-image. Further, the results implied that the user of one brand identifies himself with a "generalized user" of the same brand, and by consuming this brand the consumer expresses to others that he wishes to associate himself with the type of people he perceives as consuming that brand. Because the self-concept is maintained and enhanced by positive response from significant others' in the social interaction process, it is essential that they actually perceive and classify the symbol as does the consumer. Unfortunately, specific research designed to determine the relationship of significant others to the purchasing process, particularly relating to maintenance and enhancement of the buyer's self-concept, is nearly nonexistent [5, p. 63]:
Enhancer Regulation of Transcriptional Bursting Parameters Revealed by Forced Chromatin Looping

Mammalian genes transcribe RNA not continuously, but in bursts. Transcriptional output can be modulated by altering burst fraction or burst size, but how regulatory elements control bursting parameters remains unclear. Single-molecule RNA FISH experiments revealed that the β-globin enhancer (LCR) predominantly augments transcriptional burst fraction of the β-globin gene with modest stimulation of burst size. To specifically measure the impact of long-range chromatin contacts on transcriptional bursting, we forced an LCR-β-globin promoter chromatin loop. We observed that raising contact frequencies increases burst fraction but not burst size. In cells in which two developmentally distinct LCR-regulated globin genes are cotranscribed in cis, burst sizes of both genes are comparable. However, allelic co-transcription of both genes is statistically disfavored, suggesting mutually exclusive LCR-gene contacts. These results are consistent with competition between the β-type globin genes for LCR contacts and suggest that LCR-promoter loops are formed and released with rapid kinetics.
CYTOKINE INDUCED MYOCARDIAL DYSFUNCTION IN A PATIENT WITH HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS

Hemophagocytic lymphohistiocytosis (HLH) is a life threatening disorder of uncontrolled immune activation leading to multiorgan dysfunction. Severe congestive heart failure (CHF) due to myocardial dysfunction is rarely associated with HLH especially in healthy children. A 1-year-old previously
Interactions between a new species of Acanthoscelides and a species of verbenaceae, a new host family for bruchidae (Coleoptera)

The new species Acanthoscelides siemensi , which feeds in the seeds of Duranta dombeyana (Verbenaceae) is described from Ecuador. Data gathered on insect-plant interactions indicate that, under natural conditions, gravid females insert eggs into crevices or directly into the immature, fleshy fruits. The oviposition scars probably heal as the fruits mature. The bruchids are heterodynamic in the laboratory and probably have the same behavior in mature fruits under natural conditions. A. siemensi probably has speciated in this new and unusual host because there are few protective mechanisms in the seeds or fruits of the host (40% of the seeds are destroyed), and there is an apparent lack of intense parasitism when in this host (enemy-free space). Mature fruits usually contain viable seeds.
Improving the Harvest of State Legislative Research

The American state legislatures provide a unique opportunity for the study of law-making. This essay describes and analyzes state legislative research since 1990 and offers suggestions for future r...
Who Stays and Who Goes? Racial and Gendered Impact of Shrinking Cities

A number of studies examine the realities of population loss in urban areas, particularly medium sized cities. This paper examines the racial and gendered impact of shrinking cities. As medium-sized cities down-size, neighborhood dynamics regarding race and gender are altered. Particular attention is given to the changes in proximity to neighborhood resources like community groups, medical facilities, grocery stores, and places of worship, as well as employment opportunities, schools, and playground amenities. Additionally, the research notes changes with voting patterns, changing boundaries of precincts, and changes in district boundaries as a result of population loss in medium-sized cities.Using qualitativeresearch and a close reading of the report on communityindicators put together by municipalities, practices of community‐making that intertwine with class, race, and ethnicity are explored.
Evaluation of the Best Nutrition Balance Rice Dietary Standard of Middle School Students

According to Chinese DRIs,the best nutrition balance rice dietary standard of middle school students was developed.Table 1 prompt to junior middle school man students the nutrition balance rice(g) 510～597 g,girl students 468～510 g,higher middle school man students 618～683 g girl students 532～575 g.This were non-staple food alike:greens 600 g, fruit 500 g,fish 100 g or meat 50 g,eggs 40 g,soybeans 30 g,oil 12.5 g,salt 6 g.Table 2 prompt to the protein,fat,carbohydrate and energy of the intakes to the reach DRIS,the energy proportion of protein,fat and carbohydrate:higher middle school students 16∶20∶64, and the junior middle school students 17∶20∶63.It concluded the best nutrition balance rice dietary standard of the middle school students was reach to nutrition balance. Advice the spread best dietary standard.
Chapter 12 Determining In Vivo Activity of the Yeast Cytoplasmic Exosome

A 3'-exoribonuclease complex, termed the exosome, has important functions in the cytoplasm, as well as in the nucleus, and is involved in 3'-processing and/or decay of many RNAs. This chapter will discuss methods to study cytoplasmic exosome function in yeast with in vivo approaches. The first section will describe mutants that are available to study the processing or decay of a specific RNA by the nuclear or cytoplasmic exosome. The second section will discuss methods to determine whether the cytoplasmic exosome is functional under a specific condition(s) with reporter mRNAs that are known substrates of this complex.
MG-134 Validation of a customizable next generation sequencing panel for ear and eye diseases

Background Hearing and/or vision loss can result from both genetic and non-genetic etiologies. Up to 70% of prelingual hearing loss has a genetic basis, as does up to 60% of congenital blindness among infants. Next generation sequencing (NGS) technology is ideal for diagnostic testing for such disorders due to extreme locus heterogeneity and phenotypic overlap. Objectives The aim is to design and validate a comprehensive, customizable NGS panel for detection of pathogenic variants in genes involved in hearing and/or vision loss. Design/method 380 genes were selected for inclusion based on literature review and comparison with commercially available assays, including 245 genes for vision loss and 83 genes for hearing loss. Agilent SureSelect biotinylated RNA baits were designed to capture 1.5 Mb of DNA using SureSelect XT target enrichment followed by Illumina HiSeq 2500 sequencing. DNA from six HapMap cell lines and five Coriell repository samples with known pathogenic variants were used to assess intra-run and inter-run variability. Additionally, DNA from a family with a known hearing loss aetiology was included. Results An average yield of 6 Gb of sequence per sample was obtained, where 94% of bases were covered at a depth >20X. Genotype calls from HapMap samples were highly concordant across three runs. Eight known pathogenic variants were confirmed in GJB2, USH1C, MARVELD2, TRIOBP, and OAT. Conclusions This NGS panel targets an extensive list of genes implicated in diseases of the ear and the eye. Customizable testing allows ordering of an ear-specific or eye-specific gene panel, or both.
A Model-Based Approach for Integrating Executable Architectural Design Patterns in Space Flight Software Product Lines

The unmanned space flight software (FSW) domain contains a significant amount of variability within its required capabilities. Because of the large degree of architectural variability in FSW, it is difficult to develop a FSW software product line (SPL) architecture that covers all possible variations. In order to address this challenge, this paper presents a model-based SPL approach for FSW SPLs that manages variability at a higher level of granularity using executable software architectural design patterns and requires less modeling during SPL engineering but more modeling at the application engineering phase. The executable design patterns are tailored to individual FSW applications during application engineering. The paper describes in detail the application and validation of this approach to FSW.
Comments on Hubert L. Dreyfus “Intelligence without representation”

My main reaction to “Intelligence without representation” is to applaud. Dreyfus’s use of Merleau-Ponty is a refreshing new breeze in philosophy of psychology. About twenty or so years ago, philosophers struck an unfortunate course dictated by a pair of dubious assumptions: (1) that ordinary psychological attributions were at risk unless vindicated by some science; and (2) that the only possible scientific vindication required that intentional content be represented in the brain. Thus did representationalism become, in Jerry Fodor’s memorable phrase, “the only game in town.” As John Haugeland pointed out early on, skills (and moods) do not fit easily into the representationalist scheme. Happily, Dreyfus’s paper goes a considerable way toward an alternative approach to mind. There is one question, however, that I would like to ask. Dreyfus gives the following sufficient conditions for my bodily movements to be experienced as actions:
Aspects of Control for the Organization Design and Manpower Planning Functions

The arrangement, and the process of arranging, an organization's structural characteristics to attain or improve the efficiency, effectiveness, or adaptability of the organization is the essence of organizational design. This paper considers the interface that exists between organizational design and the existence, continuance, and mobility of human resources within the organization, and investigates this interface to identify means to develop some systematic control on the process of organizational redesign as a function of change. Section 1 provides the backdrop for the framework to be considered, while Section 2 specifically delineates the linkages existing between the manpower planning function and the organizational design—redesign process allowing this framework to be developed. Indicators, variables, and dimensions of the information analysis are then discussed in Section 3 and a numerical example of their suggested use provided in Section 4 .
Pregnancy and Anesthesia in Narcolepsy

The management of pregnancy in patients with narcolepsy involves issues regarding the risk to the mother and fetus related to the disease, potential risks at the time of conception and the risk to both the mother and fetus of the medications used to treat narcolepsy, and the risk to the infant from medications that might be secreted in breast milk. In addition there is a question of whether a patient with narcolepsy can safely undergo anesthesia.
Varieties of Near-Death Experience

Near-death experiences are profound subjective events frequently reported by individuals who have come close to death. They are of importance to mental health professionals, not only because they often happen to patients under our care, but because they have been reported to produce widespread and long-lasting changes in values, beliefs, and behavior that dramatically affect the experiencers' attitudes toward living and dying (Bates and Stanley 1985; Bauer 1985; Flynn 1982; Greyson 1983b; Noyes 1980; Ring 1984). Several studies, including surveys of recently resuscitated hospitalized patients (Ring 1980; Sabom 1982) and a nationwide poll of the general population (Gallup and Proctor 1982) have estimated that near-death experiences are reported by 30%-40% of individuals who come close to death, or about 5% of the adult American population.
Cell loading and manpower allocation with fuzzy multiple objectives in synchronised manufacturing cells

This paper seeks to determine the feasibility of using fuzzy concepts in cell loading and manpower allocation to solve multiple objectives scheduling problems in a cellular manufacturing environment. Various manpower allocation levels were considered and then products were assigned to the cells and followed up by product sequencing and manpower allocation decisions in each cell by considering the fuzzy concept. The number of operators needed in a time bucket may be different based on the manpower requirement for each process. Fuzzy mathematical model for cell loading and cell sequencing were developed in multiple cells with multiple objectives. The objectives were to minimise the total manpower shortages simultaneously with the minimum number of time buckets with manpower allocation shortage. Then, additional manpower as floaters were considered to reduce the total number of manpower shortages. The results revealed that multiple objectives with fuzzy functions balanced the manpower allocation and minimised the total shortage.
Understanding particles emitted from spray and wall-guided gasoline direct injection and flex fuel vehicles operating on ethanol and iso-butanol gasoline blends

ABSTRACTTraffic-related pollutants are an ever-growing concern. However, the composition of particle emissions from new vehicle technologies using relevant current and prospective fuel blends is not known. This study tested four current and up-and-coming vehicle technologies with nine fuel blends with various concentrations of ethanol and iso-butanol. Vehicles were driven on both the federal test procedure (FTP) and the unified cycle (UC). Additional tests were conducted under steady-state speed conditions. The vehicle technologies include spray-guided gasoline direct injection (SG-GDI), wall-guided gasoline direct injection (WG-GDI), port-fuel injection flex fuel vehicle (PFI-FFV), and a wall-guided GDI-FFV. The fuels consisted of 10–83% ethanol and 16–55% iso-butanol in gasoline. The composition of soot, water-insoluble mass (WIM), water-soluble organic mass, and water-insoluble organic mass (WIOM), and OM was measured. The majority of emissions over FTP and UC were water-insoluble (>70%), and WIOM cont...
A Nonhealing Periapical Radiolucency

1. Abstract 1.1.Background:This case discusses a radiolucent lesion in the anterior mandible, which initially was thought to be due to endodontic failure. However, the final diagnosis was xanthogranuloma. 1.2.Case description:We have reported a case of xanthogranuloma in the mandible found at the apices of two endodontically treated teeth. When present in the oral cavity, it can appear similar to several more common entities. While the radiolucent periapical lesion was thought to be the result of non-healing root canal therapy, the excisional biopsy yielded the diagnosis of xanthogranuloma. Removal of the lesion has resulted in excellent healing, as the surgeon expected. Practical implications:This case demonstrates the importance of biopsy in definitive diagnosis of oral lesions and lesions found at the apices of previously endodontically treated teeth.
Epstein-Barr Virus

In the century preceding the discovery of Epstein-Barr virus (EBV), physicians speculated that a common clinical syndrome characterized by fever, tonsillar adenopathy, splenomegaly, and mononuclear leukocytosis termed glandular fever was caused by a pathogen (1). In 1920, the name infectious mononucleosis (IM) was introduced by Thomas P. Sprunt and Frank A. Evans to characterize this syndrome (2). Three years later, Hal Downey and C.A. McKinlay described the now-classic atypical lymphocyte as a common feature of this disease (3), and in 1932 John Rodman Paul and Walls Willard Bunnell demonstrated high titers of spontaneously occurring heterophile antibodies in the sera of patients with IM (4), ensuring more accurate diagnosis. In 1961, the British surgeon Denis P. Burkitt gave the first account outside of Africa of “The Commonest Children's Cancer in Tropical Africa” at Middlesex Hospital London, detailing the geographic relationship between Burkitt's lymphoma (BL) and conditions of temperature, altitude, and rainfall associated with development of Plasmodium falciparum malaria (5, 6). M. Anthony Epstein, who was in the audience, became intrigued by the idea that a biological agent might be involved in the etiology of BL, and in 1964, the Epstein laboratory analyzed BL biopsy samples by thin-section electron microscopy and discovered a new, large, icosahedral herpesvirus that could be directly reactivated from in vitro–grown BL cells (7). These initial findings were reported in The Lancet, and the virus was named after Epstein and his graduate student Yvonne Barr (8). Shortly thereafter, two independent groups (9, 10) demonstrated the ability of EBV to transform primary human B lymphocytes into permanently growing lymphoblastoid cell lines (LCLs), providing the first concrete evidence of the ability of EBV to promote human cancer. In 1968, Gertrude Henle and Werner Henle made two further critical observations: (1) that EBV seroconversion occurred during the course of acute IM (AIM) in a laboratory technician (9) and (2) that EBV-carrying LCLs spontaneously formed from a peripheral blood leukocyte culture obtained during the acute phase of the technician's illness. The Henles confirmed their observations through study of sera provided by James Corson Niederman and Robert W. McCollum, who collected blood from incoming Yale freshmen and later from individuals who developed AIM. This study and others demonstrated EBV-specific antibodies in the sera of the students who developed AIM, confirming the etiologic association between EBV and AIM (11).
Influencing College and Higher Education Choices in Disadvantaged Hispanic High School Students Through a School-Based Health Club.

Introduction:Statistics representing professional health care providers do not adequately reflect the shift in the nation’s diverse population. Latinos are significantly underrepresented at all levels of appropriate academic programs critical for entry to health profession careers. This project describes the implementation of a student-run, faculty-facilitated Future Nurse and Health Club at a school (with majority Latino students) to emphasize the importance of higher education in health care. Demographic and psychosocial profiles of club members were also developed to understand community needs.Method:The Future Nurse and Health Club was established in partnership with faculty and researchers representing a university-based nursing program, school officials, and community leaders. Both quantitative and qualitative data were collected from club members and their parents using a variety of techniques including questionnaires and focus groups.Results:The findings of the study highlighted a variety of stude...
Post-thaw recovery of rare or very low concentrations of cryopreserved human sperm.

Objective To analyze cases in which no sperm could be identified after thawing among cryopreserved samples of rare or very low concentrations of sperm. Design Retrospective, single-institution, cross-sectional. Setting Male infertility clinic. Patient(s) We identified couples that underwent intracytoplasmic sperm injection (ICSI) with the use of either ejaculated or testicular cryopreserved-thawed sperm. Inclusion criteria were men with 20 high-power fields. Intervention(s) None. Main Outcome Measure(s) Cases in which no sperm were able to be found post-thaw (i.e., complete cellular loss) for use at the time of a programmed IVF cycle. Result(s) We analyzed 55 men (83 ICSI cycles). There were five ICSI cycles (6.0%) among five different couples in which no sperm could be identified post-thaw. Of these, four cases were from group 1 (8.5%) and one from group 2 (2.8%). Complete cellular loss occurred in 5.8% of testicular sperm samples and 7.1% of ejaculated sperm samples. There were no statistical associations between the ability to locate sperm post-thaw and the pre-cryopreservation parameters or sperm source. Conclusion(s) Failure to retrieve any sperm after thawing of rare or very low concentrations of cryopreserved sperm is an infrequent event and largely limited to those patients with rare quantities of sperm.
The Education of Adults: A World Perspective

(1977). The Education of Adults: A World Perspective. The Journal of Higher Education: Vol. 48, No. 1, pp. 108-110.
Entanglement and decoherence in optical amplifiers

An ideal optical amplifier is generally considered to be a linear device. We show that entanglement between the signal and idler modes can produce nonlinear behavior and decoherence even for small gains where the added noise is negligible.
Investigating the interference of common mode noises of AC/DC power adapters to the touchscreens of consumer electronics

The common mode (CM) noise of power adapters tends to interfere the performance of touchscreens of consumer electronics. However, there's a lack of literature illustrating and modeling the mechanism. This paper investigates the CM noise source impedances of the AD/DC adapters and the characteristics of touchscreens. Based on this understanding, the relationship of CM voltage of an adapter and the CM noise that will influence the performance of touchscreen is disclosed. Also, a noise sensitivity test is performed to investigate a touchscreen's sensitivity to CM noise. The paper also discusses how to agree this test with adapter CM voltage test.
Maybe She Is Relatable: Increasing Women’s Awareness of Gender Bias Encourages Their Identification With Women Scientists

In the current research, we explored whether informing women about gender bias in science, technology, engineering, and mathematics (STEM) would enhance their identification with a female scientist...
Enlarging the Classroom: Practices for Creating Supportive Conditions

Now that we have some grasp of how certain essential variables can bear on students’ learning we are bound to ask how we can intervene to create classroom conditions that support organizing. In this chapter, we will address this question by offering some specific practices aimed at creating supportive conditions.
Diagnostic dilation and curettage: a reappraisal.

Diagnostic dilation and curettage (D&C) is widely considered to be the method of choice for obtaining samples of endometrium for histologic examination, although the scientific basis for this assumption is elusive. Despite extensive use of D&C, the tissue yield and diagnostic accuracy of this technique have not been adequately evaluated. More is known about these features of a newer diagnostic procedure, Vabra aspiration (VA). VA also appears to be safer, less expensive, and more convenient than D&C. Until the alleged benefits of diagnostic D&C can be shown to outweigh its risks and costs (approaching one billion dollars per year in the United States alone), D&C probably should not be the primary procedure used for obtaining most samples of endometrium.
Effective Laparoscopic Repair of Gastrogastric Fistula After Laparoscopic Roux-en-Y Gastric Bypass

Abstract Introduction: Gastrogastric fistula is a communication between the gastric remnant and the gastric pouch. This type of fistula is a rare complication after a Roux-en-Y gastric bypass (RYGB). These types of fistulas may be caused by an anastomotic leak, marginal ulcers, distal obstruction, or erosion from a foreign body. The type of fistula may also form secondary to an undivided stomach with a subsequent staple line failure. Case Presentation: A 50-year-old female who was status post a laparoscopic RYGB at an outside facility in 2010 presented for weight gain. She lost 99 lbs in 2 years after the RYGB but then regained 43 lbs in a couple of months before presentation. At the time of evaluation, the patient's body mass index was 32 kg/m2. An upper gastrointestinal swallow study showed a gastrogastric fistula and an endoscopic gastroduodenoscopy documented the communication between the gastric pouch and remnant stomach. The patient underwent an elective laparoscopic repair of the fistula. Intraoper...
Masked repetition priming treatment for anomia: Inconclusive findings due to methodological limitations1

Q (1) Does repeated exposure to masked repetition primes paired with pictures improve naming of trained and untrained pictures in individuals with anomia? (2) Does masked repetition priming trainin...
Correlates of low-adherence to oral hypoglycemic medications among Hispanic/Latinos of Mexican heritage with Type 2 Diabetes in the United States

Abstract Aims We examined psychosocial- and social/economic factors related to low medication adherence, and sex differences, among 279 adults of Mexican heritage with Type 2 Diabetes. Methods Self-report and health record data were used for cross-sectional analyses. Bivariate analyses tested the association of demographic, psychosocial (depression, anxiety, stress) and social/economic factors (insurance type, health literacy, social support) and medication adherence measured by proportion of days covered. Hierarchical regression analyses examined associations between demographic, psychosocial- and social/economic- related factors and low medication adherence stratified by sex. Results More males than females demonstrated low adherence to hypoglycemic medications (75.0.% vs. 70.3%) (p Conclusions Approximately 72% of Mexican heritage adults demonstrated low adherence (PDC ≤ 0.50) to their hypoglycemic regimen, and gender differences exist. Interventions should address gender differences in preferences for social support to improve medication-taking behaviors among Mexican heritage males.
Deep Reinforcement Learning via L-BFGS Optimization

Reinforcement Learning (RL) algorithms allow artificial agents to improve their action selections so as to increase rewarding experiences in their environments. Deep Reinforcement Learning algorithms require solving a nonconvex and nonlinear unconstrained optimization problem. Methods for solving the optimization problems in deep RL are restricted to the class of first-order algorithms, such as stochastic gradient descent (SGD). The major drawback of the SGD methods is that they have the undesirable effect of not escaping saddle points and their performance can be seriously obstructed by ill-conditioning. Furthermore, SGD methods require exhaustive trial and error to fine-tune many learning parameters. Using second derivative information can result in improved convergence properties, but computing the Hessian matrix for large-scale problems is not practical. Quasi-Newton methods require only first-order gradient information, like SGD, but they can construct a low rank approximation of the Hessian matrix and result in superlinear convergence. The limited-memory Broyden-Fletcher-Goldfarb-Shanno (L-BFGS) approach is one of the most popular quasi-Newton methods that construct positive definite Hessian approximations. In this paper, we introduce an efficient optimization method, based on the limited memory BFGS quasi-Newton method using line search strategy -- as an alternative to SGD methods. Our method bridges the disparity between first order methods and second order methods by continuing to use gradient information to calculate a low-rank Hessian approximations. We provide formal convergence analysis as well as empirical results on a subset of the classic ATARI 2600 games. Our results show a robust convergence with preferred generalization characteristics, as well as fast training time and no need for the experience replaying mechanism.
Tracheostomy for the Neonate and Infant: Indications, Complications, Timing, and Outcomes

Decisions about tracheostomy in neonates and young infants involve careful consideration of a number of factors, including mortality, potential short- and long-term morbidities, prospects for home ventilation therapy, alternatives to tracheostomy and the impact of tracheostomy, and home ventilation on the family. This chapter reviews indications for tracheostomy, complications, mortality, functional and developmental effects of infant tracheostomy, and incidence and timing of decannulation, all of which should influence decisions about whether and when neonatal tracheostomy is performed. Common indications for neonatal and infant tracheostomy include congenital or acquired airway obstruction and chronic medical conditions such as cardiac disease, neuromuscular disease, and bronchopulmonary dysplasia. The indications for infant tracheostomy have changed over time, with the need for long-term ventilation for lung disease becoming more common and acquired subglottic stenosis becoming less common. Similarly, survival after infant tracheostomy has improved, from 71 % in 1989 to 89 % in 2013. However, there remains a considerable concern about the long-term morbidity in infants who undergo tracheostomy. Results of recent studies examining the developmental outcome of these infants are reviewed.
Women's Reproductive Health Education in Catholic Academic Healthcare Institutions: Time for Transparency, Authenticity, and Reflection.

This article illustrates the tensions between the precepts of the Ethical and Religious Directives for Catholic Healthcare Services and the Accreditation Council for Graduate Medical Education as t...
Faculty Development for Teaching International Students: A Seminar Series Approach

This paper describes and reflects on a seminar series in linguistically responsive instruction across academic disciplines, providing faculty in different institutions a model for faculty development in working with international students.
Antimicrobial Susceptibility Profiles To Predict the Presence of Carbapenemase Genes among Carbapenem-Resistant Pseudomonas aeruginosa Isolates.

ABSTRACT Detection of carbapenem-resistant Pseudomonas aeruginosa (CRPA) with carbapenemase-producing (CP) genes is critical for preventing transmission. Our objective was to assess whether certain antimicrobial susceptibility testing (AST) profiles can efficiently identify CP-CRPA. We defined CRPA as P. aeruginosa with imipenem or meropenem MICs of ≥8 μg/ml; CP-CRPA was CRPA with CP genes (blaKPC/blaIMP/blaNDM/blaOXA-48/blaVIM). We assessed the sensitivity and specificity of AST profiles to detect CP-CRPA among CRPA isolates collected by CDC’s Antibiotic Resistance Laboratory Network (AR Lab Network) and the Emerging Infections Program (EIP) during 2017 to 2019. Three percent (195/6,192) of AR Lab Network CRPA isolates were CP-CRPA. Among CRPA isolates, adding not susceptible (NS) to cefepime or ceftazidime to the definition had 91% sensitivity and 50% specificity for identifying CP-CRPA; adding NS to ceftolozane-tazobactam had 100% sensitivity and 86% specificity. Of 965 EIP CRPA isolates evaluated for CP genes, 7 were identified as CP-CRPA; 6 of the 7 were NS to cefepime and ceftazidime, and all 7 were NS to ceftolozane-tazobactam. Among 4,182 EIP isolates, clinical laboratory AST results were available for 96% of them for cefepime, 80% for ceftazidime, and 4% for ceftolozane-tazobactam. The number of CRPA isolates needed to test (NNT) to identify one CP-CRPA isolate decreased from 138 to 64 if the definition of NS to cefepime or ceftazidime was used and to 7 with NS to ceftolozane-tazobactam. Adding not susceptible to cefepime or ceftazidime to CRPA carbapenemase testing criteria would reduce the NNT by half and can be implemented in most clinical laboratories; adding not susceptible to ceftolozane-tazobactam could be even more predictive once AST for this drug is more widely available.
Progression to Transplant under New Heart Allocation System: The Society of Thoracic Surgeons Intermacs Database.

Abstract: Background Under the new heart allocation policy, durable left ventricular assist devices receive lower priority on the transplant list. We sought to identify predictors of successful heart transplant after durable device implant as a means to inform patient care in the current era. Methods All patients (n=25,164) undergoing primary durable left ventricular device implant in the Society of Thoracic Surgeons Intermacs database (2010-2019) were evaluated. Patients identified as bridge to transplant (BTT, n=5242) or bridge to candidacy (BTC, n=6248) were analyzed with the endpoint of transplant before (n=10,588) and after (n=902) the change in the heart allocation system on October 18, 2018. Multivariable hazard modeling was used to assess risk-adjusted time to event associations. Results Of 11,490 patients, 45.5% progressed to transplant, (BTT 53.0%, BTC 36.6%), most by 14 months post LVAD. Under the new allocation system, progression to transplant was significantly lower at 14 months (18.6% vs. 34.8%, p Conclusions Despite having priority in the previous allocation system, less than half of BTT/BTC patients progressed to transplant. Under the current system, these numbers are further reduced. Heart teams should consider the implications of longer wait times with a durable left ventricular assist device when determining the optimal bridging strategy.
Relationship between the natural abundance of soil nitrogen isotopes and condition in North Dakota wetlands

Abstract A statewide condition assessment of North Dakota wetlands in the summer of 2011 was conducted as part of the U.S. Environmental Protection Agency's National Wetland Condition Assessment (NWCA). Two other wetland condition assessments, the Index of Plant Community Integrity (IPCI) and North Dakota Rapid Assessment Method (NDRAM), were also completed at each wetland. Previous studies have identified how the distinct signatures of stable isotopes can be used to determine different land uses, anthropogenic impacts, nutrient cycling, and biological processes. To evaluate if these relationships existed in northern prairie wetlands, the data collected from the wetland assessments were compared with the natural abundance of soil nitrogen (δ15N) isotopes. Wetland soil δ15N was significantly higher (isotopically heavier) in wetlands surrounded by cropland compared to those surrounded by idle or grazed/hayed grasslands, possibly reflecting anthropogenic impacts and multiple nitrogen sources. Soil δ15N was significantly correlated with floristic quality, IPCI scores, NDRAM scores, and average buffer width, indicating that soil δ15N values may be representative of wetland condition. Soil δ15N exhibited significant differences among wetland types, although limited sample sizes of certain wetland types may have affected this result. Additional studies on the natural abundance of wetland soil isotopes need to be performed in northern prairie wetlands. This study is the first step in exploring the potential applications of wetland soil nitrogen isotopes regarding wetland assessment and surrounding land use and provides important insight for future studies.
Emerging issues in ulcerative colitis and ulcerative proctitis: individualizing treatment to maximize outcomes.

Ulcerative colitis (UC) is a chronic disease of the bowel, characterized by inflammation of the colonic mucosa. Symptoms include rectal bleeding, diarrhea, and abdominal cramping. Approximately 250,000–500,000 individuals in the United States suffer from UC, and its annual incidence ranges from 2–7 per 100,000 people.1 Although the pathophysiology of UC is not fully understood, an abnormal immune response causes chronic inflammation, which is believed to be triggered by both environmental and genetic factors (Figure 1). Open in a separate window Figure 1 Etiology and pathogenesis of ulcerative colitis.
Primary sclerosing cholangitis, autoimmune hepatitis, and overlap in Utah children: epidemiology and natural history.

The epidemiology and natural history of pediatric primary sclerosing cholangitis (PSC), autoimmune sclerosing cholangitis (ASC), and autoimmune hepatitis (AIH) are not well characterized. Using multiple, overlapping search strategies followed by a detailed records review, we identified all cases of pediatric PSC, ASC, AIH, and inflammatory bowel disease (IBD) in a geographically isolated region of the United States. We identified 607 cases of IBD, 29 cases of PSC, 12 cases of ASC, and 44 cases of AIH. The mean age at diagnosis was 13.0 years for PSC, 11.3 years for ASC, and 9.8 years for AIH. The incidence and prevalence of PSC, ASC, and AIH were 0.2 and 1.5 cases, 0.1 and 0.6 cases, and 0.4 and 3.0 cases per 100,000 children, respectively. The mean duration of follow-up was 5.9 years. The probability of developing complicated liver disease within 5 years of the diagnosis of liver disease was 37% [95% confidence interval (CI) = 21%-58%] for PSC, 25% (95% CI = 7%-70%) for ASC, and 15% (95% CI = 7%-33%) for AIH. The 5-year survival rates with the native liver were 78% (95% CI = 54%-91%) for PSC, 90% (95% CI = 47%-99%) for ASC, and 87% (95% CI = 71%-95%) for AIH. Cholangiocarcinoma developed in 2 of the 29 PSC patients (6.9%). PSC occurred in 9.9% of patients with ulcerative colitis (UC) and in 0.6% of patients with Crohn's disease (CD). ASC occurred in 2.3% of UC patients and 0.9% of CD patients. AIH occurred in 0.4% of UC patients and in 0.3% of CD patients. Liver disease occurred in 39 of 607 IBD patients (6.4%) overall. Conclusion: Immune-mediated liver diseases are important sources of morbidity in children. Using a population-based design, this study quantifies the burden and natural history of immune-mediated liver disease in children. (Hepatology 2013;58:1392–1400)
A follow-up study of the commission on chronic illness morbidity survey in Baltimore—III: Residential mobility and prospective studies

Abstract Residential mobility of the study population is an important factor to be anticipated and planned for in the conduct of prospective studies. Here we have presented data on residential mobility among the Baltimore City survey population originally interviewed by the Commission on Chronic Illness in 1953–1954 and followed for address and survivorship in 1960–1962. Within this interval, averaging around 6 yr, over half the whites and two-thirds of the non-whites had changed residences. Variation by race, age, and to some extent socio-economic status, was observed in both the volume of mobility and the destination of movers. The experience gained in our study suggests that in a prospective study of a large central city population, the greatest effort must be expended in tracing persons who move within the central city rather than beyond its limits, and this is particularly the case of the non-white population who move frequently but for whom restrictions have prevented movement into the fringes of metropolitan areas. The problem of tracing persons to out-of-state destinations was relatively minor for both whites and non-whites. Our findings indicate also that when matched by age, hospitalized persons, often the subjects for prospective studies, have roughly the same residential mobility patterns as persons who have not been hospitalized. Thus, in terms of ease of tracing, such persons present no particular advantage. Some information has been presented to show that attrition in the study population, largely through residential mobility, can alter the results of research investigations. With near-complete follow-up of our population, we found no race differences in mortality within our sample. However, had our analysis been based on a follow-up terminated at a point where we began to employ intensive measures to reach the “hard-core”, we would have found race differences in mortality among females. Last, because white out-migrants appear to be selective of persons with lower mortality, it has been suggested that the total death rate of Baltimore City, as well as race differences in death rates, may have been affected by migration patterns.
An Inventory of Carbon Storage in Forest Soil and Down Woody Material of the United States

The U.S. Department of Agriculture Forest Service Forest Inventory and Analysis (FIA) program conducts an annual forest inventory which includes measurements of down and dead wood and soil characteristics as indicators of forest health. Both indicators are measured on a systematic nationwide array of approximately 7800 plots where each one may represent up to 38,850 ha. Between 10 and 20% of these plots are measured every year. The down woody material indicator includes measurements of coarse and fine downed and deadwood. Carbon (C) storage in these down woody materials is estimated using line intersect biomass estimators and C conversion constants. The soil quality indicator is based on a range of statistically based methods including volumetric sampling of the forest floor and the collection of mineral soil cores representing depth increments of 0―10 and 10―20 cm. Carbon content of the soil samples is determined by dry combustion. We combined indicator measurements collected over 3 years (2001―2003) to estimate the C storage in soil and down wood in forests of the United States. Preliminary results suggest that as much as 80 Mg ha ―1 of C may be stored in forest soil and down woody material in some locations. Carbon storage by component is roughly ranked as follows: 0―10 cm mineral soil >10―20 cm mineral soil > the forest floor > coarse wood > fine wood. Preliminary spatial analysis of the C stocks in the North Central region of the United States illustrates the influences of latitude on C storage.
A Review of “In God's Empire: French Missionaries and the Modern World“

As Owen White and J. P. Daughton note in introducing their excellent anthology In God's Empire, the role of missionaries in the French empire has long been overlooked, despite a proliferation of sc...
The Use of Structural Distal Femoral Allograft for Acetabular Reconstruction of Paprosky Type IIIA Defects at a Mean 21 Years of Follow-Up

Abstract Background Revision total hip arthroplasty in patients with a nonsupportive superior acetabulum often requires secondary augmentation beyond a hemispherical cup to achieve reliable fixation. Treatment options include using a higher hip center, jumbo cup, custom triflange implant, cages, or filling the superior defect with a bilobed implant, structural allograft, or metal augments. We previously reported a cohort of 31 patients treated with porous-coated hemispherical cups and distal femoral allograft for Paprosky type IIIA acetabular defects. Methods The original cohort of 31 hips was retrospectively reviewed. Fourteen patients died with Results Overall, 7 hips failed, resulting in a Kaplan-Meier survivorship of 72% at 25 years of follow-up. In surviving patients, radiographs demonstrated components to be well fixed, and average Merle d'Aubigne score increased from 5 to 10 points. There were a subset of patients that failed early (median: 6.2 years), but the remaining patients demonstrated excellent clinical and radiographic results. Conclusions The use of distal femoral allograft can be considered in young patients with type IIIA acetabular defects that could benefit from restoration of bone stock.