cssi/SciSciGPT-SciSciNet huggingface dataset:
187 COLONOSCOPY MISS RATES FOR COLON CANCER AMONG VETERANS.

Background and Aims Colonoscopy has limitations in diagnosing colorectal neoplasia (CRC) and 4-12% of lesions can be missed. CRC miss rate has been studied in various settings, but no data are available for CRC miss rate among US veterans undergoing colonoscopy. Aims To evaluate miss colorectal cancer rate among veterans undergoing colonoscopy at VA Medical Center at Memphis (VAMC) and to identify factors related to CRC miss rate. Methods Cases of primary colorectal adenocarcinoma at VAMC between January 1, 2000 and April 30, 2005 were identified from a local tumor registry. These cases were cross-referenced with pathology databases to ensure accuracy of report. During this period, patients with two or more colonoscopies at our institution were identified from the endoscopic database. Retrospective chart review was done to obtain data related to missed cancer. A "real-life " estimate of missed cancer diagnosis was then determined. Results 685 veterans underwent two or more colonoscopies during January 1, 2000 to April 30, 2005. Five cases of missed colorectal cancer were found among this group (2% of all the CRC diagnosis at VAMC, Memphis during this time interval). All patients were male, and 4/5 were white. Mean age at index colonoscopy was 73 years (range 63-82 years). Gastroenterology fellows or surgical residents performed 2/5 index colonoscopies under the supervision of a staff physician. Cancer diagnosis was made at a mean interval of 33.2 months after index colonoscopy (range 17-47 months); 4/5 lesions were proximal to the splenic flexure. Colon preparation was described as fair or good in all patients. Indications for the follow-up exam were surveillance colonoscopy (2 patients), persistent anemia with weight loss or abdominal pain (2 patients), and large bowel obstruction (1 patient). In our patient group, the primary factor identified for missing a diagnosis of CRC was failure to complete a follow-up exam in the recommended interval (1-yr surveillance in 2 patients and 3-yr surveillance in 1 patient). Eighty percent of the neoplasms were stage III or higher and 3/5 patients had expired by the end of follow-up. Missed colorectal cancer diagnosis among veterans population undergoing repeat colonoscopy occurred in only 0.73% of cases. Conclusions Missed colorectal cancer diagnosis among veterans at our institution is rare. Failure to diagnose colorectal cancer in this population relates to a discrepancy in physician-recommended surveillance intervals and actual patient follow-up. Patients with delayed diagnosis of colon cancer present with advanced tumor stages, but it is unclear how survival is impacted.
Cognition in reach: continuous statistical inference in optimal motor planning.

We study the projection of cognitive representations into continuous motor (reaching) responses with a computational model that unifies three influential approaches: accumulation of evidence, statistical inference, and optimal feedback control. We modeled a number comparison task that asked participants to respond with a reaching gesture which of two side had more dots. The model successfully reproduced subjects’ pattern of reach and performance across varying difficulties of numerical comparison. Our model parameterized several potentially relevant cognitive variables, including a threshold, memory decay, and mental sampling rate. Remarkably, a threshold for movement was not needed for modeling human behavior when statistical inference is combined with optimal motor planning. Overall, the model indicates that the motorsystem positions the effectors optimally, both biomechanically through an optimal feedback controller, and cognitively by means of continuous statistical inference on the available evidence.
Proof Testing to Assure Reliability of Structural Ceramics

A reliability analysis for ceramics under complex tensile stresses in service must take into account both the variability and time-dependency of strength exhibited by these materials. Principles of fracture mechanics coupled with Weibull statistics and finite element analysis can be used for these purposes. To improve reliability, proof testing is often used since it can eliminate the weaker specimens before they are put into service; however, proof testing may not duplicate the stress distribution in service. The effectiveness of proof testing under these conditions is discussed with reference to a case study.
Bone Marrow Cell Rejection, MHC, NK Cells, and Missing Self Recognition: Ain't That Peculiar (with Apologies to Marvin Gaye).

Much modern research is quite focused, attempting to understand aspects of systems that are already revealed in broad outline. Researching a problem at its birth is an opportunity that many will never experience, a lonely exercise that many may avoid. In these situations, pre-existing findings from
Protein kinase C activity does not mediate the inhibitory effect of carbachol on chloride secretion by T84 cells

Carbachol induces calcium-dependent chloride secretion and activates protein kinase C in T84 cells. However, prolonged stimulation with carbachol or direct activation of protein kinase C inhibits subsequent calcium-dependent chloride secretion. Furthermore, the ability of carbachol to elevate inositol tetrakisphosphate levels may be linked to inhibition of chloride secretion. Here we demonstrate that protein kinase C activation increases levels of inositol tetrakisphosphates (1,3,4,6- and 3,4,5,6-isomers) in T84 colonic epithelia. Furthermore, this corresponds to an inhibition of chloride secretion. However, protein kinase C is unlikely to mediate the analogous effects of carbachol. Neither the ability of carbachol to inhibit calcium-dependent chloride secretion nor its effects on inositol 3,4,5,6-tetrakisphosphate levels were reversed by staurosporine. Carbachol also has quantitatively and qualitatively different effects on inositol tetrakisphosphate isomers than protein kinase C activators. Thus protein kinase C activity can increase levels of various inositol tetrakisphosphate isomers within T84 cells but does not mediate carbachol-induced increases in these putative messengers. These data further support the hypothesis that inositol 3,4,5,6-tetrakisphosphate is a negative second messenger, uncoupling epithelial chloride secretion from changes in intracellular calcium.
Kinetic and mechanistic investigations of the direct synthesis of dimethyl carbonate from carbon dioxide over ceria nanorod catalysts

Abstract The direct conversion of carbon dioxide (CO 2 ) to organic carbonates such as dimethyl carbonate (DMC) is favored only at low temperatures. However, these reactions are typically conducted at high temperatures due to poor reaction kinetics. In this article, the reaction kinetics were experimentally investigated for the direct conversion of CO 2 and methanol to DMC using a ceria nanorod catalyst and were compared with those of a highly crystalline commercial ceria catalyst. The apparent activation energy for this reaction over our nanorod catalyst was determined to be 65 kJ/mol whereas that of a commercial ceria catalyst was measured to be 117 kJ/mol. The reaction rate law was found to be approximately first order with respect to both catalysts, with an apparent negative one reaction order with respect to methanol. These results were found to be consistent with a Langmuir–Hinshelwood type reaction mechanism where CO 2 and methanol adsorption occurs in separate reaction steps.
Comparison of Particulate Air Samplers for Detection of Airborne Aspergillus flavus Spores.

Four air samplers (Millipore, all-glass impinger, Andersen and absorbent cotton) were evaluated for their ability to collect airborne grain particles contaminated with Aspergillus flavus spores. Corn dust containing 6.4 × 106 spores/g was aerosolized within a containment system. Each device sampled 100 L of air, thus exchanging the air in the chamber two times. Spores were enumerated from all sampling matrices using Aspergillus flavus / parasiticus agar. The efficiencies of the Millipore and the cotton samplers were almost identical, while that of the all-glass impinger was less. Measurement of particle size with the Andersen sampler revealed that these spores were associated with particles of various sizes.
Thermal conductivity enhancement of laser induced graphene foam upon P3HT infiltration

Significant research has been dedicated to the exploration of high thermal conductivity polymer composite materials with conductive filler particles for use in heat transfer applications. However, poor particle dispersibility and interfacial phonon scattering have limited the effective composite thermal conductivity. Three-dimensional foams with high ligament thermal conductivity offer a potential solution to the two aforementioned problems but are traditionally fabricated through expensive and/or complex manufacturing methods. Here, laser induced graphene foams, fabricated through a simple and cost effective laser ablation method, are infiltrated with poly(3-hexylthiophene) in a step-wise fashion to demonstrate the impact of polymer on the thermal conductivity of the composite system. Surprisingly, the addition of polymer results in a drastic (250%) improvement in material thermal conductivity, enhancing the graphene foam's thermal conductivity from 0.68 W/m-K to 1.72 W/m-K for the fully infiltrated comp...
Context-Specific Recommendation System for Predicting Similar PubMed Articles

Prioritizing a database of items in response to a given query object is a fundamental task in information retrieval and machine learning. We examine a specific realization of this problem in the context of a collection of biomedical articles. Given a query PubMed article, we investigate the problem of identifying and ranking recommended papers that are topically related to the query article. The two major classes of existing methods for this task are based on Natural Language Processing (NLP) techniques (including algebraic analyses), and those that incorporate structural information among articles, such as their co-citation networks or content similarity. In this paper, we propose a statistically rigorous method, called Context Specific Recommendation System (CSRS), along with associated algorithmic machinery to integrate structural and context-based sources of information to construct a single context-specific interaction network. We utilize this specialized network to rank papers (nodes) in terms of their similarity to query papers. Using a manually curated dataset of PubMed articles, we show that our method significantly outperforms other methods based on either the citation networks or content similarity of articles. Our methods provide a general framework that can be used to integrate other types of relationships into the recommendation process.
National Survey of US Public Transit Agency Experience with and Response to Extreme Weather Events

Extreme weather events disrupt transit operations, impair service quality, increase threats to public safety, and damage infrastructure. This paper presents the findings from a recent national survey of public transit agencies in the US investigating their extreme weather experiences, perceived risks, responses, coordination efforts and preparation activities. We find that extreme events are common and transit managers perceive increased risks from these events. Most agencies rely on the ex post emergency management approaches rather than proactive adaptation to future expected extreme weather. Limited financial resources is the greatest challenge to adaptation planning and preparation.
Effect of (n, 2n) and (n, α) Reactions on Age Calculations for Beryllium

The effect of incorporating the (n, 2n) and (n, α) reactions into Fermi age calculations for beryllium has been studied. If one neglects these effects an age to 1.44 ev of 85 cm2 is computed, inclu...
An efficient and compact row buffer architecture on FPGA for real-time neighbourhood image processing

This work presents a compact and efficient row buffer (RB) architecture on field-programmable gate array (FPGA). The design confines multiple RBs within the full capacity of Xilinx Block RAM (BRAM) in contrast to the conventional approach which partially utilizes a full BRAM per RB. The configuration of BRAM with different port aspect ratio and its data accessing via an efficient pattern generator circuitry allows the design to buffer pixelwise image data and retrieve multiple pixels per clock in a predefined pattern to achieve the functionality of multiple RBs. The design uses smallest BRAM18 primitive to be scaled in small steps for any larger kernel and image size for providing the best economical solution. The proposed architecture retains the bandwidth requirement to 1 pixel/clock at an ideal efficiency of 1 clock/pixel along with the saving of up to 87.5% BRAMs as compared to the conventional RBs and at the same time sustains high frame rates ( $$1920\times 1080$$ @ 217 fps) to support real-time image processing. Therefore, it is feasible to replace conventional high-cost RBs with our proposed RBs on latest FPGA devices especially for high performance yet area constraint neighbourhood image processing applications.
Vascular Pericyte Impairment and Connexin43 Gap Junction Deficit Contribute to Vasomotor Decline in Diabetic Retinopathy.

Adequate blood flow is essential to brain function, and its disruption is an early indicator in diseases, such as stroke and diabetes. However, the mechanisms contributing to this impairment remain unclear. To address this gap, in the diabetic and nondiabetic male mouse retina, we combined an unbiased longitudinal assessment of vasomotor activity along a genetically defined vascular network with pharmacological and immunohistochemical analyses of pericytes, the capillary vasomotor elements. In nondiabetic retina, focal stimulation of a pericyte produced a robust vasomotor response, which propagated along the blood vessel with increasing stimulus. In contrast, the magnitude, dynamic range, a measure of fine vascular diameter control, and propagation of vasomotor response were diminished in diabetic retinas from streptozotocin-treated mice. These functional changes were linked to several mechanisms. We found that density of pericytes and their sensitivity to stimulation were reduced in diabetes. The impaired response propagation from the stimulation site was associated with lower expression of connexin43, a major known gap junction unit in vascular cells. Indeed, selective block of gap junctions significantly reduced propagation but not initiation of vasomotor response in the nondiabetic retina. Our data establish the mechanisms for fine local regulation of capillary diameter by pericytes and a role for gap junctions in vascular network interactions. We show how disruption of this balance contributes to impaired vasomotor control in diabetes. SIGNIFICANCE STATEMENT Identification of mechanisms governing capillary blood flow in the CNS and how they are altered in disease provides novel insight into early states of neurological dysfunction. Here, we present physiological and anatomical evidence that both intact pericyte function as well as gap junction-mediated signaling across the vascular network are essential for proper capillary diameter control and vasomotor function. Changes to capillary blood flow precede other anatomical and functional hallmarks of diabetes establishing a significant window for prevention and treatment.
Orientalism and the Postcolonial Predicament: Perspectives on South Asia. By Carol A. Breckenridge and Peter van der Veer, editors. 1993. Philadelphia: University of Pennsylvania Press

Orientalism and the Postcolonial Predicament: Perspectives on South Asia . By Carol A. Breckenridge and Peter van der Veer, editors. 1993. Philadelphia: University of Pennsylvania Press. viii, 355 pp. Reviewed by James F. Fisher , Professor of Anthropology, Carleton College, Northfield, Minnesota.
Does competition matter in measures of job accessibility? Explaining employment in Los Angeles

Abstract Planning organizations are increasingly looking to accessibility measures to understand how well the transportation system provides access to employment opportunities. However, the most common type of job accessibility measure employed in planning practice, the cumulative opportunity measure, considers job supply but overlooks competition for jobs. Therefore, the cumulative opportunity measure may not fully capture workers' access to job opportunity. In this paper, we examine four accessibility measures, two of which account for spatial competition and the other two do not, using the Los Angeles metropolitan area as a case study. We find that measures of competitive accessibility have stronger associations with employment than non-competitive accessibility measures. We examine the relationship between residential accessibility and employment for four separate levels of educational attainment, and we find that competitive measures are especially pertinent for population segments with lower educational attainment. Therefore, we recommend competitive accessibility measures to assess the employment opportunity more accurately.
Conclusions and Further Work

This research is diverse and wide ranging. It has covered in some detail all areas necessary to determine the reliability of steel columns protected by intumescent coatings subjected to natural fires. One zone model for predicting the gas temperature of post-flashover fires and its sub-models have been reviewed in detail.
Governmental influence on unreserved fund balances for Mississippi counties

This research examines the relative influences of different forms of government on local governments' financial management. Specifically, it seeks to determine whether or not the impact of financial and environmental factors on the unreserved fund balance differs between an administrative form of government, such as the Unit system, and a political form of government, such as the Beat system of county governments in Mississippi. The purpose of this study is to explain further why governments maintain far more savings than are the recommended benchmarks. The findings suggest that savings behave differently under different financial environments. During times of resource abundance, Beat systems increase savings as per capita income, property tax, and other revenues increase. Beat systems decrease savings as the population, debt per capita, and intergovernmental revenues increase. Unit systems, however, increase savings as property tax, intergovernmental and other revenues increase, but decrease savings as per capita income, population, and debt per capita increase. During times of resource scarcity, majority-non-white counties spent savings at a much slower rate than did the majority-white counties.
Thermoreflectance imaging of electromigration evolution in asymmetric aluminum constrictions

Electromigration (EM) is a phenomenon whereby the flow of current in metal wires moves the underlying atoms, potentially inducing electronic interconnect failures. The continued decrease in commercial lithographically defined feature sizes means that EM presents an increasing risk to the reliability of modern electronics. To mitigate these risks, it is important to look for novel mechanisms to extend lifetime without forfeiting miniaturization. Typically, only the overall increase in the interconnect resistance and failure voltage are characterized. However, if the current flows non-uniformly, spatially resolving the resulting hot spots during electromigration aging experiments may provide better insights into the fundamental mechanisms of this process. In this study, we focus on aluminum interconnects containing asymmetric reservoir and void pairs with contact pads on each end. Such reservoirs are potential candidates for self-healing. Thermoreflectance imaging was used to detect hot spots in electrical ...
Surgeons overestimate postoperative complications and death when compared with the National Surgical Quality Improvement Project risk calculator.

Abstract Background The assessment of postoperative morbidity and mortality is difficult particularly for complex patients. We hypothesize that surgeons overestimate the risk for complications and death after surgery in complex surgical patients. Materials and methods General surgery residents and attending surgeons estimated the likelihood of any morbidity, mortality, surgical site infection, pneumonia, and cardiac complications for seven complex scenarios. Responses were compared with the American College of Surgeons National Surgical Quality Improvement Project Surgical Risk Calculator. Results From 101 residents and 48 attending surgeons, overall response rate was 61.7%. For all seven clinical scenarios, there was no difference between resident and attending predictions of morbidity or mortality, with significant variation in estimates among participants. Mean percentages of the estimates were 25.8%-30% over the National Surgical Quality Improvement Project estimates for morbidity and mortality. Conclusions General surgery residents and attending surgeons overestimated risks in complex surgical patients. These results demonstrate broad variance in and near universal overestimation of predicted surgical risk when compared with national, risk-adjusted models.
GNAS shifts metabolism in pancreatic cancer.

Specific combinations of mutations cause unique signalling and metabolic requirements. Concurrent G-protein αs (GNAS) and KRAS mutations in a subset of pancreatic tumours are now shown to inhibit SIK kinases through aberrant cAMP–PKA activation, triggering a metabolic program defined by lipid metabolism and fatty acid oxidation.
The Effect of Ouabain on the Rabbit Corneal Endothelium

With the method of in vitro incubation of the isolated rabbit cornea with the modified KEI medium, the effects of ouabain applied to the endothelial surface have been investigated. The change in corneal hydration with varying concentrations of ouabain was determined; one-half maximum rate of corneal swelling was found at an ouabain concentration of 3 x 10~ 7 moles per liter. Endothelial permeability in corneas exposed to ouabain was evaluated by assessing permeability to water flow and to radioactive nonelectrolytes. No significant change in these permeability coefficients was found in the corneas which were swelling under the influence of ouabain as compared to normal corneas.
Aerosol light absorption from attenuation measurements of PTFE-membrane filter samples: implications for particulate matter monitoring networks

Abstract. Mass absorption cross-section (MAC) measurements of atmospherically-relevant aerosols are required to quantify their effect on Earth’s radiative budget. Estimating aerosol light absorption from transmittance and/or reflectance measurements through filter deposits is an attractive option because of ease of deployment in field settings and low cost. These measurements suffer from artifacts that depend on a given filter measurement system and type of aerosol. Empirical correction algorithms are available for commercial instruments equipped with optically-thick fiber filters, but optically-thin filter media have not been characterized in detail. Here, we present empirical relationships between particle light absorption–measured using multi-wavelength integrated photoacoustic spectrometers and nephelometers–and attenuation measurements for polytetrafluoroethylene (PTFE) membrane filter samples of carbonaceous aerosols generated from combustion of diverse biomass fuels and kerosene (surrogate for fossil-fuel combustion). We establish a simple, wavelength-independent formulation for calculating aerosol MAC and absorption coefficients from filter attenuation measurements. We find the ratio between in-situ absorption and bulk attenuation to be inversely proportional to aerosol single scattering albedo. As a case study, we apply our formulations on 2010 attenuation datasets of the Interagency Monitoring of PROtected Visual Environments (IMPROVE) network to quantify the overestimation in their filter-based absorption coefficients.
Battle Against the Machines: World War II 1939–1945

While the 1930s saw the first efforts to cryptanalyze the new cipher machines, the advent of World War II made this work must more imperative. The Enigma, the Typex and the M-134C/SIGABA were the epitome of these machines and the efforts to create and cryptanalyze them led us into the computer age. This chapter examines the race to break the ever more sophisticated cipher machines of the 1940s and looks in some detail at the cryptographic construction of the Enigma and the M-134C/SIGABA.
Surface versus solution chemistry: manipulating nanoparticle shape and composition through metal–thiolate interactions

Nanostructures with well-defined crystallite sizes, shapes, and compositions are finding use in areas such as energy, security, and even medicine. Seeded growth is a promising strategy to achieve shape-controlled nanostructures, where specific structural features are often directed by the underlying symmetry of the seeds. Here, thiophenol derivatives capable of different metal-thiolate interactions were introduced into the synthesis of Au/Pd nanostructures by seed-mediated co-reduction. Our systematic analysis reveals that the symmetry and composition of the bimetallic nanoparticles (NPs) can be tuned as a function of additive binding strength and concentration, with symmetry reduction observed in some cases. Furthermore, additives with both thiol and amine functionalities facilitate random branching on the octahedral seed. Significantly, this synthetic versatility arises because the thiophenol derivatives modify both the surface capping of the growing nanostructures and the local ligand environment of the metal precursors, highlighting how the dual roles of synthesis components can be exploited to achieve high quality bimetallic nanostructures.
Ibrutinib for the Treatment of Chronic Graft Versus Host Disease in Pediatric Patients

Background Ibrutinib, a Bruton's Tyrosine Kinase inhibitor, is FDA approved for the treatment of chronic graft versus host disease (cGVHD) in adults. No data exist for the use of ibrutinib in pediatric patients. Methods We conducted a retrospective review on the use of ibrutinib for cGVHD at Cincinnati Children's Hospital Medical Center (CCHMC). All patients received an initial dose of 250 mg/m2 orally, once daily (max 420 mg), rounded to the nearest 70 mg for ease of administration. The ibrutinib dose was halved if patients were also on a strong concomitant CYP3A4 inhibitor. Responses were measured at 6 months after drug initiation using the 2014 NIH consensus panel response criteria. Plasma IL6 and CXCL9 before and after ibrutinib initiation were analyzed as surrogate markers of effectiveness. Results Twelve patients, median age 11 years (range 3-19), received ibrutinib between August 2017- October 2018 at CCHMC (Figure 1). Chronic GVHD grades were severe (n=8), moderate (n=1) and mild (n=3) at ibrutinib initiation. Ten patients had ≥2 organs involved, with skin being the predominant organ (n=9) followed by lung (n=6) and eyes (n=7). Two patients had steroid dependent cGVHD, while the rest were steroid-refractory. Eight patients were on a median steroid dose of 0.9 mg/kg/day at ibrutinib initiation. Median number of systemic cGVHD medications prior to ibrutinib was 2 (range 1-5). The median dose of ibrutinib was 140 mg (range 70-420 mg) daily, and median duration was 170.5 days (range 28-341 days). Four patients stopped ibrutinib on 28, 41, 54 and 82 days due to adverse events or death and could not be evaluated for 6-month response. Adverse events leading to discontinuation included recurrent fevers without a source (n=1), bleeding mouth sores (n=1), gastrointestinal distress with mouth sores (n= 1) and death due to pneumococcal sepsis(n=1) Of the 8 evaluable patients, 8 achieved a partial response at 6 months. Four of 6 patients with lung involvement had stable (n=2), improved (n=1) or recovered (n=1) lung function at 6 months. One patient had EBV reactivation, and 1 patient developed pneumococcal sepsis despite appropriate prophylactic therapy while on ibrutinib therapy. No fungal infections occurred while on ibrutinib. Additional adverse events reported included thrombocytopenia, neutropenia, muscle spasms and fatigue. Steroids were weaned in 8 patients to 50% of pre-ibrutinib dose (n=5), physiologic steroids (n=2) or discontinued (n=1) by 6 months. A decline in plasma IL-6 and CXCL9 levels was noted in all but one patient (Figure 2A and B). Interestingly, the patient with increasing cytokine levels was the patient discontinued from therapy early for recurrent fevers. Conclusion Ibrutinib administration at our proposed dosing regimen shows promising responses in cGVHD as salvage therapy. Larger studies are needed to establish dosing and efficacy in children
Deleterious Germline Mutations Are a Risk Factor for Neoplastic Progression Among High-Risk Individuals Undergoing Pancreatic Surveillance

PURPOSETo compare the risk of neoplastic progression by germline mutation status versus family history without a known germline mutation (familial risk) among individuals with an increased risk for...
Clerkship Grading Committees: the Impact of Group Decision-Making for Clerkship Grading.

Faculty and students debate the fairness and accuracy of medical student clerkship grades. Group decision-making is a potential strategy to improve grading. To explore how one school’s grading committee members integrate assessment data to inform grade decisions and to identify the committees’ benefits and challenges. This qualitative study used semi-structured interviews with grading committee chairs and members conducted between November 2017 and March 2018. Participants included the eight core clerkship directors, who chaired their grading committees. We randomly selected other committee members to invite, for a maximum of three interviews per clerkship. Interviews were recorded, transcribed, and analyzed using inductive content analysis. We interviewed 17 committee members. Within and across specialties, committee members had distinct approaches to prioritizing and synthesizing assessment data. Participants expressed concerns about the quality of assessments, necessitating careful scrutiny of language, assessor identity, and other contextual factors. Committee members were concerned about how unconscious bias might impact assessors, but they felt minimally impacted at the committee level. When committee members knew students personally, they felt tension about how to use the information appropriately. Participants described high agreement within their committees; debate was more common when site directors reviewed students’ files from other sites prior to meeting. Participants reported multiple committee benefits including faculty development and fulfillment, as well as improved grading consistency, fairness, and transparency. Groupthink and a passive approach to bias emerged as the two main threats to optimal group decision-making. Grading committee members view their practices as advantageous over individual grading, but they feel limited in their ability to address grading fairness and accuracy. Recommendations and support may help committees broaden their scope to address these aspirations.
Severe Vaginal Bleeding in a Case of Renal Cell Carcinoma

Renal Cell Carcinoma (RCC) accounts for approximately 2-3% of all adult cancers and carries the highest mortality of the genitourinary cancers. Metastatic disease is seen in approximately 16% of cases and when present represents an advanced status. Metastasis of RCC to the vagina has rarely been cited in literature and when present can mimic primary vaginal cancer in clinical presentation and symptoms. Biopsy is performed to delineate the etiology and, in the presence of clear cells and certain immunohistochemistry markers, RCC needs to be included in the differential diagnosis. Treatment protocols are limited due to the rarity of the condition, with retrospective and comparative studies alongside cervical cancer treatment protocols serving as the basis. Herein, we describe a unique case of profuse vaginal bleeding secondary to vaginal metastases of RCC and discuss the relevant aspects of diagnosis and treatment.
Comparative Clinical Pharmacology of Slow Channel Blocking Agents

The development of new slow channel blocking agents represents a major step forward in the field of cardiovascular pharmacology as well as clinical cardiology. These agents, also referred to as calcium antagonists, have been the subject of several recent reviews (1–3). While these drugs are chemically and pharmacologically dissimilar, they all have one property in common; they inhibit slow channel activity in isolated cardiac tissues and vascular smooth muscle. Clinically, they are all potent vasodilators, but their cardiac effects are a net result of direct actions on the heart and reflex responses subsequent to peripheral vasodilatation.
Modeling Dust in East Asia by CESM and Sources of Biases

East Asian dust has a significant impact on regional and global climate. In this study, we evaluate the spatial distributions and temporal variations of dust extinction profiles and dust optical depth (DOD) over East Asia simulated from the Community Earth System Model (CESM) with satellite retrievals from Luo et al. (2015a, 2015b) (L15), Yu et al. (2015) (Y15), and Cloud-Aerosol Lidar and Infrared Pathfinder Satellite Observation (CALIPSO) level 3 (CAL-L3) products. Both L15 and Y15 are based on CALIPSO products but use different algorithms to separate dust from non-dust aerosols. We find high model biases of dust extinction in the upper troposphere over the Taklamakan Desert, Gobi Desert, and Tibetan Plateau, especially in the summer (June-July-August, JJA). CESM with dust emission scheme of Kok et al. (2014a, 2014b) has the best agreement with dust extinction profiles and DOD from L15 in the Taklamakan Desert and Tibetan Plateau. CESM with the default dust emission scheme of Zender et al. (2003a) underpredicts DOD in the Tibetan Plateau compared with observations from L15 due to the underestimation of local dust emission. Large uncertainties exist in observations from L15, Y15, and CAL-L3 and have significant impacts on the model evaluation of dust spatial distributions. We also assess dust surface concentrations and 10 m wind speed with meteorological records from weather stations in the Taklamakan and Gobi Deserts during dust events. CESM underestimates dust surface concentrations at most weather stations due to the inability of CESM to capture strong surface wind events.
Mound building and summit architecture at the Carson site, a Mississippian mound center in the southeastern United States:

Significant scholarly attention has been paid to monument construction, craft production, and leadership strategies in the Mississippian world (A.D. 1000 to A.D. 1540) of the Southeastern and Midco...
Efficient (t,r) broadcast dominating sets of the triangular lattice

Abstract Blessing, Insko, Johnson and Mauretour gave a generalization of the domination number of a graph G called the ( t , r ) broadcast domination number which depends on the positive integer parameters t and r . In this setting, a v ∈ V is a broadcast vertex of transmission strength t if it transmits a signal of strength t − d ( u , v ) to every vertex u ∈ V with d ( u , v ) t . Given a set of broadcast vertices S ⊆ V , the reception at vertex u is the sum of the transmissions from the broadcast vertices in S . The set S ⊆ V is called a ( t , r ) broadcast dominating set if every vertex u ∈ V has a reception strength r ( u ) ≥ r and for a finite graph G the cardinality of a smallest broadcast dominating set is called the ( t , r ) broadcast domination number of G . In this paper, we consider the infinite triangular grid graph and define efficient ( t , r ) broadcast dominating sets as those broadcasts that minimize signal waste. Our main result constructs efficient ( t , r ) broadcasts on the infinite triangular grid graph for all t ≥ r ≥ 1 . Using these broadcasts, we then provide upper bounds for the ( t , r ) broadcast domination numbers for triangular matchstick graphs when ( t , r ) ∈ { ( 2 , 1 ) , ( 3 , 1 ) , ( 3 , 2 ) , ( 4 , 1 ) , ( 4 , 2 ) , ( 4 , 3 ) , ( t , t ) } .
Assay and Properties of IgA Protease of Streptococcus Sanguis

IgA proteases are proteolytic enzymes elaborated by Streptococcus sanguis, Neisseria gonorrhoeae and Neisseria meningitidis which cleave human immunoglobulin A proteins into intact Fab α and Fc α fragments (1). The enzymes attack prolythreonyl bonds in the “hinge” peptide of the heavy chain of human IgAl subclass proteins, but proteins of the IgA2 subclass, which lack the susceptible peptide bonds, are IgA protease resistant (2). While the biological significance of these enzymes has not been determined, they have the capacity to markedly reduce the titer of agglutinating antibodies of the IgA isotype, as has been determined by their effect on human IgA myeloma paraproteins which have defineable antibody activity (3). The specificity of the IgA proteases is of considerable interest but forms an obstacle in the assay of the enzyme because it requires IgAl protein to be used as substrate. In general, macromolecular substrates for enzyme assays create problems, e.g., difficulty in reaching molar concentrations sufficient for enzyme kinetic studies, insolubility of substrate, instability of macromolecules at extremes of pH, and confusing protein-protein interactions independent of those directly concerned with enzyme catalysis. The use of a macromolecular substrates can be aided if the substance has a biological property which is altered progressively as enzyme action proceeds. In the case of IgA, the biological properties are not yet characterized to the point where they can be used to monitor enzymatic cleavage. The loss of antibody activity in IgA paraproteins could serve such a function, but such proteins are not readily available and thus would be inappropriate for use as a general substrate.
Pole dark energy

Theories with a pole in the kinetic term have been used to great effect in studying inflation, owing to their quantum stability and attractor properties. We explore the use of such pole kinetic terms in dark energy theories, finding an interesting link between thawing and freezing models, and the possibility of enhanced plateaus with ``superattractorlike'' behavior. We assess the observational viability of pole dark energy, showing that simple models can give dark energy equation-of-state evolution with $w(z)l\ensuremath{-}0.9$ even for potentials that could not normally achieve this easily. The kinetic term pole also offers an interesting perspective with respect to the swampland criteria for such observationally viable dark energy models.
sUAS-Based Remote Sensing in Mountainous Areas: Benefits, Challenges, and Best Practices

Small unmanned aircraft systems (sUAS) offer key benefits over manned aircraft and satellite platforms used for remote sensing research, such as high spatial resolution, portability, simplicity of ...
Attachment, coping, and psychological symptoms among military veterans and active duty personnel

Background and Objectives: Military service is a stressful occupation, including increased risk for psychological distress. In order to provide the best care for service members and veterans (SMVs)...
Service Function Chain Provisioning Schemes for Multi-Layer Fog Networks

Many studies have investigated service function chain (SFC) mapping in cloud networks. However there is a growing need to extend this provisioning to fog networks to support services with tight end-to-end delay or local contextual needs. Hence this letter presents a first look at SFC provisioning in a multi-layer fog architecture that considers client resource and delay requirements. Several provisioning heuristics are presented to implement differing objectives, i.e., delay, cost or load minimization. The performance of these solutions is then evaluated using several metrics in order to gauge their effectiveness for supporting time-sensitive and resource intensive client demands.
Developing Implantable Scaffolds to Enhance Neural Stem Cell Therapy for Post-Operative Glioblastoma.

Pre-clinical and clinical studies have shown that engineered tumoricidal neural stem cells (tNSCs) are a promising treatment strategy for the aggressive brain cancer glioblastoma (GBM). Yet, stabilizing human tNSCs within the surgical cavity following GBM resection is a significant challenge. As a critical step toward advancing engineered human NSC therapy for GBM, we used a preclinical variant of the clinically utilized NSC line HB1.F3.CD and mouse models of human GBM resection/recurrence to identify a polymeric scaffold capable of maximizing the transplant, persistence, and tumor kill of NSC therapy for post-surgical GBM. Using kinetic bioluminescence imaging, we found that tNSCs delivered into the mouse surgical cavity wall by direct injection persisted only 3 days. We found that delivery of tNSCs into the cavity on nanofibrous electrospun poly-l-lactic acid scaffolds extended tNSC persistence to 8 days. Modifications to fiber surface coating, diameter, and morphology of the scaffold failed to significantly extend tNSC persistence in the cavity. In contrast, tNSCs delivered into the post-operative cavity on gelatin matrices (GEMs) persisted 8-fold longer as compared to direct injection. GEMs remained permissive to tumor-tropic homing, as tNSCs migrated off the scaffolds and into invasive tumor foci both in vitro and in vivo. To mirror envisioned human brain tumor trials, we engineered tNSCs to express the prodrug/enzyme thymidine kinase (tNSCstk) and transplanted the therapeutic cells in the post-operative cavity of mice bearing resected orthotopic patient-derived GBM xenografts. Following administration of the prodrug ganciclovir, residual tumor volumes in mice receiving GEM/tNSCs were reduced by 10-fold at day 35, and median survival was extended from 31 to 46 days. Taken together, these data begin to define design parameters for effective scaffold/tNSC composites and suggest a new approach to maximizing the efficacy of tNSC therapy in human patient trials.
Detection of retinal microvascular changes in von Hippel-Lindau disease using optical coherence tomography angiography.

Purpose Von Hippel-Lindau (VHL) disease is a hereditary disorder that can lead to ophthalmic manifestations, including retinal capillary hemangioma (RCH). The diagnosis of RCH is often guided by wide-field fluorescein angiography. In some cases, optical coherence tomography angiography (OCT-A) serves as a non-invasive alternative to FA. Herein, we used OCT-A to examine the macular microvasculature in patients with VHL disease. Subjects Subjects were selected from patients with a diagnosis of VHL. The control group included eyes without retinal diagnosis from patients with an episode of unilateral retinal detachment or trauma and age ≤ 50 years old. Methods Subjects were scanned on the Optovue RTVue-XR device to acquire 3mm x 3mm OCT-A images of the superficial (SCP) and deep capillary plexus (DCP). SCP and DCP vessel density (VD) were calculated after the images were binarized. Furthermore, for subjects with RCH, each OCT-A image was divided equally into four quadrants. SCP and DCP VD of quadrants with RCH were compared to those without RCH. T-tests were performed for statistical analysis. Results 67 eyes with a history of VHL disease were included as study subjects, while 16 eyes were included as controls. Significant increases in VD were found in patients with VHL disease for both the SCP (p = 0.0441) and DCP (p = 0.0344). When comparing quadrants with associated RCH development to those without, we found no significant difference in SCP VD (p = 0.160) or DCP VD (p = 0.484). Conclusions OCT-A can detect changes in the retinal microvasculature in the macula of patients with VHL disease. OCT-A imaging may be an additional tool for screening and early detection of patients at risk of developing ocular complications of VHL disease. Future studies should explore subtle progression on OCT-A associated with the pathogenesis and development of RCH, particularly with larger scan patterns.
Radionuclide Produced Isotopic Variations in Mantle Rocks

Evidence from short- and long-lived radioisotope systems indicates that Earth was largely built from volatile-depleted planetesimals and planetary embryos during runaway accretion that occurred within 1–10 Ma of formation of the first solar system solids at 4.567 ± 0.001 Ga. Both long- and short-lived radionuclides leave isotopic signatures in mantle rocks that bear on when and how the silicate Earth formed and differentiated. The longstanding view that the Hadean mantle was compositionally undepleted appeared to be contradicted by differences between mantle and chondrite Nd isotopes which suggested a very early enriched terrestrial reservoir. Although recent work indicates this difference reflects differing irradiation histories of Earth-forming-materials and meteorites, and thus has little bearing on the timing of silicate differentiation, both terrestrial and lunar Lu–Hf zircon data appear to require global silicate differentiation by 4.50 ± 0.02 Ga billion years. Tungsten isotopic data from mantle rocks provides evidence of core formation by about 4.53 Ga and either very early isotopic isolation of silicate reservoirs or disturbance by a late chondritic veneer. Despite evidence that Moon formed substantially from proto-Earth material between about 4.53 and 4.50 Ga, the exact mechanism by which this occurred remains controversial. The once widely accepted model of collision of a Mars-sized body has lost support in light of contradictory evidence in the form of indistinguishable isotopic compositions of volatile and refractory elements between Earth and Moon. Models that appear to transcend this problem (hit-and-run collision, synestia, successive smaller collisions, magma ocean heating, etc.) are currently being evaluated. Although geochemical evidence requiring an early terrestrial magma ocean is almost entirely lacking, the sources of thermal energy available during accretion make such an appearance appear inevitable. If solidification proceeded from the bottom up, vigorous convection would have caused the lower mantle to rapidly crystallize with the upper mantle becoming largely solidified within several million years. The high abundance of highly siderophile elements in the upper mantle is strong evidence that Earth added at least half a percent of its present mass following core formation but prior to the Mesoarchean. Preservation of mantle isotopic anomalies throughout the Hadean-Archean seem unlikely to reflect sluggish mantle convention in a stagnant lid tectonic regime during that period as the plate tectonic era is associated with a large range of isolated mantle isotopic domains.
Improving documentation of cancer staging at an academic cancer center utilizing an EMR-based system with public accountability.

197Background: Accurate TNM staging of malignancy is essential to quality care of cancer patients but maintaining consistent documentation of appropriate staging remains a challenge. We identified ...