cssi/SciSciGPT-SciSciNet huggingface dataset:
Immune Dysregulation after Hematopoietic Stem Cell Transplantation for Autoimmune Diseases Leading to Development of a Second Autoimmune Disorder: Role of Conditioning Regimen Used?.

Secondary autoimmune disorders following hematopoietic stem cell transplantation (HSCT) for malignancies occur at a reported frequency of 2 to 5%. Patients undergoing HSCT for autoimmune disorders may however have an added propensity to this complication, given the genetic predisposition to autoimmunity. Therefore, we undertook a retrospective analysis of all patients who underwent an autologous HSCT (auto−HSCT) for an autoimmune disease to determine the occurrence of a second autoimmune disorder, its nature, outcome and risk factors. In all, 154 patients underwent auto−HSCT for various autoimmune diseases in the period from August 1996 to March 2006. The peripheral blood stem cell product was either CD34−selected (n=87) or unmanipulated (n=67), depending on disease−specific protocols. The conditioning regimens consisted of various combinations of cyclophosphamide with either antithymocyte globulin (ATG) or alemtuzumab, or cyclophosphamide with intravenous busulfan or total body irradiation, again depending on disease−specific protocols. The autoimmune diseases represented were systemic lupus erythematosus (SLE) (n=60, 38.9%), systemic sclerosis (SSc) (n=13, 8.4%), multiple sclerosis (MS) (n=42, 27.3 %), rheumatoid arthritis (n=6, 3.9%), Crohn’s disease (n=20, 13.0%) and others (n=13, 8.4%). There were 5 patients (2 with SLE, one each with MS, SLE and SSc) who developed an autoimmune disorder distinct from their underlying autoimmune disease at a median of 5 months (2 to 30 months) after HSCT. The frequency of a secondary autoimmune disease was 3 of 24 among patients receiving alemtuzumab, 2 of 102 among those receiving ATG and none (0 of 28) of those who received neither of these lympho−depleting antibodies (p=0.018). The difference between the frequency of this complication was also significantly higher among those receiving alemtuzumab compared to ATG (p=0.017). The frequency of a secondary autoimmune disease among those who received a CD34−selected graft was 2 of 87 versus 3 of 67 of those who received unselected stem cells (p=0.449). Two patients with SLE who received an ATG−containing conditioning regimen, developed acquired factor VIII inhibitors with severe bleeding. One patient each with MS, SSc and SLE, who received an alemtuzumab−containing conditioning regimen, developed severe autoimmune cytopenias. The 5 patients required multiple immunosuppressants to control the secondary autoimmune disorder. ATG and alemtuzumab induce a protracted post−HSCT lymphopenia, with particularly delayed reconstitution in T cell function. The resultant immune dysregulation in an autoimmune−prone patient may predispose to a second autoimmune disease. The increased likelihood of this complication seen with alemtuzumab recommends against its use in auto−HSCT for autoimmune disease.
Symptomless Multi-Variable Apnea Prediction Index Assesses Obstructive Sleep Apnea Risk and Adverse Outcomes in Elective Surgery

Study Objective To validate that the symptomless Multi-Variable Apnea Prediction index (sMVAP) is associated with Obstructive Sleep Apnea (OSA) diagnosis and assess the relationship between sMVAP and adverse outcomes in patients having elective surgery. We also compare associations between Bariatric surgery, where preoperative screening for OSA risk is mandatory, and non-Bariatric surgery groups who are not screened routinely for OSA. Methods Using data from 40 432 elective inpatient surgeries, we used logistic regression to determine the relationship between sMVAP and previous OSA, current hypertension, and postoperative complications: extended length of stay (ELOS), intensive-care-unit-stay (ICU-stay), and respiratory complications (pulmonary embolism, acute respiratory distress syndrome, and/or aspiration pneumonia). Results Higher sMVAP was associated with increased likelihood of previous OSA, hypertension and all postoperative complications (p < .0001). The top sMVAP quintile had increased odds of postoperative complications compared to the bottom quintile. For ELOS, ICU-stay, and respiratory complications, respective odds ratios (95% CI) were: 1.83 (1.62, 2.07), 1.44 (1.32, 1.58), and 1.85 (1.37, 2.49). Compared against age-, gender- and BMI-matched patients having Bariatric surgery, sMVAP was more strongly associated with postoperative complications in non-Bariatric surgical groups, including: (1) ELOS (Orthopedics [p < .0001], Gastrointestinal [p = .024], Neurosurgery [p = .016], Spine [p = .016]); (2) ICU-stay (Orthopedics [p = .0004], Gastrointestinal [p < .0001], and Otorhinolaryngology [p = .0102]); and (3) respiratory complications (Orthopedics [p =.037] and Otorhinolaryngology [p =.011]). Conclusions OSA risk measured by sMVAP correlates with higher risk for select postoperative complications. Associations are stronger for non-Bariatric surgeries, where preoperative screening for OSA is not routinely performed. Thus, preoperative screening may reduce OSA-related risk for adverse postoperative outcomes.
Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries.

Objectives: Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction.Design: Cross-sectional.Setting: A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center.Participants/Methods: Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and cli...
Single Gene Causes of Stroke.

Though rare, monogenic causes of stroke are recognizable by key clinical and radiographic features. A lack of epidemiological data leaves their true incidence unknown, but the most common monogenetic causes of stroke are sickle cell disease, cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), Fabry's disease, and cerebral cavernous malformations. In this article, the author covers the epidemiology, clinical features, and treatment of those diseases as well as other well-described monogenic causes of ischemic and hemorrhagic stroke. A “shotgun” approach to genetic testing should be avoided in favor of targeted testing that can provide a higher yield. Neurologists caring for stroke patients should be familiar with these monogenic causes of stroke, as heightened awareness and an armamentarium of additional diagnostic techniques will allow neurologists to diagnose correctly, implement individual distinct treatment paradigms, and provide future risk assessment.
Gel phase in hydrated calcium dipicolinate

The mineralization of dipicolinic acid (DPA) molecules in bacterial spore cores with Ca2+ ions to form Ca-DPA is critical to the wet-heat resistance of spores. This resistance to “wet-heat” also depends on the physical properties of water and DPA in the hydrated Ca-DPA-rich protoplasm. Using reactive molecular dynamics simulations, we have determined the phase diagram of hydrated Ca-DPA as a function of temperature and water concentration, which shows the existence of a gel phase along with distinct solid-gel and gel-liquid phase transitions. Simulations reveal monotonically decreasing solid-gel-liquid transition temperatures with increasing hydration, which explains the experimental trend of wet-heat resistance of bacterial spores. Our observation of different phases of water also reconciles previous conflicting experimental findings on the state of water in bacterial spores. Further comparison with an unmineralized hydrated DPA system allows us to quantify the importance of Ca mineralization in decreasi...
Open to Justice: The Importance of Student Selection Decision in Law School Clinics

Clinical law professors have engaged in a significant amount of reflection and evaluation of the importance of clinic design, pedagogy, supervision styles, client selection, and case selection, but very little has been written about the significant impact student selection decisions have on the clinical experience and how clinical law professors should assess the applications of students whose fundamental values diverge from those of the clinic. A successful clinical experience is not just about what we are teaching or how we are teaching. Important issues arise when we think about who we are teaching and the context in which we are teaching them. The experiences, perspectives, and attitudes of the students are critical components of any clinical program. Student selection decisions impact the ability to meet the myriad goals of a clinical program, including the educational experience of the other students participating in the program and the quality of representation afforded to clients of that clinic. Our decisions about which students we admit or exclude from a particular clinic raise issues about clinical law professors’ educational obligation to our students and our representational obligations to the clients of the clinic. As clinical legal education plays an increasing role in legal education, with a broader range of clinical offerings and intensified student interest, we must give greater consideration to the criteria we use to admit students into clinical programs and attend to the risks that divergence of student, clinic, and client values can create. Certainly, some clinical law professors do not believe that law schools should engage in any individualized student selection decisions, and instead encourage open enrollment in clinical programs. However, where student selection models are employed, it should be done with all of a clinic’s goals in mind, rather than isolating the singular goal of providing an opportunity for experiential learning. This essay endeavors to identify some of the challenges clinical law professors face in making student selection determinations that balance the multiple goals of clinical education.
The Current State of Rural Neurosurgical Practice: An International Perspective.

Introduction: Rural and low-resource areas have diminished capacity to care for neurosurgical patients due to lack of infrastructure, healthcare investment, and training programs. This review summarizes the range of rural neurosurgical procedures, novel mechanisms for delivering care, rapid training programs, and outcome differences across international rural neurosurgical practice. Methods: A comprehensive literature search was performed for English language manuscripts with keywords “rural” and “neurosurgery” using the National Library of Medicine PubMed database (01/1971–06/2017). Twenty-four articles focusing on rural non-neurosurgical practice were included. Results: Time to care and/or surgery and shortage of trained personnel remain the strongest risk factors for mortality and poor outcome. Telemedicine consults to regional centers with neurosurgery housestaff have potential for increased timeliness of diagnosis/triage, improved time to surgery, and reductions in unnecessary transfers in remote areas. Mobile neurosurgery teams have been deployed with success in nations with large transport distances precluding initial transfers. Common neurosurgical procedures involve trauma mechanisms; accordingly, training programs for nonneurosurgery medical personnel on basic assessment and operative techniques have been successful in resource-deficient settings where neurosurgeons are unavailable. Conclusions: Protracted transport times, lack of resources/training, and difficulty retaining specialists are barriers to successful outcomes. Advances in telemedicine, mobile neurosurgery, and training programs for urgent operative techniques have been implemented efficaciously. Development of guidelines for paired partnerships between rural centers and academic hospitals, supplying surplus technology to rural areas, and rapid training of qualified local surgical personnel can create sustainable feed-forward programs for trainees and infrastructural solutions to address challenges in rural neurosurgery.
Fracturing Dams, Fractured Data: Empirical Trends and Characteristics of Existing and Removed Dams in the United States

Dam removals in the United States continue to accelerate in pace and scope, but no national analyses have examined how removed dams compare with existing dam stock. Here, we review and analyse the best available national data on dams from the National Inventory of Dams (NID), dam removals from American Rivers, the U.S. Geological Survey, and the National River Restoration Science Synthesis databases to compare trends and characteristics of removed versus existing dams in the United States. If historical trends continue, by 2050 the United States can expect between 4,000 and 36,000 total removals, including 2,000–10,000 removals of NID dams. Best‐fit regression models estimate total costs between $50.5 million and $25.1 billion (mean $10.5 billion, median $416.5 million) for all removals and $29.6 million to $18.9 billion (mean $7.2 billion, median $285 million) for NID removals, a significant cost savings over present stated dam rehabilitation needs. Structural characteristics and ages of documented removals are not representative of existing dams, with privately owned hydroelectric dams subject to public oversight and water supply dams the most disproportionately removed. We conclude that dam removal science would benefit from the creation of an interdisciplinary framework for studying dams as environmental, social, and technological interventions, facilitated by transparent datasets around dams and removals and reflexive research approaches that combine statistical approaches with place‐based analyses.
Complexities that Health Care Oversight Must Take into Account

The complexity and variability of the definitions given for the quality of care confuse physicians, patients and even specialists on this issue. Donabedian, a leader in the field of health care quality, has recognized that “several formulations are both possible and legitimate, depending on where we are located in the system of care and on what the nature and extent of our responsibilities are” (Donabedian, 1988). This wise view acknowledges that among professionals the types of interest in quality may vary. A conscientious physician in a busy practice may have a compelling interest in the quality of her or his daily interactions with patients, which is assessed essentially by immediate patient feedback. Similarly, nurses or other professionals want ongoing reassurance of the merits of their work. To such professionals, retrospective reviews months after the fact have secondary interest or importance. Their central focus is on the outcomes for particular patients, although the responses of groups have been of interest to professionals and have prompted many improvements in management.
Thinking through Others

Imagine a single chapter whose aim was to cover the breadth of approaches, theory, and arguments inquantitativeresearch, and how these could apply to community psychology. I am aware of a similar absurdity here; compressing a vast and highly articulated literature and history into a single review seems an act of hubris at best, folly at least. Nonetheless, judging from my own methodological training in psychology, it seems an introduction is in order, along with, at least, a sketchy roadmap of the domain. This chapter offers no “how to,” but instead is an attempt at an orientation or sensitization to qualitative inquiry–why it seems to be an emergent and increasingly valid consideration, how it shares many of the same values and concerns as community psychology, its advantages, and its problems. The chapter also makes a case for why community psychology and qualitative inquiry should be at the beginning of a potentially beautiful relationship
How far can you go? Association between illicit drug use and academic migration

ABSTRACT Objective: To measure the prevalence of illicit drugs use in the lifetime, last year and last month, as well as the factors associated to the last year's use and its association with academic migration, among undergraduate students of a university in southern Brazil. Methods: In this cross-sectional study, data were collected through self-administered questionnaire. It was conducted a clustered systematic sampling. For multivariate analyses, it was used Poisson regression. Results: 1,423 students participated. The prevalence of illicit drug use in the lifetime, last year and last month were 42.4%, 25.5% and 17.7%, respectively. Regarding illicit substances, marijuana use was the most prevalent. The variables independently associated with illicit drugs use in the last year were academic migration, being male, younger, single, high parent's educational level, living with peers, tobacco use in the last year, and having friend and relative that have used illicit drugs. Religious practice had a protective effect. Conclusion: Individuals who migrated from their cities to study at the university are more exposed to the main risk factors pointed out by this research and hence to the use of illicit drugs. Based on these results, we suggest that universities develop evaluation, prevention, treatment or referral strategies considering specific needs of this population
Epidemiology and Clinical Characteristics of Hirschsprung’s Disease

Hirschsprung’s disease (HSCR) is a relatively common cause of intestinal obstruction in the newborn. It is characterized by an absence of ganglion cells in the distal bowel beginning at the internal sphincter and extending proximally for varying distances. In the human fetus, neural crest-derived neuroblasts first appear in the developing esophagus at 5 weeks of gestation and then migrate down to the anal canal in a craniocaudal direction during the 5th to the 12th week of gestation. The absence of ganglion cells in HSCR has been attributed to a failure of migration of neural crest cells. The earlier the arrest of migration, the longer the aganglionic segment is. The absence of ganglion cells results in absent peristalsis in the affected bowel and the development of functional intestinal obstruction. The incidence of HSCR is estimated to be approximately 1 in 5000 live births. Over 80% of patients produce clinical symptoms and are diagnosed in the neonatal period. Delayed passage of meconium is the cardinal symptom in neonates with HSCR. The majority of patients with HSCR are male, with a male-to-female ratio of 4:1. The male preponderance is less evident in long-segment HSCR, where the male-to-female ratio is 1.5–2:1. Genetic factors have been implicated in the etiology of HSCR. It is known that HSCR occurs in families. The incidence of familial cases in rectosigmoid HSCR varies from 3.6% to 7.8% in different series.
Analytical inversions in remote sensing of particle size distributions. I - Multispectral extinctions in the anomalous diffraction approximation. II Angular and spectral scattering in diffraction approximations

Consideration is given to analytical inversions in the remote sensing of particle size distributions, noting multispectral extinctions in anomalous diffraction approximation and angular and spectral scattering in diffraction approximation. A closed-form analytical inverse solution is derived in order to reconstruct the size distribution of atmospheric aerosols. The anomalous diffraction approximation to Mie's solution is used to describe the particles. Experimental data yield the geometrical area of aerosol polydispersion. Size distribution is thus found from a set of multispectral extinction measurements. In terms of the angular and spectral scattering of light in a narrow forward cone, it is shown that an analytical inverse solution may also be found for the Fraunhofer approximation to the Kirchhoff diffraction, and for an improved expression of this approximation due to Penndorf (1962) and Shifrin-Punina (1968).
Abstract 406: Plasminogen Regulates Mesenchymal Stem Cell-mediated Tissue Repair After Ischemia Through Cry61

Objective: Stem cell transplantation has emerged as a promising strategy for improving post-ischemic tissue repair. However, the poor survival and persistence of the transplanted cells including me...
Linking global terrestrial CO 2 fluxes and environmental drivers using OCO-2 and a geostatistical inverse model

Abstract. Observations from the OCO-2 satellite, launched in July 2014, have been used to estimate CO2 fluxes in many regions of the globe and provide new insight on the global carbon cycle. A challenge now is to not only estimate fluxes using satellite observations but also to understand how these fluxes are connected to variations in environmental conditions. In this study, we specifically evaluate the capabilities and limitations of utilizing current OCO-2 observations to infer connections between CO2 fluxes and underlying environmental variables. To do so, we adapt geostatistical inverse modeling to satellite-based applications and evaluate a case study for year 2016 using OCO-2. One unique aspect of the geostatistical approach is that we can use estimates of environmental and meteorological variables to help estimate CO2 fluxes in place of a traditional prior flux model. We are able to quantify the relationships between CO2 fluxes and a few environmental variables across global biomes; we find that a simple combination of air temperature, daily precipitation, and photosynthetically active radiation (PAR) can describe almost 90 % of the variability in CO2 fluxes as seen through OCO-2 observations. PAR is an adept predictor of fluxes across mid-to-high latitudes, whereas a combined set of air temperature and precipitation shows strong explanatory power across tropical biomes. However, we are unable to quantify relationships with additional environmental variables because many variables are correlated or colinear when passed through an atmospheric model and averaged across a total atmospheric column. Overall, we estimate a global net biospheric flux of −1.73 ± 0.53 GtC in year 2016, in close agreement with recent inverse modeling studies using OCO-2 retrievals as observational constraints.
Association of musculoskeletal discomfort with the use of high heeled shoes in females.

Abstract Objective: To determine the association of musculoskeletal discomfort with the high heeled shoes related variables in females who use such footwear frequently. Methods: A cross sectional study was conducted on 174 female residents of Islamabad and Rawalpindi, for a time period stretching from July 1, 2018 to December 31, 2018. The participants aged between 18 and 55 years appeared as the frequent users of high heeled shoes. The Nordic Musculoskeletal Questionnaire (NMQ) and Numeric Pain Rating Scale (NPRS) were used as outcome measures to assess the musculoskeletal discomfort and a self-structured questionnaire was used to obtain information related to the high heeled shoes e.g. duration and frequency of high heeled shoe use. Data was analyzed using SPSS version 21. Results: The data analysis showed a positive association of shoulders’ discomfort with length of high heeled shoes used by women (p value= 0.03<0.05). Moreover, a positive association was also found between an occurrence of upper back discomfort and length of the heeled shoes (p value= 0.01<0.05). However, no significant association was found between pain intensity and length of the shoe’ heel, frequency and duration of high heeled shoe use. Conclusion: The shoulders’ and upper back discomfort in females who frequently used high heeled shoes was determined to be associated with the length of the heels in shoes. Keywords: Female, Heel, Musculoskeletal System, Pain, Shoes. Continuous...
Latent outflow tract obstruction in hypertrophic cardiomyopathy: Clinical characteristics and outcomes of septal myectomy.

Abstract Objective This investigation analyzed clinical characteristics of patients with hypertrophic cardiomyopathy (HCM) and latent left ventricular outflow tract (LVOT) and outcomes following septal myectomy. Methods We reviewed patients with HCM and LVOT obstruction undergoing septal myectomy from 2001 to 2016 at our center. Follow-up data on functional status were obtained through mailed survey questionnaires. Results There were 629 (31.8%) patients with latent obstruction (resting LVOT gradient 30 mm Hg) among 1981 patients undergoing septal myectomy. Patients with latent obstruction were more likely to be male (65.7% vs 51.8%, P Conclusions Patients with HCM and latent LVOT obstruction generally have milder left ventricular hypertrophy but similarly impaired functional capacity compared to those with resting obstruction. Septal myectomy improves functional capacity and symptoms.
Zombie Life Estates, Ghost Value Transfers, and Phantom Takings: Confusions of Title and Value in Property Law Legislation

This paper addresses a number of problems in current legislation and regulations caused by misunderstanding basic concepts of property law and value. First, in recent legislation, life estates have been treated as if they continued to exist after the life tenant dies, allowing the state to place a lien for services to the life tenant on the remainderman’s interest. Second, in many states, a joint tenant can disclaim up to half the value of the joint tenancy property when one joint tenant dies—even though there is no transfer at the time of the death. Lastly, for some time, the US Supreme Court has been making a muddle of Takings Jurisprudence based, partly, on confusing value and title. This paper argues that an understanding of the difference between value and title would go a long way to fixing these problems in property law.
Selective Versus Routine Spinal Drain Use for Fenestrated/Branched Endovascular Aortic Repair (F-BEVAR).

Abstract Background Spinal drains are used to ameliorate spinal cord ischemia (SCI), but their use may result in inherent morbidity and mortality. Although prophylactic spinal drain has proven of benefit in open repairs, that is not the case for endovascular repairs. The aim of this study was to assess the outcomes of spinal cord protection with and without the routine use of spinal drains during fenestrated-branched endovascular repair (F-BEVAR). Methods A retrospective single center study was performed using a prospectively maintained dataset of all patients undergoing F-BEVAR over a 4-year period. The primary endpoint of the study was the frequency of SCI. Prophylactic spinal drain was placed pre-operatively in 33 patients (23%) with a median time for removal of 3 days (IQR, 2-3 days). Routine intraoperative neuromonitoring was used. Spinal cord protection relied primarily on maintaining a perioperative systolic blood pressure between 140 and 160 mm Hg or a mean arterial pressure >90 mm Hg, avoiding hypotension, preservation of as many collateral beds as possible, staged repairs and early lower extremity reperfusion based on neuromonitoring. Results A total of 145 patients, 104 men (71%) and 41 women (28%) with a median age of 70 years (interquartile range [IQR], 53–62) underwent F-BEVAR. Branched custom-made devices (CMDs) (11%), fenestrated CMDs (70%) and off-the-shelf T-Branch device (17%) were used with a median number of branches/fenestrations of 4 (IQR, 3–4). SVS classification of implantation zones were determined as follows: 9 (6%) zone 2, 21 (20%) zone 3, 26 (18%) zone 4 and 89 (61%) zone 5. SCI was present in 8 patients (5.5%) and classified according to the SVS SCI grading system as follows: 1 grade 1, 5 grade 2 and 2 grade 3a. When evaluating implantation zone independently of coverage length and patency of collateral beds, a high implantation zone (1–4) was not associated with SCI (P = 0.9). Similarly, prophylactic spinal drain did not demonstrate association with the occurrence of SCI (3[9%] vs. 5[4%], with and without spinal drain, respectively) (P = 0.3). For patients with high implantation zones, staged repair was performed in 38 patients (26%) at a median time of 2 months (IQR, 2–6 months). Among these patients, the frequency of SCI was 13%. Staged repair was associated with an 80% reduction in the frequency of SCI (OR, 0.19 [95% CI, 0.04–0.084]) (P = 0.02). Conclusion F-BEVAR can be performed with a minimal risk of SCI without the need for routine prophylactic spinal drains. High implantation zones did not predict SCI after F-BEVAR; however, staged repair significantly decreased the risk of SCI after F-BEVAR.
Surgical Debulking for Symptomatic Management of Calcinosis Cutis of the Hand and Upper Extremity in Systemic Sclerosis

Purpose To determine whether elective calcinosis debulking surgery of the hands and/or upper extremities is a safe and effective treatment for painful symptomatic scleroderma. Our hypothesis was that calcinosis debulking surgery would result in improvement in patient-reported pain and range of motion (ROM) with relatively little postoperative surgical pain for scleroderma patients. Methods We performed a retrospective review of scleroderma patients who underwent elective calcinosis debulking surgery by a single surgeon between August 2014 and August 2019. Patients were included if they had a documented diagnosis of limited or diffuse scleroderma and underwent elective or nonemergent hand or upper-extremity calcinosis debulking surgery with a minimum final follow-up of 12 months. Primary outcomes measured were preoperative to final follow-up changes in visual analog scale pain scores. Secondary outcomes were changes in numbness and ROM as well as in daily opioid requirements, postoperative opioids used to control surgical pain, and complications. Results Thirty-nine patients underwent calcinosis debulking surgeries on 41 upper extremities. Median final follow-up was 22 months (range, 13–60 months). Significant decreases occurred in visual analog pain scores (preoperative median, 5 [range, 0–10); final follow-up median, 0 [range, 0–8]) and improved patient-reported ROM in 15% (no change, 85%; worse, 0%). There was no significant preoperative to final follow-up difference in patient-reported numbness (improved, 5%; no change, 85%; and worse, 10%). Thirteen patients incurred 17 complications. Conclusions Elective calcinosis debulking surgery of the hands and/or upper extremities in scleroderma decreased pain scores, improved patient-reported ROM in 15% of patients, and had no effect on patient-reported numbness at final follow-up. Type of study/level of evidence Therapeutic IV.
A Rare Case of Disseminated Tuberculosis and Hematological Malignancy in a Heart Transplant Recipient

A 77-year-old man who underwent a heart transplant 7 years ago presented with multiple bloody bowel movements. Endoscopic and histologic evaluation revealed chronic active ileitis, granulomatous inflammation, multinucleated giant cells, and a rare, equivocal acid-fast bacterium in the terminal ileum. Positive sputum cultures for Mycobacterium tuberculosis and acid-fast bacilli established a diagnosis of intestinal tuberculosis, and RIPE (rifabutin, isoniazid, pyrazinamide, ethambutol) therapy was initiated. Elevated IgG levels on quantitative immunoglobulin testing and a bone marrow biopsy specimen of ≥60% plasma cells confirmed the diagnosis of multiple myeloma that later transformed into its aggressive form, plasma cell leukemia. Induction chemotherapy was initiated; however, the patient experienced retroperitoneal bleeding and pancytopenias, limiting the continuation of chemotherapy, and as a result, the patient was transitioned to palliative care.
Cervus unicolor (Sambar deer)

Skin biopsies of two Philippine animals at San Diego Zoo were available. The newborn male had 64, the female, 65, chromosomes. The difference lies in an apparent Robertsonian system, the two acrocentric elements of the female having fused to form a submetacentric element in the male. Possibly animals with 66 elements and only two metacentric pairs exist. As in most deer the NF is 70. Chandra et al. find only 58 chromosomes with 12 metacentrics in a male from India.
Simple Fluids and Fading Memory

Incompressible simple fluids are fluids which depend only on the history of the first spatial gradient of the deformation, on ∇χt(x,τ)=F t(τ) Nearly all of the constitutive equations used for amorphous liquids are of this type. On the face of it, this is a very restrictive assumption. Certainly, we would not want to restrict attention to fluids whose histories are represented only by first derivatives with respect to time. Fluids whose constitutive equation depends on second or higher gradients, or the objects to which series of such higher gradients might approximate, are not described as simple fluids, but they could be important.
NOZZLE: a defense against heap-spraying code injection attacks

Heap spraying is a security attack that increases the exploitability of memory corruption errors in type-unsafe applications. In a heap-spraying attack, an attacker coerces an application to allocate many objects containing malicious code in the heap, increasing the success rate of an exploit that jumps to a location within the heap. Because heap layout randomization necessitates new forms of attack, spraying has been used in many recent security exploits. Spraying is especially effective in web browsers, where the attacker can easily allocate the malicious objects using JavaScript embedded in a web page. In this paper, we describe NOZZLE, a runtime heap-spraying detector. NOZZLE examines individual objects in the heap, interpreting them as code and performing a static analysis on that code to detect malicious intent. To reduce false positives, we aggregate measurements across all heap objects and define a global heap health metric. We measure the effectiveness of NOZZLE by demonstrating that it successfully detects 12 published and 2,000 synthetically generated heap-spraying exploits. We also show that even with a detection threshold set six times lower than is required to detect published malicious attacks, NOZZLE reports no false positives when run over 150 popular Internet sites. Using sampling and concurrent scanning to reduce overhead, we show that the performance overhead of NOZZLE is less than 7% on average. While NOZZLE currently targets heap-based spraying attacks, its techniques can be applied to any attack that attempts to fill the address space with malicious code objects (e.g., stack spraying [42]).
Torture and Brutality in Medieval Literature: Negotiations of National Identity

An ugly subject, but one that needs to be treated thoroughly and comprehensively, with a discreet wit and no excessive relish. These needs are richly satisfied in Larissa Tracy's bold and important book. DEREK PEARSALL, Professor Emeritus, Harvard University. Torture - that most notorious aspect of medieval culture and society - has evolved into a dominant mythology, suggesting that the Middle Ages was a period during which sadistic torment was inflicted on citizens with impunity and without provocation: popular museums displaying such gruesome implements as the rack, the strappado, the gridiron, the wheel, and the Iron Maiden can be found in many modern European cities. These lurid images of medieval torture have re-emerged within recent discussions on American foreign policy and the introduction of torture legislation as a weapon in the "War on Terror", and raised questions about its history and reality, particularly given its proliferation in some literary genres and its relative absence in others. This book challenges preconceived ideas about the prevalence of torture and judicial brutality in medieval society by arguing that their portryal in literature is not mimetic. Instead, it argues that the depictions of torture and brutality represent satire, critique and dissent; they have didactic and political functions in opposing the status quo. Torture and brutality are intertextual literary motifs that negotiate cultural anxieties of national identity; by situating these practices outside their own boundaries in the realm of the barbarian "Other", medieval and early-modern authors define themselves and their nations in opposition to them. Works examined range from Chaucer to the Scandinavian sagas to Shakespeare, enabling a true comparative approach to be taken. Larissa Tracy is Associate Professor, Longwood University.
Process Innovation in Operations

Organizations routinely innovate service and production operations for greater efficiency by introducing new tools, technologies, devices, and knowledge. We focus on process innovation in manufacturing (service innovation). In the first half of our article, we discuss flexible operations and developments in mass customization, or, more accurately, dealing with flexible demand. The second half is dedicated to organizational changes to capture benefits from process innovation. Synchronous innovations thatemphasize the organizational innovations needed to realize the benefits of process innovations, such as adoption of advanced manufacturing technologies (AMT), are vital. Finally, we discuss various organizational innovations such as changes in organizational strategy, structure, culture, and human resource management (HRM) practices. Keywords: process innovation; innovation; flexible operations; flexible demand; mass customization; synchronous innovation; advanced manufacturing technologies; manufacturing; organizational culture
Existence of Equilibria in Auctions with Private Values

A first-price sealed-bid auction of an item for which bidders are risk-neutral and have privately known values is shown to have an equilibrium in mixed behavioral strategies if the joint distribution of bidders' values has a continuous density on a cubical support. Such an equilibrium has atomless distributions of bids and is not affected by the rule for resolving tied bids.
Shareholder Value and Auditor Independence

This Article questions the practice of framing problems concerning auditors’ professional responsibility inside a principal-agent paradigm. If professional independence is to be achieved, auditors cannot be enmeshed in agency relationships with the shareholders of their audit clients. As agents, the auditors by definition become subject to the principal’s control and cannot act independently. For the same reason, auditors’ duties should be neither articulated in the framework of corporate law fiduciary duty, nor conceived relationally at all. These assertions follow from an inquiry into the operative notion of the shareholder-beneficiary. The Article unpacks the notion of the shareholder and tells a particularized story about the shareholder interest. The exercise complicates the agency description, highlighting multiple and unstable shareholder demands that displace the unitary model of the shareholder usually brought to bear. This fragmented and volatile model of the shareholder provides neither a basis for articulating a coherent set of instructions respecting aggressive accounting nor for imposing conservative accounting. The Article concludes that legal positivism provides a more appropriate conceptual framework. Auditor duties should be conceived in formal rather than relational terms, with fidelity going to the rules and the system that auditors apply rather than to a client interest. Copyright © 2003 by William W. Bratton. † Professor of Law, Georgetown University Law Center. For comments on earlier drafts, my thanks to Kim Krawiec, Larry Mitchell, Elliott Weiss, and participants at the Duke Law Journal Symposium and at workshops at the Cornell and Georgetown law schools, Harvard Business School, and the law faculty of Tilburg University. BRATTON.DOC 06/21/04 3:58 PM 440 DUKE LAW JOURNAL [Vol. 53:439 Introduction 440 I. Finance as Politics 446 A. The Elusive Value of a Share 448 B. Modeling the Shareholder 452 1. Speculation versus Investment 455 2. Noise Trading versus Fundamental Value Investment 455 3. Dumb Money versus Smart Money 458 4. Short Term versus Long Term 460 C. Summary 463 II. Managed Earnings and the Shareholder Interest 463 A. Exaggerated Reserves 465 B. Revenues, Costs, Aggressive Accounting, and the Incentives of Shareholders and Auditors 468 C. Summary 472 III. The Shareholder Beneficiary and the Choice of Treatment ....473 A. Modeling the Auditor’s Shareholder Beneficiary 474 1. Irrelevance: The Smart Money as Beneficiary 475 2. The Real World Shareholder as Beneficiary 476 3. All Constituents as Beneficiary 477 4. The Fundamental Value Investor as Beneficiary ........479 B. Market Correction versus Regulation 481 IV. Conclusion 485
Biosynthesis of a Thiouracil Pheomelanin in Embryonic Pigment Cells Exposed to Thiouracil

Abstract [2-14C]Thiouracil and [35S]thiouracil are incorporated into the melanin of chick retinal pigment epithelium incubated in vitro. This synthesis of a thiouracil pheomelanin (thiol-containing melanin) can be used to measure the rate of melanin synthesis in living cells. Thiouracil incorporation is dependent on tyrosinase activity: incorporation is inhibited by phenylthiourea, a tyrosinase inhibitor, and there is a proportional relationship between thiouracil incorporation and the level of tyrosinase activity in pigment tissues. Other chick embryo tissues do not incorporate thiouracil, but small quantities are incorporated by embryo tissues containing tyrosine hydroxylase. Radioactivity is retained in melanin prepared from isolated melanosomes of pigment tissues incubated in [2-14C]thiouracil. A comparison of [35S]thiouracil and l-[2-14C]tyrosine incorporations into melanin indicates that 1.5 moles of thiouracil are incorporated for each mole of tyrosine. These results are consistent with the hypothesis that thiouracil condenses with the quinone intermediates in the melanin pathway and is incorporated into the melanin polymer as part of the subunit structure.
Monoclonal antibody-based enzyme immunoassay for Giardia lamblia antigen in human stool.

A visually readable monoclonal antibody-based antigen-capture enzyme immunoassay for the detection of Giardia lamblia antigen in human stool specimens was developed and found to be 97% (30 of 31 stool specimens) sensitive for formalinized stools and 82% (49 of 60 stool specimens) sensitive for unfixed stool specimens by visual reading. The storage of specimens in 10% Formalin resulted in increased absorbance in 20 of 26 G. lamblia-positive specimens tested as both formalinized and unfixed specimens; the increase averaged 1,336%. The assay was specific for antigens of this organism and for antigens derived from the cyst, as opposed to the trophozoite, stage. The assay could detect the antigens of five cysts per well, but could not detect antigen in in vitro-cultured trophozoites. A mouse monoclonal antibody of the immunoglobulin G1 (IgG1) subclass, which was prepared against cysts of G. lamblia, was used as the solid-phase capture antibody. The antibody was reactive with the cyst wall, as determined by immunofluorescence. Polyclonal rabbit anti-cyst IgG was used as the secondary antibody, and peroxidase-labeled goat anti-rabbit IgG was used as the tertiary antibody in the assay format. Maximal capture of antigen from stool specimens occurred by 30 min. Optimal dilution of specimens was in the range of 1:60 to 1:600. Preliminary characterization of affinity-purified antigen recognized by the monoclonal antibody showed that it is heat stable (100 degrees C, 12 min) and resistant to sodium periodate treatment and that it may exist in multiple molecular weights from 45,000 to 110,000. Images
Adenosine A2a-receptor activation increases contractility in isolated perfused hearts

Adenosine A2a-receptor activation enhances shortening of isolated cardiomyocytes. In the present study the effect of A2a-receptor activation on the contractile performance of isolated rat hearts wa...
1,2‐Bis(diphenylphosphino)benzenecopper Hydride [(BDP)CuH]

[1006031-44-2] C30H25P2Cu InChI = 1S/C30H24P2.Cu.H/c1-5-15-25(16-6-1)31(26-17-7-2-8-18-26)29-23-13-14-24-30(29)32(27-19-9-3-10-20-27)28-21-11-4-12-22-28;;/h1-24H;; InChIKey = NPASTHZOARZNHC-UHFFFAOYSA-N (reagent for achiral conjugate reductions) Form Supplied in: 0.001 M solution in toluene; deep red colored solution. Preparative Methods: Preparation of 10 mL of 0.001 m stock solution of (BDP)CuH.1 In a flame-dried 50 mL amber vial cooled under argon were added Cu(OAc)2· H2O (20.0 mg, 0.1 mmol), o-diphenylphosphinobenzene (4.46 mg, 0.01 mmol), and triphenylphosphine (27.0 mg, 0.1 mmol). The reagents were dissolved in freshly distilled toluene (8.0 mL) and stirred at room temperature for 1 h. Polymethylhydrosiloxane (PMHS; 2.0 mL, 30 mmol) was added dropwise to the stirring solution. There was an immediate color change from blue to red. The stock solution was thoroughly purged with argon and sealed. Storage in a refrigerator is recommended. The solution prepared in this fashion can reduce a total of 10 mmol of substrate. Alternatively, active catalyst can be formed in situ either using the CuCl/alkoxide combination or simply from Cu(OAc)2·H2O.2
Vitamin D fortification in the United States and Canada: current status and data needs

Most circulating 25-hydroxyvitamin D originates from exposure to sunlight; nevertheless, many factors can impair this process, necessitating periodic reliance on dietary sources to maintain adequate serum concentrations. The US and Canadian populations are largely dependent on fortified foods and dietary supplements to meet these needs, because foods naturally rich in vitamin D are limited. Fluid milk and breakfast cereals are the predominant vehicles for vitamin D in the United States, whereas Canada fortifies fluid milk and margarine. Reports of a high prevalence of hypovitaminosis D and its association with increased risks of chronic diseases have raised concerns regarding the adequacy of current intake levels and the safest and most effective way to increase vitamin D intake in the general population and in vulnerable groups. The usual daily intakes of vitamin D from food alone and from food and supplements combined, as estimated from the US third National Health and Nutrition Examination Survey, 1988-1994, show median values above the adequate intake of 5 microg/d for children 6-11 y of age; however, median intakes are generally below the adequate intake for female subjects > 12 y of age and men > 50 y. In Canada, there are no national survey data for estimation of intake. Cross-sectional studies suggest that current US/Canadian fortification practices are not effective in preventing hypovitaminosis D, particularly among vulnerable populations during the winter, whereas supplement use shows more promise. Recent prospective intervention studies with higher vitamin D concentrations provided evidence of safety and efficacy for fortification of specific foods and use of supplements.