cssi/SciSciGPT-SciSciNet huggingface dataset:
Quality standard of penyanling mixture

Objective To establish the quality standard of penyanling mixture.Methods Angelica sinensis and rhizoma corydalis in penyanling mixture were indentified by TLC.Peoniflorin was determined by HPLC.The HPLC was conducted on an Agilent C18 column(250 mm×4.6 mm,id 5 μm) with anol-0.1% phosphoric acid(25∶75) solution,which was used as mobile phase with flow rate of 1.0 mL·min-1.The detective wavelength was 230 nm and column temperature 35 ℃.Results Angelica sinensis and rhizoma corydalis could be detected by TLC.The area under the peak of chromatography(r=0.999 9)was very well correlated with the concentration of peoniflorin at 0.015～0.15 mg·mL-1.The average recovery was 98.66%,RSD=0.94%(n=9).Conclusion The method is simple and accurate.The experiment is reproducible.The method can be used for the quality control of penyanling mixture.
Serine phosphorylation of p60 tumor necrosis factor receptor by PKC-δ in TNF-α-activated neutrophils

Tumor necrosis factor-α (TNF-α) triggers degranulation and oxygen radical release in adherent neutrophils. The p60TNF receptor (p60TNFR) is responsible for proinflammatory signaling, and protein ki...
Ultrastructural organization of calcitonin gene-related peptide immunoreactive efferent axons and terminals in the vestibular periphery

The ultrastructural distribution of calcitonin gene-related peptide immunoreactivity (CGRPi) was examined in sections of decalcified temporal bones in order to study the complex peptidergic innervation patterns of this efferent neuromodulator in the peripheral vestibular system of the rat. A new method of preembedding immunoelectron microscopy was developed to accomplish this study. Unmyelinated CGRPi axons, measuring 1 to 3 microns in diameter, passed among the primary afferent fibers in Scarpa's ganglion, and these fibers continued through the subepithelial regions of the vestibular end-organs. Within the neurosensory epithelia of the maculae and cristae, the CGRPi axons ramified to produce numerous CGRPi terminals. Immunoelectron microscopic localization of CGRPi terminals in the maculae and cristae revealed an extensive innervation pattern on the afferent vestibular pathway. Calcitonin gene-related peptide immunoreactive terminals made synaptic contacts with the unmyelinated portions of the primary afferent vestibular fibers innervating both type I and type II hair cells. Abundant synaptic contact between CGRPi terminals and the chalices surrounding type I hair cells was observed. Rare direct contact between CGRPi terminals and type I or type II hair cells was observed. In addition, vesiculated efferent terminals without CGRPi were seen contacting type II hair cells. These data suggest that the efferent vestibular system has a much more complex innervation pattern on the afferent vestibular pathway than previously believed.
Special Problems in the Diagnosis and Treatment of Surgical Sepsis

Sepsis is the major cause of mortality and morbidity occurring 48 hours or more after trauma or surgery. The greatest management problems occur in critically ill patients who are anergic. Such patients may show a “failure to thrive” or may actually develop multiple organ failure without other signs of sepsis. Intra-abdominal infections are the most important and difficult kind to diagnose and treat. Early and complete surgical drainage of all infected sites, with appropriate antibiotic coverage, is essential if these critically ill septic patients are to survive.
COGNITIVE DYSFUNCTION AND OTHER COMORBIDITIES | Language and Communication Disorders

Children with epilepsy, who have average intelligence, have difficulty using language to formulate and organize their thoughts (i.e., thought disorder). These higher level linguistic deficits make it difficult for the listener to follow what these individuals are talking about. These impaired discourse skills are associated with age, seizure-related variables, subtle cognitive deficits, psychopathology, social skill deficits, as well as with structural and functional brain abnormalities. Such associations lead to the conclusion that thought disorder is a developmental disability associated with epilepsy. Findings in this area of investigation underscore the usefulness of studies of language for providing a portal to delineating a child's higher level cognitive functions and the implications of deficits in these functions in daily life as well as the means for identifying the underlying neural substrates.
Organ preservation with neoadjuvant chemoradiation in patients with orbit invasive sinonasal cancer otherwise requiring exenteration.

Purpose We sought to determine if organ preservation (OP) with neoadjuvant chemoradiation (CRT) was feasible in patients with sinonasal cancer determined to require exenteration. Materials and methods Twenty patients were determined to require exenteration for definitive treatment from 2005 to 2014. Fourteen patients underwent OP and 6 patients received exenteration with adjuvant CRT. Exenteration free survival (EFS), locoregional control (LRC), progression-free survival (PFS), and overall survival (OS) were estimated. Results Five patients (36%) receiving OP had complete disease response at time of surgery. With a median follow-up of 18.8 months, EFS was 62% at 2 years for patients undergoing OP. At 2 years, there were no significant differences in LRC, PFS or OS (all all p > 0.050) between the groups. Less grade 3 or greater toxicity was seen in patients undergoing OP (p = 0.003). Visual function was preserved in all patients undergoing OP. Conclusion For patients with sinonasal cancer, OP may avoid exenteration, offering similar disease control and improved toxicity.
Programmable RNA Microstructures for Coordinated Delivery of siRNAs

RNA is a natural multifunctional polymer, and is an essential component in both complex pathways and structures within the cellular environment. For this reason, artificial self-assembling RNA nanostructures are emerging as a powerful tool with broad applications in drug delivery and metabolic pathway regulation. To date, coordinated delivery of functional molecules via programmable RNA assemblies has been primarily done using nanosize RNA scaffolds. However, larger scaffolds could expand existing capabilities for spatial arrangement of ligands, and enable the controlled delivery of highly concentrated molecular loads. Here, we investigate whether micron-size RNA scaffolds can be assembled and further functionalized with different cargos (e.g. various siRNAs and fluorescent tags) for their synchronized delivery to diseased cells. Since known design approaches to build large RNA scaffolds are still underdeveloped, we apply a tiling method widely used in DNA nanotechnology. DNA tiles have been extensively used to build a variety of scalable and modular structures that are easily decorated with other ligands. Here, we adapt a double crossover (DX) DNA tile motif to design de novo DX RNA tiles that assemble and form lattices via programmed sticky end interactions. We optimize assembly protocols to guarantee high yield of RNA lattices. The resulting constructs are robust and modular with respect to the presence of distinct siRNAs and fluorophores. RNA tiles and lattices are successfully transfected in either human breast cancer or prostate cancer cells, where they efficiently knockdown the expression of target genes. Blood serum stability assays indicate that RNA lattices are more resilient to nuclease degradation when compared to individual tiles, thus making them better suited for therapeutic purposes. Overall, because of its design simplicity, we anticipate that this approach will be utilized for a wide range of applications in therapeutic RNA nanotechnology.
Daily Temporal Pathways: A Latent Class Approach to Time Diary Data

Research on daily time and how it is allocated has generally considered the time spent in specific activities. However, social theory suggests that time use is socially patterned whether by social organization, heterogeneity, and/or stratification. Drawing on four broad types of time (contracted, committed, necessary, and free), we use Multinomial Logit Latent Class Analysis to discuss eight daily temporal pathways and associations with individual characteristics. Our analysis highlights the variations and similarities across pathways, the impact of paid work in structuring daily life, the social patterning of sleep and leisure, and socio-demographic profiles of the pathways of working-age Americans.
Grindelia squarrosa: A Potential Arid Lands Biofuel Plant

Gumweed (Grindelia squarrosa) has potential as a biofuel/biomaterial crop in arid lands. Two years of biomass production data at University of Nevada, Reno (UNR) field plots varied from 6700 kg/ha up to 14 900 kg/ha with an average of 9950 kg/ha. Gumweed was planted in 4 m × 4 m plots at spacings of 15, 20, 25, 30, and 37 cm with three replications each. Acetone extraction of the ground, dried biomass yielded about 12.5% extractable hydrocarbons, called biocrude or crude resin. Approximately 52% of the biocrude extract consists of the C20 diterpene acid grindelic acid, which is also approximately 6.5% of the dried plant biomass. Additional carboxylic acids bring the total carboxylic acid fraction to approximately 68% of the biocrude. Also found in the biocrude is approximately 4.7% monoterpenes, including pinene, limonene, germacrene, elemene, and camphene. Acid-catalyzed methylation of the biocrude followed by hexane extraction and removal of the hexane and remaining methanol produced an approximately 72...
340. Development of a Nuclease Screen to Improve Cas9 Targeting Specificity

CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) bacterial immunity targets invading nucleic acid sequences using an RNA guide (gRNA). The well-defined Cas9 from Streptococcus pyogenes’ type II CRISPR system has been utilized as a gene editing tool in a vast assortment of organisms. However, an inherent lack of specificity limits the potential of the current system and presents challenges to interpreting experimental results. A plasmid cleavage based screening platform has been developed with the intent to increase the fidelity of the Cas9 system. Utilizing both positive and negative selection, the screen can be used to identify variants of Cas9 or its gRNA with improved specificity. Positive selection of variants with activity towards the appropriate target site proceeds through the removal of a plasmid containing an inducible suicide gene. Conversely, negative selection of variants with reduced activity on off-target substrates involves the retention of a plasmid with an antibiotic resistance gene. Preliminary results suggest that a gRNA with an insertion in the scaffold region of the RNA can decrease the level of off-target cleavage. These results suggest that the screening platform has the potential to identify novel protein or RNA variants with greater targeting specificity compared to the naturally occurring components. A Cas9 system with enhanced fidelity will expand the potential applications of the technology and accelerate its ability to interrogate biological systems.
Expander to Implant-Based Reconstruction

This chapter describes the surgical steps for the exchange of tissue expanders to permanent implants for breast reconstruction. It discusses preoperative markings, step-by-step intraoperative details, postoperative care, and possible complications. In addition to providing a sample dictation, it also suggests further readings in the techniques that assist with implant-based breast reconstruction.
A new paradigm for use of ultrafast lasers in ophthalmology for enhancement of corneal mechanical properties and permanent correction of refractive errors

A new paradigm for strengthening of corneal tissue as well as permanent correction of refractive errors has been proposed. Ultrafast laser irradiation is confined to the levels below optical breakdown such that tissue damage is avoided while creating an ionization field responsible for subsequent photochemical modification of the stroma. The concept was assed using newly developed platform for precise application of a near-IR femtosecond laser irradiation to the cornea in in-vitro experiments. Targeted irradiation with tightly focused ultrafast laser pulses allows spatially resolved crosslinking in the interior of the porcine cornea in the absence of photosensitizers. The formation of intra- or interstromal covalent bonds in collagen matrix locally increases lamellar density. Due to high resolution, treatment is spatially resolved and therefore can be tailored to either enhance structure of corneal stroma or adjust corneal curvature towards correcting refractive errors. As the induced modification is primarily driven by nonlinear absorption, the treatment is essentially wavelength independent, and as such potentially less harmful than current method of choice, joint application of UVA light irradiation in conjunction with riboflavin. Potential applicability of a near-IR femtosecond laser for biomechanical stabilization of cornea and non-invasive refractive eye corrections is discussed.
Impact of High Altitude on Military Operations

Purpose of Review High-altitude combat and medical evacuation pose special challenges to military operations. We aim to summarize the physiologic changes that occur at altitude, as well as review the altitude-related diseases with emphasis on the impact on the military population. Finally, the impact of high-altitude exposure during transportation of combat trauma will be reviewed.
A Pseudo-One Compartment Model of Phosphorus Kinetics During Hemodialysis: Further Supporting Evidence

A pseudo-one compartment model has been proposed to describe phosphorus kinetics during hemodialysis and the immediate post-dialysis period. This model assumes that phosphorus mobilization from tissues is proportional to the difference between the pre-dialysis serum concentration (a constant) and the instantaneous serum concentration. The current study is exploratory and evaluated the ability of a pseudo-one compartment model to describe the kinetics of phosphorus during two short hemodialysis treatments separated by a 60-min inter-treatment period without dialysis; the latter is the post-dialysis rebound period for the first short hemodialysis treatment. Serum was collected frequently during both hemodialysis treatments and the inter-treatment period to assess phosphorus kinetics in 21 chronic hemodialysis patients. Phosphorus mobilization clearance and pre-dialysis central distribution volume were previously estimated for each patient during the first hemodialysis treatment and the inter-treatment period. Assuming those kinetic parameters remained constant for each patient, serum phosphorus concentrations during the second treatment were used to estimate the driving force concentration (Cdf ) for phosphorus mobilization from tissues during the second treatment. Treatment time (117 ± 14 [mean ± standard deviation] vs. 117 ± 14 min), dialyzer phosphorus clearance (151 ± 25 vs. 140 ± 32 mL/min), and net fluid removal (1.44 ± 0.74 vs. 1.47 ± 0.76 L) were similar during both short hemodialysis treatments. Measured phosphorus concentration at the start of the second hemodialysis treatment (3.3 ± 0.9 mg/dL) was lower (P < 0.001) than at the start of the first treatment or Cpre (5.4 ± 1.9 mg/dL). Calculated Cdf was 4.9 ± 2.0 mg/dL, not significantly different from Cpre (P = 0.12). Cdf and Cpre were correlated (R = 0.72, P < 0.001). The results from this study demonstrate that the driving force concentration for phosphorus mobilization during hemodialysis is constant and not different from that pre-dialysis, providing further evidence supporting a fundamental assumption of the pseudo-one compartment model.
Excitable Tissues: The Heart

Cardiac action potentials serve many purposes. They form the cellular basis for pacemaker activity, impulse spread, and control of cardiac contraction. Despite this variety of functions, there are ample reasons for believing that impulses in cardiac cells follow the same general principles as in other excitable tissues. The preceding chapters on nerve and skeletal muscle have provided a useful foundation for understanding action potentials in heart. We shall draw upon such similarities, but shall also focus on the unique aspects of cardiac activity.
Optimal Co-57 flood source activity and acquisition time for lymphoscintigraphy transmission images

2007 Objectives: To evaluate different Co-57 flood source activities and acquisition times, to obtain an optimal transmission image for breast lymphoscintigraphy that will adequately outline the body and allow detection of nodes seen on the emission scan, while minimizing radiation exposure to the patient. Methods: An anthropomorphic thorax breast phantom representing an average size patient was used to simulate lymphatic drainage of two nodes on a breast lymphoscintigraphy scan. The decayed activities in the nodes were calculated at the time of acquisition ranging from 0.6-5uCi. Four experiments were performed. Ten-minute emission and three-minute transmission anterior, posterior, right and left lateral images of the thorax phantom were acquired, utilizing five different Co-57 flood sources with activities ranging from 2.43-7.26mCi to determine the optimal source activity. Second, 10 transmission image durations for each source were acquired and compared for quality. Then, three-minute transmissions for two phantom thicknesses of 10cm and 20cm were acquired to determine contrast-to-noise ratio for each source. Lastly, total exposure was measured using an Inovision 451B meter, given standard three-minute transmission scans for total unilateral and bilateral breast protocols. Results: All sources ranging from 2.43-7.26mCi allowed visualization of the lymphatic nodes as early as 3 minutes. The 3.41mCi source demonstrated an optimal body outline with visualization of all nodes seen on the emission scan. The 2.49mCi source did not provide sufficient body outline, while the hotter sources increased the background around the nodes and patient exposure. Node activity below 1uCi became undetectable on the anterior transmission images, yet was still visible on the lateral image due to more attenuation of Co-57 photons. The calculated exposure rate per mCi was 20.21uSv/h. Conclusions: Acquiring a 3-min transmission scan utilizing a 3.41mCi source provided an optimal body outline, with visualization of all nodes seen on the emission. The estimated exposures to the patient for 3.41mCi were minimal (6.9uSv for unilateral and 10.3uSv for bilateral). Node detectability decreased on transmission images when utilizing hotter Co-57 sources, affecting thin (10cm) patients even more than average patients.
Responses of an oyster host (Crassostrea virginica) and its protozoan parasite (Perkinsus marinus) to increasing air temperature.

Background Changes in climate are predicted to influence parasite and pathogen infection patterns in terrestrial and marine environments. Increases in temperature in particular may greatly alter biological processes, such as host-parasite interactions. For example, parasites could differentially benefit from increased reproduction and transmission or hosts could benefit from elevated immune responses that may mediate or even eliminate infections. In the southeastern United States, the Eastern oyster, Crassostrea virginica, is infected by the lethal protozoan parasite, Perkinsus marinus. Under field conditions, intertidal (air-exposed) oysters have been found to have significantly higher P. marinus infection intensity and marginally higher infection prevalence than subtidal (submerged) oysters. During summer, air temperatures are much warmer than water and this exposure of intertidal oysters to higher temperatures is a suggested mechanism for increased infection intensity. Methods We simulated intertidal exposure using controlled laboratory experiments to determine how host traits (survival and immune response) and parasite infection intensity will respond to elevated air temperature ranging from 27 °C to 53 °C during emersion at low tide. In Georgia, where our work was conducted, the average summer water temperature is 29 °C and the average maximum high air temperature in July is 33 °C (though oysters have been shown to survive at much higher air temperatures). Results Host survival declined as temperature increased, with a definitive drop-off between 39-43 °C. Negative effects of air temperature on host immune response (phagocytic activity) were detectable only at extremely high temperatures (47-50 °C) when hosts were suffering acute mortality. Parasite infection intensity peaked at 35 °C. Discussion Our results suggest that an increase in average summer air temperature to 35 °C or higher could affect oyster survival directly through temperature-related impacts in the short-term and indirectly through increased P. marinus infection intensity over the long-term.
NMR and theoretical studies of solid acids: super and otherwise

Substantial controversy surrounds the role of the isopropyl cation in the reactions of propene on acidic zeolites. Here we report new experimental and theoretical results that together provide a more detailed description of the chemistry of propene on zeolite solid acids. At cryogenic temperatures, propene is weakly bound to the Bronsted site as a π complex. Density functional theory (DFT) calculations indicate the binding energy of the π complex is only 2.6 kcal/mol, with essentially no charge transfer between the acid site and the alkene. At higher temperature, propene reacts with the acid site to form a framework-bound isopropoxyl. DFT predicts this isopropoxyl has a charge of +0.44|e|, far less than the unit positive charge of a free carbenium ion. Assignment of π complex and framework bound species is supported by the excellent agreement between experimental and theoretical 13C chemical shifts. NMR experiments indicate propene does not undergo complete label scrambling on zeolite HZSM-5, demonstrating that the isopropyl cation does not exist on this catalyst (under these conditions). In contrast, complete label scrambling does occur for isopropyl bromide on true superacids such as SbF5 and AlBr3.
Caregiver and Staff Perceptions of Disruptions to Pediatric Inpatient Sleep.

Study Objectives:Sleep is critical to a child's health and well-being, but children are likely to sleep less and be awakened more often during the night in the hospital than at home. To date no stu...
The biopsychosocial-spiritual health of active duty women

Women have been an active part of the military since the beginning of American history, holding various roles in the military for centuries. The purpose of this review is to explore the literature ...
All in the Family: The Pinchots of Milford

"Little that happened in [Gifford] Pinchots childhood gave a hint of the calling he would follow," M. Nelson McGeary asserted in the prologue to his biography of the dynamic Progressive reformer. "Certainly the climate of his early upbringing encouraged acceptance of things as they were."1 Strictly speaking, McGeary s assertion is true enough. Nowhere in James and Mary Eno Pinchot s voluminous correspondence is there even a hint that they expected their first born to make the mark he did on the United States in the early 20th-century: to become one of the central architects of the conser vation movement while serving as first chief of the Forest Service; to help manage Theodore Roosevelt's Bull Moose campaign; or serve so successfully as a two-time governor of Pennsylvania. For a biographer to have evidence of such aspirations would have been astonishing?even in parents as ambitious for their children as were the Pinchots. Such a lack of documentary evidence thus turns McGeary s claim into one of those tropes that biographers occa sionally employ to gloss over what seems unexplainable. Nonetheless, if it appears odd that Pinchot, who was raised in lavish sur roundings should have matured into someone who apparently was delighted to enter the political arena and there to challenge "things as they were," per haps the problem lies in the biographer's perspective. For the Pinchots were not at all surprised at the thrust and trajectory of their son's career in politics. After all, they helped mold Gifford into the man he would become, and did so with the hope he would act much as had his paternal forbears, none of whom shied away from political engagement. The family's past was prologue.2
Mycosis fungoides with spongiosis: A potential diagnostic pitfall

Background Mycosis fungoides (MF) is characterized by epidermotropic atypical lymphocytes in the absence of spongiosis. However, we describe an unusual presentation of MF with spongiosis, mimicking benign inflammatory dermatoses and highlight the importance of pathologic interpretation for diagnostic confirmation. Methods A cross-sectional study of consecutive patients diagnosed with MF with spongiosis was conducted. The clinical, histopathologic, immunophenotypic, and molecular genetic features of cases were reviewed. Results We identified nine cases of MF (age range 34-82 years; mean 75 years), with an initial diagnosis of dermatitis (6/9), psoriasis (4/9), or other inflammatory dermatoses (2/9). Pruritus, pain, and blisters were common clinical manifestations. The most common areas of involvement were the extremities (8/9). Epidermotropism with spongiosis was a central histopathological feature in all cases. Conclusion These cases highlight prominent spongiosis in MF and overlap with common benign inflammatory dermatoses. We present these cases to show the diagnostic pitfalls associated with spongiotic presentations of MF. Dermatitis, psoriasis, and other inflammatory skin conditions not responsive to standard therapy warrant further work-up including biopsy to rule out MF. Multiple skin biopsies and review by a dermatopathologist with expertise in the diagnosis of cutaneous lymphoma is highly recommended.
The evolutionary biology of self-deception, laughter, dreaming and depression: Some clues from anosognosia

Patients with right hemisphere strokes sometimes vehemently deny their paralysis. I describe three new experiments that were designed to determine the extent and depth of this denial. Curiously, when asked to perform an action with their paralyzed arm, they often employ a whole arsenal of grossly exaggerated 'Freudian defense mechanisms' to account for their failure (e.g. 'I have arthritis' or 'I don't feel like moving it right now'). To explain this, I propose that, in normal individuals, the left hemisphere ordinarily deals with small, local 'anomalies' or discrepancies by trying to impose consistency in order to preserve the status quo. But when the anomaly exceeds threshold, a 'devil's advocate' in the right hemisphere intervenes and generates a paradigm shift, i.e. it results in the construction of a new model using the same data. A failure of this process in right hemisphere stroke would partially explain anosognosia. Also, our model provides a new theory for the evolutionary origin of self-deception that is different from one proposed by Trivers. And, finally, I use anosognosia as a launching-off point to speculate on a number of other aspects of human nature such as Freudian defense mechanisms, laughter, dreams and the mnemonic functions of the hippocampus.
Writing a good anticipatory care plan for a child with severe disability

Abstract There are increasing numbers of children with severe disability and life limiting conditions living longer in the community. In order for them to have high quality end of life care and choice of place of death there need to be discussions with the child and family about how the child may deteriorate and the pros and cons of the different possible interventions taking into account the priorities and views of the family and the child themselves. Families and professionals are reluctant to talk about the death of a child and there is always uncertainty. Parallel planning for best and worst case scenarios can be helpful and offering families a useful medical emergency care plan for their child is a positive way to start to plan for deterioration and life threatening events. The emergency care plan can include the resuscitation plan and the child and family priorities of care and leads on to further discussions about choices in end of life care including place of death and funeral plans.
100 yr of primary succession highlights stochasticity and competition driving community establishment and stability.

The study of community succession is one of the oldest pursuits in ecology. Challenges remain in terms of evaluating the predictability of succession and the reliability of the chronosequence methods typically used to study community development. The research of William S. Cooper in Glacier Bay National Park is an early and well-known example of successional ecology that provides a long-term observational data set to test hypotheses derived from space-for-time substitutions. It also provides a unique opportunity to explore the importance of historical contingencies and as an example of a revitalized historical study system. We test the textbook successional trajectory in Glacier Bay and evaluate long-term plant community development via primary succession through extensive fieldwork, remote sensing, dendrochronological methods, and newly discovered data that fills in data gaps (1940s to late 1980s) in continuous measurement over 100+ years. To date, Cooper's quadrats do not support the classic facilitation model of succession in which a sequence of species interacts to form predictable successional trajectories. Rather, stochastic early community assembly and subsequent inhibition have dominated; most species arrived shortly after deglaciation and have remained stable for 50+ years. Chronosequence studies assuming prior composition are thus questionable, as no predictable species sequence or timeline was observed. This underscores the significance of assumptions about early conditions in chronosequences and the need to defend such assumptions. Furthermore, this work brings a classic study system in ecology up to date via a plot size expansion, new baseline biogeochemical data, and spatial mapping for future researchers for its second century of observation.
A striking bone marrow dyserythropoietic change but no anemia.

![Figure][1] A 63-year-old woman with newly diagnosed low-grade follicular lymphoma underwent a bone marrow biopsy for staging before treatment. Family history was unremarkable. She presented with borderline red cell index (red blood cells [RBCs], 3.49 × 106/μL; hemoglobin, 11.7 g/dL) and
Engineer to Operations Research to Criminology: Quite a Trajectory

In reflecting on my career trajectory, I find it very intriguing: from high school science to Cornell's first class in engineering physics and then on to early involvement in the new field of opera...
Care of the Post-vaginoplasty Patient: Management of Complications and Common Gynecologic Issues

The purpose of this review is to provide an overview of the surgical complications associated with penile-inversion vaginoplasty surgery as well as the management required to address these complications. We also review common gynecologic problems after penile-inversion vaginoplasty. The incidence of reoperation is not low after penile-inversion vaginoplasty with the literature revealing incidence rates as high as 50% in certain cohorts. However, the majority of these reoperations are for cosmesis. Despite these reported complications, most patients “[feel] positive about their genitals” and “would do this operation again” when asked post-operatively. Overall, penile-inversion vaginoplasty is a safe procedure, albeit with a high incidence of patients undergoing subsequent treatment or surgery. Most complications are considered minor and can be managed in the outpatient setting. Reoperations are mostly revision surgery for cosmesis. It is important to counsel patients pre-operatively about all of the possible complications that may arise after vaginoplasty. All patients should be surgically optimized to reduce these complications.
Sensitivity of IROC phantom performance to radiotherapy treatment planning system beam modeling parameters based on community-driven data.

PURPOSE Treatment planning system (TPS) dose calculations have previously been shown to be sensitive to modeling errors, especially when treating with complex strategies like intensity-modulated radiation therapy (IMRT). This work investigates the dosimetric impact of several dosimetric and nondosimetric beam modeling parameters, based on their distribution in the radiotherapy community, in two commercial TPSs in order to understand the realistic potential for dose deviations and their clinical effects. METHODS AND MATERIALS Beam models representing standard 120-leaf Varian Clinac-type machines were developed in Eclipse 13.5 (AAA algorithm) and RayStation 9A (v8.99, collapsed-cone algorithm) based upon median values of dosimetric measurements from Imaging and Radiation Oncology Core (IROC) Houston site visit data and community beam modeling parameter survey data in order to represent a baseline linear accelerator. Five clinically acceptable treatment plans (three IMRT, two VMAT) were developed for the IROC head and neck phantom. Dose distributions for each plan were recalculated after individually modifying parameters of interest (e.g., MLC transmission, percent depth doses [PDDs], and output factors) according to the 2.5th to 97.5th percentiles of community survey and machine performance data to encompass the realistic extent of variance in the radiotherapy community. The resultant dose distributions were evaluated by examining relative changes in average dose for thermoluminescent dosimeter (TLD) locations across the two target volumes and organ at risk (OAR). Interplay was also examined for parameters generating changes in target dose greater than 1%. RESULTS For Eclipse, dose calculations were sensitive to changes in the dosimetric leaf gap (DLG), which resulted in differences from -5% to +3% to the targets relative to the baseline beam model. Modifying the MLC transmission factor introduced differences up to ± 1%. For RayStation, parameters determining MLC behaviors likewise contributed substantially; the MLC offset introduced changes in dose from -4% to +7%, and the MLC transmission caused changes of -4% to +2%. Among the dosimetric qualities examined, changes in PDD implementation resulted in the most substantial changes, but these were only up to ±1%. Other dosimetric factors had <1% impact on dose accuracy. Interplay between impactful parameters was found to be minimal. CONCLUSION Factors related to the modeling of the MLC, particularly relating to the leaf offset, can cause clinically significant changes in the calculated dose for IMRT and VMAT plans. This should be of concern to the radiotherapy community because the clinical effects of poor TPS commissioning were based on reported data from clinically implemented beam models. These results further reinforce that dose errors caused by poor TPS calculations are often involved in IROC phantom failures.
Challenging the presumptive link between musical preference and aggression

The present study sought to examine the relationship between musical preference and aspects of aggression in a United States of America community sample. A total of 400 adults (M age = 34.14; 50.3%...
Intestinal Metaplasia in the Esophageal Remnant Is Rare After Ivor Lewis Esophagectomy.

Most patients undergoing esophagectomy will experience intermittent reflux of gastric and biliary content into the remnant esophagus postoperatively. The incidence of new or recurrent intestinal metaplasia following chemoradiation and surgery has not been well-described. Furthermore, post-resection guidelines do not exist regarding surveillance for metaplasia in the esophageal remnant. Patients undergoing Ivor Lewis esophagectomy after concurrent chemoradiation for a diagnosis of esophageal adenocarcinoma from 2006 to 2018 were identified. Pathology records were reviewed for the presence of intestinal metaplasia on pretreatment biopsies, surgical specimen, or post-resection biopsies. In total, 619 patients met inclusion criteria, including 267 (43%) who had intestinal metaplasia noted either prior to or at the time of esophagectomy. The median duration of metaplastic disease prior to resection was 4.4 months. During a median follow-up time of 28 months (interquartile range, 12–60), intestinal metaplasia was noted in the remnant esophagus in 12 (2%) patients, 7 of whom had a prior history of metaplasia. Local recurrence of adenocarcinoma was also uncommon, and occurred in 37/577 (6%) of patients with complete resections, with similar event rates among those with and without a prior history of metaplasia (14/249 [6%] vs. 23/328 [7%], p = 0.614). Our findings suggest that despite several factors predisposing to mucosal damage following esophagectomy, occurrence of new intestinal metaplasia after trimodality therapy in our patient population appears to be rare, even among patient with a previous history of this pathologic finding, which may have significant implications for surveillance and cost-savings after resection.
Disparities in Cardiovascular Disease Risk Among Hispanic Breast Cancer Survivors in a Population-Based Cohort.

Background Breast cancer is the leading cause of cancer death among Hispanic women. The aim of our study was to estimate cardiovascular disease (CVD) risk among Hispanic and non-Hispanic White (NHW) breast cancer survivors compared with their respective general population cohorts. Methods Cohorts of 17 469 breast cancer survivors (1774 Hispanic and 15 695 NHW) in the Utah Cancer Registry diagnosed between 1997 and 2016, and 65 866 women (6209 Hispanic and 59 657 NHW) from the general population in the Utah Population Database were identified. Cox proportional hazards models were used to estimate hazard ratios (HRs) for CVD. Results The risk of diseases of the circulatory system was higher in Hispanic than NHW breast cancer survivors 1-5 years after cancer diagnosis, in comparison with their respective general population cohorts (HRHispanic = 1.94, 99% confidence interval [CI] = 1.49 to 2.53; HNHW = 1.38, 99% CI = 1.33 to 1.43; 2-sided P heterogeneity = .01, respectively). Increased risks were observed for both Hispanic and NHW breast cancer survivors for diseases of the heart and the veins and lymphatics, compared with the general population cohorts. More than 5 years after cancer diagnosis, elevated risk of diseases of the veins and lymphatics persisted in both ethnicities. The CVD risk due to chemotherapy and hormone therapy was higher in Hispanic than NHW breast cancer survivors but did not differ for distant stage, higher baseline comorbidities, or baseline smoking. Conclusions We observed a risk difference for diseases of the circulatory system between Hispanic and NHW breast cancer survivors compared with their respective general population cohorts but only within the first 5 years of cancer diagnosis.
Ponce de Leon: Confidential Instructions for Newman Knight, Elaine Bennett's Agent

Ponce de Leon (POL) is a four-party negotiation exercise in which a film studio is trying to sign a major actress to star in an upcoming movie. The negotiation centers around the different extrinsic and intrinsic motivations underlying each of these party's approach to the movie, and therefore to the negotiation. The exercise allows exploration of the risks of "monetizing" different types of extrinsic (e.g. pay, awards, status) and intrinsic (e.g. love of the work, values) motivation. Learning Objective: The exercise allows for a rich discussion of different types of motivation, the role of money and motivation, Maslow's hierarchy of needs, and the use of reference points to judge value, particularly in regard to compensation issues. It can be used in courses on managing human resources, negotiation, behavioral economics and organizational behavior.
(Review) True South: Henry Hampton and Eyes on the Prize, the Landmark Television Series That Reframed the Civil Rights Movement by Jon Else

A review of "True South: Henry Hampton and Eyes on the Prize, the Landmark Television Series That Reframed the Civil Rights Movement" by Jon Else.
A Comprehensive Approach to Assuring Quality of Laboratory Testing in HIV Surveys: Lessons Learned From the Population-Based HIV Impact Assessment Project.

BACKGROUND Conducting HIV surveys in resource-limited settings is challenging because of logistics, limited availability of trained personnel, and complexity of testing. We described the procedures and systems deemed critical to ensure high-quality laboratory data in the population-based HIV impact assessments and large-scale household surveys. METHODS Laboratory professionals were engaged in every stage of the surveys, including protocol development, site assessments, procurement, training, quality assurance, monitoring, analysis, and reporting writing. A tiered network of household, satellite laboratories, and central laboratories, accompanied with trainings, optimized process for blood specimen collection, storage, transport, and real-time monitoring of specimen quality, and test results at each level proved critical in maintaining specimen integrity and high-quality testing. A plausibility review of aggregate merged data was conducted to confirm associations between key variables as a final quality check for quality of laboratory results. RESULTS Overall, we conducted a hands-on training for 3355 survey staff across 13 surveys, with 160-387 personnel trained per survey on biomarker processes. Extensive training and monitoring demonstrated that overall, 99% of specimens had adequate volume and 99.8% had no hemolysis, indicating high quality. We implemented quality control and proficiency testing for testing, resolved discrepancies, verified >300 Pima CD4 instruments, and monitored user errors. Aggregate data review for plausibility further confirmed the high quality of testing. CONCLUSIONS Ongoing engagement of laboratory personnel to oversee processes at all levels of the surveys is critical for successful national surveys. High-quality population-based HIV impact assessments laboratory data ensured reliable results and demonstrated the impact of HIV programs in 13 countries.
Factors Affecting Profitability of the Cow-Calf Enterprise

One hundred and eighty five cow-calf enterprises were analyzed for production and financial performance measures that may affect profitability. Results of these analyses would indicate that for cow-calf enterprises in the Northern Great Plains, high levels of profit are a function of lower than average levels of investment, at least average levels of biological production (with particular attention paid to measures of weaning and pregnancy percentage), achieved with lower than average total expenses, and higher than average market values for calves produced. Neither high nor low levels of production, geographical region, size of operation, or year were factors that explained differences in profitability. The levels of profitability measured as return on assets (ROA) in the High Profit group are competitive with opportunities available in other sectors of the economy. The profit levels in the Medium and Low Profit groups are not competitive, and the long-term sustainability of the operations in these groups would be difficult without other sources of income and investment.
Utilization of a waste audit at a community hospital emergency department to quantify waste production and estimate environmental impact

Introduction A waste audit can clarify waste composition and inform improvements in waste disposal, thereby decreasing carbon emissions and reducing costs. The purpose of this study was to conduct a waste audit in the Emergency Department of a suburban community hospital to identify waste content, estimate environmental impact and explore avenues for improvement in waste disposal. Methods A 24-hour waste audit was performed in the ED of a community hospital in January 2020. The audit examined all waste generated in the ED during the study period. Waste was collected, manually sorted by predominant material, and weighed. Direct pollutant emissions were calculated using the M+WasteCare Calculator. Results A total of 255.30 kilograms (kg) of waste was produced in a 24-h period, of which 98.2% was solid waste and 1.8% was regulated medical waste. A total of 1.63 kg of waste was produced per patient encounter. The largest category of waste was plastic (61.0%), followed by paper (18.2%). More than 170 unused items (5.2% of total waste) were identified during the audit, including unopened boxes of gloves, surgical face masks, suturing material, and medications. The audit also identified 418 Styrofoam cups disposed of in a 24-h period, which extrapolates to an estimated 152,570 disposed cups each year. Direct pollutant emissions from waste disposal in the ED were estimated at 304 kg of carbon dioxide per day. Conclusions This 24-h waste audit in the ED of a community hospital identified waste content, estimated environmental impact, and proposed potential avenues for improvement in waste disposal.
Pediatric otolaryngology in the coronavirus disease 2019 pandemic: what have we learned?

Purpose of review Coronavirus disease 2019 (COVID-19) has changed the face of healthcare. The current review is to discuss the major aspects that have changed in pediatric otolaryngology, from surgical operations management, to clinic workflow, to procedural precautions. Recent findings There have been many studies over the past year describing different ways to improve the safety of healthcare delivery in pediatric otolaryngology amidst a global pandemic, as well as ways to improve clinic and surgical logistics along with guidelines for telehealth of a surgical specialty. Summary COVID-19 has forever altered how healthcare is viewed and practiced, and pediatric otolaryngology was not exempt. With an increased focus on provider safety, as well as novel ways of utilizing changes in methods of communication, the practice of pediatric otolaryngology has evolved with the rest of healthcare to take on the new challenges brought on by this global pandemic.
Soft Contact Lenses: A Look into the Future

In the year 1960, WICHTERLE and LIM published a brief review in Nature concerning their research with hydrogel materials for use as prosthetic devices (1). They stated that the demands for such a material were: 1) a structure permitting the desired water content; 2) inertness to normal biological processes; and 3) permeability for metabolites. Materials meeting these demands had to have high molecular weights; they had to contain hydrophilic groups; and it was necessary that they have enough cross-linkage to prevent absorption. Materials meeting these requirements were copolymers of glycomonomethacrylate with several tenths percent of glycodimethacrylate. WICHTERLE and LIM mentioned almost incidentally (in the last sentence of their report) that promising results had been obtained with these materials in the manufacture of contact lenses.
Mobility Biomechanics in Young and Old Healthy Adults

This paper surveys recent work from our laboratory at the University of Michigan on. the biomechanics of mobility in the elderly.