cssi/SciSciGPT-SciSciNet huggingface dataset:
An Apparent Obesity Paradox in Cardiac Surgery.

Article, see p 850 In this issue of Circulation , Mariscalco and colleagues1 report findings from 2 separate analyses that describe lower in-hospital mortality rates in overweight and obese (class I and class II) patients undergoing cardiac surgery in comparison with leaner patients. Obesity paradoxes are not new to the field of cardiovascular disease and have been observed in heart failure,2 acute coronary syndromes,3 and chronic kidney disease.4 Rather, the novelty of the present study is the authors’ interpretation that the common practice of recommending weight loss before surgery may not be warranted, and that refusing surgery to patients who are morbidly obese should be reconsidered. Although such strong clinical recommendations contradict the extensive body of research describing the risk of significant perioperative complications for obese patients undergoing any type of surgery, the methodologies they used to generate their findings are appropriate and the provocative findings warrant continued discussion. With the use of both a clinical registry and a meta-analysis, patients in the overweight and class I and class II obesity groups had unadjusted in-hospital and 30-day mortality rates that were half those of patients who were normal weight and almost two-thirds lower than those who were underweight. Two of the most common arguments in opposition to the obesity paradox are that patients who are leaner are sicker and have a higher burden of comorbidities that independently contribute to mortality, or their health behaviors, namely cigarette smoking, contribute directly to …
Takotsubo Cardiomyopathy Presenting as Wellens’ Syndrome

Takotsubo cardiomyopathy, also known as apical ballooning syndrome and stress cardiomyopathy, is a transient systolic and diastolic left ventricular dysfunction with a variety of cardiac wall-motion abnormalities that is increasingly being associated with significant morbidity and mortality. Wellens’ syndrome is an electrocardiographic pattern in a pain-free patient that is indicative of critical occlusion of the left anterior descending coronary artery requiring immediate cardiac catheterization. The authors report a case of a patient presenting with electrocardiographic findings consistent with Wellens’ syndrome that was later found to have Takotsubo cardiomyopathy with angiographically normal coronary arteries on cardiac catheterization after a seizure.
Review Article Coenzyme-B12-Dependent Glutamate Mutase☆

Abstract Adenosylcobalamin (coenzyme B12)-dependent glutamate mutase catalyzes a most unusual carbon skeleton rearrangement involving the isomerization of l-glutamate to L-threo-methylaspartate, a reaction that is without precedent in organic chemistry. This reaction proceeds through a mechanism involving free radical intermediates that are initiated by homolysis of the cobalt-carbon bond of the coenzyme. The enzyme serves as a paradigm for adenosylcobalamin-dependent catalysis and, more generally, provides insights into how enzymes generate and control reactive free radical species. This review describes how recent studies on the mechanism and structure of glutamate mutase have contributed to our understanding of adenosylcobalamin-mediated catalysis.
Antiviral prophylaxis of cytomegalovirus reactivation in immune competent patients-the jury remains out.

Cytomegalovirus (CMV) has been recognized as a pathogen in immunosuppressed patients for many years, with viral reactivation after transplantation continuing to plague many patients.
The Role of Botulinum Toxins in Treatment of Cancer-Related Issues: Post-radiation and Post-surgical Pain and Radiation-Induced Damage to the Salivary Glands

Cancer-related pain arises from a variety of different mechanisms. Notable among them are direct local invasion leading to irritation of motor and sensory nerve fibers and post-radiation/post-surgical pain due to nervous system damage. Botulinum neurotoxins (BoNTs) exert their analgesic effect via impeding conduction at the neuromuscular junction as well as inhibition of the release of pain mediators from peripheral nerve endings, dorsal root ganglia, and spinal sensory neurons. One double blind and five open label prospective studies have demonstrated effectiveness of BoNT-As in relieving pain at the site of radiation or surgery for cancer. Single case observations have shown that local intramuscular injection of BoNTs can alleviate chronic and disabling local pain and improve quality of the end of life state among patients with terminal cancer. One blinded study reported that in head and neck cancer, pretreatment of salivary glands with botulinum toxins reduces the incidence of post-radiation damage to the salivary glands.
MAPK activation patterns of AT1R and CB1R in SHR versus Wistar astrocytes: Evidence of CB1R hypofunction and crosstalk between AT1R and CB1R.

Abstract Background Angiotensin (Ang) II and cannabinoids regulate physiologically relevant astroglial functions via receptor-mediated activation of Mitogen-activated protein kinases (MAPKs). In this study, we investigated the consequences of astroglial Ang II type 1 receptor (AT1R) and Cannabinoid type 1 receptor (CB1R) activation, alone and in combination, on MAPK activation in the presence and absence of hypertensive states. In addition, we also investigated a novel unidirectional crosstalk mechanism between AT1R and CB1R, that involves PKC-mediated phosphorylation of CB1R. Methods Astrocytes were isolated from the brainstem and cerebellum of Spontaneously hypertensive rats (SHRs) and normotensive Wistar rats. The cells were treated with either 100 nM Ang II or 10 nM Arachidonyl-2′-chloroethylamide (ACEA), both alone and in combination, for varying time periods, and the extent of phosphorylation of MAPKs, ERK and p38, and the phosphorylated forms of CB1R (p-CB1R), were measured using western blotting. Results Ang II treatment resulted in a greater activation of MAPKs in SHR brainstem astrocytes, but not SHR cerebellar astrocytes when compared to Wistar rats. ACEA-mediated MAPK activation was significantly lower in brainstem astrocytes of SHRs when compared to Wistar rats. ACEA negatively modulates AT1R-mediated MAPK activation in both cerebellar and brainstem astrocytes of both models. The effect however was diminished in brainstem astrocytes. Ang II caused a significant increase in phosphorylation of CB1R in cerebellar astrocytes, while its effect was diminished in brainstem astrocytes of both models. Conclusion Both Ang II and ACEA-induced MAPK activation were significantly altered in SHR astrocytes when compared to Wistar astrocytes. A possible reduction in CB1R functionality, coupled with a hyperfunctional AT1R in the brainstem, could well be significant factors in the development of hypertensive states. AT1R-mediated phosphorylation of CB1R could be critical for impaired cerebellar development characterized by a hyperactive RAS.
A Randomized Controlled Evaluation of Prevent-Teach-Reinforce for Young Children:

Prevent-Teach-Reinforce for Young Children (PTR-YC) is a standardized model of positive behavior support designed to deliver individualized interventions for preschool-aged children with severe and...
Targeting mRNA Decapping in AML

In this issue of Cancer Cell, Yamauchi et al. identify a dependency of acute myeloid leukemia (AML) on DCPS, which catalyzes the final step of 3′-to-5′ mRNA decay and is implicated in numerous aspects of RNA metabolism. DCPS is targetable with a clinical inhibitor, underscoring the translational importance of this discovery.
Management of Patients with Acute Methotrexate Nephrotoxicity with High-Dose Leucovorin.

Background Acute kidney injury complicating high-dose methotrexate (HDMTX) therapy increases the risk for severe mucositis, myelosuppression, and death. It is unclear whether high-dose leucovorin and supportive therapy without the use of glucarpidase can reduce toxicity from HDMTX. Study design The charts of all patients at Memorial Sloan Kettering Cancer Center whose methotrexate (MTX) drug levels at 48 or 72 hours after administration were 10 times or more the toxic level were reviewed between January 2000 and December 2011. Results Eighty-eight patients (median age 51 years, range 9-90 years) who received 100 courses of HDMTX were identified. Serum creatinine increased by 2-fold from baseline (median, range 1- to 10-fold), but all patients recovered kidney function. Serum levels of MTX were 69 μmol/L (median, range 2.2-400), 6.9 μmol/L (1.3-64), and 2.0 μmol/L (0.05-26) at 24, 48, and 72 hours, respectively, after administration. A statistically significant correlation existed between MTX levels at 48, 72, 96, and 120 hours after administration but not between 24 and 72 hours or subsequent time points. High-dose leucovorin was given in 81% of courses in accordance with institutional protocols in most cases. Myelosuppression was present in 42%; grade III or higher neutropenia in 29%, and thrombocytopenia in 25%. Infectious complications, oral mucositis, and diarrhea occurred in 21%, 17%, and 6% of patients, respectively. Five deaths occurred, none directly attributed to complications from MTX administration. Seven additional patients received glucarpidase at the discretion of a treating physician during the study period, and results are reported separately. Conclusion Patients who had 100 episodes of HDMTX-associated acute kidney injury were treated with a strategy that only included usual supportive measures and high-dose leucovorin. No deaths were directly attributed to complications related to HDMTX. Glucarpidase, an expensive drug, may not be necessary for a significant number of patients.
An Analysis of Near-Surface Optical Turbulence and Aerosol Concentration Coupling during a Solar Eclipse

Paper links dynamics of near-surface aerosol particles with meteorological observations as well as derived optical turbulence during a solar eclipse while suggesting causes for the unanticipated direct correlation of turbulence fluctuations and aerosol particle counts.
Regional assessment of ozone sensitive tree species using bioindicator plants.

Tropospheric ozone occurs at phytotoxic levels in the northeastern and mid-Atlantic regions of the United States. Quantifying possible regional-scale impacts of ambient ozone onforest tree species is difficult and is confounded by other factors, such as moisture and light, which influence the uptake of ozone by plants. Biomonitoring provides an approach to document direct foliar injury irrespective of direct measure ofozone uptake. We used bioindicator and field plot data from theUSDA Forest Service to identify tree species likely to exhibit regional-scale ozone impacts. Approximately 24% of sampled sweetgum (Liquidambar styraciflua), 15% of sampled loblollypine (Pinus taeda), and 12% of sampled black cherry (Prunus serotina) trees were in the highest risk category. Sweetgum and loblolly pine trees were at risk on the coastal plain of Maryland, Virginia and Delaware. Black cherry trees were at riskon the Allegheny Plateau (Pennsylvania), in the Allegheny Mountains (Pennsylvania, West Virginia, and Maryland) as well ascoastal plain areas of Maryland and Virginia. Our findings indicate a need for more in-depth study of actual impacts on growth and reproduction of these three species.
Convection, diffusion and their interaction in the bronchial tree.

Oxygen transfer from the ambiance to the gas exchange units of the lung takes place in the bronchial tree. In this asymmetrically multi-generation conduit, the inspired gas meets the resident gas and mixing occurs.
Thrombolysis in Stroke Caused by Infective Endocarditis May Not Be Effective (S49.005)

OBJECTIVE: To determine if the use of intravenous (IV) thrombolysis for acute ischemic stroke (AIS) secondary to infective endocarditis (IE) resulted in improved outcomes. BACKGROUND: Cerebral ischemic events are highly prevalent and associated with high rates of death and disability in patients with IE. DESIGN/METHODS: We analyzed the data obtained as part of the Nationwide Inpatient Sample. All patients admitted to hospitals between 2002 and 2010 with primary discharge diagnosis of stroke (identified by the International Classification of Disease, Ninth Revision) and secondary diagnosis of IE were included. Patients with AIS secondary to IE treated with IV thrombolysis were compared to those treated for AIS secondary to other etiologies. Outcomes were defined as rates of intracerebral hemorrhage (ICH), in-hospital mortality, or favorable outcome (discharge disposition of home/self-care). RESULTS: There were 222 patients (mean age 59±18 years, 46% women) who were treated with IV thrombolysis for AIS secondary to IE as compared to 134,048 patients (mean age 69±15 years, 49% women) who were treated for AIS secondary to other etiologies. The rate of ICH was significantly greater in the IE group compared to the non-IE AIS treated group (20% vs 6%, p=0.001). There was no difference in rate of in-hospital mortality between the two groups (p=0.5); however, there was a significantly lower rate of favorable outcome in the IE group when compared to the non-IE AIS treated group (10% vs 37%, p=0.01). CONCLUSIONS: The high rate of ICH and low rates of favorable outcome mandate caution in utilizing IV thrombolysis in patients with AIS secondary to IE. Disclosure: Dr. Asaithambi has nothing to disclose. Dr. Adil has nothing to disclose. Dr. ATACH Investigators has nothing to disclose.
The Evolving Police Response to Individuals with Behavioral Health Challenges

Police are responsible for addressing a myriad of community problems, but none may be more challenging than responding to calls for service involving people with behavioral health challenges (e.g.,...
Filthy Lucre or Fitting Offer? Understanding Worries About Payments to Research Participants.

Offers of payment made in exchange for research participation are common. And yet they are often regarded as, at best, a “necessary evil.” This is odd. In most nonresearch contexts, people find pay...
Volume-outcome relationships in spine surgery – does increasing caseload co-relate with reduced complications?

Abstract With the advent of value-based models of healthcare and introduction of alternative payment models, there has been a renewed interest towards the consideration of regionalization policies revolving around ‘concentrating’ spine surgeries to high volume providers in an attempt to reduce complication rates and promote delivery of quality care. The current paper reviews pertinent evidence on the surgeon volume-outcome relationship in spine surgeries, with particular reference to complication rates. The review also provides valuable information on the unintended ramifications of regionalization of care on the healthcare system.
Locomotor muscle group III/IV afferents constrain stroke volume and contribute to exercise intolerance in human heart failure

KEY POINTS Heart failure patients with reduced ejection fraction (HFrEF) exhibit severe limitations in exercise capacity ( VO2 peak). One of the primary peripheral mechanisms suggested to underlie exercise intolerance in HFrEF is excessive locomotor muscle group III/IV afferent feedback; however, this has never been investigated in human heart failure. HFrEF patients and controls performed an incremental exercise test to volitional exhaustion to determine VO2 peak with lumbar intrathecal fentanyl or placebo. During exercise, cardiac output, leg blood flow and radial artery and femoral venous blood gases were measured. With fentanyl, compared with placebo, patients with HFrEF achieved a higher peak workload, VO2 peak, cardiac output, stroke volume and leg blood flow. These findings suggest that locomotor muscle group III/IV afferent feedback in HFrEF leads to increased systemic vascular resistance, which constrains stroke volume, cardiac output and O2 delivery thereby impairing VO2 peak and thus exercise capacity. ABSTRACT To better understand the underlying mechanisms contributing to exercise limitation in heart failure with reduced ejection fraction (HFrEF), we investigated the influence of locomotor muscle group III/IV afferent inhibition via lumbar intrathecal fentanyl on peak exercise capacity ( VO2 peak) and the contributory mechanisms. Eleven HFrEF patients and eight healthy matched controls were recruited. The participants performed an incremental exercise test to volitional exhaustion to determine VO2 peak with lumbar intrathecal fentanyl or placebo. During exercise, cardiac output and leg blood flow ( QL ) were measured via open-circuit acetylene wash-in technique and constant infusion thermodilution, respectively. Radial artery and femoral venous blood gases were measured. VO2 peak was 15% greater with fentanyl compared with placebo for HFrEF (P < 0.01), while no different in the controls. During peak exercise with fentanyl, cardiac output was 12% greater in HFrEF secondary to significant decreases in systemic vascular resistance and increases in stroke volume compared with placebo (all, P < 0.01). From placebo to fentanyl, leg VO2 , QL and O2 delivery were greater for HFrEF during peak exercise (all, P < 0.01), but not control. These findings indicate that locomotor muscle group III/IV afferent feedback in patients with HFrEF leads to increased systemic vascular resistance, which constrains stroke volume, cardiac output and O2 delivery, thereby impairing VO2 peak and thus exercise capacity. These findings have important clinical implications as VO2 peak is highly predictive of morbidity and mortality in HF.
Palmitate and pyruvate carbon flux in response to choline and methionine in bovine neonatal hepatocytes.

Choline and methionine may serve unique functions to alter hepatic energy metabolism. Our objective was to trace carbon flux through pathways of oxidation and glucose metabolism in bovine hepatocytes exposed to increasing concentrations of choline chloride (CC) and d,l-methionine (DLM). Primary hepatocytes were isolated from 4 Holstein calves and maintained for 24 h before treatment with CC (0, 10, 100, 1000 μmol/L) and DLM (0, 100, 300 μmol/L) in a factorial design. After 21 h, [1-14C]C16:0 or [2-14C]pyruvate was added to measure complete and incomplete oxidation, and cellular glycogen. Reactive oxygen species (ROS), cellular triglyceride (TG), and glucose and s-hydroxybutyrate (BHB) export were quantified. Exported very-low density lipoprotein particles were isolated for untargeted lipidomics and to quantify TG. Interactions between CC and DLM, and contrasts for CC (0 vs. [10, 100, 1000 μmol/L] and linear and quadratic contrast 10, 100, 1000 μmol/L) and DLM (0 vs. [100, 300 μmol/L] and 100 vs. 300 μmol/L) were evaluated. Presence of CC increased complete oxidation of [1-14C]C16:0 and decreased BHB export. Glucose export was decreased, but cellular glycogen was increased by the presence of CC and increasing CC. Presence of CC decreased ROS and marginally decreased cellular TG. No interactions between CC and DLM were detected for these outcomes. These data suggest a hepato-protective role for CC to limit ROS and cellular TG accumulation, and to alter hepatic energy metabolism to support complete oxidation of FA and glycogen storage regardless of Met supply.
Contented Cuckolds: Infertility and Queer Reproductive Practice in Middleton’s A Chaste Maid in Cheapside and Machiavelli’s Mandragola

This chapter is interested in disability and queerness as they are represented in early modern dramatic texts, especially in the plays A Chaste Maid in Cheapside (Thomas Middleton, c.1613, published 1630) and Mandragola (Niccolo Machiavelli, c.1518, published 1524). Each of these plays features a married couple dealing with infertility, and a “cure” that involves the wife sleeping with a man with proven fertility, with the husband’s implicit or explicit consent. Though infertility has been at the margins of contemporary disability studies, and most mainstream contemporary discussions of infertility avoid discourses of disability, there is a long relationship between disability rights and theory and movements for reproductive rights and justice. These plays demonstrate that early modern authors saw a connection between infertility and disability by explicitly medicalizing infertile bodies and barren couples in ways that mark them as disabled. But early modern representations of infertility also do queer work: they go beyond the cuckold/bastard narrative and undermine normative heterosexual monogamy, offering models of consensual polyamory, generative extra-marital desire, nonreproductive heterosexual sex, and non-genetic kinship and inheritance systems. Presented superficially as a problem, infertile/disabled bodies actually open up new textual possibilities for queering marriage, sex, reproductive practice, and family structures.
The Effects of Probation Stipulations on Perceptions of Employability Among People on Probation in Rhode Island

Roughly one-third of the people under the purview of the Rhode Island Department of Corrections are on active probation. People on probation are typically mandated to a variety of stipulations, such as meetings with their probation officer, court appointments, drug and/or mental health counseling, and crime-specific stipulations, such as anger management groups. Evidence suggesting that mandating these stipulations reduces a person’s likelihood to be rearrested is minimal. In contrast, there is a wealth of evidence suggesting that stable employment decreases recidivism. A person’s perceptions of their employability have been demonstrated as a key component to both pursuing and maintaining employment opportunities. Drawing on Labeling Theory, this study surveyed 170 persons on active probation to explore the correlation between probation stipulations and employability perceptions. Results suggest there is a negative association between stipulations and perceptions of employability. Social work practitioners working with people on probation or people who are incarcerated should work to increase their clients’ perceptions of employability.
Estimates of COVID-19 Cases and Deaths Among Nursing Home Residents Not Reported in Federal Data.

Importance Federal data underestimate the impact of COVID-19 on US nursing homes because federal reporting guidelines did not require facilities to report case and death data until the week ending May 24, 2020. Objective To assess the magnitude of unreported cases and deaths in the National Healthcare Safety Network (NHSN) and provide national estimates of cases and deaths adjusted for nonreporting. Design, Setting, and Participants This is a cross-sectional study comparing COVID-19 cases and deaths reported by US nursing homes to the NHSN with those reported to state departments of health in late May 2020. The sample includes nursing homes from 20 states, with 4598 facilities in 12 states that required facilities to report cases and 7401 facilities in 19 states that required facilities to report deaths. Estimates of nonreporting were extrapolated to infer the national (15 397 facilities) unreported cases and deaths in both May and December 2020. Data were analyzed from December 2020 to May 2021. Exposures Nursing home ownership (for-profit or not-for-profit), chain affiliation, size, Centers for Medicare & Medicaid Services star rating, and state. Main Outcomes and Measures The main outcome was the difference between the COVID-19 cases and deaths reported by each facility to their state department of health vs those reported to the NHSN. Results Among 15 415 US nursing homes, including 4599 with state case data and 7405 with state death data, a mean (SE) of 43.7% (1.4%) of COVID-19 cases and 40.0% (1.1%) of COVID-19 deaths prior to May 24 were not reported in the first NHSN submission in sample states, suggesting that 68 613 cases and 16 623 deaths were omitted nationwide, representing 11.6% of COVID-19 cases and 14.0% of COVID-19 deaths among nursing home residents in 2020. Conclusions and Relevance These findings suggest that federal NHSN data understated total cases and deaths in nursing homes. Failure to account for this issue may lead to misleading conclusions about the role of different facility characteristics and state or federal policies in explaining COVID outbreaks.
Considering "Respect for Sovereignty" Beyond the Belmont Report and the Common Rule: Ethical and Legal Implications for American Indian and Alaska Native Peoples.

We agree with Saunkeah and colleagues (2021) that research ethics principles outlined by the Belmont Report—which guide the procedural basis for “human subjects” research in the United States throu...
Defining Aquatic Habitat Zones Across Northern Gulf of Mexico Estuarine Gradients Through Submerged Aquatic Vegetation Species Assemblage and Biomass Data

Submerged aquatic vegetation (SAV) creates highly productive habitats in coastal areas, providing support for many important species of fish and wildlife. Despite the importance and documented loss of SAV across fresh to marine habitats globally, we lack consistent baseline data on estuarine SAV resources, particularly in the northern Gulf of Mexico (NGOM) estuaries. To understand SAV distribution in the NGOM, SAV biomass and species identity were collected at 384 sites inter-annually (June–September; 2013–2015) from Mobile Bay, Alabama, to San Antonio Bay, Texas, USA. Coastwide, SAV distribution and biomass were consistent across years, covering an estimated 87,000 ha, and supporting approximately 16 ± 1% total cover with an average biomass of 24.5 ± 1.9 g m−2. Differences in hydrology (i.e., precipitation, freshwater input, water depth) and exposure (i.e., wave and wind energy) manifested in unique SAV assemblages and biomass distributions across the region (i.e., Coastal Mississippi-Alabama, Mississippi River Coastal Wetlands, Chenier Plain, Texas Mid-Coast) and estuarine gradient (i.e., marsh zones defined as fresh, intermediate, brackish, saline). Descriptive cluster analyses identified indicator SAV species, known as medoid observations that represented combined salinity, turbidity, and depth conditions unique to different region and marsh zone combinations. While the presence of SAV is often used as an indicator of ecological health, identifying a medoid-based SAV indicator species in aquatic habitats can be used to describe estuarine conditions in more detail and develop aquatic habitat zones. Exploration and the use of this type of field data could be developed as a means to track, manage, and define aquatic habitats across regional and estuarine gradients and further develop ecosystem-based assessment and restoration activities. Identifying aquatic zones through a representative medoid associates SAV species with locations defined by both long-term salinity and salinity variability, water depth, and exposure, which is a powerful potential tool for managers and restoration decision-makers.
A missense variant Arg611Cys in LIPE which encodes hormone sensitive lipase decreases lipolysis and increases risk of type 2 diabetes in American Indians.

Aims Hormone sensitive lipase (HSL), encoded by the LIPE gene, is involved in lipolysis. Based on prior animal and human studies, LIPE was analysed as a candidate gene for the development of type 2 diabetes (T2D) in a community-based sample of American Indians. Materials and methods Whole-exome sequence data from 6782 participants with longitudinal clinical measures were used to identify variation in LIPE. Results Amongst the 16 missense variants identified, an Arg611Cys variant (rs34052647; Cys-allele frequency = 0.087) significantly associated with T2D (OR [95% CI] = 1.38 [1.17-1.64], p = 0.0002, adjusted for age, sex, birth year, and the first five genetic principal components) and an earlier onset age of T2D (HR = 1.22 [1.09-1.36], p = 0.0005). This variant was further analysed for quantitative traits related to T2D. Amongst non-diabetic American Indians, those with the T2D risk Cys-allele had increased insulin levels during an oral glucose tolerance test (0.07 SD per Cys-allele, p = 0.04) and a mixed meal test (0.08 log10 µU/ml per Cys-allele, p = 0.003), and had increased lipid oxidation rates post-absorptively and during insulin infusion (0.07 mg [kg estimated metabolic body size {EMBS}]-1 min-1 per Cys-allele for both, p = 0.01 and 0.009, respectively), compared to individuals with the non-risk Arg-allele. In vitro functional studies showed that cells expressing the Cys-allele had a 17.2% decrease in lipolysis under isoproterenol stimulation (p = 0.03) and a 21.3% decrease in lipase enzyme activity measured by using p-nitrophenyl butyrate as a substrate (p = 0.04) compared to the Arg-allele. Conclusion The Arg611Cys variant causes a modest impairment in lipolysis, thereby affecting glucose homoeostasis and risk of T2D.
Qualitative Thematic Analysis of Pharmacy Student Blogs for International Advanced Pharmacy Practice Experiences.

Objective The primary objective of this study is to gain an understanding of student pharmacist learning occurring during international advanced pharmacy practice experiences (APPEs). The secondary objective is to direct the development of suitable pre-departure orientation activities for pharmacy students.Methods University of Kentucky College of Pharmacy students authored blogs between 2012 and 2019 describing patient-care and non-patient care international APPEs. Investigators utilized inductive thematic analysis to analyze the blogs and define codes, categories, and themes from the data set. The entire data set was utilized to generate changes for pre-departure orientation.Results. The analysis included 47 blogs from which seven pictorial codes and 24 text codes were isolated from the data set to ultimately form four categories: Learning About Health care; My Surroundings; Logistics; and Me, Myself, and I. Two overall themes emerged from the codes and categories: Everything is Different and Here's What I Think and Feel. Examination of the data in conjunction with review of other studies focusing on study abroad demonstrated that the themes isolated in this study parallel previously described benefits of study abroad. Additionally, analysis of the blogs suggested expansion of pre-departure orientation for students and follow-up discussion to ensure understanding may be required prior to travel.Conclusion: This study gives a unique insight into thoughts and relative importance of pharmacy student experiences during study abroad. Evaluation of the data and review of previously published studies will guide educators in refining pre-departure material. Further studies are needed to evaluate the effectiveness of revised pre-departure orientation.
Automated Bruch's Membrane Opening Segmentation in Cases of Optic Disc Swelling in Combined 2D and 3D SD-OCT Images Using Shape-Prior and Texture Information

When the optic disc is swollen, the visibility of the Bruch’s membrane opening (BMO) is often drastically reduced in spectral-domain optical coherence tomography (SD-OCT) volumes. Recent work pro- posed a semi-automated method to segment the BMO using combined information from 2D high-definition raster and 3D volumetric SD-OCT scans; however, manual placement of six landmark points was required. In this work, we propose a fully automated approach to segment the BMO from 2D high-definition and 3D volumetric SD-OCT scans. Using the topographic shape of the internal limiting membrane and textural information near Bruch’s membrane, two BMO points are first estimated in the high-definition central B-scan and then registered into the corresponding volumetric scan. Utilizing the information from both the high- definition BMO estimates and the standard-definition SD-OCT volume, the cost image was created. A graph-based algorithm with soft shape-based constraints is further applied to segment the BMO contour on the SD-OCT en-face image domain. Using a set of 23 volumes with reasonably centered raster scans and swelling larger than 14.42 mm3, the fully automated approach was significantly more accurate than a traditional approach utilizing information only from the SD-OCT volume (RMS error of 7.18 vs. 21.37 in pixels; p < 0.05) and had only a slightly higher (and not significantly different) error than the previously proposed semi-automated approach (RMS error of 7.18 vs. 5.30 in pixels; p = 0.08).
Artificial Intelligence: Its Use in Medical Diagnosis

In nuclear medicine, analysis, interpretation and diagnosis may each be appropriate as applications for ANNs. Image processing and pattern recognition are two application areas of ANN technology that appear promising. An ANN (21) was used to classify normal and abnormal FDG-PET scans and performed better than discriminant analysis. Favorable results have been obtained from an ANN (22) in the interpretation of data recorded by experienced observers using various standard V/Q scans to determine the likelihood of pulmonary embolism. Carver Mead's book (23) on the development of hardware neural systems defines new approaches to ANN fabrication, including an electronic 100,000 transistor retina. As hardware is developed to permit the design of very large networks, we may expect many useful imaging applications to emerge for ANNs in the medical field.
Web-Based CAI for a Distance Education Neurology Course

At the University of Illinois College of Medicine at Rockford, the Rural Medical Education Program prepares students with the special knowledge, skills, and attitudes to be successful as Family Physicians in rural Illinois. Students in this special medical education track spend four months off-campus on a rural preceptorship under the supervision of a practicing rural family physician. This poster session presented an instructional unit that was developed to provide these students an opportunity to complete their required senior neurology clerkship off-campus. This unique distance-education neurology course provides a focused tutorial on the neurological physical exam plus sixteen WWW-accessible case studies whose medical content is identical to the paper cases used in the traditional clerkship. The unit proved to be an effective vehicle to support mastery of a defined set of learning objectives in neurology. Most participants expressed interest in further web-based courses after this initial experience.
Malaria adhesins: structure and function

Summary The malaria parasite Plasmodium utilizes specialized proteins for adherence to cellular receptors in its mosquito vector and human host. Adherence is critical for parasite development, host cell traversal and invasion, and protection from vector and host immune mechanisms. These vital roles have identified several adhesins as vaccine candidates. A deficiency in current adhesin-based vaccines is induction of antibodies targeting non-conserved, non-functional and decoy epitopes due to the use of full length proteins or binding domains. To alleviate the elicitation of non-inhibitory antibodies, conserved functional regions of proteins must be identified and exploited. Structural biology provides the tools necessary to achieve this goal, and has succeeded in defining biologically functional receptor binding and oligomerization interfaces for a number of promising malaria vaccine candidates. We describe here the current knowledge of Plasmodium adhesin structure and function, and how it has illuminated elements of parasite biology and defined interactions at the host/vector and parasite interface.
Factors That Control the Effect of pH on Glycolysis in Leukocytes

Stimulation of glycolysis accompanies a rise in pH in intact polymorphonuclear leukocytes and supernatant preparations derived from homogenates of these cells. The curve of lactate production plotted against pH for the cell-free system was steepest between pH 6.5 and 7.0. Our studies indicate that phosphofructokinase is the key control point, and a secondary locus of control may be at glyceraldehyde phosphate dehydrogenase or diphosphoglycerate kinase. The over-all effect of pH on glycolysis appears not to be dependent on the concentrations of cofactors known to affect phosphofructokinase. In the case of inorganic phosphate, the concentration of neither the monobasic nor the dibasic species is involved in the effect of pH.
Measuring MPI Latency Variance

Point to point latency and bandwidth measurements are often the first benchmarks run on a new machine or MPI implementation. In this paper we show that the common way of measuring latency hides valuable information about the transmission time characteristics. We introduce a simple benchmark to measure transmission time variance and report on the results from a variety of systems.
Catlin's Lament: Indians, Manifest Destiny, and the Ethics of Nature

Review of: "Catlin’s Lament: Indians, Manifest Destiny, and the Ethics of Nature," by John Hausdoerffer.
MUCOEPIDERMOID TUMOR OF THE LOWER LIP. REPORT OF TWO CASES.

Abstract Two cases of mucoepidermoid tumor of the lower lip have been reported. A review of the literature indicates that only three other mucoepidermoid tumors of the lower lip have been recorded. On the basis of the discussions by Bhaskar and Bernier, both of these reported cases represent the benign form of mucoepidermoid tumor. The clinical resemblance to mucocele has been pointed out, and the importance of microscopic examination has been re-emphasized.
Obstetrics and gynecology at the crossroads—again? Still!: Presidential address☆

Abstract It seems, if one can believe presidential addresses, as if our specialty is always at some crossroads or other. In this “opinion piece,” uniquely, I don’t complain about managed care. I do attempt to identify some of the issues that will be of import for obstetrics and gynecology in the near and not-so-near futures. With regard to research, we await breakthroughs, for example, in the early detection of ovarian cancer, so as to finally be able to improve outcomes. A problem, though, is our failure to focus enough effort on developing a cadre of clinician scientists, who can work out research findings with direct clinical application; this is an issue with which the specialty needs to come to grips. Regarding education, I believe we need to refocus from what type of practitioners we might want to produce to best meet the needs of our patients. The bottom line should be more flexibility in training and emphasis on clinical competence, so that excellent practitioners with competence across the breadth of our specialty are available to provide a full range of appropriate women’s health care. The concept of “women’s health” is controversial and evolving rapidly. Review of several available sources suggests that reproductive medicine will remain an important component of women’s health but that our specialty must now evolve to include other areas, as the major health problems of women change. We need to shift from an organ-based paradigm to a more holistic view, reflecting the woman-centered focus for our specialty. This “paradigm shift” will need to entail continuation of first-rate surgical and obstetrics services but will be expanded to include a full range of services, probably offered by highly trained and competent individuals with specific areas of expertise, practicing in a multi-single-specialty group. Obstetrics and gynecology at the crossroads, indeed! (Am J Obstet Gynecol 2001;184:1313-9.)
Comparison of HOMA-IR, HOMA-β% and disposition index between US white men and Japanese men in Japan in the ERA JUMP study: was the calculation of disposition index legitimate? Reply to Yamauchi K, Sato Y, Nakasone Y et al [letter]

To the Editor:We thank Yamauchi et al for their letter [1] on our recent article [2] in which we reported that, based on fasting samples, white men living in the USA have higher insulin resistance, insulin secretion and disposition index (DI) than Japanese men living in Japan. Yamauchi et al [1] point out that DI calculated using fasting measures of insulin resistance and insulin secretion is a function of basal glucose levels. Furthermore, they mention that basal levels of glucose may not always be a good indicator of beta cell function. Here, we reply to their comments. First, the notion that DI calculated using fasting measures is a function of fasting glucose levels is nothing new but has previously been demonstrated by Mari et al [3]. Second, we agree with Yamauchi et al [1] that estimates of DI based on fasting samples may not always be a good indicator of beta cell function—we mentioned in our paper that DI calculated using fasting measures of insulin sensitivity and insulin secretion is a less credible index of beta cell function and that this represents a major limitation and thus the results should be interpreted with caution [1]. However, the uniqueness of our study lies in our samples: we used population-based samples with standardised methods, whereas all the other studies comparing insulin secretion and resistance used samples from volunteers or hospital-based samples [4]. Though Yamauchi et al [1] point out that other investigators have reported that the hyperbolic relationship between indices of insulin sensitivity and insulin secretion exist for a certain combination of the two but not all [5], our assumption of a hyperbolic relationship between insulin sensitivity and insulin secretion at basal levels is based on the work of other investigators, namely, Turner et al [6]. Furthermore, Yamauchi et al comment that the relationship between insulin sensitivity and insulin secretion, i.e. DI, is different between Japanese and white populations [1]. Our data showed the same results despite estimating DI using fasting samples. We agree that insulin resistance and secretion would be better evaluated by the hyperinsulinaemic– euglycaemic clamp, yet when comparing these across different racial groups, samples from volunteers are more likely than population-based samples to suffer from selection biases. Therefore, further studies evaluating insulin indices using direct methods and comparing these indices between whites in the USA and Japanese individuals in Japan in populationbased samples are warranted to explore the hypothesis that a higher DI is one of the contributing factors to a lower susceptibility to developing type 2 diabetes in white men compared with Japanese men for a given BMI.
Which way the natural gas price: an attempt to predict the direction of natural gas spot price movements using trader positions

Abstract This research provides a method of predicting direction of spot price movements in the natural gas market for the month succeeding from market participants positions in the futures market. Cumby and Modest (Cumby, R.E., Modest, D.M., 1987. Testing for market timing ability: a framework for forecast evaluation. Journal of Financial Economics 19, 169–189) provide the backdrop for analyzing the futures market positions of large hedgers and speculators to arrive at conclusions of market price movements in the spot market. This methodology is suggested as a means for municipalities entering the natural gas market to improve upon their ordering of quantities of gas for the ensuing months in order to take advantage of possibly foreseeable price trends.
A 5MHz BW 70.7dB SNDR noise-shaped two-step quantizer based ΔΣ ADC

In this paper, a new ΔΣ ADC using a noise-shaped two-step integrating quantizer is presented. Attaining an extra order of noise-shaping from the integrating quantizer, the proposed ΔΣ ADC manifests a second-order noise-shaping with a first-order loop filter. Furthermore, this quantizer provides an 8b quantization in itself, drastically reducing the oversampling requirement. The proposed ADC also incorporates a new feedback DAC topology that alleviates feedback DAC complexity of a two-step 8b quantizer. The measured results of the prototype ADC implemented in a 0.13µm CMOS demonstrate peak SNDR of 70.7dB at 8.1mW power, with an 8x OSR at 80MHz sampling frequency.
Intermediate Filaments: Not Just for Structure Anymore

A recent paper has identified the tumor suppressor APC as a linker protein between intermediate filaments and microtubules. In the absence of APC, intermediate filaments collapse and the cells are no longer polarized and fail to migrate.
The development of a combined b-mode, ARFI, and spectral Doppler ultrasound imaging system for investigating cardiovascular stiffness and hemodynamics

The progression of atherosclerotic disease, caused by the formation of plaques within arteries, is a complex process believed to be a function of the localized mechanical properties and hemodynamic loading associated with the arterial wall. It is hypothesized that measurements of vascular stiffness and wall-shear rate (WSR) may provide important information regarding vascular remodeling, endothelial function, and the growth of soft-lipid filled plaques that could help a clinician better diagnose a patient's risk of clinical events such as stroke. To that end, the approach taken in this work was to combine conventional B-mode, Acoustic Radiation Force Impulse (ARFI), Shear Wave Elasticity Imaging (SWEI), and spectral Doppler techniques into a single imaging system capable of simultaneously measuring the tissue displacements and WSR throughout the cardiac cycle and over several heartbeats. Implemented on a conventional scanner, the carotid arteries of human subjects were scanned to demonstrate the initial in vivo feasibility of the method. Two non-invasive ultrasound based imaging methods, SAD-SWEI and SAD-Gated Imaging, were developed that measure ARF-induced on-axis tissue displacements, off-axis transverse wave velocities, and WSR throughout the cardiac cycle. Human carotid artery scans were performed in vivo on 5 healthy subjects. Statistical differences were observed in both on-axis proximal wall displacements and transverse wave velocities during diastole compared to systole.
Estimated value of improvements in transport services

Abstract This paper uses the conjoint measurement technique for estimating the value of increased sailing frequency in inter-island transportation in Hawaii and the value of alternative queuing arrangements. The technique uses ordinal rankings of shipper preferences to estimate each shipper's utility function which, in turn, is used to estimate the change in consumer's surplus attribute to changes in service attributes.
Recycling signaling molecules during development.

Sonic hedgehog (Shh) has many functions in development. A new study reports a key role for Shh in cell survival, proliferation and morphogenesis in formation of the forebrain and midbrain.
Enthalpies of combustion and formation of [4.5], [5.5], and [5.6]spiroalkanes

Abstract The enthalpies of combustion of spiro[4.5]decane, spiro[5.5]undecane, and spiro[5.6] dodecane were measured by precision oxygen-bomb combustion calorimetry. The standard enthalpies of combustion ΔH c o (298.15 K), of these compounds in the liquid state are −(1507.54 ± 0.48), −(1659.28 ± 0.67), −(1819.75 ± 0.55) kcal th mol −1 , respectively. The derived standard enthalpies of formation at 298.15 K in the liquid state are accordingly −47.81 ± 0.51), −(58.44 ± 0.72), −(60.33 ± 0.61) kcal th mol −1 . The uncertainties are “uncertainty intervals”.