cssi/SciSciGPT-SciSciNet huggingface dataset:
Presence of a fellowship improves perioperative outcomes following hepatopancreatobiliary procedures

There is an increase in subspecialization and in the number of surgeons seeking fellowship training in the USA. Little is known regarding the effect of hepatopancreatobiliary (HPB) fellowship programs’ status of an institution on perioperative outcomes. This study aims to examine the effect of such status on perioperative outcomes across all institutions following complex surgeries involving HPB procedures in the State of New York (NYS). The Statewide Planning and Research Cooperative System administrative database was used to identify several complex surgeries involving the pancreas, liver, and gallbladder by using ICD-9 codes for inpatient procedures between 2012 and 2014. Procedures were compared in terms of 30-day readmission, hospital length of stay (HLOS), and major complications between institutions with and without fellowship. Linear mixed model and generalized linear mixed models were used to compare the differences. There were 4156 procedures identified during 2012–2014 in NYS. Among these, 1685 (40.5%) were pancreatic surgeries only, 1031 (24.8%) were liver surgeries only, 1288 (31.0%) were gallbladder surgeries only, 11 (0.3%) were both pancreatic and liver surgeries, 124 (3.0%) were both liver and gallbladder, and 17 (0.4%) were both pancreatic and gallbladder. Elderly patients tended to go to the hospitals with HPB fellowship. Following multivariable regression and controlling for other factors, hospitals with fellowships remained significantly associated with less severe complications (OR 0.49, 95% CI 0.29–0.83, p = 0.0075). No significant differences were seen between hospitals with and without fellowship in terms of 30-day readmissions (p = 0.6) and HLOS (p = 0.4). Institutions offering HPB fellowship training were associated with significantly improved rate of complications, although there was no significant difference in terms of 30-day readmission rate or HLOS. This data highlight the importance of a presence of a fellowship in complex hepatopancreatobiliary procedures.
Hemoglobin Decline and Health Outcomes in the Elderly: the Cardiovascular Health Study

Introduction: Anemia is associated with increased morbidity and mortality in the elderly, though the risk factors for and the consequences of hemoglobin (HGB) decline are poorly characterized. Methods: We studied 5201 men and women ≥65 participating in the Cardiovascular Health Study. The cohort was followed biannually and had baseline and repeat hemograms 3 years later. HGB decline was defined as >1g/dL HGB drop, or incident anemia at 3 years by WHO criteria. Results: 4006 participants survived to 3 years and had two HGB measures. The median HGB change was −0.2g/dL (IQR-0.8, 0.1). 961 (24%) participants had a >1g/dL HGB drop and 335 (8%) developed incident anemia. The left side of the table presents adjusted logistic regression models of baseline risk factors for HGB decline. Those with baseline cardiovascular disease (CVD), diabetes and kidney disease were more likely to develop >1g/dL HGB drop while only baseline kidney disease was associated with incident anemia. The table also shows the adjusted risk of HGB decline with concurrent development of co-morbid conditions. A >1g/dL drop in HGB was more likely in those who concurrently developed incident CVD, hypertension or inflammation. Incident anemia was more likely in participants with concurrent development of kidney disease or inflammation. Both incident anemia and a HGB drop >1g/dL were associated with subsequent 9-year mortality adjusting for age, race, gender, year 3 HGB, hypertension, CVD, diabetes, and renal disease; HRs (95% CI) 1.4 (1.2, 1.6) and 1.2 (1.1, 1.4) respectively. Discussion: Among studied factors, baseline CVD, diabetes and kidney disease were risk factors for >1g/dL HGB drop while only baseline kidney disease was a risk factor for incident anemia. Incident CVD and hypertension were associated concurrently with >1g/dL HGB drop while kidney disease was associated with concurrent incident anemia. Inflammation development was the strongest risk factor accompanying HGB decline. HGB decline, especially a 1g/dL drop, was associated with subsequent mortality irrespective of HGB concentration. These data suggest that small HGB changes not captured by the WHO anemia criteria are associated with poor health outcomes and that inflammation is a major correlate of HGB decline in the elderly. Table : Risk Factors for HGB Decline in Age-, Race-, Gender, and Baseline HGB-Adjusted Logistic Regression Models
Scoping scalp disorders: practical use of a novel dermatoscope to diagnose hair and scalp conditions.

BACKGROUND Dermoscopy has been widely implemented to diagnose various skin and scalp disorders. However, existing devices that call for direct scalp contact may alter the appearance of hair features or perifollicular structures. OBJECTIVE This paper will show how the Canfield DermScope can quickly and easily identify various nonscarring and scarring scalp disorders. Its open design does not change the direction of affected hairs or blanch certain features such as erythema. Features like perifollicular hyperkeratosis and loss of follicular orifices are still easily visible. METHODS AND MATERIALS The author prospectively photographed patients with hair and scalp disorders in private practice between 2011 to 2012 using the handheld Canfield DermScope device. RESULTS The presence of scale, erythema, tufting, miniaturized or broken hairs, and loss of follicular orifices were quickly identified to make a diagnosis. CONCLUSION The diagnosis of hair and scalp disorders can be greatly facilitated by the use of the DermScope device.
Nature-Based Hybrid Computational Geometry System for Optimizing Component Structure

This paper describes a novel computational geometry system developed for application in the design of full-scale industrial components. This system combines a bottom-up growth strategy based on slime mould behaviour in nature with a top-down genetic algorithm strategy for optimization. The growth strategy uses an agent-based algorithm to create individual instances of designs based on a small number of input parameters. These parameters can then be controlled by a genetic algorithm to optimize the final design according to goals such as minimizing weight and minimizing structural weakness. Together, these two strategies create a hybrid approach which ensures high performance while allowing the designer to explore a wider range of novel designs than would be possible using traditional design methods.
Assessing DNA structures with 125I radioprobing

Iodine-125 radioprobing is based on incorporation of radioiodine into a defined position in a nucleic acid molecule. Decay of 125I results in emission of multiple low energy Auger electrons that, along with positively charged residual daughter nuclide, produce DNA strand breaks. The probability of such strand breaks at a given nucleotide is in reverse proportion to the distance from the 125I atom to the sugar of that nucleotide. Therefore, conclusions can be drawn about the conformation or folding of a DNA or RNA molecule base on the distribution of 125I decay-induced strand breaks. Here we describe in detail an application 125I radioprobing to study the conformation of quadruplex structures, and discuss the advantages and limitations of the method.
Beyond Poisson: Modeling Inter-Arrival Time of Requests in a Datacenter

How frequently are computer jobs submitted to an industrial-scale datacenter? We investigate the trace that contains job requests and execution collected in one of large-scale industrial datacenters, which spans near half of a Terabyte. In this paper, we discover and explain two surprising patterns with respect to the inter-arrival time (IAT) of job requests: (a) multiple periodicities and (b) multi-level bundling effects. Specifically, we propose a novel generative process, Hierarchical Bundling Model (HiBM), for modeling the data. HiBM is able to mimic multiple components in the distribution of IAT, and to simulate job requests with the same statistical properties as in the real data. We also provide a systematic approach to estimate the parameters of HiBM.
Reefs and Benthic Microcosms

The ecosystems of underwater surfaces are important, often conspicuous, intensively metabolic, and some are the most organized and diverse in the biosphere. Water motions relative to the fixed surface help to maintain the attached organisms and high rates of metabolism. We have already considered stream microcosms where the water flow is unidirectional. This chapter concerns microcosms which mimic the reefs, bottom communities, and encrusting ecosystems in lakes and seas where water motions are multidirectional.
Chaotic Oscillations in a Simplified model for Langmuir Waves

The results of a further study of the chaotic solutions of the single-mode equations corresponding to Zakharov's model for Langmuir waves in a plasma are described briefly.
Pairing in quantum critical systems: Transition temperature, pairing gap, and their ratio

We compute the ratio of the pairing gap $\mathrm{\ensuremath{\Delta}}$ at $T=0$ and ${T}_{c}$ for a set of quantum-critical models in which the pairing interaction is mediated by a gapless boson with local susceptibility $\ensuremath{\chi}(\mathrm{\ensuremath{\Omega}})\ensuremath{\propto}1/{|\mathrm{\ensuremath{\Omega}}|}^{\ensuremath{\gamma}}$ (the $\ensuremath{\gamma}$ model). The limit $\ensuremath{\gamma}=0+$ $[\ensuremath{\chi}(\mathrm{\ensuremath{\Omega}})=log|\mathrm{\ensuremath{\Omega}}|]$ describes color superconductivity, and models with $\ensuremath{\gamma}g0$ describe superconductivity in a metal at the onset of charge or spin order. The ratio $2\mathrm{\ensuremath{\Delta}}/{T}_{c}$ has been recently computed numerically for $0l\ensuremath{\gamma}l2$ within Eliashberg theory and was found to increase with increasing $\ensuremath{\gamma}$ [T.-H. Lee et al., Phys. Rev. Lett. 121, 187003 (2018)]. We argue that the origin of the increase is the divergence of $2\mathrm{\ensuremath{\Delta}}/{T}_{c}$ at $\ensuremath{\gamma}=3$. We obtain an approximate analytical formula for $2\mathrm{\ensuremath{\Delta}}/{T}_{c}$ for $\ensuremath{\gamma}\ensuremath{\le}3$ and show that it agrees well with the numerics. We also consider in detail the opposite limit of small $\ensuremath{\gamma}$. Here we obtain the explicit expressions for ${T}_{c}$ and $\mathrm{\ensuremath{\Delta}}$, including numerical prefactors. We show that these prefactors depend on fermionic self-energy in a rather nontrivial way. The ratio $2\mathrm{\ensuremath{\Delta}}/{T}_{c}$ approaches the BCS value 3.53 at $\ensuremath{\gamma}\ensuremath{\rightarrow}0$.
Bioproduction of single-stranded DNA from isogenic miniphage

Abstract Scalable production of gene-length single-stranded DNA (ssDNA) with sequence control has applications in homology directed repair templating, gene synthesis and sequencing, scaffolded DNA origami, and archival DNA memory storage. Biological production of circular single-stranded DNA (cssDNA) using bacteriophage M13 addresses these needs at low cost. A primary goal toward this end is to minimize the essential protein coding regions of the produced, exported sequence while maintaining its infectivity and production purity, with engineered regions of sequence control. Synthetic miniphage constitutes an ideal platform for bacterial production of isogenic cssDNA, using inserts of custom sequence and size to attain this goal, offering an inexpensive resource at milligram and higher synthesis scales. Here, we show that the Escherichia coli (E. coli) helper strain M13cp combined with a miniphage genome carrying only an f1 origin and a β-lactamase-encoding (bla) antibiotic resistance gene enables the production of pure cssDNA with a minimum sequence genomic length of 1,676 nt directly from bacteria, without the need for additional purification from contaminating dsDNA, genomic DNA, or fragmented DNAs. Low-cost scalability of isogenic, custom-length cssDNA is also demonstrated for a sequence of 2,520 nt using a commercial bioreactor. We apply this system to generate cssDNA for the programmed self-assembly of wireframe DNA origami objects with exonuclease-resistant, custom-designed circular scaffolds that are purified with low endotoxin levels (
Impact of Mitral Regurgitation Severity and Cause on Effort Tolerance-Integrated Stress Myocardial Perfusion Imaging and Echocardiographic Assessment of Patients With Known or Suspected Coronary Artery Disease Undergoing Exercise Treadmill Testing.

Background Mitral regurgitation (MR) has the potential to impede exercise capacity; it is uncertain whether this is because of regurgitation itself or the underlying cause of valvular insufficiency...
Analysis of the In Vivo Transcriptome of Bordetella pertussis during Infection of Mice.

ABSTRACT Bordetella pertussis causes the disease whooping cough through coordinated control of virulence factors by the Bordetella virulence gene system. Microarrays and, more recently, RNA sequencing (RNA-seq) have been used to describe in vitro gene expression profiles of B. pertussis and other pathogens. In previous studies, we have analyzed the in vitro gene expression profiles of B. pertussis, and we hypothesize that the infection transcriptome profile in vivo is significantly different from that under laboratory growth conditions. To study the infection transcriptome of B. pertussis, we developed a simple filtration technique for isolation of bacteria from infected lungs. The work flow involves filtering the bacteria out of the lung homogenate using a 5-μm-pore-size syringe filter. The captured bacteria are then lysed to isolate RNA for Illumina library preparation and RNA-seq analysis. Upon comparing the in vitro and in vivo gene expression profiles, we identified 351 and 255 genes as activated and repressed, respectively, during murine lung infection. As expected, numerous genes associated with virulent-phase growth were activated in the murine host, including pertussis toxin (PT), the PT secretion apparatus, and the type III secretion system. A significant number of genes encoding iron acquisition and heme uptake proteins were highly expressed during infection, supporting iron acquisition as critical for B. pertussis survival in vivo. Numerous metabolic genes were repressed during infection. Overall, these data shed light on the gene expression profile of B. pertussis during infection, and this method will facilitate efforts to understand how this pathogen causes infection. IMPORTANCEIn vitro growth conditions for bacteria do not fully recapitulate the host environment. RNA sequencing transcriptome analysis allows for the characterization of the infection gene expression profiles of pathogens in complex environments. Isolation of the pathogen from infected tissues is critical because of the large amounts of host RNA present in crude lysates of infected organs. A filtration method was developed that enabled enrichment of the pathogen RNA for RNA-seq analysis. The resulting data describe the “infection transcriptome” of B. pertussis in the murine lung. This strategy can be utilized for pathogens in other hosts and, thus, expand our knowledge of what bacteria express during infection.
Transformation of systems of coordinates

In many problems of mathematical physics it is better to use an orthogonal coordinate system u, v, winstead of the cartesian coordinates x, y, z. The choice of a particular coordinate system may be motivated by physical reason and can result in a considerably simplified analysis of the problem.
MITRAL VALVE REPLACEMENT IN CHILDREN.

SUMMARY The cases of 2 children with severe mitral insufficiency have been presented with emphasis on the pathologic physiology and surgical treatment. The Starr-Edwards prosthesis was used to totally replace the diseased mitral valve in each instance. In selected cases, the use of prosthetic valves is indicated for the treatment of severe mitral valvular disease in children.
In situ exfoliated 2D molybdenum disulfide analyzed by XPS

Molybdenum disulfide, a two-dimensional transition metal dichalcogenide, was analyzed using in situ x-ray photoelectron spectroscopy (XPS). The XPS spectra obtained from a fresh surface which was exfoliated and annealed in ultrahigh vacuum include a survey scan, high resolution spectra of O 1s, C 1s, Mo 3d, S 2s, S 2p, Mo 3p, Mo 4p, S 3s, and the valence band. Quantitative analysis indicates a sulfur deficient surface composition of MoS1.8, and impurities were below the XPS detection limit.
Evaluating the Impact of Telehealth-Based, Diabetes Medication Training for Community Health Workers on Glycemic Control.

Background: Diabetes is a major contributor to morbidity and mortality. Community Health Workers (CHWs) have been instrumental in improving patient outcomes. However, CHW training largely focuses on general diabetes concepts rather than medications. Providing accessible, diabetes medication training for CHWs has the potential to increase patient understanding, personalized care, and adherence, thereby improving outcomes. Objective: To evaluate the impact of a telehealth-based diabetes medication training for CHWs on patient outcomes as measured by HbA1c changes. Methods: We provided a 12-month weekly, telehealth (videoconference) medication training for CHWs who led 6-month diabetes programs for low-income Latino(a)s in community clinics. We measured participant HbA1c (primary outcome), blood pressure, and body mass index (BMI) changes. We evaluated CHW knowledge via two pre/post-tests: medication adverse events/side effects (TEST-1, months 1–6) and dosing, titration, and emergencies (TEST-2, months 7–12). We assessed CHW training application by their ability to identify patient, provider, and healthcare system medication barriers. Results: Participants’ (n = 55) HbA1c improved (9.0% (75 mmol/mol) to 7.8% (62 mmol/mol) (p = 0.001)). Blood pressure and BMI changes were not significant. CHWs improved their knowledge: TEST-1: 10.5-18.2/20.0 (p = 0.002), TEST-2: 10.3–17.3/19.0 (p = 0.0019). CHWs identified 984 patients (n = 610), providers (n = 151), and healthcare systems (n = 223) medication barriers during the 12-month training. Conclusions: Providing a telehealth-based, diabetes medication training program for CHWs allowed a personalized approach to identify barriers to care at several levels, which was associated with significant participant HbA1c reductions and improved CHW knowledge. This is a promising cost-effective, culturally sensitive strategy to improve diabetes care. Larger longitudinal evaluations are needed to fully understand the impact of CHW medication training.
Colonization with Gastrointestinal Pathogens Prior to Hematopoietic Cell Transplantation and Associated Clinical Implications.

ABSTRACT Infectious diarrhea following hematopoietic cell transplantation (HCT) significantly contributes to morbidity and mortality. Most HCT recipients experience diarrhea in the post-transplantation period, and infectious pathogens are frequently detected during diarrheal episodes. However, little is known about how frequently these patients are colonized with gastrointestinal (GI) pathogens before their transplantation and whether colonization predicts future diarrheal illness. We sought to determine how frequently HCT recipients are colonized with GI pathogens before HCT and the degree to which pre-HCT colonization predicts post-transplantation infectious diarrheal illness. We conducted a prospective cohort study of allogeneic and autologous HCT recipients at a single center between December 2016 and January 2019. Stool samples were collected during the week before HCT, and formed samples were evaluated for the presence of 22 diarrheal pathogens using the BioFire FilmArray GI panel. We determined the frequency with which participants were colonized with each pathogen and identified factors associated with colonization. We then determined how frequently pretransplantation colonization led to post-transplantation diarrheal infections due to the colonizing pathogen and whether colonization was associated with increased number of days of post-transplantation diarrhea during the transplant hospitalization. We enrolled 112 asymptomatic patients (allogeneic, 61%; autologous, 39%) who had a formed stool specimen before HCT, of whom 41 (37%) had a GI pathogen detected. The most commonly detected organisms were Clostridioides difficile (n = 21; 19%), Yersinia enterocolitica (n = 9; 8%), enteropathogenic Escherichia coli (EPEC) (n = 6; 6%), and norovirus (n = 5; 4%). Female sex and previous C. difficile infection were associated with C. difficile colonization, and having non-Hodgkin lymphoma was associated with being colonized with a diarrheal pathogen other than C. difficile. Thirteen of 21 patients (62%) with pretransplantation C. difficile colonization developed a clinical C. difficile infection post-transplantation, and 8 of 10 patients (80%) colonized with EPEC or enteroaggregative E. coli developed post-transplantation infections due to their colonizing pathogen. Pretransplantation C. difficile colonization was also associated with an increased duration of post-transplantation diarrhea (P = .048). Conversely, none of the 9 patients with pretransplantation Yersinia enterocolitica colonization developed a post-transplantation Y. enterocolitica infection. Patients admitted for HCT are frequently colonized with a diverse range of GI pathogens. Colonization with C. difficile colonization and diarrheagenic E. coli is frequently associated with post-transplantation diarrheal infections caused by these organisms, but the clinical significance of colonization with other GI pathogens is not clear.
Factor-Bounded Nonnegative Matrix Factorization

Nonnegative Matrix Factorization (NMF) is broadly used to determine class membership in a variety of clustering applications. From movie recommendations and image clustering to visual feature extra...
Maturation and Carbonation

Raw or green beer is transferred to the conditioning tanks to hold until it is ready to serve or move to the packaging line. Conditioning is important in the brewing process as it is the last time that the beer can be adjusted to match a set of specifications or be aged to provide the flavors that the brewer desires. The equipment and processes in conditioning can be quite varied, but tend to follow a common set of guidelines. We’ll look at these guidelines in detail as we uncover the process known as conditioning.
Abstract P280: CCL5 Causes Vascular Injury Via CCR5 And Nadph Oxidase 1- Derived Ros

Chemokine (C-Cmotif) ligand 5 (CCL5) and its receptor CCR5 belong to the family of chemokines and are expressed and active in the vasculature. NADPH oxidases (Noxs) are the major source of reactive...
Low-precision Floating-point Arithmetic for High-performance FPGA-based CNN Acceleration

Low-precision data representation is important to reduce storage size and memory access for convolutional neural networks (CNNs). Yet, existing methods have two major limitations: (1) requiring re-...
MISO: mixed-integer surrogate optimization framework

We introduce MISO, the mixed-integer surrogate optimization framework. MISO aims at solving computationally expensive black-box optimization problems with mixed-integer variables. This type of optimization problem is encountered in many applications for which time consuming simulation codes must be run in order to obtain an objective function value. Examples include optimal reliability design and structural optimization. A single objective function evaluation may take from several minutes to hours or even days. Thus, only very few objective function evaluations are allowable during the optimization. The development of algorithms for this type of optimization problems has, however, rarely been addressed in the literature. Because the objective function is black-box, derivatives are not available and numerically approximating the derivatives requires a prohibitively large number of function evaluations. Therefore, we use computationally cheap surrogate models to approximate the expensive objective function and to decide at which points in the variable domain the expensive objective function should be evaluated. We develop a general surrogate model framework and show how sampling strategies of well-known surrogate model algorithms for continuous optimization can be modified for mixed-integer variables. We introduce two new algorithms that combine different sampling strategies and local search to obtain high-accuracy solutions. We compare MISO in numerical experiments to a genetic algorithm, NOMAD version 3.6.2, and SO-MI. The results show that MISO is in general more efficient than NOMAD and the genetic algorithm with respect to finding improved solutions within a limited budget of allowable evaluations. The performance of MISO depends on the chosen sampling strategy. The MISO algorithm that combines a coordinate perturbation search with a target value strategy and a local search performs best among all algorithms.
CARDIORESPIRATORY SYNDROME OF OBESITY (PICKWICKIAN SYNDROME) IN CHILDREN

The clinical, pulmonary and hemodynamic findings in two boys with the Pickwickian syndrome are presented. In contrast to adults with this syndrome, all four children thus far reported have been mentally retarded. Both of our cases were cyanotic, lethargic and in congestive heart failure at the time of admission. They both exhibited polycythemia, cardiac enlargement, electrocardiographic evidence of right atrial and right ventricular hypertrophy, decreased pulmonary function without evidence of obstructive pulmonary disease and pulmonary arterial hypertension. Symptoms of cardiorespiratory disease subsided following weight reduction. The pathophysiologic mechanisms of alveolar hypoventilation, pulmonary arterial hypertension, and congestive heart failure in patients with this disease complex are discussed. The clinical recognition of this syndrome is of practical importance because: 1) it is a preventable disease, 2) the changes are reversible following weight reduction and 3) because of the dangers of oxygen administration.
Clusters of new identical mutants and the fate of underdominant mutations

Given favorable environmental and demographic conditions, premeiotic clusters of identical mutations can produce a broad distribution of the initial frequency of underdominant alleles. Because of these clusters, new underdominant mutations may not necessarily be as rare in a population as previously assumed. The fixation of underdominant mutations, especially those with low heterozygous fitness, is increased when mutations appear in a cluster due to a genetic change that occurred before germline differentiation. Most restrictions on the fixation of underdominant mutations in a single population, such as strong genetic drift, weak selection against mutant heterozygotes, isolated population structure, inbreeding, meiotic drive, and selection in favor of mutant homozygotes can be relaxed or even dropped. Instead, the fate of strong underdominant mutations is determined mainly by ecological and genetic factors that affect the cluster size distribution of new premeiotic mutations. Accumulation of reproductive isolation by the fixation of underdominant mutations becomes more feasible with clusters, and mutation is not always the weakest force during this evolutionary process. The large mean and variance of reproductive success in many multicellular species make it possible that even underdominant mutations with very low heterozygous fitness could contribute substantially to reproductive isolation.
Context effects on nonsense codon suppression in Escherichia coli.

The influence of mRNA context on nonsense codon suppression has been studied by suppression measurements at one site in the Escherichia coli trpE gene and at two sites in the trpA gene. The ratio of suppression efficiencies of amber and ochre codons at each site (homotopic pairs) has been compared using ochre suppressing derivatives of tRNA 1Tyr. This ratio is independent of differential effects of the inserted amino acid on enzyme function. We have found that mRNA context can change the ratio of suppression efficiencies of homotopic nonsense codons at the three sites in the trp gene system over a ten-fold range. The causes of such variation, and, in particular the effect of certain adjacent nucleotides on nonsense codon suppression are considered.
Distance learning: a case study

For different reasons, Distance Learning (DL) is a popular option in higher education. Information Technology (IT) has made education more available for students without regard to location or time. Universities are now offering online degrees at all levels. This study presents an exploratory investigation designed to identify some of the advantages and disadvantages of DL. Seventeen students from one MBA course took part in this investigation. In online courses, not only does the educational process occur by means of a computer system (generally over the internet), but instruction occurs via the computer as well. Based on seven years of experience with online teaching, the author identifies some factors for success, as well as the potential disadvantages and advantages of online learning. Online learning has the ability to provide a Virtual Learning Environment (VLE). The author hopes that this paper provides valuable insights into the advantages and disadvantages of online learning.
Confirmation of metastases by fine needle aspiration biopsy in patients with gynecologic malignancies

Abstract Fine needle aspirations (FNA) were performed on 48 patients treated for gynecologic malignancies and suspected of having recurrence of their disease. The suspected sites of metastases were peripheral lymph nodes (38 patients) and the retroperitoneal region (10 patients). Metastatic tumors were detected in 22 out of the 48 patients (45%) by FNA, with 9 patients having additional confirmation by excisional biopsies. Of the remaining patients, 9 had unsatisfactory specimens, and 2 had false-negative results. The report emphasizes the efficacy of this procedure, especially when positive results are obtained. Open biopsy can be restricted to those patients with negative or unsatisfactory results and a high clinical suspicion of metastasis.
Clinician-discoverers--Marshall, Warren, and H. pylori.

Dr. Julie Parsonnet writes that the clinical and scientific importance of H. pylori has exceeded everyone's wildest expectations. Yet the most important legacy of Marshall and Warren's Nobel Prize ...
Energy Expenditure During Physically Interactive Video Game Playing in Male College Students With Different Playing Experience

Objective: Researchers have yet to explore the effect of physically interactive video game playing on energy expenditure, despite its potential for meeting current minimal daily activity and energy expenditure recommendations. Participants and Methods: Nineteen male college students-12 experienced Dance Dance Revolution (DDR) players and 7 inexperienced players- completed maximal oxygen uptake assessments and a 30-minute DDR gaming session. The authors recorded heart rate (HR), rating of perceived exertion (RPE), respiratory exchange rate (RER), oxygen consumption (VO2), and total steps (TS30). Results: Experienced participants showed higher exercise HR, RPE, RER, VO2, total and relative energy expenditure, exercise intensity, TS30, and average steps per minute, and less time and steps to expend 150 kilocalories (p < .05). Conclusions: Participants with greater playing experience can work at higher intensities, promoting greater energy expenditure.
Performance Characteristics Of Multimode And Single Mode Optical Fiber Waveguides

AbstractPresent fiber performance properties are discussed with a particular emphasis on tradeoffsrelating to system economics. The discussion concentrates on the fiber attenuation rate andinformation carrying capacity. Both state -of- the -art as well as typical performance levelsare indicated.IntroductionThe technology of optical fiber communications is rapidly expanding into a new phase --commercial development. Research and development on individual system components and feasi-bility trials of the preceding decade have given way to more detailed studies of overallsystem optimization. However if the technology is to continue its rapid evolution, the trade-off questions now being raised must involve economic in addition to technical issues, and mustdeal not only with individual components but also with interactions between components.Fiber performance properties and tradeoffs is the subject of the present discussion.Nearly all technical issues involving fiber tradeoffs are understood and quantified at thepresent time. The economic tradeoffs are becoming known. Several points seem clear and willbe further amplified in the remainder of the presentation. First, no single design appearscapable of optimally handling the myriad applications in which the optical fiber will be used.Second, it is no longer sufficient to speak about champion performance for any single fibervariable, rather all fiber parameters must simultaneously fall within the acceptable rangesfor a given application. Third, intrinsic attenuation differences do not appear to existbetween any of the major processes being used today -- this being purely a function of theglass composition. Fourth, while high bandwidth, in the 1 -3 GHz -km range, is reported, thelength dependence of this quantity is not known with certainty.Simplistically the dominant optical parameters are still fiber attenuation and bandwidth.In the following paragraphs the state -of- the -art for both of these will be considered.AttenuationThe single most important fiber parameter is still the optical attenuation. From thesystem standpoint this attenuation has three components; the distributed loss of the fiberand cable, the input coupling loss and the interconnection loss. Each of these depends onthe key fiber design variables; core diameter and numerical aperture.Considering the distributed loss component first, it appears that the three major manu-facturing process9 qx'e able to generate the same intrinsic attenuation rate level as shownin Fig. la and lb
Obesity and survival in population-based patients with pancreatic cancer in the San Francisco Bay Area

Background Obesity has been consistently associated with increased risk of pancreatic cancer incidence and mortality. However, studies of obesity and overall survival in patients with pancreatic cancer are notably lacking, especially in population-based studies.
Cardiovascular and renal hemodynamic effects of intravenous infusions of the selective DA1 agonist, fenoldopam, used alone or in combination with dopamine and dobutamine.

Fenoldopam (0.1 and 0.2 microgram/kg/min i.v.) was administered to pentobarbital-anesthetized dogs alone and combined with dopamine (DA) and dobutamine. Renal blood flow, heart rate, and mean arterial pressure were measured. Both dosages of fenoldopam increased renal blood flow without altering blood pressure, similar to the effects of DA (1 and 2 micrograms/kg/min). Administration of fenoldopam with only DA (1 microgram/kg/min) produced further increase in renal blood flow. After administration of phenoxybenzamine (15 mg/kg i.v.), DA produced significant increments in renal blood flow and reductions in renal vascular resistance when compared with experiments without phenoxybenzamine, suggesting even low dosages of DA exert alpha-adrenoceptor agonist activity. Dobutamine (2 and 4 micrograms/kg/min) increased renal blood flow about 37% of that produced by DA. Fenoldopam added to dobutamine produced similar increments in renal blood flow as DA. Fenoldopam did not affect the increase in cardiac contractile force produced by DA and dobutamine. Thus, fenoldopam alone or in combination with DA had no advantage over 2 and 4 micrograms/kg/min DA to further increase renal blood flow. In contrast, fenoldopam with dobutamine produced greater increments in cardiac contractile force than DA and equivalent increases in renal blood flow as DA.
Losing Neverland: creating a better world to age in.

The long-term care (LTC) system is broken. Even those with extensive training and knowledge cannot get it to do what it should. Policy makers concentrate on the cost of care without stopping to ask whether what we are already spending is buying anything like care we want. It is time to focus on the infrastructure of LTC and to ask how we can create a system of care that comes closer to what we would want for ourselves and our parents. Almost everyone agrees that the LTC system we have today is not what anyone would have designed if they were starting from scratch. Instead it has grown in fits and starts shaped by extreme reactions to bad events and a need to make hasty decisions. Although we will never get a clean slate, perhaps it is still worthwhile to consider what we might wish for, at least to provide some basic building blocks. If we do not know where we are going, we have little hope of ever getting there. Let us start with some basic premises:
SU-E-T-360: A Novel Procedure to Determine the Dose Output Change with Spread Out Bragg Peak Width and Range Shift in Passively Scattered Proton Beams

Purpose: Two of the major factors affecting the change in output of a passively scattered proton beam are the spread‐out Bragg peak width factor (SOBPF) and range shifter factor (RSF), both of which are usually measured during clinical commissioning. The purpose of this study is to determine these two factors by numerically constructing the SOBP from experimentally measured pristine Bragg peak (PBP), which can serve as an independent monitor unit (MU) calculation procedure. Methods: SOBPs were constructed by superposition of PBPs that are shifted by the water‐equivalent thicknesses (WET) of the corresponding steps of the range modulation wheel. A least‐squares fit was used to determine the weightings of the shifted PBPs to form the required SOBPs. With a simplification in modeling that MU monitor in the nozzle receives dose proportional to the surface dose of the SOBP (higher by an inverse‐square factor), we can relate the MU to the dose at the center of SOBP and compute the SOBP factors for different SOBP widths. When the range shifter was added, the SOBP was shifted toward the surface by the WET of the range shifter and the RSF can also be calculated from the change in the surface dose.Results: The SOBP and range shifter factors were calculated for SOBPs with modulation widths between 4 and 16 cm of 250 and 200 MeV proton beams. The calculated SOBPF and RSF agreed within 2%, and 1.5% with the respective measured values. Conclusions: Starting with measured pristine Bragg peaks, SOBPs can be numerically constructed by simulating the range modulation process, and important dosimetry factors dependent on the modulation width and range shifters can be calculated within 2% accuracy.
Oncology Patient–Centered Medical Home

The oncology patient-centered medical home is a physician-driven, patient-focused value proposition that can make a difference for patients, oncologists, and the cost of health care.
Routine production of reactive fluorine-18 fluoride salts from an oxygen-18 water target

The use of a conventional small volume [ 18 O]water target gave rise to two problems. First, the water tendedto be expelled from the target by radiolytic gas production and second, continued use of the target gave [ 18 F]fluoride which could not be used for organic synthesis due to metal ions dissolving in the target water. Both of these problems have been overcome by using a silver target with a head space that permits the gas to leave the target without removing water.
The nuclear receptor steroidogenic factor 1 is essential for the formation of the ventromedial hypothalamic nucleus.

The nuclear receptor steroidogenic factor 1 (SF-1) regulates the biosynthesis of the two essential mediators of male sexual differentiation, androgens and Mullerian-inhibiting substance, and is required for adrenal and gonadal development and gonadotropin expression. SF-1 is also expressed in the embryonic ventral diencephalon, subsequently localizing to the ventromedial hypothalamic nucleus, a region important for reproductive behavior. Mice lacking SF-1 secondary to targeted disruption of the Ftz-F1 gene had normal numbers and location of GnRH neurons but exhibited grossly impaired ventromedial hypothalamic nucleus structure. Despite their apparently normal GnRH neurons, treatment of Ftz-F1-disrupted mice with GnRH restored pituitary gonadotropin expression. These studies define SF-1's essential role within a discrete hypothalamic nucleus previously linked to reproduction.
The effects of information availability on the group consensus process

Abstract Can a group reach consensus without the right information? To support group interaction, groupware must provide the correct amount and kind of information. This pilot study tests the relationship between information availability and consensus. Availability includes amount of information, as well as the usefulness of information. Does the group have enough information? Does the group have and use the right information? Discovering the information availability/consensus relationship may help decide whether or not consensus is desired under certain information circumstances.
Enhancement of CD uniformity and throughput with KrF photomask repeater

It is intended to clarify the feasibity of 0.15 μm generation mask fabrication with the photomask repeater that is based on a KrF stepper(step-and-repeat exposure system). In a photomask repeater patterning, a daughter mask is exposed to KrF light through a mother mask. Inter-field registration accuracy(3sigma) is 14 nm in X direction and 28nm in Y direction within a 80mm ×100mm area on a daughter mask and intra-field registration accuracy(3sigma) is 21nm in X direction and 26nm in Y direction within a 18.4mm ×23.0mm field on a daughter mask. Inter-field CD uniformity (3sigma) is 8nm in 100mm ×100mm area on a daughter mask and intra-field CD uniformity (3sigma) is 24nm within a 18.4mm ×23.0mm field on a daughter mask. The errors of registration and CD within a field can be improved by compensating for these errors to a mother mask. With the compensation, the intra-field registration error can be reduced to about 13.5nm and the intra-field CD uniformity (3sigma) can be improved into 15nm. Pattern fidelity in the KrF photomask repeater is inferior to that in the e-beam process. So we need to apply OPC pattern to a mother mask in order to get an equivalent pattern fidelity to profiles in the e-beam process.
In-transit intramammary sentinel lymph nodes from malignant melanoma of the trunk.

Objective: Our goal was to determine the incidence and outcomes of intramammary in-transit sentinel lymph nodes (IMSLN) from primary malignant melanoma (MM) of the trunk. We hypothesize that regional metastasis to the breast from anterior trunk MM also occurs via the lymphatic system to these intramammary in-transit sentinel lymph nodes. Background: MM is the most common solid tumor metastasis to the breast. The mechanism of intramammary (IM) metastasis is generally attributed to hematogenous rather than lymphatic spread. Methods: We retrospectively reviewed medical records from all patients who underwent selective sentinel lymph node dissection at the UCSF Melanoma Center from 1993 to 2008 after the approval of UCSF Committee on Human Research. Of the 1911 cases, we found 614 patients with primary MM located on the trunk, and queried their medical records for in-transit SLN and SLNs in the breast. Data from preoperative lymphoscintigraphy, intraoperative lymphatic mapping, operative notes, and pathology and clinic notes were gathered. Results: Of the 1911 patients with MM, 169 (8.9%) and 420 (22.0%) had anterior and posterior trunk lesions, respectively, and 25 patients (1.3%) with flank lesions (lateral abdominal wall below the rib cage, above the iliac crest). Of the anterior trunk population, 18 patients had in-transit SLNs. The vast majority of these patients (14 of 18, 77.8%) had in-transit IMSLN. Of patients with posterior trunk melanoma, 27 patients had in-transit nodes with 1 patient having IMSLNs. Of patients with flank melanomas, 3 patients had in-transit nodes with 1 patient having IMSLNs. Interestingly, all patients with IMSLNs had primary lesions located inferior to the breasts. Two of the 16 patients with IMSLNs had micrometastasis to IMSLN; 1 patient died and the other currently is disease free 4 years after initial SLND. Four of the 32 patients with non-IM in-transit nodes had micrometastases to these in-transit nodes. Of all patients with trunk melanomas, 4 patients had micrometastases to axillary SLNs (AxSLNs). Three of the 4 patients with positive AxSLNs also had positive in-transit nodes whereas only half of the patients with positive in-transit SLNs had positive AxSLNs. Conclusions: IMSLNs exist in the breast. Our results establish an anatomic basis for lymphatic metastasis to the breast from primary cutaneous melanoma mainly from the anterior trunk inferior to the breasts. For anterior trunk melanomas, IMSLNs should not be overlooked during SLND as they may harbor micrometastasis.
THE IMPACT OF INTERNET COMMUNICATIONS ON SOCIAL INTERACTION

ABSTRACT The Internet is clearly on the way to becoming an integral tool of business, communication, and popular culture in many parts of the world. Computer Mediated Communications has a wide range of supporters and detractors. Some individuals argue the Internet will revolutionize social interactions, where others argue that the Internet will lead to loss of privacy, impersonal communications and isolation. There are also those who argue that the Internet is also being presented as a pedagogical tool for changing how public education is delivered. We believe that the Internet is a neutral social structural tool with several positive possibilities. However, the Internet's extraordinary growth is not without concern. Of particular relevance is the issue of the potential impact of the Internet and computer-mediated communications on the nature and quality of social interaction, especially among young people. This article is an analysis of the possible consequences online communication might have on social ...
A new look at old carbon in active margin sediments

Recent studies suggest that as much as half of the organic carbon (OC) undergoing burial in the sediments of tectonically active continental margins may be the product of fossil shale weathering. These estimates rely on the assumption that vascular plant detritus spends little time sequestered in intermediate reservoirs such as soils, freshwater sediments, and river deltas, and thus only minimally contributes to the extraneously old 14C ages of total organic matter often observed on adjacent shelves. Here we test this paradigm by measuring the Δ14C and δ13C values of individual higher plant wax fatty acids as well as the δ13C values of extractable alkanes isolated from the Eel River margin (California). The isotopic signatures of the long chain fatty acids indicate that vascular plant material has been sequestered for several thousand years before deposition. A coupled molecular isotope mass balance used to reassess the sedimentary carbon budget indicates that the fossil component is less abundant than previously estimated, with pre-aged terrestrial material instead composing a considerable proportion of all organic matter. If these findings are characteristic of other continental margins proximal to small mountainous rivers, then the importance of petrogenic OC burial in marine sediments may need to be reevaluated. © 2009 The Geological Society of America.
Instabilities in a sandpile

Bak, Tang, and Wiesenfeld proposed the idea of self-organized criticality in order to gain a general understanding of the behavior of extended dynamical systems driven in a nonequilibrium state. In particular this idea was intended to explain the ubiquitous scaling behavior and fractal structures that are observed in many different phenomena occurring spontaneously in nature. Recent experiments on the dynamics of a pile of sand, which had been expected to show self-organized criticality, are reviewed and it is shown that sand behaves in a manner more reminiscent of a first-order transition than of a second order (or critical) one.