cssi/SciSciGPT-SciSciNet huggingface dataset:
Case of Recurrent, Severe Rhabdomyolysis with Chronic Pain and Dysphagia Cause by Novel Mutation in RYR1 Gene (P5.064)

Objective: To report a case of recurrent, severe rhabdomyolysis with chronic pain and dysphagia cause by novel mutation in RYR1 gene. Background: 31-year-old female developed recurrent rhabdomyolysis in 2012 (age 28). Initial episodes were confined to the legs with subsequent involvement of entire body. From 2012-2014, she had episodes at least monthly, lasting 1-4 weeks. All were associated with swelling, severe pain, and numbness. Pain was dysesthetic (“death by torture”). In some episodes, she was immobilized by total-body pain/numbness. For recurrent compartment syndrome, she underwent fasciotomies of legs and hands. Methods: Chart review and follow up. Results: Creatine kinases (CKs) were markedly elevated (maximum 363,000 U/L). Interictal CKs were 313-639. By 2014, she had chronic, generalized pain managed with opioids and dysphagia that increased in severity. Ictal swallow study showed pharyngeal dysphagia with aspiration. Interictal examinations showed no weakness. Some episodes were triggered by mild, prolonged exertion, but others were unprovoked. She had unprovoked exacerbations of ongoing rhabdomyolysis while immobilized in the hospital. EMG showed a diffuse, irritable myopathy. Muscle biopsy showed an active/chronic myopathy with prominent denervation atrophy (no cores). Immunohistochemical stains for various dystrophies, myoglobinuria panel, and electron transport chain enzymatic analysis were normal. Whole exome sequencing showed a novel, likely pathogenic, heterozygous mutation in the RYR1 gene [c.8651A>T(p.ASN2884ILE)] . Identification of this variant in other family members is pending. Conclusion: Mutations in RYR1 are increasingly recognized in patients with exertional rhabdomyolysis. The frequency and severity of the episodes, exquisitely severe ictal pain/numbness, chronic pain, unprovoked nature of many attacks, and pharyngeal involvement are unique features. In addition to muscle, ryanodine receptors ( RYRs ) are expressed in central and peripheral neurons. Neuronal RYR dysfunction has been implicated in animal models of acute/chronic pain and impaired motor nerve terminal regeneration/synaptic function, a possible explanation for this patient’s pain and denervation atrophy. Disclosure: Dr. Mankad has nothing to disclose. Dr. Collins has received personal compensation for activities with Medpace as a consultant. Dr. Thompson has nothing to disclose. Dr. Bick has nothing to disclose. Dr. La Pean Kirschner has nothing to disclose.
Application of emotional speech recognition technology in military intelligent robot

A realized approach ofthe emotionalspeech recognition system based on HMM and ANN is proposed.The process ofconstruction of the system is clarified by involving the gain of emotional speech,the extraction of emotion features,emotion recognition and so on.The system realizes the extraction ofemotion features parameter,the training ofemotional speech modelparameter and recognition of the recorded emotional speech.The research results show that the system can achieve an effective solution to emotion recognition.
Getting Real: Embracing the Conditions of the Third-year Clerkship and Reimagining the Curriculum to Enable Deliberate Practice

There are many calls in the literature for changes in how medical students are educated. Although many curricular innovations have been attempted, a look at the theory behind how complex skills are learned provides useful information to guide new curriculum developments. The requirement of deliberate practice as the road map for success in the learning of clinical skills suggests that perhaps the current clinical milieu is not an optimal place for medical students to learn. The idiosyncrasy inherent in the dramatically changed medical landscape of the last 20 years makes it difficult for such practice to occur; the apprentice model of legitimate peripheral participation in a community of practice as it used to exist does no longer. Indeed, current workplace environments are at odds with the needs of medical students. Overwhelming numbers of goals and objectives in existing third-year clerkships serve as wish lists of what students should learn. They should be replaced by a systematic, longitudinal curriculum in which all students can be guaranteed to have encountered the core clinical competencies as defined. Moving the goals and objectives of the current clerkships to a longitudinal, spiral curricular format frees up clinical time in the third year to be used for students to find their future specialty and socialize into medicine. Doing so allows for an opportunity for students to spend extended time in areas of their interest. Moving to such a new curriculum format maximizes and optimizes learning while embracing the reality of current clinical workplace environments.
Inheriting patients with questionable medication regimens.

Inheriting a patient on an inappropriate or questionable medical regimen is a scenario that every physician confronts when practicing continuity care. It can present frustrating challenges, especially for resident physicians, who, because of the nature of training programs, care for patient panels with high turnover rates. Regardless of the practice setting, several issues pertaining to certain medication categories should be considered.
Food Waste Composting in Seattle: The Political Perspective

Over the course of two decades, organics collection in Seattle (population 620,778) evolved from a limited yard waste collection service initiated in 1989 to a comprehensive and mandatory residential curbside food and yard waste collection system established in 2011. This development was not the result of state pressure, as the State of Washington has no waste reduction mandate. Instead curbside compostables collection in Seattle was propelled by the skyrocketing landfill disposal costs and bolstered by elected officials and city staff who were committed to waste reduction. Also working in its favor, Seattle had a local yard waste processing plant that was able to integrate food waste, as well as a solid waste utility supported by a PAYT (pay as you throw) system. Trash disposal fee-based incentives, paired with a zero waste resolution and a participation mandate for single- and multi-family residences, have increased Seattle’s composting levels and helped the city achieve one of the highest per capita compostables collection rates in the nation.
Perceptions Of Disparate Impact As Employment Discrimination

Managers must be aware of work situations where illegal employment discrimination may be occurring. This requires an understanding of two different types of discrimination that may be taking place: disparate treatment and disparate impact. This study was conducted to discover the extent to which college students taking a class in human resource management perceive instances of disparate treatment and disparate impact to be illegal employment discrimination, and whether or not they believe that each type of discrimination should be considered illegal discrimination. Eighty-three percent (83%) of respondents correctly identified a scenario portraying disparate treatment to be illegal discrimination, while only 37% correctly identified a scenario portraying disparate impact to be illegal discrimination. Regarding beliefs about what situations should be considered illegal discrimination, 91% believed that the disparate treatment scenario should be considered illegal discrimination, while 34% believed that the disparate impact scenario should be considered illegal discrimination. The parallels between attitudes toward affirmative action and beliefs about disparate impact as a form of discrimination are discussed. Implications for teaching managers and future managers to avoid discriminatory actions in the workplace, as well as societal implications for understanding disparate impact as a form of discrimination, are presented.
Toxicology and Mode of Action of Pyrethroid Insecticides

Publisher Summary This chapter provides a review of the toxicological properties of pyrethroid insecticides in mammals, with emphasis on the neurotoxic properties that are characteristic of pyrethroids as a class. Pyrethrum is arguably the most effective natural insecticide, but its use is limited by its instability in light and air, which limits its effectiveness in crop protection and other insect control contexts in which residual activity is essential. The development of pyrethroids involved an iterative process of structural modification and biological evaluation in an effort to identify compounds with increased photostability that retained the potent and rapid insecticidal activity and relatively low acute mammalian toxicity of pyrethrum. The insecticidal properties of pyrethroids derive from their ability to alter the function of voltage-gated sodium channels in insect neuronal membranes, thereby disrupting electrical signaling in the nervous system. Although the discovery and development process for pyrethroids involved the optimization of insecticidal activity using whole insects, optimization for high intrinsic activity on insect sodium channels was implicit throughout this process. The structure, function, and pharmacology of voltage-gated sodium channels are highly conserved between insects and mammals. It is therefore not surprising that pyrethroids also alter the function of mammalian sodium channels. There is broad agreement that voltage-gated sodium channels are the primary target sites for the neurotoxic actions of pyrethroids, they may not be the only targets involved in pyrethroid intoxication in mammals. Pyrethroids also are known to affect a variety of voltage- and ligand-gated ion channels.
Mixed convexity & optimization of the SVM QP problem for nonlinear polynomial kernel maps

Support vector machine (SVM) can be used for regression analysis and data classification of a data set. In particular, non-linear classification of a given data set is possible by using the (inhomogeneous) polynomial kernel k (x, y) = (1 + xT ċ y)d. In this work, the SVM QP problem with (inhomogeneous) polynomial kernel k (x, y) is expressed as a mixed convex optimization problem with respect to the real variables α ∈ Rl and b ∈ R; and the integer variable d ∈ Z.
Self-assembling peptide-based building blocks in medical applications ☆

Peptides and peptide-conjugates, comprising natural and synthetic building blocks, are an increasingly popular class of biomaterials. Self-assembled nanostructures based on peptides and peptide-conjugates offer advantages such as precise selectivity and multifunctionality that can address challenges and limitations in the clinic. In this review article, we discuss recent developments in the design and self-assembly of various nanomaterials based on peptides and peptide-conjugates for medical applications, and categorize them into two themes based on the driving forces of molecular self-assembly. First, we present the self-assembled nanostructures driven by the supramolecular interactions between the peptides, with or without the presence of conjugates. The studies where nanoassembly is driven by the interactions between the conjugates of peptide-conjugates are then presented. Particular emphasis is given to in vivo studies focusing on therapeutics, diagnostics, immune modulation and regenerative medicine. Finally, challenges and future perspectives are presented.
Chapter 50 – Copper

: Intestinal Cu++ absorption appears to be enhanced by dietary protein. Ceruloplasmin carries Cu++ in plasma, and also assists circulating transferrin in the reception of hepatic iron. Superoxide dismutase is the most abundant Cu++-containing enzyme. Copper is a component of the mitochondrial electron transport chain. Copper is required for both catecholamine synthesis and degradation. Lysyl oxidase is a Cu++-containing enzyme that aids in the crosslinking of elastin and collagen. Copper toxicity causes hepatic necrosis, methemoglobinemia, and hemolysis. Copper deficiency is associated with anemia, skin and hair depigmentation, CNS disturbances, and vascular degeneration. Wilson’s-like disease is prevalent in Bedlington terriers.
Impact of the Sales Tax Rate on its Base: Evidence from a Small Town:

Local governments and businesses fear that increased local sales tax rates will induce losses to the local economy, even inducing losses so severe that no additional revenue will result from a high...
Age moderates the relationship between source of social support and mental health in racial minority lesbian, gay, and bisexual youth.

We examined the relationship between source of social support and mental health (and the moderating impact of age) in 64 low socioeconomic status, racial minority lesbian, gay, and bisexual adolescents/young adults. Social support from family ( β = -.302, p = .03; β = -.364, p = .008), but not friends or significant others, was independently related to posttraumatic stress disorder and depression symptoms, respectively. Family social support was associated with lower posttraumatic stress disorder and depression symptoms in participants aged 16-19 years, while friend social support was associated with lower symptoms for participants aged over 20 years. Friend social support was also associated with lower posttraumatic stress disorder symptoms in participants aged 16-17 years. Interventions should target age-appropriate sources of social support.
Loss and crosstalk of scalable MZI-based switch topologies in silicon photonic platform

A detailed analysis of silicon photonic switches is performed for both Benes and Omega topologies and worst-case insertion loss and crosstalk levels are presented. The worst-case power penalty for 2×2, 4×4, and 8×8 Benes switches is approximated to be 1.36 dB, 3.87 dB, and 6.69 dB, respectively.
Lattice-Boltzmann lattice-spring simulations of flexibility and inertial effects on deformation and cruising reversal of self-propelled flexible swimming bodies

Abstract A lattice-Boltzmann lattice-spring method is employed to simulate cruise dynamic behaviors of self-propelled flexible swimming bodies at finite Reynolds numbers in a three-dimensional space. In simulations, the leading edge of the swimmer plunges in the vertical direction and generates a thrust force, which drives the swimmer to move in the horizontal direction freely. To investigate the effect of rigidity and inertia on cruising speed, power coefficient, propulsive efficiency, and deformation are computed while the rigid and inertia are varied at different levels. It is demonstrated that at a given Reynolds number, the cruising forward speed increases as the rigidity decreases from a high level. The forward speed increases continuously and arrives at a maximum as the rigidity reduces to an intermediate level. However, the forward cruise speed decreases when the rigidity continuously decreases. When the rigidity further reduces to a level lower than a critical value, the cruise reverses its direction and the swimmer moves backward. In this study, it is revealed that a snake-shaped two-curved swimming body due to large deformation induces two vortices and their “sucking” effect is responsible for the backward cruise while the reaction force of sweeping motion of one-curved swimming body causes the forward cruise. It is also found that the forward cruise may become backward as the inertia exceeds a critical level, suggesting that the inertia has a significant impact on the cruising direction reversal. It is revealed that two swimmers in a tandem configuration have one equilibrium separating distance, associated with the reverse Karman vortex street, which is independent of initial distances.
GoLCoNDa: Geo-IP Lookup for campus network NetFlow data

It is a challenging task for network administrators to properly monitor and manage an institution's incoming and outgoing network traffic patterns. While NetFlow is useful to gather flow-level data, its feature is limited to traditional flow-level information such as the source IP address, destination IP address, source port number, destination port number, and the protocol type. Thus, if we are to understand geographic dynamics of any flow connected to hosts at an institution from the outside world, it is not currently possible with NetFlow. To address the geo-location information of such flows, we developed the tool, GoLCoNDa, for use by campus network administrators. This tool allows the correlation of IP addresses with the geo-location information to visualize the geo-location of incoming and outgoing flows. Our tool handles millions of records quickly.
Criteria for solvability and supersolvability in Leibniz algebras

ABSTRACTLeibniz algebras are certain generalization of Lie algebras. Recently, analyzing the structure of subalgebras, David Towers gave some criteria for the solvability and supersolvability of Li...
Metallic and highly conducting two-dimensional atomic arrays of sulfur enabled by molybdenum disulfide nanotemplate

Element sulfur in nature is an insulating solid. While it has been tested that one-dimensional sulfur chain is metallic and conducting, the investigation on two-dimensional sulfur remains elusive. We report that molybdenum disulfide layers are able to serve as the nanotemplate to facilitate the formation of two-dimensional sulfur. Density functional theory calculations suggest that confined in-between layers of molybdenum disulfide, sulfur atoms are able to form two-dimensional triangular arrays that are highly metallic. As a result, these arrays contribute to the high conductivity and metallic phase of the hybrid structures of molybdenum disulfide layers and two-dimensional sulfur arrays. The experimentally measured conductivity of such hybrid structures reaches up to 223 S/m. Multiple experimental results, including X-ray photoelectron spectroscopy (XPS), transition electron microscope (TEM), selected area electron diffraction (SAED), agree with the computational insights. Due to the excellent conductivity, the current density is linearly proportional to the scan rate until 30,000 mV s−1 without the attendance of conductive additives. Using such hybrid structures as electrode, the two-electrode supercapacitor cells yield a power density of 106 Wh kg−1 and energy density ~47.5 Wh kg−1 in ionic liquid electrolytes. Our findings offer new insights into using two-dimensional materials and their Van der Waals heterostructures as nanotemplates to pattern foreign atoms for unprecedented material properties. Molybdenum disulfide (MoS2) layers can be used as templates for the formation of two-dimensional elemental sulfur. A team led by Hongli Zhu at Northeastern University used density functional theory calculations to show that the sulfur atoms sandwiched between MoS2 layers can arrange themselves into two-dimensional atomic layers, featuring a triangular array structure that results from the intrinsic triangular pattern of the parent sulfur atoms within MoS2. These arrays are metallic, and thus contribute to the metallic phase and associated conductivity of the resulting hybrid structure composed of alternating MoS2 layers and two-dimensional sulfur layers. The experimentally synthesized compounds show conductivity up to 223 S/m. This strategy may be used for engineering of two-dimensional material hybrids by means of nano-template patterns.
Adipocyte size variability in benign and malignant lipomatous tumors and morphologic mimics: a quantitative definition using digital pathology

Among well-differentiated lipomatous lesions, variability in adipocyte size has been proposed as a morphologic feature of malignancy. Specifically, normal adipose tissue and benign lipomas tend to contain adipocytes of uniform size, whereas atypical lipomatous tumor/well-differentiated liposarcoma (ALT/WDL) is described as containing adipocytes with a conspicuous variation in cell size. However, this proposed variance has never been objectively, quantitatively correlated with diagnosis. Using whole-slide scanning combined with semiautomated digital image analysis, we aimed to quantitatively test the hypothesis that variance in adipocyte size is a feature of malignancy in well-differentiated lipomatous tumors. Whole-slide scanning was performed on representative hematoxylin and eosin-stained slides selected from 130 cases representing benign (lipoma, spindle cell lipoma) and malignant lipomatous neoplasms (ALT/WDL) and morphologic mimics (normal adipose tissue, fat necrosis, fat atrophy). A previously validated, open source software package (Fiji-based Adiposoft) was used in semiautomated analysis of adipocyte size from a representative 1-cm2 portion of each slide. Median, range, and variance of cell sizes were compared across all diagnoses. Fat atrophy demonstrated smaller adipocyte cell size compared with other diagnoses. Among the remaining diagnostic groups, no significant differences were identified in adipocyte size or variance by objective quantitative morphologic analysis. However, the maximum range of adipocyte size was significantly higher in ALT/WDL than conventional lipoma and spindle cell lipoma. These data quantitate the morphology of ALT/WDL and its mimics and more specifically define the somewhat subjective "variability" of cell size as maximum range, rather than variance, of adipocyte size.
Medical Malpractice in Neurosurgery: A Comprehensive Analysis

Background Of all specialists, neurosurgeons have the highest probability of facing a medical malpractice claim. Here we report the first specialty-wide review of malpractice claims in neurosurgery performed using a well-established national online legal database. Methods The Westlaw legal research service (Thomson Reuters, Eagan, Minnesota, USA) was queried for jury verdicts and settlements related to neurosurgery and medical malpractice between 1985 and 2015. Case files were examined, and factors recorded included the age and sex of the patient, the state and year in which the verdict was reached, defendant specialties, award payouts, and alleged reasons for malpractice. Case files were sorted into neurosurgical subspecialties based on the nature of the condition and the type of treatment administered. Results A total of 516 cases were identified, and 343 cases were analyzed. A defendant's verdict was reached in 165 (48.1%) cases, and a plaintiff's verdict was reached in 93 (27.1%) cases. A settlement was reached in 81 cases (23.6%). The median payout for plaintiff's verdicts was $2,550,000 (range, $80,000–$216,849,187), and that for settlements was $1,300,000 (range, $100,000–$13,300,000). Procedural error (45.5%), a failure to diagnose (41.4%), or a failure to treat (42.9%) were the most commonly cited reasons for litigation. Neurosurgeons accounted for 21.1% of defendants. The median plaintiff award payout was highest for pediatric cases ($10,100,000). Conclusions A defendant's verdict was reached in nearly one-half of the cases. In instances where a plaintiff's verdict was reached, large payouts were common, especially in pediatric and cerebrovascular cases. An emphasis on reducing procedural error, and making timely differential diagnoses, may reduce future litigation.
1977 National Debate Tournament Final Debate: Should the Federal Government Significantly Strengthen the Guarantee of Consumer Product Safety Required of Manufacturers?

Transcript, editorial analysis, and critiques of the NDT final debate: Resolved, That the federal government should significantly strengthen the guarantee of consumer product safety required of man...
Small animal imaging using a clinical PET/CT and super-resolution

208 Objectives Although commercial small animal PET/CT scanners are available, the large installed base of clinical PET/CT scanners presents a low cost opportunity for research use, provided that image quality is acceptable. Clinical PET/CT reconstruction software includes modeling the point spread function (PSF) to improve spatial resolution. We investigated image quality of phantom and mouse scans attainable on a clinical PET/CT using vendor software versus "super-resolution" (SR) techniques. Methods FDG PET/CT scans of a NEMA NU-4 small animal phantom and a 28 g mouse were acquired with a clinical scanner (Biograph mCT). The phantom or mouse was placed on an animal bed having three motorized linear stages. In each case, two sets of PET data were acquired, first a 16-minute static scan, followed by a SR scan of 16 one-minute frames while stepping the animal bed between frames to subsample data below the intrinsic PET resolution. The static images were reconstructed with 1mm voxels, with PSF modeling and without ("NoPSF"). The super-resolution images were processed by Richardson-Lucy deconvolution of the 16 individual frames. Results Most NU-4 rods were well visualized (5, 4, 3, and 2 mm) in the SR images, whereas the NoPSF and PSF images contained artifacts. Recovery coefficients for the 5 and 4 mm rods were 46% & 23% for NoPSF, 65% & 25% for PSF, and 53% & 36% for SR. Gibbs ringing artifact was significant in PSF images but was better controlled in the SR images. The mouse FDG SR images showed good image quality with clear uptake in the major organs. Conclusions Image quality is significantly improved with the SR technique. The combined data from multiple spatial locations compensates for inaccuracies in image reconstruction. Although the image quality does not rival that of dedicated small animal PET scanner, it is acceptable for many small animal studies. The SR technique may also be applied to small animal PET scanners to further improve those images as well. Research Support American Asthma Foundation (Sandler) and NIH RC1-HL09930
Effects of maternal nutrition and rumen-protected arginine supplementation on ewe performance and postnatal lamb growth and internal organ mass

The hypothesis of this study was that arginine supplementation would overcome negative effects of restricted maternal feed intake during the last two-thirds of gestation on ewe performance and positively affect postnatal lamb growth and development. Multiparous, Rambouillet ewes (n = 32) were allocated to 3 treatments in a completely random design at 54 ± 3.9 d of gestation. Dietary treatments were 100% of nutrient requirements (control, CON), 60% of control (restricted, RES), or RES plus a rumen-protected arginine supplement dosed at 180 mg/kg BW once daily (RES-ARG). Ewes were penned individually in a temperature-controlled facility. At parturition, lambs were immediately removed from dams and reared independently. At day 54 ± 3 of age, lambs were stunned using captive bolt, exsanguinated, and organs were collected and weighed. Ewe BW from day 68 of gestation through parturition was greater (P ≤ 0.03) in CON compared with RES or RES-ARG. Similarly, ewe BCS from day 68 of gestation through parturition was greater (P ≤ 0.03) in CON than either RES or RES-ARG. Total ewe colostrum mass (g) at 3 h after parturition was greater (P ≤ 0.001) in CON than RES or RES-ARG. Lamb birth weight was greater (P = 0.04) in CON than RES ewes and tended (P = 0.10) to be greater in CON vs. RES-ARG. Lambs born to CON ewes had greater (P ≤ 0.03) BW than lambs from RES ewes at 7, 14, and 33 d postpartum. On day 19, lambs from CON and RES-ARG ewes both had greater (P ≤ 0.04) BW than lambs from RES ewes (12.0 and 11.5 vs. 10.3 ± 0.41 kg, respectively). Lambs born to CON and RES-ARG ewes had greater (P ≤ 0.04) ADG than lambs from RES ewes on day 19 (355.0 and 354.0 vs. 306.4 ± 15.77 g, respectively). Lambs from CON and RES-ARG ewes also had greater (P ≤ 0.02) girth circumference than lambs from RES ewes on day 19 (55.4 and 54.6 vs. 51.3 ± 0.97 cm, respectively). On day 54, lambs from RES-ARG ewes had greater (P = 0.003) curved crown rump length than lambs from RES ewes (99.8 vs. 93.9 ± 1.28 cm, respectively). Adrenal glands in lambs from CON dams had greater (P = 0.01) mass than adrenal glands in lambs from RES dams. Livers from lambs born to RES-ARG ewes weighed more (P = 0.05) than livers from lambs born to RES ewes. These results confirm our hypothesis that arginine supplementation during the last two-thirds of gestation can mitigate offspring, but not maternal negative consequences associated with restricted maternal nutrition.
Implications of heterostructural alloying for enhanced piezoelectric performance of (Al,Sc)N

An understanding of the heterostructural implications on alloying in the aluminum nitride-scandium nitride system (${\mathrm{Al}}_{1\ensuremath{-}x}{\mathrm{Sc}}_{x}\mathrm{N}$) can highlight opportunities and design principles for enhancing desired material properties by leveraging nonequilibrium states. The fundamental thermodynamics, and therefore composition- and structure-dependent mechanisms, underlying property evolution in this system have not been fully described, despite significant recent efforts driven by interest in enhanced piezoelectric performance. Practical realization of these enhanced properties, however, is hindered by the strong driving thermodynamic driving force for phase separation in the system, highlighting the need for increased study into the role of heterostructural alloying on the thermodynamics and composition-structure-property relationships in this system. With this need in mind, ab initio computed alloy thermodynamics and properties are compared to combinatorial thin-film synthesis and characterization to develop a more complete picture of the structure and property evolution across the ${\mathrm{Al}}_{1\ensuremath{-}x}{\mathrm{Sc}}_{x}\mathrm{N}$ composition space. The combination of structural frustration and a flattened free-energy landscape lead to substantial increases in electromechanical response. The energy scale of alloy metastability is found to be much larger than previously reported, helping to explain difficulties in achieving homogeneous materials with high scandium concentration. Scandium substitution for aluminum softens the wurtzite crystal lattice, and energetic proximity to the competing hexagonal boron-nitride structure enhances the piezoelectric stress coefficient. Overall, this work provides insight into the understanding of the structure-processing-property relationships in the ${\mathrm{Al}}_{1\ensuremath{-}x}{\mathrm{Sc}}_{x}\mathrm{N}$ system, suggests material design strategies for even greater property enhancements, and demonstrates the increased property tunability and underexplored nature of nonequilibrium heterostructural alloys.
Proposing a Transactional Model of eHealth Literacy: Concept Analysis

Background: Electronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts. Objective: The objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC. Methods: Walker and Avant’s concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC. Results: Systematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of “communication” in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions. Conclusions: The Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of “noise” (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply).
Age-Related Changes in Penile Erections and Circulating Testosterone in Middle-Aged Male Rats

This symposium has documented a variety of neural and endocrine changes associated with the process of aging. The present chapter focuses on a specific behavioral consequence of these neuroendocrine changes. The behavior is penile erection. It has long been recognized that the erection response in human males declines with increasing age although this was first described systematically by Kinsey, Pomeroy and Martin (1948). Yet, the factors which account for the decline are poorly understood. One possible factor is testicular dysfunction, and innumerable sages, alchemists, and doctors have attempted to restore potency in aging men by administering testicular products, with varying degrees of success.
Phase Transfer Extraction of Copper, Silver and Gold

These three coinage metals are grouped together because of the similarities of their chemistries and because each of them has a high commercial value. These metals have long been recognized for their high electrical conductivities and their ease of manipulation in manufacturing processes. In addition, both silver and gold have been used in jewelry. Copper is also used in the manufacture of bronzes, brass, other copper alloys and ammunition. Previously the metal has been used for water pipes and as a roofing material in buildings. Silver is used for plating other metal surfaces in addition to being used as a photographic material. Gold is also used for plating metals and as a decorative metal. These metals are also used as alloys, including those alloys that are comprised of all three of them together.
Biomass removal, soil compaction, and vegetation control effects on five-year growth of Douglas-fir in coastal Washington.

Sustainable forest production requires an understanding of the effects of site disturbance on tree growth and the consequences of soil amelioration and vegetation control practices. We assessed the impacts of biomass removals at harvest, soil compaction and tillage, and vegetation control on early growth of Douglas-fir in coastal Washington. Harvest treatments included removal of commercial bole only (BO), bole only up to 5-cm top diameter (B05), total tree (TT), and total tree plus all legacy coarse woody debris (TTP). Vegetation control (VC) effects were tested in BO, while soil compaction (BO/SC) and compaction plus tillage (BO/SCT) were imposed in BONC. Five years after planting, biomass removal and soil compaction/tillage effects on tree growth were relatively small. At year 5, mean stem basal diameter in BO was greater than in TT, whereas mean height was similar in BO and BO/SC, but increased in BO/SCT. Control of competing vegetation markedly increased tree growth. At year 5, mean tree stem diameter at 1.3-m height (dbh) and height in BOlno vegetation control (NVC) were 34 mm and 308 cm, respectively, compared to 45 mm and 357 cm in BONC (P <0.01). Mean relative growth rate in stem diameter for trees in BONCwas greater than in BOINVC in years 2-4, but this trend reversed in year 5, suggesting that tree intraspecific competition may be greater in BONC than in BOINVC. Vegetation control also increased second-flushing (i.e., the flushing of set buds in late summer) in years 4 and 5. Vegetation competition effects on tree growth appeared to be related to changes in available soil water rather than to competition for nutrients. FOR. SCI. 53(5):600-610.
Recent Advances in Therapeutic Radiation: An Overview

Meningiomas account for about 20% of intracranial tumors. They are generally well-circumscribed and slow-growing tumors. Between 90 and 95% of meningiomas are benign, and the remaining are atypical or malignant. They can present as small, indolent, and asymptomatic convexity lesions to skull base tumors encasing major blood vessels, cranial nerves, optic pathways, or compressing vital structures of the brain. For benign meningiomas, complete surgical resection remains the best treatment option. Unfortunately, in many instances tumors in skull base locations such as the cavernous sinus, petroclival region, or the orbit cannot be completely resected because of unacceptable risks of morbidity. For incompletely resected or unresectable benign meningiomas, postoperative radiation therapy is frequently employed to reduce the risk of progression. In a surgical series from the Massachusetts General Hospital, the cumulative risk of progression was 37, 55, and 91% at 5, 10, and 15 years, respectively. Several retrospective series have demonstrated that radiotherapy decreases the rate of local failure or progression of benign meningiomas after subtotal resection to less than 20%. Atypical and malignant meningiomas, when compared with benign meningiomas, have a higher and more rapid propensity to recur locally. Even after complete resection, postoperative radiation therapy is indicated to reduce the risk of recurrence or progression. For optic nerve sheath meningiomas, surgery often results in postoperative blindness in the involved eye and has been abandoned as a treatment option for some patients. With observation alone, tumor progression can occur resulting in progressive visual impairment, eventually leading to blindness. Radiation therapy can be used to prevent tumor progression and vision stabilization. Data from retrospective series in the literature have suggested a significant risk of 20% or more of normal tissue complications. Furthermore, there is a small but real risk of development of radiation-induced tumors or cancer. High-precision radiotherapy techniques such as stereotactic radiosurgery (SRS), fractionated stereotactic radiotherapy (FSRT), intensity-modulated radiotherapy (IMRT), and proton beam radiotherapy (PBT) have been developed in recent years, and the early results appear to be promising. Meningiomas are suitable targets for these high-precision techniques because they are usually sharply delineated, almost never infiltrate normal brain tissue, frequently have complex and irregular shapes, and are often located in close proximity to various sensitive structures such as the optic pathway. This chapter focuses on advanced radiation therapy techniques for the treatment of meningiomas. SRS will be discussed in two other chapters in this book.
The spectrum of histopathologic findings in pemphigoid: Avoiding diagnostic pitfalls.

Background Bullous pemphigoid (BP) is an autoimmune vesiculobullous dermatitis that primarily affects the elderly and presents with tense, fluid-filled blisters. The histological hallmark on routine hematoxylin & eosin (H&E)-stained specimens is a subepidermal blister with luminal eosinophils. However, there are histologic variants than can produce diagnostic confusion. Methods All immunofluorescence reports from an independent certified dermatopathology laboratory (2006-2015) were inspected, and those with findings consistent with an autoimmune subepidermal blistering process were selected. Seventy-seven cases were identified, and the corresponding H&E-stained specimens were reviewed by two dermatopathologists who tabulated the histopathologic findings. Results Just over half of biopsies showed subepidermal clefting (54%). The histologic variants included: urticarial or eczematous findings (17%), partial or complete re-epithelialization (28%), and epidermal necrosis (7%). Conclusion While re-epithelialization of subepidermal blisters is a commonly accepted phenomenon, there are no published data demonstrating its incidence. Because only half of the biopsies showed the classic subepidermal blister, it is important to be aware of the spectrum of histopathologic findings that occur in this disease. Specifically, the presence of an intraepidermal blister and/or epidermal necrosis on routine H&E-stained specimens does not preclude the diagnosis of pemphigoid.
Paid sick leave benefits, influenza vaccination, and taking sick days due to influenza-like illness among U.S. workers.

Abstract Introduction Staying home when sick can reduce the spread of influenza. The objectives of this study were to quantify the percentage of workers who had paid sick leave (PSL) benefits, examine sociodemographic characteristics that may be associated with having these benefits, and examine the association between having PSL benefits and use of sick days and influenza vaccination status. Methods The public-use dataset from the 2009 National H1N1 Flu Survey (NHFS) were analyzed in 2017. Wald chi-square tests and t-tests were used to test for associations between having PSL benefits and sociodemographic characteristics and industry and occupation groups, the associations between having PSL benefits and seeking treatment when sick with influenza-like illness (ILI), and taking days off work when sick with ILI. Logistic regression was used to determine variables associated with having PSL benefits and the association between having PSL benefits and influenza vaccination status. Results Sixty-one percent of employed adults reported having PSL benefits during the 2009–10 influenza season. Being younger, female, Hispanic, less educated, or a farm/blue collar worker were associated with reduced likelihood of having PSL benefits. Not having PSL benefits was associated with a lower likelihood of receiving an influenza vaccination and visiting a health professional when sick with ILI. Conclusions The percentage of workers who have PSL benefits differs by sociodemographic characteristics and industry/occupation groups. Offering PSL benefits along with promoting influenza vaccination and encouraging employees with ILI to stay home can increase influenza vaccination coverage and help control the spread of influenza.
Clinical and Functional Characterization of Melanocortin 4 Receptor genetic variants in African American and/or Hispanic children with severe early onset obesity.

Abstract Context Mutations in melanocortin receptor (MC4R) are the most frequent cause of monogenic obesity in children of European ancestry, but little is known about their prevalence in children from minority populations in the United States. Objective This study aims to identify the prevalence of MC4R mutations in children with severe early onset obesity of African-American and/or Latina ancestry. Design and Setting Individuals were recruited from the weight management clinics at two hospitals and from the institutional biobank at a third hospital. Sequencing of the MC4R gene was performed by whole exome and/or Sanger sequencing. Functional testing was performed to establish the surface expression of the receptor and cAMP response to its cognate ligand α-melanocyte stimulating hormone. Participants Three hundred and twelve children (1-18 years, 50% girls) with body mass index (BMI) > 120% of 95th percentile of CDC 2000 growth charts at an age Results Eight rare MC4R mutations (2.6%) were identified in this study (R7S, F202L (n=2), M215I, G252D, V253I, I269N, F284I), three of which have not been previously reported (M215I, G252D, F284I). The pathogenicity of the variants was confirmed either by prior literature reports, or by functional testing. There was no significant difference in the BMI or height trajectories of children with or without MC4R mutations in this cohort. Conclusions While the prevalence of MC4R mutations in this cohort was similar to that reported in obese children of European ancestry, some of the variants were novel.
Diabetes distress among healthcare providers: A qualitative study.

Abstract Aims Diabetes-related distress stemming from the burden of managing diabetes has been measured in multiple patient populations; however, the medical management of diabetes also presents unique challenges for health care providers. The purpose of this study was to conduct a qualitative evaluation of the experiences of healthcare providers in caring for people with diabetes (PWD). Methods Interviews and focus groups were conducted in a sample of 22 healthcare providers. Participants were drawn from medical residency and fellowship programs, diabetes healthcare provider networks and professional organizations. Participants were queried about their experiences working with PWD. Results Themes were extracted and discussed by the investigator team until consensus was reached. Themes included: adherence (frustration that patients don’t follow recommendations), emotions associated with treating PWDs (frustration with redundancy of treatment topics, overwhelmed by social needs of patients, worry for patient outcomes), fatigue (emotionally and physically worn-out), role definition (role as supporter and perceived responsibility for medical outcomes), and work environment (limitations of time or resources to provide care). Conclusions Diabetes related distress was described as a component of the caregiving experience among health care providers who treat PWD. These data indicate an emotional impact that warrants further investigation and intervention.