cssi/SciSciGPT-SciSciNet huggingface dataset:
Incidence and Predictors of Opioid Prescription at Discharge After Traumatic Injury

Importance In the current health care environment with increased scrutiny and growing concern regarding opioid use and abuse, there has been a push toward greater regulation over prescriptions of opioids. Trauma patients represent a population that may be affected by this regulation, as the incidence of pain at hospital discharge is greater than 95%, and opioids are considered the first line of treatment for pain management. However, the use of opioid prescriptions in trauma patients at hospital discharge has not been explored. Objective To study the incidence and predictors of opioid prescription in trauma patients at discharge in a large national cohort. Design, Setting, and Participants Analysis of adult (18-64 years), opioid-naive trauma patients who were beneficiaries of Military Health Insurance (military personnel and their dependents) treated at both military health care facilities and civilian trauma centers and hospitals between January 1, 2006, and December 31, 2013, was conducted. Patients with burns, foreign body injury, toxic effects, or late complications of trauma were excluded. Prior diagnosis of trauma within 1 year and in-hospital death were also grounds for exclusion. Injury mechanism and severity, comorbid conditions, mental health disorders, and demographic factors were considered covariates. The Drug Enforcement Administration’s list of scheduled narcotics was used to query opioid use. Unadjusted and adjusted logistic regression models were used to determine the predictors of opioid prescription. Data analysis was performed from June 7 to August 21, 2016. Exposures Injury mechanism and severity, comorbid conditions, mental health disorders, and demographic factors. Main Outcomes and Measures Prescription of opioid analgesics at discharge. Results Among the 33 762 patients included in the study (26 997 [80.0%] men; mean [SD] age, 32.9 [13.3] years), 18 338 (54.3%) received an opioid prescription at discharge. In risk-adjusted models, older age (45-64 vs 18-24 years: odds ratio [OR], 1.28; 95% CI, 1.13-1.44), marriage (OR, 1.26; 95% CI, 1.20-1.34), and higher Injury Severity Score (≥9 vs Conclusions and Relevance The incidence of opioid prescription at discharge (54.3%) closely matches the incidence of moderate to severe pain in trauma patients, indicating appropriate prescribing practices. We advocate that injury severity and level of pain—not arbitrary regulations—should inform the decision to prescribe opioids.
Applied physics: Optical sensing gets exceptional.

Conventional sensors based on devices called optical resonators have fundamentally limited sensitivity. Careful engineering has been used to overcome this constraint, opening the door to ultraprecise sensing. See Letters & Recent insights into open (non-Hermitian) physical systems have led to a new range of optical systems in which, counter-intuitively, loss is introduced. By careful tuning of loss and gain, certain degeneracies called 'exceptional points' emerge, which have intriguing properties that can be harnessed, for example, in new types of lasers, one-way optical waveguides and topological effects. Two papers in this issue demonstrate the high sensitivity of such non-Hermitian degeneracies to external perturbations, which can be used for precision sensing and detection. Weijian Chen et al. report sensing of nanoparticles with exceptional points generated in a silicon dioxide micro-toroid resonator. Hossein Hodaei et al. generated a higher-order exceptional point by coupling three micro-rings made from a semiconductor laser material. This third-order exceptional point has an even higher, cube-root (rather than square-root) dependence on perturbations. The two papers together provide a new route to ultraprecise chip-based sensing systems.
Aeon Flux: Transforming with Technology

Libraries frequently turn to new technologies to improve the user’s experience. This could be something as simple as a macro that speeds up data entry for catalogers to implementing a new discovery system. New technologies can result in a positive transformation for the organization or unit, but the process of implementing a new technology across an organization can be challenging. The Kenneth Spencer Research Library, the special collections library at the University of Kansas, has implemented Aeon, an online circulation system that not only gets rid of the need for paper call slips, but also facilitates data-driven management decisions for all areas of the library. Aeon has improved our users’ experience and transformed our workflows. This case study will address the reasons why we chose Aeon, how we developed new workflows, staff training and our plans for encouraging more data driven decisions. Unique Needs of Special Collection
Suicide Lethality: A Concept Analysis.

Purpose: Suicide is a significant health problem internationally. Those who complete suicide may have different behaviors and risk factors than those who attempt a non-fatal suicide. The purpose of...
Attempts to Increase the Expression of Rat Liver Mitochondrial Aldehyde Dehydrogenase in E. coli by Altering the mRNA

We have recently cloned and expressed the cDNA coding for rat and human liver mitochondrial class 2 aldehyde dehydrogenase (Farres et al., 1989; Jeng and Weiner, 1991, Zheng et al., submitted). The recombinantly expressed enzymes were found to have properties virtually identical to those of the native enzyme. Having an expression system has allowed us to perform site directed mutagenesis to study the role of amino acid residues such as glutamate 487, histidine 235, cysteine 302, and serine 74, to mention just a few. Though we could isolate the enzyme using conventional procedures (Jeng and Weiner, 1991) or a hydroxyacetophenone-Sepharose affinity matrix (Ghenbot and Weiner, submitted) the amount of enzyme produced was very low. Using the plasmid pT7–7 others have reported that as much as 20% of the protein expressed was from their cDNA (see Marston, 1986 for a review) while we could obtain just 1–2 mg of ALDH per liter of cultured cells using the same system. In order for us to study chemical and physical properties of the recombinantly expressed enzymes it will be necessary for us to produce much more enzyme.
Anomaly imaging using decomposed lamb wave modes

This paper presents a tomography-based method for structural health monitoring (SHM) using guided Lamb waves. The method assumes an active SHM system in which the structure is excited sequentially using a set of piezoelectric transducers attached to it. The resulting waveforms are collected at the remaining sensors on the structure for further analysis. The algorithm compares waveforms collected at inspection time to baseline signals corresponding to the pristine state of the structure and defines an appropriate anomaly index. The anomaly index used in this work is based on the attenuation of the first arriving mode component. The damage indices associated with all actuatorsensor pairs form the input to an algebraic reconstruction tomography algorithm that reconstructs an anomaly map for the structure. The reconstruction is performed using a sparse recovery method known as basis pursuit denoising assuming, that the anomalies are relatively small compared to the size of the structure. The reconstructed map is further processed to estimate the boundaries of the anomaly on the structure. Experimental results for estimating the outline of aluminum masses attached to a unidirectional composite plate are presented in this paper. These results indicate that our approach works better than traditional approaches in accurately estimating the extend of anomalies outline in composite structures.
Anatomic Limitations of the Transmetatarsal Amputation With Consideration of the Deep Plantar Perforating Branch of the Dorsalis Pedis Artery

Abstract The transmetatarsal amputation is considered a durable procedure with respect to limb salvage when managing the consequences of diabetic foot disease. The success of the procedure is, in part, determined by the preoperative appreciation of arterial and functional status. The objectives of the present investigation were to determine the length of the remaining first metatarsal required during transmetatarsal amputation to preserve the anastomotic connection of the deep plantar perforating artery and subsequent “vascular arch” of the foot and the insertion of the tibialis anterior tendon. The primary outcome measure of our investigation was a measurement of the distance between the first metatarsal–medial cuneiform articulation and the distal extent of the deep plantar perforating artery in 85 embalmed lower limbs. As a secondary outcome measure, the insertion of the tibialis anterior tendon was evaluated relative to the deep plantar perforating artery. The most distal extent of the deep plantar perforating artery was observed at a mean ± standard deviation of 15.62 ± 3.74 (range 6.0 to 28.28) mm from the first metatarsal–medial cuneiform articulation. Most (89.41%) of the arteries were found within 20 mm of the first metatarsal–medial cuneiform articulation. The insertion of the tibialis anterior tendon was found to be proximal to the deep plantar perforating artery in all specimens (100.0%). In conclusion, 2.0 cm of remnant first metatarsal might represent an anatomic definition of how “short” a transmetatarsal amputation can safely be performed in most patients when considering the vascular and biomechanical anatomy.
Crystal structures of complexes of tri-, tetra-, or nonaethyleneglycol dimethyl ether with dichloropicric acid and water

The 1:2:2 triglyme/dichloropicric acid/water adduct is triclinic, space group P\(\overline 1\); at 172(2) K, a = 4.9210(10), b = 13.424(3), c = 14.068(3) A, α = 115.04(3), β = 90.93(3), γ = 92.24(3)°, Dx = 1.600(5) g cm−3, V = 840.8(3) A3, and Z = 1. Each water molecule is hydrogen bonded to a terminal OCH3 group of one polyether and to an oxygen adjacent to an OCH3 of a neighboring polyether, resulting in two-dimensional ribbons. These ribbons, in turn, are assembled into a three-dimensional structure held together by chains of dichloropicric acid molecules connected to each other through chlorine–nitro group oxygen intermolecular interactions. The picric acid chains are attached to the water–polyether ribbons by hydrogen bonds from the picric acid to the water. The 1:2:2 tetraglyme/dichloropicric acid/water adduct is monoclinic, space group C2/c; at 172(2) K, a = 30.529(6), b = 5.4210(11), c = 25.413(5) A, β = 122.33(3)°, Dx = 1.597(3) g cm−3, V = 3553.7(12) A3, and Z = 4. The hydrogen bonding pattern resembles that of the analogous 1:2:2 pentaglyme complex reported previously, with the exception that both of the lone pairs of the central oxygen atom participate in hydrogen bonding to protons of water molecules. The second water proton is hydrogen bonded to a terminal OCH3 group. In this complex the dichloropicric acid molecules form a two-dimensional layer through chlorine–nitro group oxygen intermolecular interactions. The water molecules bond each isolated polyether molecule to adjacent dichloropicric acid layers. The 1:4:4 nonaglyme/dichloropicric acid/water complex is triclinic, space group P\(\overline 1\); at 172(2) K, a = 8.0830(16), b = 13.570(3), c = 16.751(3) A, α = 102.01(3), β = 102.39(3), γ = 96.43(3), Dx = 1.637(6) g cm−3, V = 1731.5(6), and Z = 1. The hydrogen bonding pattern is similar to that in the pentaglyme complex, except that four dichloropicric acid molecules and four water molecules are coordinated to a single polyether, and the polyether chain is appreciably disordered. In this case there are again chains of dichloropicric acid molecules held together by intermolecular chlorine–oxygen interactions. The chains are packed into two-dimensional layers held together through hydrogen bonds to water. Each isolated polyether is connected to four water molecules, two attached to dichloropicric acid molecules in one layer and the other two connected to the adjacent layer.
Abstract 17497: Risk Stratification of Patients With Out of Hospital Cardiac Arrest without ST-Segment Elevation: An Initial Exploratory Risk Score-The ‘PEA’ Score

Introduction: Out-of-hospital cardiac arrest (OHCA) affects over 325,000 adults each year in the United States, with survival rates of about 10.6%. Predicting risk of mortality in patients who achieve return of spontaneous circulation (ROSC) remains a challenge. While scoring tools to predict the risk of mortality in OHCA patients exist, risk stratification specifically in the patient with OHCA and no ST elevation on ECG (NSTE) has not been explored. Hypothesis: A simple risk model can be used to predict in-hospital mortality in patients presenting with OHCA and NSTE. Methods: Patient-level data were obtained from the Nationwide Inpatient Sample (NIS) from 2008-2011. A stepwise logistic regression model with backward elimination was used to determine the contribution of all candidate covariates. We assigned risk factors identified by multivariable analysis weighted points proportional to the logarithmic transformation of the β regression coefficient values. A risk score was then calculated for each patient in the derivation cohort, and validated with patients in the validation cohort. We used Stata 12.0SE (StataCorp, College Station, TX). A P value of Results: A total of 97,042 patients presenting to the hospital with OHCA and NSTE were examined. Among these, 58,066 patients (59.8%) died before hospital discharge. Three independent prognostic factors were identified, and each was assigned a number of points proportional to its regression coefficient: Pulseless (non-ventricular fibrillation) arrest (1 point), Elderly (Age greater than 85 years) (1 point), and Acidosis (1 point).The c- statistic for the PEA score point system was 0.61 (95% CI 0.60-0.62, p Conclusions: A novel risk model can predict in-hospital mortality in patients presenting with OHCA and NSTE. This simple score can be used on initial presentation to the hospital and may help to inform healthcare teams and families regarding patients’ prognoses.
Taipei and Tokyo: Turf Wars and Taiwanese Identity

By examining four films involving Taiwanese gangs in different periods and locations, Yun Xia demonstrates how turf wars in these films unveil ethnic conflicts, social problems, and identity crises experienced by average Taiwanese. Both set in Taipei, A Brighter Summer Day and Monga demonstrate the ethnic divide between Chinese mainlanders and native Taiwanese that polarized the main society and the underworld since the late 1940s. Shinjuku Black Society and Shinjuku Incident touch on the rivalry between Taiwanese and Chinese gangs in the hierarchical underworld of Tokyo. This chapter analyzes how underworld struggles over territory serve as cinematic metaphors for Taiwanese anxiety over the loss of physical and cultural space, and over Taiwan’s uncertain status as an un-national nation-state between two powerhouses in East Asia.
AN INTERDISCIPLINARY MODEL OF ASSESSMENT AND TREATMENT FOR MANAGING BEHAVIORAL AND PSYCHOLOGICAL SYMPTOMS OF DEMENTIA ON AN INPATIENT PSYCHIATRY UNIT: AN ADAPTATION OF THE TIME MODEL.

Introduction Patients are admitted to inpatient psychiatric units to help manage behavioral and psychological symptoms of dementia (BPSD). The estimated percentage of hospitalized inpatients with dementia is significant, ranging from 12.9 to 63.0% ( Mukadam et al, 2011 ). As the population ages and the expected prevalence of dementia increases, inpatient psychiatric admissions for BPSD treatment will increase. Managing BPSD in the psychiatric setting can be challenging and requires an interdisciplinary approach. Currently there are no models of care for BPSD in the acute psychiatric setting. In this feasibility study, we adapted a model initially developed for BPSD treatment in a nursing home and tested it in our inpatient unit. We explored the model's efficacy in reducing BPSD and the model's acceptability and ease of implementation. Methods We modified the Targeted Interdisciplinary Model for Evaluation and Treatment of Neuropsychiatric Symptoms (TIME Model) ( Lichtwarck et al, 2015 , 2018 ) for use on our inpatient psychiatric unit at the William S. Middleton VA hospital. Outcome measures included the Montreal Cognitive Assessment (MOCA), Functional Assessment and Staging for Alzheimer's Disease (FAST), Neuropsychiatric Inventory Questionnaire (NPI-Q), Cornell Scale for Depression in Dementia (CSDD), Pain Assessment in Advanced Dementia (PAINAD), and a Family Questionnaire regarding neuropsychiatric symptoms. Notable modifications included not utilizing the full Neuropsychiatric Inventory-NH due to staffing/time constraints, and limiting the duration of behavioral data collection to 3 days, both prior to and following the team meeting. The essential process was the same as the TIME Model, with identification of behaviors or symptoms tracked by nursing, the collection of preliminary data regarding frequency, and a systematic approach to interpreting the patient's behavior and formulating SMART goals as a team. In addition, an online staff satisfaction questionnaire was deployed to collect feedback from staff regarding the perceived value of the model. Primary outcome variables included a reduction in neuropsychiatric symptoms as measured by the NPI-Q and staff satisfaction with the model. Results Currently, this protocol has been implemented on our inpatient psychiatry unit with data collection in process. An analysis of findings will be presented at the AAGP meeting. Conclusions A systematic approach to appropriately manage behavioral and psychological symptoms of dementia (BPSD) on inpatient psychiatry is needed. We tested a modification of the TIME Model for use on an acute inpatient psychiatric unit. This research was funded by The authors received no specific funding for this work.
Genetic disruption of Npr1 depletes regulatory T cells and provokes high levels of proinflammatory cytokines and fibrosis in the kidneys of female mutant mice

The present study was designed to determine the effects of gene knockout of guanylyl cyclase/natriuretic peptide receptor-A (GC-A/NPRA) on immunogenic responses affecting kidney function and blood ...
Clinical features and outcomes associated with tracheostomy in congenital diaphragmatic hernia.

Introduction The purpose of this study was to examine the clinical features/outcomes associated with tracheostomy in infants with congenital diaphragmatic hernia (CDH). Methods The study population consisted of liveborn infants reported to the CDH Study Group registry between 2007 and 2017. Subjects were identified as having a tracheostomy if they were discharged or transferred to another hospital with tracheostomy and/or on mechanical ventilation. Multivariate mixed models were used for analyses. Results The registry population consisted of 5434 subjects, of whom 230 (4.2%) underwent tracheostomy placement. Only 3830 (70.5%) infants survived until discharge/transfer. The median age of tracheostomy placement was 3.3 months (range, 1.3-13.4 when known; n = 58 out of 154 survivors). The mortality rate among subjects with tracheostomy was 32.8% with a median of 37 days (range, 8-189 when known; n = 32 out of 75 deceased) ensuing between tracheostomy placement and death. The clinical features found to be associated with increased odds ratio of tracheostomy placement included male sex, birth weight, 5-minute APGAR score, defect size, liver in chest, ECMO use, cardiac abnormality, other congenital abnormalities, pulmonary hypertension, and the presence of a feeding tube. There was center variation in the rate of tracheostomy placement, which may be partially accounted for by disease severity, but not center size. Conclusion There are several clinical features that are associated with increased likelihood of tracheostomy placement. Most deaths in subjects with tracheostomies occurred outside the immediate postoperative period. The utility of a standardized protocol for tracheostomy in infants with CDH should be considered.
Functional outcomes of arteriovenous fistulas recruited with regional anesthesia

Abstract Objective Regional anesthesia (RA)-induced vasodilation increases the proportion of patients with vein anatomy suitable for arteriovenous fistula (AVF) creation. The functional outcomes of AVFs created with veins initially small for size on preoperative duplex ultrasound mapping (≤2.4 mm) that are recruited under RA have not been clearly defined. We aimed to evaluate freedom from revision or thrombosis, time to first cannulation, and reintervention rates of AVFs created with veins recruited after induction of RA. Methods A prospectively maintained quality improvement database from a single institution was queried for patients who had dialysis access created under RA. We compared AVFs created according to the original surgical plan (preoperative minimum vein diameter >2.5 mm) with AVFs recruited with RA (preoperative minimum vein diameter ≤2.4 mm). End points included freedom from revision or thrombosis, time to first cannulation, and reintervention rates. Results Between May 2014 and April 2018, there were 208 dialysis access cases performed under RA. Excluding grafts, revisions, patients with previous ipsilateral AVFs, and those without preoperative ultrasound vein mapping, 135 patients were included in our analysis. Induction of RA with intraoperative duplex ultrasound allowed a change in surgical plan in 55 of 135 (42%) patients (recruited with RA), including 31 patients originally scheduled for an arteriovenous graft (mean preoperative distal upper arm cephalic vein diameter of 1.8 mm [standard deviation, 0.2 mm]) who were converted to an AVF (12 brachiobasilic, 11 brachiocephalic, and 8 radiocephalic). The remaining patients in the group of AVFs recruited with RA included 13 scheduled for brachiobasilic configurations who were converted to brachiocephalic or radiocephalic AVFs and 11 scheduled for brachiocephalic AVFs who were converted to radiocephalic AVFs. Comparing AVFs created according to the original surgical plan vs AVFs recruited with RA, there were no differences in reintervention rates (48% vs 49%; P = .90) or functional outcomes at 6 months (60% vs 65% used on hemodialysis [P = .58] and 7% vs 2% primary failure [P = .19]). Conclusions In this series, RA increased the proportion of patients who underwent AVF creation without compromising functional outcomes. Routine use of RA in access surgery could have significant implications in meeting national guidelines for autogenous access in the prevalent hemodialysis population.
Learning from Adversity: Lessons from the COVID-19 Crisis.

One month into the crisis caused by COVID-19 (coronavirus disease 2019; the disease caused by SARS-CoV-2) in the United States, rheumatologists began to feel the effects of our hastily constructed temporary response plans. While we may not have been staffing the front lines with our colleagues in emergency medicine and critical care, our patients were uniquely vulnerable to infection and continued to require care. Managing their illnesses remained no less important then than it ever was. Necessity forced us to learn important lessons about delivering this care in safer, more efficient ways. While some of these adaptations will revert to “business as usual,” others may change the way we communicate with patients and colleagues long after this crisis has passed. In our own clinic, the importance of social distancing catalyzed a transition to telemedicine. Healthcare has typically been excluded from stay-at-home orders, so patients can still come into the clinic, but should they? Many of us practice in large medical complexes. Reducing traffic in these locations makes social and medical sense. Even for rheumatologists with independent offices, waiting rooms are a worrisome potential locus for virus transmission. Most importantly, physicians and medical staff have close personal contact with dozens of patients per day, many of whom could be asymptomatic carriers. The rationale for moving to telemedicine was strong. Telemedicine is not new to rheumatology. Publications on telemedicine approaches go back 20 years, though the major focus has typically been on the use of these tools to deliver specialty care to rural areas1,2. Despite this, adoption has been slow, and in many places, nonexistent. Many factors have … Address correspondence to Dr. E.M. Ruderman, Northwestern University Feinberg School of Medicine, Division of Rheumatology, 675 North St. Clair 14-100, Chicago, Illinois 60611, USA. E-mail: e-ruderman{at}northwestern.edu
Influential Factors of Deaf Identity Development

The development of deaf identity is a complicated and difficult process, and it was studied by many researchers from last century. They found that the development of deaf identity was affected by a lot of different factors and then they proved these influential factors by the qualitative or quantitative research methods in their articles or books, such as, the status of hearing loss, the educational experience, the environment of family, the mode of communication and so on. In present article, such influential factors will be summarized based on analyzing the theory of deaf identity development, and how these factors influence the development of deaf identity will be analyzed in the view of deafness as culture.
The genome of North American beaver provides insights into the mechanisms of its longevity and cancer resistance

The North American beaver (Castor canadensis) is an exceptionally long-lived and cancer-resistant rodent species, and thus an excellent model organism for comparative genomic studies of longevity. Here, we utilize a significantly improved beaver genome assembly to assess evolutionary changes in gene coding sequences, copy number, and expression. We found that the beaver Aldh1a1, a stem cell marker gene encoding an enzyme required for detoxification of ethanol and aldehydes, is expanded (~10 copies vs. two in mouse and one in human). We also show that the beaver cells are more resistant to ethanol, and beaver liver extracts show higher ability to metabolize aldehydes than the mouse samples. Furthermore, Hpgd, a tumor suppressor gene, is uniquely duplicated in the beaver among rodents. Our evolutionary analysis identified beaver genes under positive selection which are associated with tumor suppression and longevity. Genes involved in lipid metabolism show positive selection signals, changes in copy number and altered gene expression in beavers. Several genes involved in DNA repair showed a higher expression in beavers which is consistent with the trend observed in other long-lived mammals. In summary, we identified several genes that likely contribute to beaver longevity and cancer resistance, including increased ability to detoxify aldehydes, enhanced tumor suppression and DNA repair, and altered lipid metabolism.
Agential Free Choice

The Free Choice effect—whereby $\lozenge (p {\textsc {or}} q)$ seems to entail both $\lozenge p$ and $\lozenge q$ —has traditionally been characterized as a phenomenon affecting the deontic modal ‘may’. This paper presents an extension of the semantic account of free choice defended by Fusco (Philosophers’ Imprint, 15, 1–27, 2015) to the agentive modal ‘can’, the ‘can’ which, intuitively, describes an agent’s powers. On this account, free choice is a nonspecific de re phenomenon (Bauerle 1983; Fodor 1970) that—unlike typical cases—affects disjunction. I begin by sketching a model of inexact ability, which grounds a modal approach to agency (Belnap Theoria, 54, 175–199, 1998; Perloff 2001) in a Williamson (Mind, 101, 217–242, 1992; Erkenntnis, 79, 971–999, 2014)-style margin of error. A classical propositional semantics combined with this framework can reflect the intuitions highlighted by Kenny (1976)’s dartboard cases, as well as the counterexamples to simple conditional views recently discussed by Mandelkern et al. (Philosophical Review, 126, 301–343, 2017). In Section 3, I turn to an independently motivated actual-world-sensitive account of disjunction, and show how it extends free choice inferences into an object language for propositional modal logic.
Non-Lactulose Medication Therapies for the Management of Hepatic Encephalopathy: A Literature Review.

Objective:The most appropriate medication regimen to mitigate the consequences hepatic encephalopathy remains inconclusive. This review seeks to serve as a reference for clinicians to help guide th...
Social Media & PrEP: A Systematic Review of Social Media Campaigns to Increase PrEP Awareness & Uptake Among Young Black and Latinx MSM and Women

Pre-exposure prophylaxis (PrEP) has been shown to be highly effective at reducing the risk of HIV. Despite efforts to employ various social marketing strategies to promote PrEP among young people at greater risk for HIV, PrEP awareness and uptake remain low. We conducted a comprehensive review of current literature that presents or evaluates the use of social media and/or specific communication campaigns to increase PrEP awareness among young Black and Latinx men who have sex with men (MSM) and women. Eight articles met the inclusion criteria for the final analysis. The most used platforms included Facebook, Instagram, and custom mobile applications. Social media is a dynamic and promising tool that may be used to increase PrEP awareness, uptake, and adherence among young Black and Latinx MSM and women.
Medical Education Transformation: Lifestyle Medicine in Undergraduate and Graduate Medical Education, Fellowship, and Continuing Medical Education:

A gaping void of adequate lifestyle medicine (LM) training exists across the medical education continuum. The American College of Lifestyle Medicine's (ACLM's) undergraduate medical education (UME) Task Force champions the need for widespread integration of LM curriculum in UME by sharing ideas for catalyzing success, lessons learned, and publishing standards and competencies to facilitate curriculum reform. When it comes to graduate medical education and fellowship, the ACLM and American Board of Lifestyle Medicine have made great strides in filling the void, developing both Educational and Experiential Pathways through which physicians may become certified LM Physicians or LM Specialists (LMSs). The Lifestyle Medicine Residency Curriculum meets the Educational Pathway requirements and prepares resident graduates for the LM Physician board certification. LMS is the second tier of LM certification that demonstrates expertise in disease reversal. The LMS Fellowship is an Educational Pathway intent on American Board of Medical Specialties recognition of LM as a new subspecialty in the near future. Finally, continuing medical education and maintenance of certification equip physicians with LM training to support knowledge, application, and certification in LM.
A Helicase-tethered ORC Flip Enables Bidirectional Helicase Loading

Abstract Replication origins are licensed by loading two Mcm2-7 helicases around DNA in a head-to-head conformation poised to initiate bidirectional replication. This process requires ORC, Cdc6, and Cdt1. Although different Cdc6 and Cdt1 molecules load each helicase, whether two ORC proteins are required is unclear. Using colocalization single-molecule spectroscopy combined with FRET, we investigated interactions between ORC and Mcm2-7 during helicase loading. We demonstrate that a single ORC molecule can recruit both Mcm2-7/Cdt1 complexes via similar interactions that end upon Cdt1 release. Between the first and second helicase recruitment, we observe a rapid change in interactions between ORC and the first Mcm2-7. In quick succession ORC breaks the interactions mediating first Mcm2-7 recruitment, releases from its initial DNA-binding site, and forms a new interaction with the opposite face of the first Mcm2-7. This rearrangement requires release of the first Cdt1 and tethers ORC as it flips over the first Mcm2-7 to form an inverted Mcm2-7-ORC-DNA complex required for second-helicase recruitment. To ensure correct licensing, this complex is maintained until head-to-head interactions between the two helicases are formed. Our findings reconcile previous observations and reveal a highly-coordinated series of events through which a single ORC molecule can load two oppositely-oriented helicases.
Industrial Uses of the System Architect’s Workbench

High level synthesis has been recognized in both academic and industrial circles as the next major advance in commercial design tools for digital CMOS VLSI circuits. The potential advantages of high level synthesis, such as reduced design time, improved opportunities for design space exploration, and ease of verification of the implementation against an executable specification, have been stated frequently in recent years [1].
An Integrating Method of Time-Resolved EXAFS Measurement

One of the advantages of using EXAFS as a structure probe is its high event rate. With a beam of 1012 photons-s−1 −ev−1, it is feasible to measure microsecond- or submicrosecond-resolved transmission EXAFS spectra. However7 one would need integrating detectors for such measurements. Even in the fluorescence mode, dilute biological samples often yield strong enough fluorescence that an integrating detector is needed in order to take the full advantage of intense synchrotron radiation (SR). For example a SR pulse of 106 photons (of 7.2 Kev) incident on a haemoglobin (Hb) solution of 0.5 mM concentration in Fe yields (1/3)x103 Fe K-shell fluorescence photons. A detector subtending 5% of 4π at the sample (which is easily achievable with a 1” detector) would intercept about 20 photons. Since these photons are practically inseparable in time, the conventional counting method would have to sacrifice a factor of 20 in the detecting solid angle in order to measure the variations in absorption. As the SR laboratories continue to develop more powerful sources, the need for integrating detectors will undoubtedly intensify. In this paper I will describe an integrating method for measuring 100 μs-resolved EXAFS of photolyzed haemoproteins [1].
Interaction of Malate and Lactate with Chromium(III) and Iron(III) in Aqueous Solutions

Malate is generated from the hydration of fumarate by the action of fumarase in the citric acid cycle. Lactate is one of the most important products of glucose catabolism. From our ongoing efforts to study and understand the interaction and behavior of many hydroxycarboxylates with variety of metal ions (Hamada et al., 2003a; 2003b), we are reporting the interaction and behavior of malate and lactate with the Cr3+ and the Fe3+ ions using the potentiometric method in aqueous solutions at 25 °C. It appeared that the potentiometric titration graphs are different for the different titration systems; these differences are discussed. It also appeared that the malate as a chelating ligand solubilized both Cr3+ and Fe3+ at the physiological pH. In contrast to malate, the lactate ligand did not solubilize either Cr3+ or Fe3+ at the physiological pH. The Cr3+ and the Fe3+ lactate systems form the simple one‐to‐one metal chelates because only one proton was observed in all metal to lactate molar ratios with both the...
Television programs as socializing agents for mentally retarded children

Nearly three out of every 1000 school children are classified as trainably mentally retarded. Their IQs range from 30 to 50. That these children have retarded learning abilities is obvious. What is not so obvious are the other equally debilitating characteristics of mental retardation: poor personal and social adjustment (Guthrie et al., 1964), impaired parental and family adjustment (Fliegler & Hebeler, 1960), poor self-concept (Lawrence & Winschel, 1973), increased dependence (Ross, 1966). The President's Committee on Mental Retardation (1973) put these problems into perspective: "In many cases, retarded mental development is not the major problem. The main factors blocking individual progress may be uncontrolled emotions, or negative self-image, or entrenched negative habits that are reinforced with repetition, or physical handicaps. These 'side effects' are often more inhibiting to development than mental retardation itself" (p. 3). Much recent special education research focuses on the use of television as a teaching tool for retarded children. Striefel (1972) noted that "the greatest potential of TV may be in programming the stimulus side of language or other training procedures" (p. 28). Yoder (1965) used videotaped reinforcements to increase the rate of verbalization in retarded adolescent males. Ross (1970) demonstrated "the efficacy of an au-
Formulation refinement and access to space for the ST8 mission

NASA's The New Millennium Program (NMP) approach to space flight validation of advanced technologies is to alternate between subsystem and system flight validations, candidates for each NMP project (subsystem or system) are competed through a NASA Research Announcement process, and proposal selection is determined by NASA Headquarters. Space Technology 8 (ST8) is the second NMP subsystem project. It hosts four technology experiments selected from technology capability areas: (1) The SAILMAST, a light-weight, deployable boom for potential solar sail structural applications (2) the next generation ultraflex (NGU), a lightweight, deployable solar panel (3) the environmentally adaptive fault tolerant computing (EAFTC) experiment, a commercial-off-the-shelf (COTS) electronics package for validation of high speed computing in a radiation environment. (4) The miniature loop heat pipe (MLHP), a small spacecraft thermal control subsystem experiment. The launch is planned for early 2009 on a Pegasus XL launch vehicle. Access to space for ST8 involves working with the technology experiment development activity to baseline a mission, procuring a spacecraft bus to host the experiments, and procuring appropriate launch services through NASA. Because of the competitive element of NMP, however, the mission concept and preliminary spacecraft bus requirements were developed in parallel with the independent development of the technology experiment proposals. This initial part of the mission formulation process and the interaction between the NMP project architects and the experiment selection process is described in an earlier paper P. R. Turner and L. M. Herrell (2004). The selection of the technology payloads is a key step towards developing the procurement of the spacecraft bus and evaluating competing launch services approaches. An earlier "Space Technology Carrier" study confirmed the feasibility of obtaining a spacecraft bus from among available commercial design concepts. Additional steps used to proceed included: (i) confirmation of capabilities and cost projections. (ii) Development of top level requirements on the bus. (iii) Evaluating competing launch services options (iv) Developing materials to support a procurement activity. This paper tells the story of these steps in the formulation refinement of the ST8 mission leading to its establishment as a formal flight project, with some insights and comments on the benefits and risks of the approach.
The superficial femoral-popliteal vein transposition fistula: description of a new vascular access procedure.

With advances in the medical care of patients with end-stage renal disease, an increasing number of patients continue to need reliable AV access after failure of multiple upper-extremity vascular access sites. In many cases, these failures are related to central venous outflow obstruction caused by previous subclavian vein catheters. Although it is technically possible to restore central venous patency in some patients with the use of percutaneous transluminal angioplasty and stent placement, 1-year patency rates as low as 17% have been reported with this approach. Given the success of using the superficial femoral–popliteal vein (SFPV) for arterial and venous reconstructions, I decided to use this conduit to construct a transposition AV fistula in the thigh of patients presenting for AV access surgery in the face of multiple failed upper-extremity access attempts and central venous occlusion. To my knowledge, this is the first study using this technique.
Biosynthesis of Glycoproteins

Since membrane glycoproteins have been implicated in many neurobiological processes and functions (see Chapters 7, 8, and 11), the mechanisms and regulation of biosynthesis of the oligosaccharide units have been of great interest to cell and neurobiologists during the past 20 years. Much of this research activity has focused on the structure, biosynthesis, and function of N-linked oligosaccharides because the majority of the carbohydrate chains attached to membrane glycoproteins in nervous tissue are attached via N-glycosidic bonds (Krusius and Finne, 1977). For further discussion of the structural details of carbohydrate units of brain glycoproteins, see Chapter 3.
Isolation and sequence of the gene for ferredoxin I from the cyanobacterium Anabaena sp. strain PCC 7120.

We are interested in the multiple forms of ferredoxin found in photo-synthetic cells. Two easily dissolved and one membrane bound form of ferredoxin are found in the vegetative cells of cyanobacteria and in higher plants.(1) Another form of ferredoxin has been found in the heterocysts of nitrogen fixing cyanobacteria and this form preferentially reacts with nitrogenase.(2) Here we describe the isolation and structure of the gene for ferredoxin I — the most commonly encountered form of ferredoxin.
E2 transition in the reaction 2H( gamma,n)1H.

The ratio of the differential cross section for $^{2}\mathrm{H}$(\ensuremath{\gamma},n${)}^{1}$H at \ensuremath{\theta}=45\ifmmode^\circ\else\textdegree\fi{}, 135\ifmmode^\circ\else\textdegree\fi{}, and 155\ifmmode^\circ\else\textdegree\fi{}, to that at \ensuremath{\theta}=90\ifmmode^\circ\else\textdegree\fi{} lab angle, is found to furnish a very fine microscope for resolving the strength of the E2 multipole transition which reflects the admixture of nonspherical components in the NN system.
Neuroprotective and Neurorestorative Effects of Thymosin Beta4 Treatment after Traumatic Brain Injury (S21.004)

OBJECTIVE: This study was designed to test the hypothesis that thymosin β4 (Tβ4) treatment reduces brain damage and improves functional recovery after traumatic brain injury (TBI) in rats. BACKGROUND: Thymosin β4 has shown beneficial effects in treatment of cerebral ischemia. However, there have been no studies to evaluate its efficacy for treatment of TBI, therefore, the present study was designed to investigate the merits of potential therapy for TBI. DESIGN/METHODS: Adult male Wistar rats were injured with controlled cortical impact and treated either with 6 mg/kg (n=8) or 30 mg/kg (n=8) Tβ4 administered intraperitoneally (ip) at 6, 24 and 48 hours after TBI. A control group (n=8) received saline and a sham group (n=6) underwent surgery without injury or treatment. Functional analysis was performed using modified neurological severity scores (mNSS) and Morris water maze test (MWM). Animals were euthanized 35 days after injury and brain sections were processed for histological analysis. RESULTS: Compared with saline administration both doses of Tβ4 significantly reduced cortical lesion volume and hippocampal cell loss (p<0.05) and enhanced neurogenesis in the hippocampus (p<0.05). Also the functional outcome was significantly improved (p<0.05) by both modalities of testing (mNSS and MWM). The higher dose of Tβ4 showed better beneficial effects compared with the low-dose treatment. CONCLUSIONS: Tβ4 treatment provides both neuroprotection and neurorestoration after TBI indicating that it has promising therapeutic potential in patients with TBI. Study Supported by: Disclosure: Dr. Mahmood has nothing to disclose. Dr. Xiong has nothing to disclose. Dr. Chopp has received personal compensation for activities with EVER Pharmaceutical and Johnson & Johnson. Dr. Chopp has received license fee payments from RegenRx.
The role of interorganizational partnerships in health services provision among rural, suburban, and urban local health departments.

Context: With limited resources and increased public health challenges facing the US, the Centers for Disease Control and Prevention and others have identified partnerships between local health departments (LHDs) and nongovernmental organizations (NGOs) as critical to the public health system. LHDs utilize financial, human, and informational resources and develop partnerships with local NGOs to provide public health services. Purpose: Our study had 2 primary goals: (1) compare resources and partnerships characterizing rural, suburban, and urban LHDs, and (2) determine whether partnerships play a mediating role between LHD resources and the services LHDs provide. Methods: We conducted secondary data analysis using the National Association of County and City Health Officials 2005 Profile Study. We used chi-squared and analysis of variance (ANOVA) to examine differences between rural, suburban, and urban LHDs. We used regression-based mediation methods to test whether partnerships mediated the relationship between resources and service provision. Findings: We found significant differences between LHDs. Urban LHDs serve larger jurisdictions, have larger budgets and more staff, cultivate more partnerships with local NGOs, and provide more health services than suburban or rural LHDs. We found that partnerships were a partial mediator between resources and service provision. In playing a mediating role, partnerships reduce differences in service provision between rural, suburban, and urban LHDs. Conclusions: Partnerships mediate the relationship between resources and service provision in LHDs. LHDs could place more emphasis on cultivating relationships with local NGOs in order to increase service provision. This strategy may be especially useful for rural LHDs facing limited resources and numerous health disparities.
Glutathione S-transferases in elasmobranch liver. Molecular heterogeneity, catalytic and binding properties, and purification

In order to gain insight into the phylogeny and physiological significance of organic-anion-binding proteins in the liver, the hepatic glutathione S-transferases of rat and a typical elasmobranch, the thorny-back shark (Platyrhinoides triseriata), were compared with respect to both glutathione S-transferase activites and organic-anion-binding properties. On gel filtration (Sephadex G-75, Superfine grade) of rat cytosol, the elution volumes of enzyme activities with 1-chloro-2,4-dinitrobenzene and p-nitrobenzyl chloride as substrates were identical (rat Y-fractions; Mr 45000). In contrast, two peaks of enzyme activity for 1-chloro-2,4-dinitrobenzene with elution volumes corresponding to Mr 52000 (PLAT Y1) and Mr 45000 (PLAT Y2) were detected on gel filtration of P. triseriata cytosol. Only fraction PLAT Y2 had enzyme activity with p-nitrobenzyl chloride. Enzyme kinetic studies showed that rat Y-fraction had higher affinities for both 1-chloro-2,4-dinitrobenzene and glutathione than PLAT Y1- and PLAT Y2-fractions. The two forms of P. triseriata glutathione S-transferases differed greatly in affinity for glutathione. At a glutathione concentration that we found to be physiological in P. triseriata, PLAT Y2 accounted for approx. 70% of the total glutathione S-transferase activity with 1-chloro-2,4-dinitrobenzene. Binding studies revealed that PLAT Y1 and PLAT Y2 fractions had much lower affinities for sulphobromophthalein and bilirubin than rat Y-fraction. In contrast, binding affinities of PLAT Y1 and PLAT Y2 for Rose Bengal and 1-anilino-8-naphthalenesulphonate were comparable with that of rat Y-fraction. Inhibitory kinetics suggested that sulphobromophthalein and Rose Bengal were non-competitive inhibitors of glutathione S-transferase activities when 1-chloro-2,4-dinitrobenzene was used as substrate for both PLAT Y1 and PLAT Y2. The major glutathione S-transferase from the PLAT Y2 fraction was purified 81-fold by sequential chromatography on Sephadex G-75, DEAE-Sephadex and hydroxyapatite, and consisted of two identical subunits with pI7.7. The highly enriched Y2-fraction retained high affinity binding of Rose Bengal and 1-anilino-8-naphthalenesulphonate.