cssi/SciSciGPT-SciSciNet huggingface dataset:
Model-based quality of service control

This thesis presents a model-based feedback control approach for network Quality-of-Service (QoS), that achieves accurate control, better resource utilization, and faster response to network and traffic changes than other prevalent techniques. It is a significant departure from the traditional approaches in providing network QoS, that either calculate and provision a priori the required network resources in a feed forward way to meet certain QoS requirements, or use ad-hoc adaptive solutions, that need significant tuning and calibration efforts. Models are used as the basis for performance control of the network problems under study. We apply our control approach at several points in the network, starting with differentiated packet marking, where we introduce a new marking algorithm for assured services based on a feedback model of TCP congestion control. Then, we develop models for per-hop QoS using statistical modeling techniques and build model-based controllers for QoS over network nodes using these models. We further use control-theoretic design techniques to build QoS-controlled FIFO-based network services. These services are reservation-less and self-controlled, so they are capable of tracking reference QoS in a way that could not be easily achieved using operator-controlled or other commonly-used techniques. The problems and applications studied in the thesis demonstrate the effectiveness and the importance of using new and versatile methods such as statistical analysis, design of experiments and control-theory in studying network QoS. We evaluate the new control approach using both simulation and experimentation on a Linux-based network testbed showing its correct functionality as well as comparing it with other available QoS schemes. We also present a two-tier QoS Gateway architecture that works at the first mile to facilitate the use of these controls for QoS-sensitive applications and end-user devices and enables better deployment and utilization of QoS frameworks in general. The overall research in this thesis will provide a better understanding of QoS modeling and control problems and enable wide QoS deployment.
Induction of cell death by the novel proteasome inhibitor marizomib in glioblastoma in vitro and in vivo

New therapies for glioblastoma (GBM) are needed, as five-year survival is <10%. The proteasome inhibitor marizomib (MRZ) has inhibitory and death-inducing properties unique from previous inhibitors such as bortezomib (BTZ), and has not been well examined in GBM. We evaluated the mechanism of death and in vivo properties of MRZ in GBM. The activation kinetics of initiator caspases 2, 8, and 9 were assessed using chemical and knockdown strategies to determine their contribution to cell death. Blood brain barrier permeance and proteasome inhibition by MRZ and BTZ were examined in an orthotopic GBM model. Blockade of caspase 9, relative to other caspases, was most protective against both MRZ and BTZ. Only MRZ increased the proteasome substrate p27 in orthotopic brain tumors after a single injection, while both MRZ and BTZ increased p21 levels after multiple treatments. Cleavage of caspase substrate lamin A was increased in orthotopic brain tumors from mice treated with MRZ or BTZ and the histone deacetylase inhibitor vorinostat. Our data indicate that MRZ induces caspase 9-dependent death in GBM, suggesting drug efficacy biomarkers and possible resistance mechanisms. MRZ reaches orthotopic brain tumors where it inhibits proteasome function and increases death in combination with vorinostat.
Indomethacin in the treatment of premature labor. Effects on the fetal ductus arteriosus.

Abstract Indomethacin is a potent agent in the treatment of premature labor, but its use has been limited because of concern about its constrictive effects on the fetal ductus arteriosus. To study these effects we used serial fetal echocardiography in 13 pregnant women in premature labor who received indomethacin according to three different dose schedules, ranging from 100 to 175 mg per day, for a maximum of 72 hours. The gestational ages of the fetuses ranged from 26.5 to 31.0 weeks. The detection of ductal constriction in 7 of the 14 fetuses by echocardiography led to the discontinuation of indomethacin. Three fetuses also had tricuspid regurgitation. There was no statistically significant difference between the mean (±SEM) gestational age of the fetuses with ductal constriction and that of those without constriction (29.3±0.59 and 28.4±0.52, respectively). There was no relation between serum indomethacin levels in the mothers and ductal constriction. In all seven fetuses affected, ductal constriction ...
Trends and Demographics in Anterior Cruciate Ligament Reconstruction in the United States.

The purpose of this study was to identify the trends and demographics of patients undergoing arthroscopic anterior cruciate ligament (ACL) reconstruction in the United States. Patients who underwent arthroscopic ACL reconstruction between 2004 and 2009 were identified by searching Current Procedural Terminology codes in the PearlDiver Patient Record Database (PearlDiver Technologies, Fort Wayne, IN). The year of procedure, age, gender, and region of the United States were recorded for each patient. Associated meniscal procedures and the absence or presence of a femoral nerve block were also recorded. The incidence of ACL reconstruction significantly increased over the study period, from 40.9 cases per 10,000 patients in 2004 to 47.8 in 2009 (p
Optimizing statistical analysis for DOT to image rapid brain function events

A general linear model was used to statistically analyze HD-DOT data during rapid, event-related brain activation. Spatial and temporal properties of data were evaluated and used in the response modeling and statistical inference.
Estimating the Effect of Regression toward the Mean under Stochastic Censoring

This investigation estimated regression toward the mean in the evaluation of a blood cholesterol educational program in which the probability of return for a follow-up measure was positively related to the initial measure--a situation the authors term "stochastic censoring." The situation in which selection is by a fixed cutpoint is well known. The authors estimate the extent of regression toward the mean when selection is probabilistically related to an initially higher blood cholesterol level. A Monte Carlo method is proposed, conditional on the observed data, for estimating the regression toward the mean and its precision. In 106 simulations, regression toward the mean was estimated to be 0.012 mmol/liter (standard deviation (SD), 0.032 mmol/liter). Similar estimates were obtained using Empirical Bayes shrinkage estimates of baseline cholesterol (regression toward the mean = 0.0106 mmol/liter) and numeric integration (0.0109 mmol/liter). The observed reduction in blood cholesterol was 0.271 mmol/liter (SD, 0.061 mmol/liter); after correction for regression toward the mean, the estimate of the true educational effect was 0.259 mmol/liter (SD, 0.069 mmol/liter). Functions are presented that will enable investigators to predict regression toward the mean and its standard deviation under the conditions that errors are gaussian and stochastic censoring can be approximated by a logistic model.
Microstructure variation tendency of T91-steel based on quantitative analysis

Carbide size,substructure and dislocation density of T91-steel in different service stage were investigated quantitatively by scanning electron microscopy(SEM),electron backscattered diffraction microscope(EBSD)and X-ray diffraction(XRD).The results show that the quantity of the carbide particle precipitates increases obviously with the microstructure deterioration of T91 steel at early service stage,however,the carbide particles grows obviously by aggregation at later service stage.During early service stage,the density of dislocation reduces distinctively and the substructure merges due to the movement of dislocation.The movement of dislocation also induces substructure coarsening.During the later service stage,the density of dislocation keeps stability approximately while the substructure merges quickly which causes the density of sub-grain boundary decreases notablely.
Autonomous Adaptive Brain Systems and Neuromorphic Agents

Models which embody brain design principles and mechanisms that subserve visual perception, cognition, emotion, and action have clarified how the brain can adapt in real time to changing environmental conditions. The brain’s ability to do this in a self-stabilizing fashion employs several different types of predictive mechanisms. The present talk will discuss recent progress towards explaining various of these processes, and how they are being transferred to large-scale applications in technology.
Commentary: honesty is the best policy.

and since all antibiotic use generates resistance, the most prudent approach is to maximise the appropriate use of antibiotics and minimise their inappropriate use? whether that be use when they are not indicated, or in the wrong dose, or the wrong regimen. As this is good clinical practice, there is little conflict between good clinical medicine and good public health practice. It would be difficult and wrong to sustain an argument that antibiotics should be withheld when clinically appropriate because of a potential future risk to others. It would also be difficult to sustain an
Pinhole fistula: a cause of persistent incontinence from a Kock pouch.

AbstractA case is reported of persistent urinary leakage from the stoma of a Kock pouch owing to a pinhole fistula bypassing the efferent nipple.
Personnel officer to Robin the Boy Wonder: Do you have any references besides Batman? 1: The final (but still important) job application piece

Conseils pour constituer une liste de references dans la recherche d'un emploi (en particulier dans une bibliotheque)
How to Select and Scope a Project

You’ll likely encounter many opportunities to improve patient care delivery processes on a daily basis. In this chapter, we will share the best practices for selecting the “right” project and scope in order to improve your chances of success.
Abstract A22: Identification of a novel protein that blocks the Rag-Ragulator interaction and inhibits mTORC1

mTORC1 controls key pathways that maintain cell viability, including translation, ribosome biogenesis and autophagy. Amino acids are a crucial input to mTORC1 activation, resulting in the recruitment of the complex to the surface of lysosomal membrane. The kinase activity of mTORC1 is subsequently turned on at the lysosome downstream of growth factor signaling. mTORC1 is brought to the lysosome by the Rag GTPases, which are tethered to the membrane by their lysosomal scaffold and guanine nucleotide exchange factor, Ragulator. We have identified a novel regulator of mTORC1 activity that inhibits mTORC1 through binding to the Ragulator. This binding prevents the interaction between the Ragulator and its only known substrate, the Rag GTPases, both in cells and in vitro. This disruption of the Rag-Ragulator interaction results in impaired mTORC1 activation by amino acids. However, the novel Ragulator-interacting protein is not regulated by amino acids; it behaves as a link that integrates another signal transduction pathway that inhibits mTORC1 regardless of the presence of amino acids. Citation Format: Lawrence D. Schweitzer, David M. Sabatini. Identification of a novel protein that blocks the Rag-Ragulator interaction and inhibits mTORC1. [abstract]. In: Proceedings of the AACR Special Conference: Targeting the PI3K-mTOR Network in Cancer; Sep 14-17, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Mol Cancer Ther 2015;14(7 Suppl):Abstract nr A22.
Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis.

Use of the Endocuff during routine colonoscopy examination improves adenoma detection: A meta-analysis
Carcinoma Detection by Quantitation and Interrelation of Serum ANTI-T IgM and Total IgM

Abstract We describe here a solid-phase indirect immunofluorescence assay with human erythrocyte-derived Thomsen-Friedenreich (T) glycoprotein coupled to polyacrylamide beads, which measures human serum anti-T IgM. Total serum IgM is measured concomitantly using anti-human IgM coupled to polyacrylamide beads. Both assays utilize fluorescein-labelled anti-human IgM as the second antibody. We detected by this procedure overall 108/131 (82%) carcinomata of lung, pancreas, and breast. There were false positive reactions among 5/60 healthy hospital personnel and blood donors (92% negative ), as well as 8 of 58 patients with benign diseases of lung, pancreas, and breast. Six of the 8 had benign but hyperplastic breast lesions.
In the valley of the blind, the USMLE is king.

the dutch humanist philosopher Erasmus published in Latin a collection of popular idioms, entitled “Adagia.” One of these “in regione caecorum rex est luscus” is translated as “in the land of the blind, the one eyed man is king” ([7][1]). A similar truism exists in most cultures. Value
Analysis and testing of notifications in Android wear applications

Android Wear (AW) is Google's platform for developing applications for wearable devices. Our goal is to make a first step toward a foundation for analysis and testing of AW apps. We focus on a core feature of such apps: notifications issued by a handheld device (e.g., a smartphone) and displayed on a wearable device (e.g., a smartwatch). We first define a formal semantics of AW notifications in order to capture the core features and behavior of the notification mechanism. Next, we describe a constraint-based static analysis to build a model of this run-time behavior. We then use this model to develop a novel testing tool for AW apps. The tool contains a testing framework together with components to support AW-specific coverage criteria and to automate the generation of GUI events on the wearable. These contributions advance the state of the art in the increasingly important area of software for wearable devices.
Soil: The Forgotten Piece of the Water, Food, Energy Nexus

Abstract The water, food, energy nexus has prompted sustainability concerns as interactions between these interdependent human needs are degrading natural resources required for a secure future world. Discussions about the future needs for food, water, and energy to support the increasing world population have ignored our soil resource that is the cornerstone or our capacity to produce food, capture water, and generate energy from biological systems. Soil scientists often recognize soils as a critical component of food, energy, or water security; however, the translation of that awareness into action strategies to either enhance public recognition of soil resource importance or improve soil management is lacking. Food, water, and energy security represents the current and future challenge of sustaining humankind while protecting the environment. These interactions are recognized by scientists, but the linkage to policy decisions or implementation of strategies to create positive outcomes for food, energy, or water enhancement is lacking. If we consider that soil is responsible for 99% of the world's food production, then the importance of soil in the food, energy, water nexus becomes apparent. If we further consider that soil erosion is the major factor, affecting soil degradation and declines in productivity are directly related to degradation of the soil resource, then the implications of soil in the context of increasing food, energy, and water security becomes more evident. However, if the attitude is one that technology will provide answers to these problems, then the soil degradation rate will continue to increase and we will reach a tipping point in which technological advances will not be able to overcome the impacts of a reduced topsoil depth coupled with a more variable climate. Soil is the forgotten piece of the food, energy, water nexus; however, the oversight extends beyond this nexus to include many of the ecological services required by humankind.
Dual-band platform-mounted HF/VHF antenna design using the characteristic mode theory

The design of a dual-band antenna mounted on a military platform is presented. The antenna operates in both high-frequency (HF) and very-high-frequency (VHF) bands and consists of two half-loops mounted on the platform. When the two half-loops are excited differentially, they act as coupling elements exciting the platform dominant characteristic mode. This generates a horizontally polarised radiation with maximum radiation towards to zenith. Due to the presence of the platform, the antenna bandwidth is increased compared with that of an isolated antenna. When the two half-loops are excited in the common mode, they behave as an ultra-wideband antenna with monopole-like radiation in the VHF band. A diplexer is used to achieve dual-band operation, which allows the antenna operating at both bands simultaneously. A 60:1 scaled antenna prototype and its feed network is fabricated and characterised. At the lower band, the antenna exhibits an impedance bandwidth of 2.8% for a voltage standing wave ratio (VSWR) better than 2.25:1 and a directional radiation pattern with horizontal polarisation. At the higher band, the antenna exhibits a VSWR better than 2.25:1 and monopole-like radiation characteristics across 2:1 bandwidth. The impact of the presence of a realistic ground plane on the antenna performance is also studied and discussed.
Privatization at the State and Local Level

Increasingly, state and local officials are seeking ways to cut costs without reducing the level of government-provided services. As a result, many jurisdictions have increased their use of cost-saving privatization techniques, and countless more are investigating the potential outcomes from greater use of the private sector. This paper examines privatization, defined as the methods and strategies designed to transfer the production or provision of public services from government to the private sector, at the state and local level.
Local Health Departments and the 2008 Recession: Characteristics of Resiliency

Background The 2008 recession had a significant impact on local health departments (LHDs), with more than half of such agencies experiencing job losses and program cuts. Purpose To identify potential modifiable factors that can protect LHDs from job losses and budget cuts during future economic crises. Methods This retrospective cohort study used data from 2005 and 2010 surveys of LHDs. The outcome of interest was financial resiliency for maintaining budgets during the recession and was based on the ratio of observed to predicted expenditures (O/E) per capita for 2010. Logistic regression was used to model the resiliency of the LHD with independent variables grouped around domains of organization, revenues, and services, with stratification by size of the LHD jurisdiction. Data were analyzed in 2013. Results Of the 987 LHDs in the final data set, 328 (33.2%) were categorized as resilient and 659 (66.8%) as non-resilient. Overall, resilient LHDs received a higher percentage of revenues from non-local sources compared to non-resilient LHDs ( p p Conclusions Funding streams and service mix may be modifiable characteristics, suggesting possible means for LHDs to weather future economic stress; however, these characteristics may be unique to the size of the population served.
Sustaining Resilience: Modeling Nonprofit Collaboration in Recovery

In New Zealand, where nonprofit and government partnerships have been formally developing since the 1990s, pathways for nonprofits to improve outcomes for affected communities were open when a magn...
Can task-shifting work at scale?: Comparing clinical knowledge of non-physician clinicians to physicians in Nigeria

In contexts with severe physician shortages, the World Health Organization advocates task shifting to cadres with shorter training. To investigate the effects of task shifting at scale in primary health care, we assessed the clinical knowledge of non-physician clinicians versus physicians working in public primary care facilities in Nigeria. We assessed 4138 health workers using clinical vignettes of hypothetical patients suffering from illnesses commonly seen in primary care. Facility-level fixed effects models were used to compare health worker knowledge of (i) consultation guidelines, (ii) diagnostic accuracy and (iii) treatment guidelines. Unadjusted averages of overall health worker knowledge were low across all types of worker except medical officers. After adjustment for potential confounding, the differences across all three measures between cadres became small or statistically insignificant. Non-physician clinicians can provide the same quality of primary care, for a set of common illnesses, as Medical Officers with similar personal characteristics, but clinical skills across cadres need strengthening.
Hog Cholera Virus

The hog cholera virus belongs to the Togaviridae family and is characterized by an acute contagious condition affecting all ages of swine with a high morbidity and mortality. The clinical signs of the disease are diverse, but fever, inappetance, and hemorrhage are often manifested. Strains of the virus differ in their pathogenicity, and low virulent strains are responsible for reproductive losses. The disease is found in pigs. Australia, Canada, Denmark, Finland, Great Britain, Iceland, Ireland, New Zealand, Norway, Sweden, and the United States are the countries that are free from the virus. Fluorescent antibody, agar gel immunodiffusion, immunoelectroosmophoresis (IEOP), virus neutralization, complement fixation, and indirect haemagglutination assay are some of the techniques to diagnose the disease. FA is considered as one of the most practical and reliable tests for the diagnosis of the disease.
Replication Management of Application Sharing for Multimedia Conferencing and Collaboration

Multimedia desktop conferencing systems are gaining momentum and increasingly becoming a reality. In these systems, besides using audio, video and multi-user applications, users can share a vast number of single-user applications for collaborative work. In these sys- tems, there are two basic architectures for sharing single-user applications, centralized and replicated. In this paper, we present the important issues involved in designing and implementing ap- plication sharing systems based on the replicated architecture. We show what type of objects need to be replicated, the specification of these objects and the different approaches for imple- menting the replication processes. The concepts presented were used in implementing JCE, a multimedia desktop conference system for sharing Java applications. RESUME. Les environnements collaboratifs multimedia sont en train de gagner de plus en plus d'interet et deviennent une realite. Dans ces systemes, en plus de l'utilisation de la voix , la video et les applications multi-utilisateurs, les utilisateurs peuvent collaborer en utlisant des applications prevues pour une seule personne. Il existe deux types d'architectures pour partager de telles applications: l'architecture centralisee et l'architecture repliquee. Ce papier decrit la conception et l'implementation d'un systeme de partage d'applications base sur l'architecture repliquee. Nous montrons quels types d'objets doivent etre repliques, la specification de ces objets et les differentes approches pour implementer les processus de replication. Ces concepts ont ete utilises pour implementer JCE, un systeme de conference multimedia et de partage d'applications Java.
Bush v. Gore at the Dawning of the Age of Obama

In “Bush, Gore, Florida, and the Constitution”, 61 Fla. L. Rev. 945 (2009), Akhil Amar restates the academic consensus that emerged very quickly after Bush v. Gore was decided. According to his view, the Florida Supreme Court’s decision was correct, while five Republicans on the U.S. Supreme Court concocted a novel, untenable, and absurdly ad hoc interpretation of the Fourteenth Amendment to stop the Florida courts from conducting a recount of the ballots. Three of those Republican Justices, moreover, are alleged to have disingenuously joined a majority opinion that “ran counter” to their previous views and was inconsistent with “originalism.” What’s more, these three also endorsed an interpretation of Article II that Professor Amar thinks is easily refuted by his own “crisp and cogent” defense of the Florida court’s decision.Using evidence that has been on the public record for many years, this short response demonstrates that Professor Amar’s critique of Bush v. Gore rests on a series of red herrings, factual misstatements, and critical omissions. There is apparently no hope that the unrebutted evidence can ever persuade those who are consumed with disdain for Republicans, or Bush, or “conservative” Justices. Today, however, as we stand at what Professor Amar calls “the dawning of the Age of Obama,” there are also many students and lawyers who have encountered snippets of Bush v. Gore in a case book, along with editorial comments from professors who have publicly excoriated the Court and its decision. Perhaps some of these readers can be moved to take a closer, and unprejudiced, look at the facts. They will find a story that bears almost no resemblance to the one told by Professor Amar.
Primary Prevention Scanning for Older Persons

Throughout this book we have offered a manual to support the helping professional in bringing primary prevention thoughts and actions on health and wel1-being to his or her older clients. In a postindustrial society such as ours, we enjoy more years of “old age” than ever before, and those years are usually spent in better health than at any previous time in history. Thus, we have suggested various ways — one by one — to protect existing states of health among older persons, prevent those problems for which individuals might have some known risk, and promote desired states of functioning.
Statutory Damages and Standing after Spokeo v. Robins

In Spokeo v. Robins, the U.S. Supreme Court held that courts may no longer infer the existence of an injury in fact—and thus constitutional standing—from a statute’s use of a particular remedy, such as a statutory or liquidated damages provision. But Spokeo also directed courts to consider whether Congress intended to identify an intangible harm and elevate it to the status of a “concrete” injury in fact when deciding standing questions. This article argues that courts can and should continue to pay close attention to the structure and language of statutory remedial provisions in making that assessment. The article proposes that statutes be assessed on a spectrum from true statutory-damages schemes to mere minimum actual-damages schemes. Where Congress has created a true statutory-damages scheme—one that allows for both actual damages to remedy actual injuries, and also statutory damages to remedy intangible injuries—courts should continue to infer that Congress has identified an intangible injury that it intends to elevate to the status of an injury in fact. But when Congress merely sets a minimum amount for actual damages, courts should not make any inference regarding injury and should continue to require plaintiffs to plead and prove a recognized actual injury to meet the injury-in-fact requirement.
Biomethane addition to California transmission pipelines: Regional simulation of the impact of regulations

Abstract Biomethane is a promising alternative fuel to mitigate the climate impacts arising from the natural gas sector. In California, several policies are in place to facilitate the development of biomethane. However, constraints on gas quality and gas properties can limit biomethane introduction into the gas pipeline. In this study, regional biomethane supplies and potential deviations in gas quality were assessed using steady-state simulation of natural gas pipeline networks at the zip-code scale under a variety of biomethane development scenarios and regulatory limits. Three regions of California – San Diego, Hanford, and South San Francisco bay area – were modeled. We explore local impacts to gas quality under various biomethane price scenarios and different levels of regulatory support. Across all regions, we do not find regional or local gas quality deviations to exceed interchangeability guidance with slightly relaxed biomethane heating value standards. Agricultural regions such as Hanford with high concentrations of dairy farms and low natural gas consumption may require pipeline upgrades to act as net exporters of biomethane. Regions with large seasonal variation in natural gas consumption may necessitate more stringent gas quality requirements to ensure safe combustion as gas composition varies across the year. High year-round demand for gas in urban regions will minimize gas quality deviation and could allow for case-by-case relaxation in gas quality requirements. We find that CO2 and biofuel credits under state and federal regulations such as the California Low Carbon Fuel Standard (LCFS) and U.S. Renewable Fuel Standard (RFS) are vital to development of biomethane. With the incorporation of LCFS revenues, the portion of natural gas demands served by biomethane could be 4.3% in San Diego (5.2 bcf/y or 150 million m3/y), 54% in Hanford (2.66 bcf/y or 75.3 million m3/y), and 2.4% in the South Bay area (3.8 bcf/y or 110 million m3/y). Adding in current federal RFS credits, the biomethane supply only rises slightly in San Diego and South Bay Area but exceeds 100% of natural gas demand in Hanford (4.5 bcf/y or 130 million m3/y).
GreenTPU: Improving Timing Error Resilience of a Near-Threshold Tensor Processing Unit

The emergence of hardware accelerators has brought about several orders of magnitude improvement in the speed of the deep neural-network (DNN) inference. Among such DNN accelerators, Google Tensor Processing Unit (TPU) has transpired to be the best-in-class, offering more than $15 \times$ speedup over the contemporary GPUs. However, the rapid growth in several DNN workloads conspires to escalate the energy consumptions of the TPU-based data-centers. In order to restrict the energy consumption of TPUs, we propose GreenTPU--- a low-power near-threshold (NTC) TPU design paradigm. To ensure a high inference accuracy at a low-voltage operation, GreenTPU identifies the patterns in the error-causing activation sequences in the systolic array, and prevents further timing errors from the same sequence by intermittently boosting the operating voltage of the specific multiplier-andaccumulator units in the TPU. Compared to a cutting-edge timing error mitigation technique for TPUs, GreenTPU enables 2X -3X higher performance in an NTC TPU, with a minimal loss in the prediction accuracy.
Variation in the Quality of Thyroid Nodule Evaluations Before Surgical Referral

Abstract Background Thyroid nodules are highly prevalent, and owing to their malignant potential, proper evaluation is imperative. The objective of this study was to characterize variation in thyroid nodule evaluations. Materials and methods This retrospective review included all consecutive surgical referrals for thyroid nodules from October to December 2017 at a single institution. We determined the proportion of evaluations that contained a thyroid-stimulating hormone (TSH) level and a high-quality ultrasound because these components of thyroid nodule evaluations are common to several evidence-based guidelines. Results The study cohort included 64 patients, with a median age of 51.5 y. Primary care providers referred most patients (51.6%), followed by endocrinologists (40.6%), and other specialists (7.8%). In total, 35.9% of evaluations did not include a TSH value, which is vital to any thyroid nodule evaluation. Most evaluations (95.3%) included a dedicated ultrasound, but only 12.3% of ultrasound reports commented on nodule size in three dimensions, structure, echogenicity, and lymph nodes, which we considered the minimum commentary indicative of a high-quality ultrasound. Only 51.5% of evaluations included both a TSH and a thyroid ultrasound. If patients receiving low-quality ultrasound reports were excluded, 9.4% of the entire cohort received a guideline-concordant, high-quality evaluation. Conclusions Great variation exists in the quality of thyroid nodule evaluations before surgical referral. Two necessary components of thyroid nodule evaluations that contribute most to the observed deviation from guidelines are obtaining a TSH value and obtaining an ultrasound with enough information to risk stratify the nodule.
Altered recognition of antigen is a novel mechanism of CD8+ T cell tolerance in cancer

1587 Antigen-specific CD8+ T-cell tolerance is one of the major mechanisms of tumor escape. Recent studies have shown that this tolerance was induced by myeloid-derived suppressor cells (MDSC). Using in vivo models we have found that MDSC directly disrupted the binding of the specific peptide-MHC dimers (pMHC) to CD8+ T cells via nitration of tyrosines within TCR/CD8 complex, which resulted in the inability of CD8+ T cells to bind pMHC and respond to the specific peptide. At the same time, these cells retained their ability to respond to non-specific stimulation. Nitration of TCR/CD8 was induced by MDSC via hyperproduction of reactive oxygen species (ROS) and peroxynitrite during direct cell-cell contact. Molecular modeling suggested specific sites of nitration that could affect conformational flexibility of TCR/CD8 and its interaction with pMHC. This data demonstrates novel mechanisms of T-cell tolerance in cancer that also can be pertinent to many pathological conditions associated with accumulation of MDSC.
Carotid endarterectomy for asymptomatic carotid stenosis is safe in octogenarians.

Abstract Objective Carotid endarterectomy (CEA) is the gold standard to prevent a recurrent stroke in symptomatic patients with carotid stenosis. However, in the modern era, the benefit of CEA in asymptomatic octogenarian patients has come into question. This study investigates real-world outcomes of CEA in asymptomatic octogenarians. Methods Patients who underwent CEA for asymptomatic carotid stenosis were identified in the American College of Surgeons National Surgical Quality Improvement Program CEA-targeted database from 2012 to 2017. They were stratified into two groups: octogenarians (≥80 years old) and younger patients ( Results We identified 13,846 patients with asymptomatic carotid stenosis who underwent an elective CEA including 2509 octogenarians and 11,337 younger patients. Octogenarians were more likely to be female and less likely to be diabetic or smokers compared with younger patients. There was no difference in preoperative use of statins or antiplatelet therapy. Examination of 30-day outcomes revealed that octogenarians had slightly higher mortality (1.2% vs 0.5%; odds ratio, 2.1; 95% confidence interval, 1.3-3.4; P Conclusions The 30-day outcomes of CEA in octogenarians are comparable with those in younger patients. Although the octogenarians had slightly higher mortality than younger patients, the absolute risk of mortality was still low at 1.2%. Therefore, CEA is safe in asymptomatic carotid stenosis in octogenarians. Overall life expectancy and preoperative functional status, rather than age, should be the major determinants in the decision to operate.
EXCLUSION SPOTTER: APPLYING ADVANCES IN AI TO IDENTIFY AGEISM IN ONLINE JOB POSTING

The landscape in which employers and candidates interact is changing as more job adverts are pushed online. Employment platforms (e.g., Indeed and LinkedIn) are now among the primary mechanisms for job posting, job search, and initial negotiations. Through such job platforms, a single job advert can now reach millions of people around the world. This exposure of a job advert has obvious benefits for the employer, but this exposure also has the power to alienate and exclude large portions of society. In particular, the word choice of a single job advert can, perhaps unintentionally, exclude thousands of people by their personal traits (e.g., gender or race). Age is a particular trait that garners more attention as ageism is often cited in the literature as going overlooked, not understood, and generally escaping social awareness. To begin tackling this problem, with the purpose of supporting older adults and enabling their contribution to society, we applied advances in AI to create a tool, called Exclusion Spotter, that gives feedback to recruiters and employers on which words in their advert are possibly excluding people by age. We applied Exclusion Spotter to 3660 job adverts, clustered by 372 job titles. We found a significant difference (p=.02) in the number of age-related words for engineering related positions versus all other job titles. Among 47 engineering related titles we matched 47.37 age related words per title and 2.8 per advert. Among the other 325 titles we matched 24.37 age related words per title and 2.1 per advert.
RISK FACTORS FOR VENTRICULAR TAHCYARRHYTHMIC EVENTS IN PATIENTS WITHOUT LEFT BUNDLE BRANCH BLOCK WHO RECEIVE CARDIAC RESYNCHRONIZATION THERAPY

We hypothesized that combined assessment of factors associated with increased risk for ventricular arrhythmic event (VTE) after cardiac resynchronization therapy (CRT) implantation can be used to identify non-LBBB patients in whom CRT implantation will not be pro-arrhythmic. We analyzed 412 non-
The Effects of Prosthesis Inversion/Eversion Stiffness on Balance-Related Variability During Level Walking: A Pilot Study.

Prosthesis features that enhance balance are desirable to people with transtibial amputation. Ankle inversion/eversion compliance is intended to improve balance on uneven ground, but its effects remain unclear on level ground. We posited that increasing ankle inversion/eversion stiffness during level-ground walking would reduce balance-related effort by assisting in recovery from small disturbances in frontal-plane motions. We performed a pilot test with an ankle-foot prosthesis emulator programmed to apply inversion/eversion torques in proportion to the deviation from a nominal inversion/eversion position trajectory. We applied a range of stiffnesses to clearly understand the effect of the stiffness on balance-related effort, hypothesizing that positive stiffness would reduce effort while negative stiffness would increase effort. Nominal joint angle trajectories were calculated online as a moving average over several steps. In experiments with K3 ambulators with unilateral transtibial amputation (N = 5), stiffness affected step-width variability, average step width, margin of stability, intact-foot center of pressure variability, and user satisfaction (p ≤ 0.05, Friedman's test), but not intact-limb evertor average, intact-limb evertor variability, and metabolic rate (p ≥ 0.38, Friedman's test). Compared to zero stiffness, high positive stiffness reduced step-width variability by 13%, step width by 3%, margin of stability by 3%, and intact-foot center of pressure variability by 14%, whereas high negative stiffness had opposite effects and decreased satisfaction by 63%. The results of this pilot study suggest that positive ankle inversion stiffness can reduce active control requirements during level walking.
An evaluation of the complication risks following peroral endoscopic myotomy in patients on antithrombotic therapy.

Per oral endoscopic myotomy (POEM) is used to treat a variety of esophageal motility disorders and is associated with relatively few complications. However, complications in patients on antithrombotic therapy (AT) is not well-studied. We hypothesize AT patients have a higher risk of post-operative bleeding and 30-day complication rate compared to all other patients, even when these medications are held peri-operatively. A single-institution retrospective review of a prospectively collected database of patients who underwent POEM procedures January 2011–July 2019 was performed. All 30-day complications were recorded, as well as management of AT medications peri-operatively. Demographic and clinical characteristics were compared using t test, Chi-Square, and Fisher’s exact test as appropriate. Multivariate logistic regression was performed to examine factors associated with post-operative complications. A total of 219 POEM procedures were performed. 50.2% of patients were male, and AT patients tended to be older (66.9 vs. 55.4, p = 0.01). The major complication rate was higher among AT patients (36.8% vs. 9.0%, p = 0.01), as was the rate of post-operative bleeding (10.5% vs. 1.0%, p = 0.04). After adjusting for gender and age, the use of antithrombotic therapy was significantly associated with 30-day complications (OR 6.03, p = 0.001). Patients on AT who undergo POEM are significantly more likely to experience complications, including bleeding, within 30 days of surgery. Safe timing of post-operative resumption of antithrombotic medications remains a difficult decision that must be carefully considered by the endoscopist.
Leveraging Tools from Autonomous Navigation for Rapid, Robust Neuron Connectivity.

As biological imaging datasets continue to grow in size, extracting information from large image volumes presents a computationally intensive challenge. State-of-the-art algorithms are almost entirely dominated by the use of convolutional neural network approaches that may be difficult to run at scale given schedule, cost, and resource limitations. We demonstrate a novel solution for high-resolution electron microscopy brain image volumes that permits the identification of individual neurons and synapses. Instead of conventional approaches where voxels are labelled according to the neuron or neuron segment to which they belong, we instead focus on extracting the underlying brain graph represented by synaptic connections between individual neurons, while also identifying key features like skeleton similarity and path length. This graph represents a critical step and scaffold for understanding the structure of neuronal circuitry. Our approach, which we call Agents, recasts the segmentation problem to one of path finding between keypoints (i.e., connectivity) in an information sharing framework using virtual agents. We create a family of sensors which follow local decision-making rules that perform computationally cheap operations on potential fields to perform tasks such as avoiding cell membranes and finding synapses. These enable a swarm of virtual agents to efficiently and robustly traverse three-dimensional datasets, create a sparse segmentation of pathways, and capture connectivity information. We achieve results that meet or exceed state-of-the-art performance at a substantially lower computational cost. Agents offers a categorically different approach to connectome estimation that can augment how we extract connectivity information at scale. Our method is generalizable and may be extended to biomedical imaging problems such as tracing the bronchial trees in lungs or road networks in natural images.
Low Concordance Between Pediatric Emergency Attendings and Pediatric Residents for Predictors of Serious Intracranial Injury.

Objectives Minor head trauma is a common cause of pediatric emergency room visits. The Pediatric Emergency Care Applied Research Network head trauma clinical decision rules (PECARN-CDR) are designed to assist clinicians in determining which patients require imaging. However, only minimal data are available on the accuracy of residents' assessments using PECARN-CDR. Prior research suggests that trainees often come to erroneous conclusions about pediatric head trauma. The objective of the present study was to assess concordance between pediatric residents' and attending physicians' assessments of children with low-risk head trauma, with the ultimate goal of improving education in pediatric trauma assessment. Methods This is a retrospective cohort study analyzing concordance between pediatric residents and pediatric emergency attendings who provided PECARN-CDR-based evaluations of low-risk head injuries. It is a planned subanalysis based on a prospectively collected, multicenter data set tracking pediatric head trauma encounters from July 2014 to June 2019. Results Data were collected from 436 pediatric residents, who encountered 878 patients. In the case of patients younger than 2 years, low concordance between residents and attendings was observed for the following elements of the PECARN-CDR: severe mechanism (κ = 0.24), palpable skull fracture (κ = 0.23), Glasgow Coma Scale (GCS) score less than 15 (κ = 0.14), and altered mental status (AMS; κ = -0.03). There was moderate to high agreement between residents and attendings for loss of consciousness (κ = 0.71), nonfrontal hematoma (κ = 0.48), and not acting normally per parent (κ = 0.35). In the case of patients older than 2 years, there was low concordance for signs of basilar skull fracture (κ = 0.28) and GCS score less than 15 (κ = 0.10). Concordance was high to moderate for history of vomiting (κ = 0.88), loss of consciousness (κ = 0.67), severe headache (κ = 0.50), severe mechanism (κ = 0.44), and AMS (κ = 0.42). Residents were more conservative, that is, more likely to report a positive finding, in nearly all components of the PECARN-CDR. Conclusions Resident assessment of children presenting to the ED with minor head trauma is often poorly concordant with attending assessment on the major predictors of clinically important traumatic brain injury (abnormal GCS, AMS, signs of skull fracture) based on the PECARN-CDR. Future work may explore the reasons for low concordance and seek ways to improve pediatric resident education in the diagnosis and management of trauma.
Stroke in critical COVID-19 patients: a cautionary tale from the frontlines

INTRODUCTION: Although Coronavirus Disease 2019 (COVID-19) is primarily a disease of the respiratory system in its transmission and clinical manifestations, physicians have also reported a tropism toward the nervous system METHODS: Neurological symptoms can occur as one of many systemic manifestations of a critical form of the disease or in isolation as the predominant presenting complaint RESULTS: We report a series of 6 patients who suffered significant cerebrovascular accidents while being treated for critical COVID-19 in the intensive care units of a quaternary care hospital in New York's Hudson valley CONCLUSIONS: This series demonstrates how a relatively rare but catastrophic neurological complication can occur in patients with COVID-19 while they are being managed for their more common problems such as respiratory and renal failure
Differences in Physical Activity During Walking and Two Pokémon Go Playing Styles

Objective: Two self-selected playing styles of Pokemon Go (PG) have been observed: intermittent and continuous. However, it is unknown how playing style impacts volume and pattern of physical activ...