cssi/SciSciGPT-SciSciNet huggingface dataset:
Early reperfusion as a rationale from of therapy in ischemic stroke

In the last few years considerable evidence has been seen making it clear that although focal neurological deficiency (or ischaemic stroke) develops in parallel with intracranial arterial occlusion, the irreversible damage neurons suffer (i e necrosis) in many parts of the ischaemic territory is delayed by several hours. After an occlusion of the middle cerebral artery, such a lapse is particularly evident in the region of the cerebral cortex, an area which could be considered as the most peripheral region of the ischaemic territory, also known as 'penumbra'. This article sets out to review the secondary events in time-dependent studies which show that many of the consequences of intracranial artery occlusion may be totally or partly reversible by reopening the artery 60 minutes after. The right middle cerebral artery (MCA) of some two hundred adult Wistar rats was blocked up by inserting a nylon monofilament through the outer carotid artery. In some of the animals such occlusion was resolved by removing the filament minutes or hours later whereas in others light from the MCA remained occluded until the end of the experiment seven days later. Many histological and histochemical analyses were performed as well as microscopic preparation for each subject to obtain information concerning the movement of circulating leucocytes and of platelets, the integrity of capillaries as opposed to a circulating macromolecule (mw: 43 kd), the development of neuronal necrosis and the relationship between neurological deficiency and the level of histological damage. Once the MCA was blocked, both neuronal necrosis and leukocyte movement followed a somewhat parallel course. A large number of necrotic neurons appeared in the next twelve hours, coinciding with the time most intravascular leukocytes (neutrophiles) take in making themselves visible around the area affected by the blocked artery. In any case, prior to the development of neuronal necrosis and of leucotaxis, significant abnormalities appear affecting the perivascular astrocytes and capillary endothelial cells. The structural changes in these cells, and especially tumefaction, are what cause important abnormalities in microvascular integrity appearing several hours before neuronal necrosis. To recap: a) despite the fact that leucocyte migration and progressive neuronal necrosis follow a parallel course in time, the casual relationship between these two physiopathological phenomena is still not firmly established: b) the structural changes affecting vascular endothelial cells and astrocytes could fulfill a primordial role in possible neuronal necrosis that in the context of an experimental infarct is not produced until six hours after arterial blockage; c) microvascular deterioration may be reversible by reopening the blockage if this is carried out at most 60 minutes afterwards. This point would suggest that selective treatment of ischaemic stroke patients using thrombotic agents or angioplasty could have beneficial effects.
Urethral Strictures Following Transurethral Resection of Posterior Urethral Valves

AbstractDense urethral strictures developed in 8 of 36 patients (8 per cent) following transurethral fulguration of posterior urethral valves. Common potential etiologies include the use of a loop resectoscope, large size of the valves and immediate supravesical diversion. The latter results in a “dry” urethra and the strictures that resulted may be analogous to the stenosis seen following a “dry” ureteral reimplant. Techniques to maintain flow through the urethra after resection and the avoidance of an extensive resection may be helpful in preventing urethral strictures.
TH-CD-201-11: Optimizing the Response and Cost of a DNA Double-Strand Break Dosimeter

Purpose: A DNA double-strand break (DSB) dosimeter was developed to measure the biological effect of radiation. The goal here is to refine the fabrication method of this dosimeter to reproducibly create a low coefficient of variation (CoV) and reduce the cost for the dosimeter. Methods: Our dosimeter consists of 4 kilo-base pair DNA strands (labeled on one end with biotin and on the other with fluorescein) attached to streptavidin magnetic beads. The final step of the DNA dosimeter fabrication is to suspend these attached beads in phosphate-buffered saline (PBS). The amount of PBS used to suspend the attached beads and the relative volume of the DNA strands to the beads both affect the CoV and dosimeter cost. We diluted the beads attached with DNA in different volumes of PBS (100, 200, and 400 µL) to create different concentrations of the DNA dosimeter. Then we irradiated these dosimeters (50 µL samples) in a water-equivalent plastic phantom at 25 and 50 Gy (three samples per dose) and calculated the CoV for each dosimeter concentration. Also, we used different masses of DNA strands (1, 2, 8, 16, 24, and 32 µg) to attach to the same volume of magnetic beads (100 µL) to explore how this affects the cost of the dosimeter. Results: The lowest CoV was produced for the highest concentration of dosimeter (100 µL of PBS), which created CoV of 2.0 and 1.0% for 25 and 50 Gy, respectively. We found that the lowest production cost for the dosimeter occurs by attaching 16 µg of DNA strands with 100 µL of beads. Conclusion: : We optimized the fabrication of the DNA dosimeter to produce low CoV and cost, but we still need to explore ways to further improve the dosimeter for use at lower doses. This work was supported in part by Yarmouk University (Irbid, Jordan) and CPRIT (RP140105)
A Review of Studies on the System-Wide Implementation of Evidence-Based Psychotherapies for Posttraumatic Stress Disorder in the Veterans Health Administration

Since 2006, the Veterans Health Administration (VHA) has instituted policy changes and training programs to support system-wide implementation of two evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD). To assess lessons learned from this unprecedented effort, we used PubMed and the PILOTS databases and networking with researchers to identify 32 reports on contextual influences on implementation or sustainment of EBPs for PTSD in VHA settings. Findings were initially organized using the exploration, planning, implementation, and sustainment framework (EPIS; Aarons et al. in Adm Policy Ment Health Health Serv Res 38:4-23, 2011). Results that could not be adequately captured within the EPIS framework, such as implementation outcomes and adopter beliefs about the innovation, were coded using constructs from the reach, effectiveness, adoption, implementation, maintenance (RE-AIM) framework (Glasgow et al. in Am J Public Health 89:1322-1327, 1999) and Consolidated Framework for Implementation Research (CFIR; Damschroder et al. in Implement Sci 4(1):50, 2009). We highlight key areas of progress in implementation, identify continuing challenges and research questions, and discuss implications for future efforts to promote EBPs in large health care systems.
Amino Acid-Related Diseases

Abstract Inborn errors of amino acid metabolism encompass diverse entities, including disorders which are caused by enzyme deficiencies in the metabolic pathway of one or more amino acid(s) or, rarely, a transport abnormality. The focus is on Phenylketonuria, Tyrosinemia Type 1, Urea Cycle defects, disorders of branched-chain amino acid metabolism (eg, Maple Syrup Urine Disease, Isovaleric Aciduria, Propionic Aciduria, Methylmalonic Aciduria), and Homocystinuria. Furthermore, Glutaric Aciduria Type 1, Nonketotic Hyperglycinemia, and a selection of amino acid transport defects will be discussed. This chapter provides an introduction on underlying metabolic derangements and diagnostic principles in conjunction with treatment summaries. For many of these disorders, ongoing clinical assessments of patients together with monitoring of disease-specific biochemical parameters and individualized therapies, including diets/medications, remain essential. For most of the severe forms, there is also the need to implement emergency treatment as indicated, and to optimize current therapeutic strategies in order to maximize long-term outcomes.
Species-specific diagnostics using a β-1,4-endoglucanase gene for Pratylenchus spp. occurring in the Pacific Northwest of North America

A PCR assay was designed and optimised to differentiate four Pratylenchus species commonly encountered in soil and root samples from the Pacific Northwest of North America. Species-specific primers were designed to accessions from Pratylenchus species deposited in GenBank which encoded a β -1,4-endoglucanase gene. The optimised β -1,4-endoglucanase gene primer sets produced amplicons that were 380, 293, 528 and 364 bp from P. crenatus , P. neglectus , P. penetrans and P. thornei , respectively. Primer sets were tested successfully for functionality and specificity within each of the four species as well as against other species not commonly found in the Pacific Northwest. This method allowed for the identification of juveniles to species, thereby precluding the necessity of the presence of females in a sample for accurate diagnostics. Ultimately, this diagnostic PCR assay could be used as an efficient tool for rapid diagnostics of these Pratylenchus species recovered from soil and root samples in any laboratory equipped for PCR.
Prior therapy and volume of disease are prognostic for metastatic hormone sensitive prostate cancer (mHSPC) in a hospital-based database.

221Background: Recent reports have shown that patients (pts) with low volume (LV) mHSPC and those who relapse after prior local therapy (PLT) have median overall survival (OS) longer than 5 years with androgen deprivation therapy (ADT) alone. Using data from our prospectively collected hospital-based database, we aimed to detail the outcomes of pts with mHSPC by combining PLT or de novo (DN) and LV or high volume (HV) of disease. Methods: A cohort of mHSPCpts treated with ADT between 1990 and 2013 was identified in the Dana-Farber Cancer Institute IRB approved database and categorized as DN or PLT and HV or LV, at time of ADT start. HV was defined as visceral metastases and/or ≥ 4 bone metastases (BM) with at least 1 BM beyond the pelvis and axis. The analysis endpoints included OS, defined as time from ADT start to death from all causes. Kaplan-Meier method estimated the time to events distribution with median (95% CI). Cox proportional hazards model evaluated patient and disease volume groups on disease...
PELUANG DAN TANTANGAN USAHA MIKRO KECIL DAN MENENGAH DALAM MENGHADAPI MASYARAKAT EKONOMI ASEAN

Nowadays we are already in the ASEAN economic community section that should always be aware of the opportunities and challenges that occur especially in the case of SMEs (Small Medium Micro Enterprises), which plays a major role in the development of economic growth in Indonesia as a developing country in Indonesia. The performance of SMEs in Indonesia still must be monitored because there is still debate among academics about whether the Indonesian SMEs can compete in export markets or at least survive at home against the competition of imported goods that come from abroad. The study was conducted for our SMEs in order to take all the opportunities and overcome the challenges that occur either from internal and external environment in a company engaged in the SME industry. Monitoring of the SMEs was conducted through the presence of several strategies that lead to bottom-up which focus on the development of SMEs as one measure of economic growth. Research method is descriptive analytical study outlining strategies for SMEs as a way out alternatives in running the ASEAN economic community who are always ready to face any challenges and opportunities from both internal and external factors. Data collection through literature study secondary data sourced from literature journal reports and other official information that supports research on SMEs. Results from this study any measures or program that can compete in the market of regional (ASEAN) and maintaining or retaining domestic products in the domestic market share by increasing number of goods imported into the country. Therefore to support this it is necessary to empower back all the centers of SMEs that had developed with government support through a number of policies regarding the feasibility of SMEs. Keywords : Challenges Opportunities SME Strategy, ASEAN Economic Community
Nociceptive Circuits: Can’t Escape Detection

Organisms rely on nociceptive sensory neurons to detect and avoid potentially tissue-damaging stimuli in the environment. New research has unraveled previously unknown downstream neural circuit components for nociceptive (pain-like) behavior in Drosophila larvae.
Vegetation and Shear Strength in a Delta-splay Mouth Bar

The mechanism by which new deltaic wetlands form is a complex suite of biological and physical processes that can modify one another. Understanding these processes and their interactions is imperative to successful coastal restoration. This study investigated the relationship between belowground plant biomass and sediment cohesion. We hypothesized that greater root densities increase shear strength, variably across plant communities, and that these communities are associated with distinct inundation regimes. A significant relationship was found between belowground biomass and surface shear strength when accounting for sediment grain size, water content, and organic matter content. Sites dominated by native graminoids or woody species had significantly higher shear strengths than unvegetated areas. However, sites dominated by Phragmites australis or forbs did not differ significantly in shear strength from the unvegetated sites. Sites dominated by Phragmites australis were also subject to significantly higher inundation rates during the previous water year than any other vegetation type. These results suggest that vegetation community differences lead to differences in shear strength that result in locally differential erosion rates, in turn modifying future geomorphology, hydrology, sedimentation, and vegetation distribution. This feedback implies that certain vegetation communities in wetland restoration projects could not only impart immediate erosion resistance to the substrate, but affect the long-term potential for land creation.
Stigma and Pain in Adolescents Hospitalized for Sickle Cell Vasoocclusive Pain Episodes.

Objectives Sickle cell disease (SCD) pain and hospitalizations increase during adolescence and adolescents with SCD may be at-risk for experiencing health-related stigma, which may result in poor health outcomes. This study examined relations among health-related stigma, pain interference, social support, quality of life (QOL), and hospital outcomes (ie, loneliness, pain reduction, and length of stay [LOS]) in adolescents hospitalized with SCD pain. Materials and methods Twelve- to 18-year-old adolescents (N=92) hospitalized with SCD pain completed measures of stigma, pain interference, social support, QOL, and state loneliness. Reduction of pain intensity during hospitalization and LOS were collected from medical chart review. Results Higher stigma was associated with higher pain interference, lower QOL, more loneliness, and less pain reduction in the hospital. Pain interference was positively associated with LOS. Discussion These preliminary findings highlight the importance of assessing and addressing SCD-related stigma and pain interference in adolescents hospitalized for SCD pain as these factors may influence treatment outcomes.
Is hemodynamic transesophageal echocardiography needed for patients with left ventricular assist device

Abstract Background Interventions in patients with a left ventricular assist device (LVAD) in the intensive care unit (ICU) are typically performed based on the results of conventional monitoring, such as vital signs and Swan–Ganz catheter (SGC) and LVAD parameters. These variables might not always accurately reflect a patient's cardiac function, volume status, and interventricular septal configuration, however. To assess the accuracy of standard monitoring, we performed routine continuous hemodynamic transesophageal echocardiography (hTEE) to evaluate cardiac function, volume status, and septal position. Methods Between 2011 and 2015, 93 HeartMate II LVADs were implanted. The study group comprised 30 patients with an SGC in place who were monitored routinely by hTEE in the ICU every 1 to 3 hours until extubation. A total of 147 hTEE studies were analyzed retrospectively to observe differences between conventional monitoring and hTEE. Results Among the 30 patients studied, 26 (87%) had at least 1 disagreement between conventional monitoring and hTEE findings. In 22 patients (73%), at least 1 of the hTEE studies was abnormal whereas conventional parameters were normal. Abnormal hTEE findings included a shift in the interventricular septum in 19 patients (63%), abnormal ventricular volume status in 22 patients (73%), and right ventricular failure in 9 patients (30%). Based on conventional monitoring, none of the patients required an LVAD speed change, whereas hTEE showed that 14 patients (47%) needed an LVAD speed adjustment. Conclusions Conventional monitoring in the ICU might not provide an accurate representation of cardiac function, ventricular volume status, or septal position in patients with LVAD. Continuous monitoring with hTEE in patients with an LVAD may help guide optimal intervention in the ICU setting during the early postoperative period.
The history of education in Japan (1600–2000), edited by Masashi Tsujimoto and Yoko Yamasaki

I am Japanese. For half my life, I have lived in English-speaking countries and still live in one. How do I read and review The History of Education in Japan (1600–2000)? The book, in particular, e...
Process to Planet Approach to Sustainable Process Design: Multiple Objectives and Byproducts

While standard life cycle assessment methods exclude fundamental process engineering models in its analysis, sustainable process design (SPD) is plagued by the dilemma of boundary selection that results in consideration of incomplete life cycles and shifting of emissions outside the system boundary. The Process to Planet (P2P) framework bridges this gap by combining sustainable process design with environmentally extended input output analysis. This framework extending across multiple scales provides the capability of working with process variables and designing processes at the equipment scale while considering the entire life cycle through the supply chain and economic scale models. This work expands the P2P framework to account for byproducts originating from any unit within the model. The framework is further modified to incorporate an economic objective function, henceforth developing a multiobjective (MO) optimization problem for optimal design of any generic industrial process. The modified P2P framework is demonstrated by application to a corn ethanol manufacturing process case study. The MO problem is solved using the epsilon constraint method to obtain Pareto optimal frontiers that reveal the trade-off between environmental and economic dimensions of the sustainable process design problem. Comparison between commonly practiced conventional SPD and P2P SPD Pareto curves exposes the chance of choosing non optimal solutions if the former method is employed.
Increased synthesis of the phosphorylated form of the myosin light chains in cardiac hypertrophy in the rat.

The incorporation rate of [3H]leucine into cardiac myosin subunits was studied in rat hearts undergoing hypertrophy secondary to constriction of the ascending aorta. Cardiac myosin was prepared by a modified Shiverick’s method on the second and fourth day after constriction. Myosin light chains were separated by urea and subjected to two-dimensional electrophoresis. Incorporation of [3H]leucine was determined in electrophoretically separated heavy and light chains by the method of Martin et al. (11). It was found that the incorporation rate of [3H]leucine into the phosphorylated form of the myosin light chain 2 is significantly increased in hypertrophic hearts as compared to sham animals.
A Neuromechanical Rat Model with a Complete Set of Hind Limb Muscles

To accomplish many useful tasks, robots must be capable of navigating complex, dynamic environments. For this reason, robots often take inspiration from the adaptive responsiveness inherent to living organisms. Our existing model of rat neuromechanics [1] has provided insight into neuromuscular control structures that can generate quadruped locomotion. However, that model is limited by only using a single antagonistic muscle pair per hind limb joint. This work demonstrates a neuromuscular rat hind leg model of a complete muscle set with biologically derived attachment points as reported in the literature. The redundant nature of the muscle architecture provides new challenges for coordinating walking, including the need to account for synergistic muscle contractions. A linear decomposition of generalized muscle activation is applied to functional muscle groups responsible for actuating hind limb actuation. Functional group activation signals are then combined to recreate the generalized inputs previously determined to coordinate motion indicating a possible method of representing muscle synergy in the expanded model. This expanded hind limb model is fundamental to the analysis of three-dimensional motion as well as the impact of more sophisticated muscle synergy decompositions.
Technical note: Protocol for electrophoretic separation of bovine myosin heavy chain isoforms and comparison to immunohistochemistry analysis

Myosin heavy chain (MyHC) isoform composition is a primary determinant of contractile speed of muscle fibers. Currently, bovine MyHC isoforms are evaluated using time-consuming histochemical analysis by immunflourescence or ATPase activity. Electrophoretic separation of MyHC isoforms is more rapid; however, a reliable procedure without use of gradients has not been validated for cattle. Therefore, our objectives were to develop and validate a procedure for separating bovine MyHC isoforms (I, IIa, and IIx) using sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), and compare results to immunohistochemistry (IHC) analysis. Muscle samples were collected from masseter, sternomandibularis, diaphragm, longissimus lumborum, and cutaneous trunci within 1.5 h postmortem. To determine appropriate conditions for electrophoretic separation, several parameters of gel composition were varied. Bovine MyHC isoforms were clearly separated by increasing glycerol content of polyacrylamide gels to 37%. Identity of MyHC isoforms was confirmed using western blotting. Percent MyHC composition evaluated by gel electrophoresis was consistent with IHC (P > 0.2). Thus, SDS-PAGE produces clear separation of MyHC isoforms, and is a viable alternative to IHC-based methods.
Real-world Performance of Meta-analysis Methods for Double-Zero-Event Studies with Dichotomous Outcomes Using the Cochrane Database of Systematic Reviews.

Meta-analysis combines multiple independent studies, which can increase power and provide better estimates. However, it is unclear how best to deal with studies with zero events; such studies are also known as double-zero-event studies (DZS). Several statistical methods have been proposed, but the agreement among different approaches has not been systematically assessed using real-world published systematic reviews. The agreement of five commonly used methods (i.e., the inverse-variance, Mantel–Haenszel, Peto, Bayesian, and exact methods) was assessed using the Cohen’s κ coefficients using 368 meta-analyses with rare events selected from the Cochrane Database of Systematic Reviews. Three continuity corrections, including the correction of a constant 0.5, the treatment arm continuity correction (TACC), and the empirical (EMP) correction, were used to handle DZS when applying inverse-variance and Mantel–Haenszel methods. When the proportion of DZS studies was lower than 50% in a meta-analysis, different methods had moderately high agreement. However, when this proportion was increased to be over 50%, the agreement among the methods decreased to different extents. For the Bayesian, exact, and Peto methods and the inverse-variance and Mantel–Haenszel methods using the EMP correction, their agreement coefficients with the inverse-variance and Mantel–Haenszel methods using a constant 0.5 and TACC decreased from larger than 0.70 to smaller than 0.30. In contrast, the agreement coefficients only decreased slightly among the Bayesian, exact, and Peto methods and the inverse-variance and Mantel–Haenszel methods using the EMP correction. To utilize all available information and reduce research waste and avoid overestimating the effect, meta-analysts should incorporate DZS, rather than simply removing them. The Peto and other conventional methods with continuity correction should be avoided when the proportion of DZS is extremely high. The exact and Bayesian methods are highly recommended, except when none of the included studies have an event in one or both treatment arms.
1725 Dual-Opioid Post-Operative Prescription Model in Gynecologic Surgery – A Pilot Study

Study Objective Determine if providing two opioid prescriptions postoperatively is an effective strategy to decrease total number of opioids obtained. Design Retrospective descriptive study. Setting Tertiary care academic institution. Patients or Participants Thirty-nine patients undergoing gynecologic surgery. Interventions Two oral narcotic prescriptions were provided post-operatively. Patients were instructed to initially fill the first prescription with 10 pills. If the patient continued to have opioid requirement for pain control, she was instructed to fill the second prescription with an additional 20 pills. Opioids obtained within 6 weeks post-operatively were confirmed utilizing the Arizona Board of Pharmacy Controlled Substance Monitoring Program. Measurements and Main Results Thirty-nine patients underwent gynecologic surgery via laparoscopy or robotics (N=26), laparotomy (N=3), or vaginal routes (N=10). In the post-operative period, 24 patients (61.5%) filled only 10 pills and 15 patients (38.4%) filled the additional 20 pills (CI 44.62%-76.64% p-value 0.15). Patients filling only one prescription versus two prescriptions were not affected by age (49.6 years vs. 43.2 years, p-value 0.193), BMI (26.9 kg/m2 vs. 29.3 kg/m2 p-value 0.157), history of chronic pain (25% vs. 46.7%, p-value 0.163), smoking history (never smokers 66.7% vs. 66.7%, p-value 0.713), or post-operative IV narcotic use (morphine milligram equivalents) prior to discharge (23.3 mg vs. 31.2 mg p-value 0.187). There were no pain related post-operative clinic visits. Conclusion Providing dual narcotic prescriptions after gynecologic surgery can decrease the number of opioids obtained by patients postoperatively. Patient characteristics cannot be used to predict who fills the second prescription. This strategy was not associated with pain related post-operative visits.
The synthesis characterization of historical novel azo pigments: implications for conservation science

A series of synthetic organic pigments (SOP’s) with azo-containing linkages have been synthesized and characterized by Fourier transform infrared (FTIR) and Raman spectroscopies and laser desorption ionization mass spectrometry (LDI-MS). These pigments include representatives of the chemical classes arylide (Hansa) yellow, diarylide yellow and oranges, and Naphthol AS. Certain of these (PR7, PR10, PR11, PR18, PR19, PO14, PO15, PO16, PY49, PY98, PY106, PY113, PY124, PY203) are historical pigments, that is they were manufactured but subsequently were removed from production. Of these, some have been brought back into limited production. In addition to the above-mentioned pigments, 18 products of azo-linkage reactions formed between N,N′-bis(acetoacetyl)-o-toluidine and substituted anilines have been synthesized and characterized by the methods listed above as well as by visible reflectance spectroscopy. While not commercially available azo pigments, these colorants will serve as model systems to study substituent effects on pigment color.
Associations Between Premarital Factors and First-Married, Heterosexual Newlywed Couples’ Frequency of Sex and Sexual Satisfaction Trajectories

Sex is a defining feature of marriage with important implications for marital success. Nevertheless, frequency and quality of sex decline across the early years of marriage. Given many modern-day couples in the U.S. are delaying marriage and thus experiencing many traditional aspects of marriage before their nuptials, the current research explored the extent to which premarital factors such as courtship duration, cohabitation, and children are associated with trajectories of couples' sexual relationships during the early years of marriage. Using a 4-year longitudinal study of newlywed couples, results demonstrated that couples with longer (versus shorter) courtships or who did (versus did not) cohabit engaged in less frequent sex at the start of marriage; interestingly, couples with longer (versus shorter) courtships or with (versus without) children prior to marriage experienced less steep declines in frequency of sex over time. Couples who did (versus did not) cohabit were less sexually satisfied initially and over time; couples with longer (versus shorter) courtships experienced less steep declines in sexual satisfaction over time. Notably, each of these associations emerged independent of related individual differences and marital quality. These findings highlight the notion that premarital factors can explain, at least in part, differences in newlywed couples' sexual relationships.
Efficacy of adding activity of daily living simulation training to traditional pulmonary rehabilitation on dyspnea and health-related quality-of-life.

Introduction Exercise modalities offered as part of traditional pulmonary rehabilitation (PR) do not always translate to successful performance of Activities of Daily Living (ADL) and may hinder gains in patient's sense of well-being. Data is lacking on the efficacy of incorporation of ADL-focused training in PR. The aim of this study was to determine the impact of incorporation of ADL simulation and energy-conservation training in PR as part of a quality-initiative on health-related-quality-of-life (HRQOL), dyspnea, fatigue, and six-minute-walk-test among PR patients. Methods Retrospective study where medical records of consecutive patients with chronic respiratory diseases who completed PR from 2016 to 2018 were reviewed. ADL-focused energy-conservation training was added to traditional PR in September 2017 by replacing three monthly sessions of traditional PR with energy-conservation training as a quality-improvement-initiative. The change from baseline on HRQOL measured by COPD assessment test (CAT), six-minute-walk-test, MMRC dyspnea score and CRQ-dyspnea and CRQ-fatigue questionnaires, were compared between patients who received traditional PR versus energy-conservation PR. Within and between group differences were calculated via repeated-measures ANOVA. Results The baseline characteristics of 91 patients who participated in traditional PR versus energy-conservation PR (n = 85) were similar (mean age = 68.6±10.4 years, 49% men). While improvement from baseline was similar and significant for both groups for MMRC, CRQ-dyspnea and CRQ-fatigue scores, and six-minute walk test, patients who participated in energy-conservation PR had significantly higher improvement in HRQOL CAT scores (p = 0.01) than those who completed traditional PR. Conclusion Tailoring patient's training programs to include energy-conservation training exercises specific to ADL in PR improved HRQOL over traditional PR in patients with chronic respiratory diseases despite no significant change in functional status. Future randomized-controlled trials will be needed to confirm these initial findings.
Targeted Metagenomics Offers Insights into Potential Tick-Borne Pathogens.

Tickborne disease pathogen identification remains a diagnostic challenge due to the multiple tests necessary for diagnosis. Targeted metagenomic sequencing is an evolving method to detect multiple different pathogens with a single test. In this issue of the Journal of Clinical Microbiology, L. Kingry, S. Sheldon, S. Oatman, B. Pritt, et al. (J Clin Microbiol 58:e00147-20, 2020, https://doi.org/10.1128/JCM.00147-20) explore 16S rRNA gene targeted metagenomics to identify bacterial pathogens in 881 of more than 13,000 specimens submitted for tickborne pathogen testing, giving new insights into suspected tickborne pathogens.
The Ethics and Politics of Microaffirmations

The role of microaggressions has gained increasing philosophical attention in recent years. However, microaggressions only tell part of the story. An often-overlooked component of inequality is the uneven and unjust distribution of microaffirmations. In this paper, I give a new definition of microaffirmations as signals that a recipient belongs to some valued or high-status class. Microaffirmations can—but need not—lead individuals to gain a sense of confidence, belonging, and merit. I then explain the harms of microaffirmations, arguing that when microaffirmations are distributed inequitably, they can have larger ramifications for injustice, harming some vulnerable groups more than others. In addition, microaffirmations can lead individual actors to make choices based on who gives them microaffirmations and where they receive them, and thus can have outsized influence over the direction of an individual’s life because individuals tend to migrate to where they feel valued, appreciated, and included. I then turn to solutions to the problems I raise. I argue we should attend to and attempt to rectify inequalities in microaffirmations because doing so can help ensure not just the absence of negative attention, but also that the presence of positive attention is flowing in a just and equitable way.
Prediction of Skin Sensitization Potential of Silver and Zinc Oxide Nanoparticles Through the Human Cell Line Activation Test

The development of nanotechnology has propagated the use of nanoparticles (NPs) in various fields including industry, agriculture, engineering, cosmetics, or medicine. The use of nanoparticles in cosmetics and dermal-based products is increasing owing to their higher surface area and unique physiochemical properties. Silver (Ag) NPs’ excellent broad-spectrum antibacterial property and zinc oxide (ZnO) NPs’ ability to confer better ultraviolet (UV) protection has led to their maximal use in cosmetics and dermal products. While the consideration for use of nanoparticles is increasing, concerns have been raised regarding their potential negative impacts. Although used in various dermal products, Ag and ZnO NPs’ skin sensitization (SS) potential has not been well investigated using in vitro alternative test methods. The human Cell Line Activation Test (h-CLAT) that evaluates the ability of chemicals to upregulate the expression of CD86 and CD54 in THP-1 cell line was used to assess the skin sensitizing potential of these NPs. The h-CLAT assay was conducted following OECD TG 442E. NPs inducing relative fluorescence intensity of CD86 ≥ 150% and/or CD54 ≥ 200% in at least two out of three independent runs were predicted to be positive. Thus, Ag (20 nm, 50 nm, and 80 nm) NPs and ZnO NPs were all predicted to be positive in terms of SS possibility using the h-CLAT prediction model. Although further confirmatory tests addressing other key events (KEs) of SS adverse outcome pathway (AOP) should be carried out, this study gave an insight into the need for cautious use of Ag and ZnO NPs based skincare or dermal products owing to their probable skin sensitizing potency.
A Prospective US National Trauma Center Study of Firearm Injury Survivors Weapon Carriage and Posttraumatic Stress Disorder Symptoms.

OBJECTIVE To describe the demographic, injury-related, and mental health characteristics of firearm injury patients and trace firearm weapon carriage and PTSD symptoms over the year after injury. SUMMARY AND BACKGROUND DATA Based on the increasing incidence of firearm injury and need for novel injury prevention strategies, hospital-based violence intervention programs are being implemented in US trauma centers. There is limited data on the long-term outcomes and risk behaviors of firearm injury survivors to guide this work. METHODS We conducted a secondary analysis of a pragmatic 25-trauma center randomized trial (N = 635). Baseline characteristics of firearm-injured patients (N = 128) were compared with other trauma patients. Mixed model regression was used to identify risk factors for postinjury firearm weapon carriage and PTSD symptoms. RESULTS Firearm injury patients were younger and more likely to be black, male and of lower socioeconomic status, and more likely to carry a firearm in the year before injury. Relative to preinjury, there was a significant drop in firearm weapon carriage at 3- and 6-months postinjury, followed by a return to preinjury levels at 12-months. Firearm injury was significantly and independently associated with an increased risk of postinjury firearm weapon carriage [relative risk = 2.08, 95% confidence interval (1.34, 3.22), P < 0.01] and higher PTSD symptom levels [Beta = 3.82, 95% confidence interval (1.29, 6.35), P < 0.01]. CONCLUSIONS Firearm injury survivors are at risk for firearm carriage and high PTSD symptom levels postinjury. The significant decrease in the high-risk behavior of firearm weapon carriage at 3-6 months postinjury suggests that there is an important postinjury "teachable moment" that should be targeted with preventive interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT02655354.
HBV Genotype: A Significant Risk Factor in Determining Which Patients With Chronic HBV Infection Should Undergo Surveillance for HCC: The Hepatitis B Alaska Study.

BACKGROUND AND AIMS Information is limited regarding HBV genotype and the outcome of chronic HBV (CHB) infection. We examined the effect of HBV genotype on HCC occurrence in Alaska Native (AN) persons with CHB, where five HBV genotypes are found: A2, B6, C2, D, and F1. APPROACH AND RESULTS We calculated HCC incidence per 1,000 person-years of follow-up to determine which groups by age, sex, and genotype met current American Association for the Study of Liver Diseases (AASLD) HCC surveillance criteria. We used Poisson regression to compare HCC risk by genotype, age, sex, and Alaska region. Incidence of HCC was calculated using the sex-specific AASLD cutoff recommended for the Asian population of 50 years for women and 40 years for men. HCC screening was conducted semiannually using alpha-fetoprotein levels and abdominal ultrasound. Among 1,185 AN persons, median follow-up was 35.1 years; 667 (63%) were male. The HBV genotype distribution was 49% D, 18% F, 13% A, 6% C, 3% B, 0.1% H, and 12% undetermined. Sixty-three cases of HCC occurred. HCC incidence for genotype F was 5.73 per 1,000 person-years of follow-up, followed by 4.77 for C, 1.28 for A, 0.47 for D, and 0.00 for B. The HCC risk was higher for genotypes F (relative rate [RR], 12.7; 95% CI, 6.1-26.4), C (RR, 10.6; 95% CI, 4.3-26.0), and A (RR, 2.9; 95% CI, 1.0-8.0) compared to genotypes B and D. Among men < 40 years of age and women < 50 years of age, genotype F had the highest incidence (4.79/1,000 person-years). CONCLUSIONS HBV genotype was strongly associated with HCC. HBV genotype should be considered in risk factor stratification.
Foreseeable Police Shootings

Though officer-involved shootings are common, shooting victims rarely prevail in civil rights actions. The Supreme Court has ruled for officers who shoot in an ever-expanding set of circumstances. Jennifer and Angel Mendez were asleep on a futon when Los Angeles County Sheriff’s deputies searching for a wanted parolee entered their home and fired fifteen rounds, causing severe injuries. But the Mendezes’ civil rights action did not result in an officer-friendly outcome. They obtained a $4-million damages award. Following a Supreme Court remand, the Ninth Circuit held that when officers entered their home “armed and on alert,” without a warrant, consent, or other justification, the shooting that followed was foreseeable. The Fourth Amendment’s protection against unreasonable home entries is, under circumstances like the entry in Mendez, a clearly established right. This essay updates Los Angeles v. Mendez: Proximate Cause Promise for Police Shooting Victims. Following this introduction, Part II summarizes the Ninth Circuit’s opinion on remand, and describes how lower courts have applied it. Part III considers how Mendez might impact future civil rights actions arising out shootings in an individual’s home or curtilage. In this context, it examines the tragic shooting of Stephon Clark and the foreseeable consequences of Sacramento police officers’ entry into Clark’s driveway and backyard.
A unique case of Miller Fisher-Guillain-Barré overlap syndrome in a liver transplant recipient.

Guillain-Barre syndrome (GBS) is an ascending demyelinating polyneuropathy often associated with recent infection. Miller Fisher syndrome represents a variant with predominant facial and cranial nerve involvement, although Miller Fisher and Guillain-Barre overlap syndromes can occur. Guillain-Barre spectrum syndromes have been thought to be rare among solid organ transplant recipients. We describe an immunocompromised patient with a liver transplant who presented with ophthalmoplegia and bulbar deficits. His symptoms rapidly progressed to a state of descending paralysis involving the diaphragm; he then developed acute respiratory failure and eventually developed quadriparesis. Electromyography and a nerve conduction study demonstrated a severe sensorimotor axonal polyneuropathy consistent with Miller Fisher variant Guillain-Barre syndrome. Despite several negative nasopharyngeal swabs for COVID-19 polymerase chain reaction, a serology for SARS-CoV-2 IgG was positive. He was diagnosed with Miller Fisher-Guillain-Barre overlap syndrome with rapid recovery following treatment with plasma exchange. Although Guillain-Barre is a rare complication in solid organ transplant recipients, this case highlights the importance of rapid diagnosis and treatment of neurologic complications in transplant patients. Furthermore, it demonstrates a possible case of neurological complications from COVID-19 infection.
Successful supportive encounters from the peer supporter's perspective: Do status similarities to support recipients matter?

Experientially similar others, or "peer supporters," are persons who have faced a support recipient's stressor before. Theory suggests that peer supporters' understanding of and empathy for support recipients will be heightened when they match recipients not only in stressor experience but on one or more social statuses (e.g., age, education). Thus, peer-support volunteers may perceive supportive encounters as more successful when participants' statuses match. To explore this, volunteer Mended Hearts Visitors (former heart patients who visit currently hospitalized cardiac patients and their family members) were interviewed in-depth (N = 84). Visitors more often perceived same age and gender, but not same race and education, as enhancing rapport and patients' receptivity to their help. The findings suggest statuses which are culturally relevant to a shared stressor (here, cardiac surgery) can boost supporters' effectiveness, with practical implications for peer support-giving organizations that bring together experiential peers with recipients in pairs or small groups.
Some Economics of Labor Law

The law governing employment is of vast compass. Among the subjects it embraces are racial and sexual discrimination in employment, the liability of an employer ("master") for the torts of his employees ("servants"), the regulation of occupational health and safety, employees' rights under the pension-regulation law (ERISA), the emerging tort of wrongful discharge of an employee at will, and much else besides. But, to lawyers anyway, the most important subject in the law of employment, as measured by the number of cases, the density of legal doctrine, and other measures of legal activity, remains-even in a period of union decline-the regulation by the National Labor Relations Board of the process by which unions seek to bargain collectively on behalf of workers.1 This regulation is conducted under the authority of the National Labor Relations Act,2 which is the Wagner Act of 1935,3 as amended, principally by the Taft-Hartley Act of 1947.4 When I use the term "labor law" in this paper, I shall, unless otherwise indicated, be referring to this regulatory scheme, even though properly speaking it is just a part of a much larger field. Whether defined broadly or, as I am doing, narrowly, labor law is as natural a field for the application of economics to law as one could imagine. It regulates explicit markets that have been a subject of continuous and fruitful economic study since Adam Smith's
Spinocerebellar Ataxia 1 (SCA1)

Publisher Summary This chapter provides an overview of Spinocerebellar ataxia type 1 (SCAl). SCAl is an autosomal dominant neurodegenerative disease typically with mid-life onset characterized by motor symptoms in the absence of cognitive deficits. SCAl is a member of an intriguing group of neurodegnerative disorders known as the polyglutamine diseases. At the present, nine diseases are shown to result from expansion of CAG repeats coding for polyglutamine tracts in the respective proteins. These disorders include spinobulbar muscular atrophy (SBMA), Huntington's disease (HD), spinocerebellar ataxias, and dentatorubropallidoluysian atrophy (DRPLA).Expansion of the polyglutamine tract in the SCAl encoded protein, ataxin-1, results in an alteration in its folding. A key aspect of SCAl pathogenesis is localization of mutant ataxin-1 to the nucleus.
No Mere Anarchy

Quantum tunneling through a potential barrier is a well-understood phenonmenon that, for example, explains hydrogen tunneling in chemical reactions. Add a time dependence, however, and things become more murky, as [Habib][1] explains in his Perspective. He highlights the report by [ Steck et al .][2], who have gone one step further and have studied quantum dynamics in a classically chaotic system. Their observations provide experimental proof of chaos-assisted tunneling. [1]: http://www.sciencemag.org/cgi/content/full/293/5528/221 [2]: http://www.sciencemag.org/cgi/content/short/293/5528/274