cssi/SciSciGPT-SciSciNet huggingface dataset:
Frequency and cause of readmissions following pediatric otolaryngologic surgery.

Objectives/Hypothesis To characterize the frequency and nature of readmissions to free standing pediatric hospitals after otolaryngologic procedures. Study Design Retrospective national database analysis. Methods Using the Pediatric Health Information Systems database, we examined 30-day inpatient readmissions in children less than 18 years old who underwent otolaryngology procedures between January 1, 2009, and December 31, 2011. Univariate and multivariate logistic regression analyses accounting for correlated structure of the data identified factors related to readmission rate. Reasons for readmission and the postoperative day at which readmission occurred were also examined. Results In the 24-month study period, a total of 493,507 procedures were performed, resulting in 11,574 (2.3%) 30-day readmissions. Readmission rates varied significantly based on the type of procedure, patient age, and presence of chronic medical condition(s). Direct surgical complications accounted for 3,432 (29.7%) of all readmissions; and 4,729 (40.9%) of all readmissions occurred following tonsil and adenoid surgery. Conclusion Readmissions after pediatric otolaryngologic surgery are relatively uncommon. These readmission rates vary directly with the type of procedure performed, as well as patient level factors (i.e., patient age, ethnicity, and the presence of other medical comorbidities). These data demonstrate that if readmission rates are to be used as a quality measure in pediatric otolaryngology procedures, complex risk adjustment of patient level variables will be necessary to accurately compare outcomes between different hospitals. Level of Evidence 2c. Laryngoscope, 2015
Continuous time stopping games with monotone reward structures

We prove the existence of a Nash equilibrium for a class of continuous time stopping games when certain monotonicity conditions are satisfied.
Characterization of the electrophile binding site and substrate binding mode of the 26-kDa glutathione S-transferase from Schistosoma japonicum.

The 26-kDa glutathione S-trans- ferase fromSchistosoma japonicum(Sj26GST), a helminth worm that causes schistosomiasis, cata- lyzes the conjugation of glutathione with toxic sec- ondary products of membrane lipid peroxidation. Crystal structures of Sj26GST in complex with gluta- thione sulfonate (Sj26GSTSLF), S-hexyl glutathione (Sj26GSTHEX), and S-2-iodobenzyl glutathione (Sj26GSTIBZ) allow characterization of the electro- phile binding site (H site) of Sj26GST. The S-hexyl and S-2-iodobenzyl moieties of these product ana- logs bind in a pocket defined by side-chains from the !1-"1 loop (Tyr7, Trp8, Ile10, Gly12, Leu13), helix"4 (Arg103, Tyr104, Ser107, Tyr111), and the C-terminal coil (Gln204, Gly205, Trp206, Gln207). Changes in the Ser107 and Gln204 dihedral angles make the H site more hydrophobic in the Sj26GSTHEX complex relative to the ligand-free structure. These struc- tures, together with docking studies, indicate a possible binding mode of Sj26GST to its physiologic substrates 4-hydroxynon-2-enal (4HNE),trans-non- 2-enal (NE), and ethacrynic acid (EA). In this bind- ing mode, hydrogen bonds of Tyr111 and Gln207 to the carbonyl oxygen atoms of 4HNE, NE, and EA could orient the substrates and enhance their elec- trophilicity to promote conjugation with gluta- thione. Proteins 2003;51:137-146.
Annealing of Cold Worked Hypostoichiometric Ni3Al Alloys Using Positron Lifetime Spectroscopy

Hypostoichiometric Ni/sub 3/Al alloys of composition 76.2 Ni:23.8 Al containing impurity levels of boron and hafnium were either cold rolled or pressed. Rolled and pressed samples were deformed by 20% and 10% thickness reductions, respectively. Samples were annealed isochronally at approximately 50/sup 0/C intervals up to 1050/sup 0/C. Two major annealing stages were apparent in all three alloys studied. These could be attributed to vacancy migration to sinks and annealing of dislocations and(or) recrystallization. The onset of vacancy migration occurred at approximately 200/sup 0/C in all three alloys. Annealing of dislocations started at 650/sup 0/C to 700/sup 0/C and was complete at 1000/sup 0/C for alloys which contained boron and or hafnium impurities. In the pure alloy the onset of dislocation annealing occurred at 800/sup 0/C and was incomplete at the highest (1050/sup 0/C) annealing temperatures reached.
Thermomechanical Behavior of Refractory Concrete Linings

A numerical analysis model was developed for predicting the behavior of dual-component, refractory-lined coal-gasification vessels. The temperature-dependent constitutive law, failure criteria, creep behavior, thermal expansion contraction behavior, and shrinkage characteristics of refractory concrete were formulated. To verify the proposed model, a three-dimensional simulation analysis was made of an experimental gasifier vessel. The model was then used to study parameters on a circular, dual-component, refractory concrete-lined coal-gasification vessel. The effects of shrinkage, creep, temperature distributions, vessel shell temperatures, bond barriers and anchor spacing, size, and shape on the performance of the gasifier vessel were studied. Design recommendations are made to aid in improving the mechanical reliability of refractory concrete-lined coal-gasification vessels.
ERROR PROPAGATION IN A FOREST SUCCESSION MODEL:THE ROLE OF FINE-SCALE HETEROGENEITY IN LIGHT

A central challenge in ecology is understanding the emergence of broad-scale community and ecosystem patterns as the result of interactions among individuals. We identify the role of fine-scale light heterogeneity in controlling broad-scale community behavior in SORTIE, an empirically derived, stochastic forest simulation model. SORTIE employs a very detailed measure of local light based on a 216-point sample around every tree. We test the importance of this fine-scale description of local light by reformulating SORTIE with less detail in this algorithm. Predicted forests are compared at several scales from total tree biomass (coarse grained) and patterns of forest succession to the local spatial pattern of light availability at the forest floor (fine grained). SORTIE is surprisingly insensitive to the amount of detail used in the calculation of the local resource, light. In all simulations, 48- and 16-point samples accurately reproduce the local light environment and thus predict forest development without appreciable error. A one-point sample of light significantly alters the estimates of the local light environment, but the emergent forest dynamics are insensitive to these alterations. The robustness of the forest model to the altered light environment stems from two very different mechanisms. First, the alterations of the light environment have very short correlation lengths in time and space. This allows fine-scale averaging to occur on the landscape. Second, the functional relationships among light availability, growth rate, and mortality risk in several key species tend to prevent the altered light environment from affecting individual tree performance. These results demonstrate that emergent forest dynamics in SORTIE do not require detailed local light estimation to capture the interaction between local resource heterogeneity and the functional responses of trees. In addition, we have shown that comparing model predictions at several scales provides a strong methodology to identify relevant detail and understand scaling in this model of a forest.
Treatment and Survival Trends in Glottic Carcinoma in Situ and Stage I Cancer From 1988 to 2012

Objective:To identify trends in treatment and survival for patients with stage I glottic cancer and glottic carcinoma in situ (CIS).Methods:The 18-registry SEER data were analyzed for CIS and stage...
Influence of IgG Subclass on Human Antimannan Antibody-Mediated Resistance to Hematogenously Disseminated Candidiasis in Mice

Candida albicans is a yeast-like pathogen and can cause life-threatening systemic candidiasis. Its cell surface is enriched with mannan that is resistant to complement activation. Previously, we developed the recombinant human IgG1 antimannan antibody M1g1. M1g1 was found to promote complement activation and phagocytosis and protect mice from systemic candidiasis. Here, we evaluate the influence of IgG subclass on antimannan antibody-mediated protection. Three IgG subclass variants of M1g1 were constructed: M1g2, M1g3, and M1g4. The IgG subclass identity for each variant was confirmed with DNA sequence and subclass-specific antibodies. These variants contain identical M1 Fabs and exhibited similar binding affinities for C. albicans yeast and purified mannan. Yeast cells and hyphae recovered from the kidney of antibody-treated mice with systemic candidiasis showed uniform binding of each variant, indicating constitutive expression of the M1 epitope and antibody opsonization in the kidney. All variants promoted deposition of both murine and human C3 onto the yeast cell surface, with M1g4 showing delayed activation, as determined by flow cytometry and immunofluorescence microscopy. M1g4-mediated complement activation was found to be associated with its M1 Fab that activates the alternative pathway in an Fc-independent manner. Treatment with each subclass variant extended the survival of mice with systemic candidiasis (P < 0.001). However, treatment with M1g1, M1g3, or M1g4, but not with M1g2, also reduced the kidney fungal burden (P < 0.001). Thus, the role of human antimannan antibody in host resistance to systemic candidiasis is influenced by its IgG subclass.
Dental School Applicants by State Compared to Population and Dentist Workforce Distribution

Millions of Americans face significant barriers that limit their access to oral health care, including the lack of dental health care professionals willing to provide dental services in underserved areas. The purpose of this study was to evaluate the relationship between the geographic distribution of dental school applicants and the population and number of dentists by state. Data from the Associated American Dental Schools Application Service (AADSAS), the American Dental Association (ADA), the U.S. Census Bureau, and the U.S. Department of Commerce were used to determine the total number of dental school applicants, dentists, and populations by individual state. Results suggest that, based on national averages, the majority of states may have too few dentists to meet current and future state population needs. Also, many of these same states may have too few dental school applicants when compared to state population and dental workforce figures. It was concluded that states may wish to consider targeted initiatives aimed at increasing the sizes of their dental school applicant pools in order to help address current and future local or regional dental workforce needs.
An efficient computational method for total variation-penalized Poisson likelihood estimation

Approximating non-Gaussian noise processes with Gaussian models is standard in data analysis. This is due in large part to the fact that Gaussian models yield parameter estimation problems of least squares form, which have been extensively studied both from the theoretical and computational points of view. In image processing applications, for example, data is often collected by a CCD camera, in which case the noise is a Guassian/Poisson mixture with the Poisson noise dominating for a sufficiently strong signal. Even so, the standard approach in such cases is to use a Gaussian approximation that leads to a negative-log likelihood function of weighted least squares type. In the Bayesian point-of-view taken in this paper, a negative-log prior (or regularization) function is added to the negative-log likelihood function, and the resulting function is minimized. We focus on the case where the negative-log prior is the well-known total variation function and give a statistical interpretation. Regardless of whether the least squares or Poisson negative-log likelihood is used, the total variation term yields a minimization problem that is computationally challenging. The primary result of this work is the efficient computational method that is presented for the solution of such problems, together with its convergence analysis. With the computational method in hand, we then perform experiments that indicate that the Poisson negative-log likelihood yields a more computationally efficient method than does the use of the least squares function. We also present results that indicate that this may even be the case when the data noise is i.i.d. Gaussian, suggesting that regardless of noise statistics, using the Poisson negative-log likelihood can yield a more computationally tractable problem when total variation regularization is used.
Sacral osteomyelitis after laparoscopic sacral colpopexy performed after a recent dental extraction: a case report.

BACKGROUND: Sacral osteomyelitis and subsequent discitis is a rare complication after laparoscopic sacral colpopexy to repair apical vaginal prolapse. CASE: We present a patient who developed Bacteroides fragilis sacral osteomyelitis and discitis after laparoscopic sacrocolpopexy with synthetic monofilament mesh and sacral titanium coil fixation. The patient had undergone dental extraction of 3 infected teeth approximately 2 weeks before sacrocolpopexy for stage IV apical vaginal prolapse. Computed tomography and magnetic resonance imaging (MRI) confirmed sacral osteomyelitis and discitis along with Bacteroides fragilis bacteremia approximately a week and a half after the original surgery. The patient was followed up with serial MRIs of the spine which revealed degeneration at the sacral promontory. The patient underwent successful removal of the entire mesh and sacral titanium coils with resolution of her symptoms. Follow-up MRI of the spine revealed resolution of her sacral osteomyelitis. CONCLUSIONS: Sacral osteomyelitis is a rare complication after sacrocolpopexy for pelvic organ prolapse repair. There should be a high index of suspicion for patients presenting with disproportionate low back pain and vague symptoms after surgery. Recent oral surgery may increase the risk of bacteremia and subsequent infectious morbidity after sacrocolpopexy with the use of synthetic mesh for prolapse repair.
Thyroid function in human pregnancy: VIII. Retardation of progeny aged 7 years; relationships to maternal age and maternal thyroid function☆

Abstract Of 1,394 prenatal patients, 356 registered early and were euthyroid continuously with uncomplicated pregnancies and deliveries of single neonates weighing at least 2,500 grams; 131 others were hypothyroxinemic during uncomplicated pregnancies. For euthyroid mothers, 227 progeny, age 4, and 57, age 7 years, had standard psychological examinations of the Collaborative Study of the National Institute of Neurological Diseases and Stroke. At 4 years, 55 children born to girls age 15 to 17 and 33 children born to women over 35 had significantly lower mean Intelligence Quotients than 18 children born to mothers age 23 and 24. At 7 years, 19 children born to girls age 15 to 17 and 9 children born to women over 35 had significantly lower scores than 10 progeny of women age 25 to 34. Compared to progeny of euthyroid women, lower scores of 4-year-old children of hypothyroxinemic, untreated mothers have been described. At 7 years, 4 of 11 (36 per cent) progeny of hypothyroxinemic, untreated women scored in the dull normal range or below, compared to only 9 of 57 (16 per cent) of children of euthyroid mothers.
Chromatin structural analysis of the 5' end and contiguous flanking region of the myeloperoxidase gene

Myeloperoxidase (MPO) synthesis is known to be associated with the promyelocyte stage of myeloid differentiation. In particular the downregulation of MPO gene transcription is associated with myeloid cell maturation. We examined the changes in the deoxyribonuclease I hypersensitive sites within the 5′ end of the MPO gene and its 5′ flanking region during dimethyl sulfoxide (DMSO)-induced differentiation of HL-60 cells to determine the changes in chromatin structure that accompany this process. The locations of hypersensitive sites surrounding the 5′ end of the gene in proliferating, uninduced cells were determined: three were observed in the 5′ flanking region and one within the gene. Progressive changes in all sites accompanied the downregulation of MPO transcription after treatment with DMSO. No evidence of hypersensitivity was observed in the chromatin region examined after 8 days of DMSO exposure. The results provide an example of the changes that occur in the chromatin structure of a gene as it is inactivated during differentiation.
Evaluation of Direct Enrichment at Elevated Temperature for Recovery of Salmonellae from Oysters 1 .

A comparison of the recovery of salmonellae from naturally contaminated oysters was made by using either Lactose broth preenrichment at 35°C followed by selective enrichment in Tetrathionate and Selenite Cystine broths at 35, 41 and 43°C, or direct enrichment in Tetrathionate and Selenite Cystine broths with incubation at 35, 41 and 43°C. Direct enrichment in Selenite Cystine broth at both elevated temperatures produced the greatest number of positive samples. Similar results were obtained with artificially contaminated oyster samples (1 Salmonella /5 g of meat). Statistical analysis of the data showed that significantly higher recovery of salmonellae was obtained by using direct enrichment of samples in Selenite Cystine broth at the elevated temperature.
AZTEC: A Cloud-based Computational Platform to Integrate Biomedical Resources

Omics phenotyping has become increasingly recognizedin our path to Precision Medicine. A major computationalchallenge of our investigator community is to identify the necessarydata analytical tools to process multi-omics data. To aidnavigation of the analytical tools fragmented across the web, wehave created a novel computational resource platform, AZTEC,that empowers users to simultaneously search a diverse arrayof digital resources including databases, standalone software,web services, publications, and large libraries composed ofmany interrelated functions. AZTEC fosters an environment ofsustainable resource support and discovery, enabling researchersto overcome the challenges of information science. An online videoof the demonstration can be viewed at https://www.youtube.com/watch?v=FIxvlof6Kbg.
Should physicians tell the truth without taking social complications into account? A striking case

The principle of respect for autonomy requires informing patients adequately and appropriately about diagnoses, treatments, and prognoses. However, some clinical cases may cause ethical dilemmas regarding telling the truth. Under the existence especially of certain cultural, social, and religious circumstances, disclosing all the relevant information to all pertinent parties might create harmful effects. Even though the virtue of telling the truth is unquestionable, sometimes de facto conditions compel physicians to act paternalistically to protect the patient/patients from imminent dangers. This article, which aims to study the issue of whether a physician should always tell the truth, analyzes an interesting case that represents the detection of misattributed paternity during pre-transplant tests for a kidney transplant from the son to the father in Turkey, where social, cultural, and religious factors have considerable impact on marital infidelity. After analyzing the concept of telling the truth and its relationship with paternalism and two major ethical theories, consequentialism and deontology, it is concluded that the value of the integrity of life and survival overrides the value of telling the truth. For this reason, in the case of a high possibility of severe and imminent threats, withholding some information is ethically justifiable.
Analysis of Flow Migration in an Ultra-Compact Combustor

The Ultra Compact Combustor (UCC) has the potential to offer improved thrust-to-weight and overall efficiency in a turbojet engine. The thrust-to-weight improvement is due to a reduction in engine weight by shortening the combustor section through the use of the revolutionary UCC design. The improved efficiency is achieved by using an increased fuel-to-air mass ratio, and allowing the fuel to fully combust prior to exiting the UCC system. Furthermore, g-loaded combustion offers increased flame speeds that can lead to smaller combustion volumes. The circumferential combustion of the fuel in the UCC cavity results in hot gases present at the outside diameter of the core flow. This orientation creates an issue in that the flow from the circumferential cavity needs to migrate radially and blend with the core flow to present a uniform temperature distribution to the high-pressure turbine rotor. A computational fluid dynamics (CFD) analysis is presented for the flow patterns in the combustor section of a representative fighter-scale engine. The analysis included a study of secondary flows, cavity flow characteristics, shear layer interactions and mixing properties. An initial understanding of primary factors that impact the radial migration is presented. Computational comparisons were also made between an engine realistic condition and an ambient pressure rig environment.
Beyond Altruism and Self-interest: The Growing Importance of External Factors in the Determination of Remittances Flowing to Latin America

Remittances have become an important and reliable source of funds for many developing countries, affecting the well-being of its population and the performance of their economies. However, challeng...
How Should Biobanks Collect Biosamples for Clinical Application? A 20-year Biomarker-related Publication and Patent Trend Analysis

Objectives This study was designed to analyze biomarker-related publications and patent trends which biobanks could consider in planning biosample collections for biomarker research. Methods Publications and patents containing the term "biomarker" in the title published between 1998 to 2017 were retrieved using Scopus database and Google Patents search engine. Results Over the last 20 years there has been a steady increase in biomarker-related publications and patents; however this has slowed for patents over the last few years. Publications in 2017 that contained blood, serum, and plasma search terms in the abstract accounted for 50%, and serum as a search term in the title and abstract was more numerous than those containing blood, plasma, tissue, or urine. Blood-related patents were the most common patent in the last 10 years, and accounted for 110 patents in 2017. Biomarker-related publications since 2010 containing RNA and protein search terms in the title and abstract, were more numerous than those containing DNA and metabolite search terms. More than 27% of biomarker-related publications in 2017 and 21% of biomarker-related patents were associated with cancer. Conclusion The results of this study will help biobanks establish a biosample collection strategy for clinical application.
Attention Deficit Hyperactivity Disorder: Use of Evidence-Based Assessments and Interventions

Attention deficit hyperactivity disorder (ADHD) is a complex chronic neurocognitive disorder that impairs students’ academic, social, and behavioral functioning in school and home (e.g., Kent et al., 2011; Kessler et al., 2005). ADHD-related symptoms and high rates of comorbidity impact the teaching and learning process for children and pose unique challenges for practitioners, educators, and parents for assessment and intervention planning.
On-Line Control of Unit Operations

This chapter describes computer applications in the control of specific unit operations that make up any one stage of processing.
A Hyperlink-Based Recommender System Written in Sqeal.

1. ABSTRACT Human beings, not machines, are the ultimate experts for information retrieval tasks, including recommender systems. Consequently, computers are most useful when they combine information about people’s judgments. Collaborative filtering systems make use of this observation by having users explicitly rate items, such as Web pages, with the system making recommendations to other users based on overlapping areas of interest. A disadvantage of collaborative filtering, at least as currently implemented, is that it depends on users’ explicitly entering data, which can be inconvenient and time-consuming. We describe the design, implementation, and performance of a recommender system that works by mining publiclyavailable hyperlinks on the Web, producing results competitive with the best text-based system. We also demonstrate the utility of the Squeal language for structure-based Web queries.
Universal testing for hormonal status in breast cancer: Are we choosing wisely?

6583Background: Characterizing estrogen receptor (ER) and progesterone receptor (PR) status has long been standard practice with newly diagnosed breast cancers. ER and PR expression suggests a more...
Temperature Sensitive Mutations in Influenza A Viral Ribonucleoprotein Complex Responsible for the Attenuation of the Live Attenuated Influenza Vaccine

Live attenuated influenza vaccines (LAIV) have prevented morbidity and mortality associated with influenza viral infections for many years and represent the best therapeutic option to protect against influenza viral infections in humans. However, the development of LAIV has traditionally relied on empirical methods, such as the adaptation of viruses to replicate at low temperatures. These approaches require an extensive investment of time and resources before identifying potential vaccine candidates that can be safely implemented as LAIV to protect humans. In addition, the mechanism of attenuation of these vaccines is poorly understood in some cases. Importantly, LAIV are more efficacious than inactivated vaccines because their ability to mount efficient innate and adaptive humoral and cellular immune responses. Therefore, the design of potential LAIV based on known properties of viral proteins appears to be a highly appropriate option for the treatment of influenza viral infections. For that, the viral RNA synthesis machinery has been a research focus to identify key amino acid substitutions that can lead to viral attenuation and their use in safe, immunogenic, and protective LAIV. In this review, we discuss the potential to manipulate the influenza viral RNA-dependent RNA polymerase (RdRp) complex to generate attenuated forms of the virus that can be used as LAIV for the treatment of influenza viral infections, one of the current and most effective prophylactic options for the control of influenza in humans.
Design of Crystal-Oscillator Frequency Quadrupler for Low-Jitter Clock Multipliers

Implementation of low-noise power-efficient clock multipliers requires low-noise high-frequency reference clocks. This paper presents ways to generate such reference clocks at four times the frequency of a standard crystal oscillator (XO) output frequency. Using extensive digital correction techniques, a 216-MHz reference clock with an integrated jitter of 77 $\text {fs}_{\mathrm{ rms}}$ is generated from a 54-MHz Pierce XO. A ring oscillator-based injection locking clock multiplier driven by the proposed quadrupler is used to demonstrate the efficacy of the quadrupler. Fabricated in a 65-nm CMOS process, the proposed clock multiplier occupies an active area of 0.16 mm2 and achieves 366 $\text {fs}_{\mathrm{ rms}}$ integrated jitter at 4.752-GHz output frequency while consuming 6.5-mW power from a 1.0-V supply of which 1.5 mW is consumed in the quadrupler.
Election Interference: The Real Harm and The Only Solution

Foreign interference is a violation of the membership rules for political decision-making, that is, the idea that only members of a polity should participate in elections. Outsiders are free to express their opinions, but covertly representing themselves as insiders constitutes a violation of these political norms, which are constitutive of the notion of self-determination. The first section of the chapter briefly describes and analyzes Russia’s interference in the 2016 and 2018 U.S. elections. The second section focuses on the existing legal debate over election interference and why the existing literature has failed to capture its distinctive harm. Then, the third section outlines this harm as a violation of the membership rules for the election process, especially when outsiders masquerade as insiders in order to influence an election. The fourth section concludes that governments must ensure transparency in the deliberative process by exposing covert election interference in real time before the election is over. The fifth section addresses objections to this account.
The Impact of Non-state Security on Perceptions of State Legitimacy in South Africa

This chapter is the first empirical chapter. Using original survey data collected on hundreds of South African citizens, and original data from interviews with elected officials, civil society organizations, and police officers, Kushner explores the impact that non-state security reliance and South Africans’ broader experiences of victimization and insecurity have on their perceptions of state legitimacy. She finds that non-state security reliance strengthens perceptions of state legitimacy in some instances while undermining it in others. The finding critically hinges on how ordinary South Africans view the state’s responsibility and role in the provision of security.
The role of academic language in written composition in elementary and middle school

Academic language has been identified as an important focus for instructing students about the quality of written composition they need to be successful in college and career. However, the role of academic language in written composition achievement is not well understood. This study explores the role of academic language skills in students’ written composition outcomes. Measures of general academic language at the word, and sentence levels, as well as a reading comprehension measure that included academic text and a word recognition measure were administered to 1316 students in Grade 4 and 1302 students in Grade 8. Students’ skill with these four areas were compared to their pass rate on the state accountability test for written composition. Results from a series of general linear mixed models indicate that these four measures predict 65% of the variance in pass rates on a written composition assessment in Grade 4 and 86% in Grade 8. Academic language contributed a small amount of unique, but mostly common variance to distinguishing between proficient and non-proficient writers. Implications related to the unique and common contribution of academic language for improving writing outcomes are discussed.
Efficacy of dance-based paradigms, wearable sensors, and auditory feedback for gait retraining in children: A feasibility study.

Abstract Background Different feedback modes such as auditory, visual and haptic have been used in the past for gait retraining or learning movement patterns. The primary goal of this study was to investigate whether real time auditory feedback would be effective in children learning novel, dance-based movement patterns. For this purpose, a prototype wearable sensor was developed to provide auditory feedback whenever a child touches their heel to the ground. Methods To test the effectiveness of the auditory feedback in learning new patterns, typically developing children were taught simple Indian dance protocols consisting of four counts of foot-work which involved alternating heel-toe movements. The effect of wearing the sensor was assessed by the maximum vertical force with which the subjects struck their foot on the plate. Results Auditory feedback reduced the learning time and increased the number of correct movement patterns for trial duration of 2 min. The prototype device did not alter the maximum force with which the subject placed the foot on the ground. Conclusions Real time auditory feedback can be reliably used to learn novel movement patterns.
The role of the nucleus accumbens in learned approach behavior diminishes with training

Nucleus accumbens dopamine plays a key role in reward-directed approach. Past findings suggest that dopamine's role in the expression of learned behavior diminishes with extended training. However, little is known about the central substrates that mediate the shift to dopamine-independent reward approach. In the present study, rats approached and inserted the head into a reward compartment in response to a cue signaling food delivery. On days 4 and 5 of 28-trial-per-day sessions, D1 receptor antagonist R(+)-7-chloro-8-hydroxy-3-methyl-1-phenyl-2,3,4,5-tetrahydro-1H-3-benzazepine hydrochloride (SCH23390) infused to the NAc core reduced the probability and speed of cued approach. The disruptive effect of D1 receptor blockade was specific to the nucleus accumbens core and not seen with drug infusions to nearby dopamine target regions. In rats that received drug infusions after extended training (days 10 or 11), accumbens core D1 receptor blockade produced little effect on the expression of the same behavior. These results could have been due to a continued accumbens mediation of cued approach even after the behavior had become independent of accumbens D1 receptors. However, accumbens core ionotropic glutamate receptor blockade disrupted cued approach during early but not late stages of training, similar to the effects of D1 antagonist infusions. The results suggest that with extended training, a nucleus accumbens D1-dependent behavior becomes less dependent not only on nucleus accumbens D1 transmission but also on excitatory transmission in the nucleus accumbens. These findings fill an important gap in a growing literature on reorganization of striatal function over the course of training.
YouTube as a Source of Patient Information for Prenatal Repair of Myelomeningocele.

Objective With the increasing interest in fetal repair of myelomeningoceles (MMCs) over the last decade, it is reasonable to anticipate the need for high quality and accessible educational materials for patients. Patients often look to the internet for details regarding medical topics and specifically to YouTube for informative health-related videos. This study aims to analyze the content and shortcomings of currently available videos on YouTube regarding prenatal repair of MMCs. Study Design A YouTube search was performed on December 15, 2018, using the terms “fetoscopic surgery for neural tube defect” and “fetal surgery for neural tube defect.” The first 50 videos from each search were sorted by relevance and evaluated for video source (i.e., professional, personal, or other), target audience (medical professionals or general public), general descriptive statistics (i.e., video length, number of views, number of comments), and for five areas of content determined by the authors to constitute basic patient information regarding a surgical procedure: (1) procedure details, (2) eligibility criteria, (3) alternatives to surgery, (4) surgical risks, and (5) success rate. Accuracy of videos was not assessed. Results Of the 16 videos that met inclusion criteria, only 1 discussed fetoscopic surgery. The majority (62.5%) of videos were produced by a professional source and 81.3% were targeted toward the general public rather than medical professionals. Of the 16 videos, 10 (62.5%) included details regarding the surgery, 3 (18.8%) discussed eligibility criteria, and 8 (50.0%) mentioned alternatives to surgery. Additionally, seven videos (43.8%) discussed risks of the procedure and six (37.5%) included surgical success rate. Conclusion Only 2 of the 16 videos included all five areas of content that were evaluated, and both were in regard to open fetal repair. This study not only calls attention to the initial shortcomings of YouTube videos regarding fetal surgery for neural tube defects but also demonstrates the need for further investigation and more comprehensive analysis.
Repair of Superior Sinus Venosus Atrial Septal Defect Using a Modified Two-Patch Technique.

Background Surgical repair of superior sinus venosus atrial septal defect associated with partial anomalous pulmonary venous connection is usually performed with either a two-patch technique or the Warden procedure. However, both techniques can lead to superior vena cava or pulmonary vein stenosis, as well as sinus node dysfunction. To prevent these complications, we have utilized a modified two-patch technique. Methods Between January 2000 and December 2015, 44 patients underwent modified two-patch repair of superior sinus venosus atrial septal defect associated with partial anomalous pulmonary venous connection at our institution. The technique utilizes the right atrial appendage to patch the superior vena cava and avoid superior vena cava obstruction. Patients' data were collected from reviewing hospital charts and clinic records. Results Mean age was 10.3 years (range, 0.68 to 61 years). There was no hospital mortality. Six patients (13.6%) had sinus node dysfunction after surgery. All of them recovered their normal sinus node function at a mean follow-up period of 45.7 months. No superior vena cava or pulmonary vein stenosis was observed at long-term follow-up. Conclusions A modified two-patch technique is a valid alternative to other methods of superior sinus venosus atrial septal defect and partial anomalous pulmonary venous connection repair, and prevents late systemic/pulmonary venous pathway obstruction while maintaining sinus rhythm.
Healthy Transitions: A Quality Improvement Project of the down Syndrome Center of Western Pa to Create a Pathway to Adulthood

The transitional process is a fluid movement from a paradigm of pediatric to adult oriented care. As the life expectancy of people with Down syndrome extends, this creates a large population of adolescents moving into adulthood. Similar to other people with special needs, there are defined goals of transition that have been laid out by the AAP, ABIM and AAFP. The challenge is to implement these goals into an already established system of care. The purpose of this project was to create a transition program that operationalized this process …
Cognitive Software-Defined Radar: Evaluation of Target Detection with RFI Avoidance

Demand for access to the radio frequency (RF) spectrum is higher than ever, which has led to increasing spectral congestion. This circumstance has motivated research and development of systems that can share the RF spectrum efficiently. Systems that share the spectrum non-cooperatively may occasionally attempt to access the same frequency band at the same time. These “collisions” will cause mutual interference, which degrades the performance of both systems. While spectrum sharing techniques and systems are designed to minimize this interference, careful evaluation must be done to assess the performance of the systems sharing a given spectrum. Integration of radar signal processing with a software-defined radar system that employs reactive interference avoidance is done to evaluate the effect that interference avoidance has on radar target detection.
Experimental demonstration of pseudospin behavior and classical entanglement in a phononic structure (Conference Presentation)

We present experimental and theoretical demonstrations of quantum-like behavior in phononic structures. This demonstration extends the notion of classical “entanglement” or classical “nonseparability” to the emerging field of phononics, opens the door for acoustic analogues to true quantum system in quantum information processing, since the preparation and control of entangled superposition of states is an essential ingredient for harnessing the second quantum revolution.
A case of pediatric visceral leishmaniasis-related hemophagocytic lymphohistiocytosis diagnosed by mNGS

Abstract Background Visceral leishmaniasis-related hemophagocytic lymphohistiocytosis (VL-HLH) is a secondary hemophagocytic syndrome, which can be life-threatening, caused by leishmania and transmitted by infected sandflies. Rapid and accurate identification of leishmania is crucial for clinical strategies. Case report Here, we report an infantile infection in a non-epidemic area of China. The infant was a 9.5-month-old girl with fever, pancytopenia and hepatosplenomegaly, which meet the HLH-2004 standard, and the negative gene results exclude congenital HLH. However, chemotherapy is ineffective and is accompanied by severe infection. Fortunately, she is diagnosed with VL-HLH (visceral leishmaniasis-related hemophagocytic lymphohistiocytosis), as leishmania is detected by next-generation meta-genome sequencing (mNGS) and quickly relieved after treatment with libosomal amphotericin B (L-AMB). Conclusion mNGS can detect leishmania in pediatric HLH, and should be performed as a new detection for VL-HLH, particularly for infants, who may not respond to HLH-2004 regimen.
Right Place, Right Time: An Informal Memoir.

My career spanned the revolution in understanding of the large-scale fluid ocean, as modern electronics produced vast new capabilities. I started in the days of almost purely mechanical instruments...
Deep Learning to Refocus 3D Images

High-throughput volumetric fluorescence microscopic imaging remains an important challenge in biology, life sciences and engineering. Imaging 3D fluorescent samples usually involves scanning to acquire images at different focal planes, reducing imaging speed and increasing potential photodamage to the sample. As an alternative approach, we have created a deep-learning-based framework, Deep-Z, to digitally refocus 2D fluorescence microscopic images onto user-defined 3D surfaces.
Is Inhaled Therapy Better Than IV? Challenges of PVOD

Introduction Group 1 pulmonary hypertension (PH) includes pulmonary veno-occlusive disease (PVOD). Diagnosis & management of this rare disease poses multiple challenges. Here we present 2 patients who worsened on systemic vasodilators but responded to inhaled therapy. Case Report 76 year old female with sarcoidoisis was admitted with worsening hypoxia requiring high flow nasal cannula. Cardiac sarcoidosis was ruled out by PET-CT (Fig. B, C). Right heart catheterization (RHC) showed severe PH with a negative vasodilator response & normal capillary wedge pressure. PVOD was suspected given hypoxia out of proportion to PH & her CT findings (D, E). She was started on intravenous treprostinil but developed pulmonary edema with worsening V/Q mismatch (F). She was weaned off treprostinil & transitioned to inhaled epoprostenol. She was discharged on inhaled treprostinil only needing nasal cannula. Another 76 year old lady with a recent diagnosis of limited sclerosis was evaluated as an outpatient for dyspnea. Echocardiogram (I) showed PH with a CTA negative for a PE (G). RHC confirmed the diagnosis. She was started on ambrisentan & tadalafil but her hypoxia worsened from 6 to 15 liters. She was referred to cardiology for further evaluation with concern for PVOD. CT chest showed diffuse ground glass pattern & fluid in the fissure (H). Her PFT's showed a normal FEV1, FVC & DLCO of 30%, both consistent with PVOD. She was started on inhaled treprotstinil & has improved since. Summary PH specific therapies are directed towards pre-capillary vasculature & pose a risk of causing pulmonary edema in patients with PVOD. Connective tissue disorders are known to be associated with PVOD but there is little data to support the improvement of PH by treating the underlying cause. Right ventricular myocardial biopsies have shown an inherent myocardial defect limiting the response to therapy, leading to poorer outcomes. Given our patients’ improvement on inhaled vasodilator therapy we hypothesize that it may help improve V/Q mismatch, but more research is needed to help with management.
Altering stem cell fate by deregulated c-Myc influences tumor phenotype.

2397 c-Myc is an oncoprotein known to induce proliferation, transformation and apoptosis in mammalian cells. We have previously shown that c-myc influences epidermal stem cell fate determination, specifically diverting multipotent stem cells to sebaceous glands. To determine how c-myc affects stem cells in vivo , we generated an inducible mouse model (Gene-switch c-Myc) in which deregulated expression of c-myc is targeted to the basal layer of the epidermis and multipotent stem cells located within the bulge region of the hair follicle. The expression of c-myc can be regulated by topical application of the anti-progesterone RU486. Gene expression profiling studies using samples from mice treated once with RU486 and taken 12 and 24 hours after treatment indicate that c-myc activates specific target genes to influence epidermal stem cell fate. Target genes include the wnt pathway inhibitor, dickkopf1, and a member of the hedgehog family, Indian Hedgehog. Dickkopf1 has been shown to inhibit hair follicle formation when ectopically expressed in the epidermis. Indian Hedgehog has been shown to be involved in sebaceous gland development. Thus, c-myc diverts stem cells to a sebaceous gland fate at the expense of the hair follicle by activating specific target genes. To determine if c-myc’s ability to divert stem cells into sebaceous glands would influence tumor phenotype, we subjected K14.myc2 mice to a chemical carcinogenesis protocol. K14.myc2 mice developed tumors at an accelerated rate and higher incidence compared to wildtype littermates. Interestingly, K14.myc2 mice developed sebaceous gland tumors at a frequency of 100%, while none developed in wildtype littermates. In addition, we are currently assessing the role of c-Myc in tumor progression using the Gene-switch c-Myc model, since the K14.myc2 mice die prematurely due to severe ulcerated lesions. Gene-switch c-Myc mice exposed to DMBA/TPA, followed by induction of c-Myc exhibited accelerated tumorigenesis. Furthermore, we have now observed progression of tumors that developed in DMBA/TPA treated mice to metastatic lesions in the lung, and determined by an analysis of DNA content that the metastases were aneuploid. A member of the minichromosome maintenance family of proteins, MCM7, has been found to be a direct target of c-Myc and may potentially play a role in inducing genomic instability. Tumors that developed in both the K14.myc2 mice and Gene-switch c-Myc stained positively for MCM7. Interestingly, recent preliminary data demonstrate that induction of c-Myc can also take the place of TPA and function as a tumor promoter. The predisposition of K14.myc2 mice to develop sebaceous adenomas suggests that tumor phenotype can be influenced by deregulated expression of genes that alter stem cell fate and further analysis indicates that c-Myc may induce genomic instability through direct targets as well.
Mycoplasma hominis septicemia associated with abortion.

Abstract A case of septic abortion is presented in which Mycoplasma hominis was isolated from the blood and cervical discharge of the mother and from the liver of the fetus. The mother demonstrated a sixteenfold rise in antibody titer to the homologous organism, but not to other Mycoplasma species. Further study is needed to determine the frequency and significance of M. hominis infection in abortion.