cssi/SciSciGPT-SciSciNet huggingface dataset:
Causes and outcomes of finger ischemia in hospitalized patients in the intensive care unit

Abstract Objective Vascular surgeons may be consulted to evaluate hospitalized patients with finger ischemia. We sought to characterize causes and outcomes of finger ischemia in intensive care unit (ICU) patients. Methods All ICU patients who underwent evaluation for finger ischemia from 2008 to 2015 were reviewed. All were evaluated with finger photoplethysmography. The patients' demographics, comorbidities, ICU care (ventilator status, arterial lines, use of vasoactive medications), finger amputations, and survival were also recorded. ICU patients were compared with concurrently evaluated non-ICU inpatients with finger ischemia. Results There were 98 ICU patients (55 male, 43 female) identified. The mean age was 57.1 ± 16.8 years. Of these patients, 42 (43%) were in the surgical ICU and 56 (57%) in the medical ICU. Seventy (72%) had abnormal findings on finger photoplethysmography, 40 (69%) unilateral and 30 (31%) bilateral. Thirty-six (37%) had ischemia associated with an arterial line. Twelve (13%) had concomitant toe ischemia. Eighty (82%) were receiving vasoactive medications at the time of diagnosis, with the most frequent being phenylephrine (55%), norepinephrine (47%), ephedrine (31%), epinephrine (26%), and vasopressin (24%). Treatment was with anticoagulation in 88 (90%; therapeutic, 48%; prophylactic, 42%) and antiplatelet agents in 59 (60%; aspirin, 51%; clopidogrel, 15%). Other frequently associated conditions included mechanical ventilation at time of diagnosis (37%), diabetes (34%), peripheral arterial disease (32%), dialysis dependence (31%), cancer (24%), and sepsis (20%). Only five patients (5%) ultimately required finger amputation. The 30-day, 1-year, and 3-year survival was 84%, 69%, and 59%. By Cox proportional hazards modeling, cancer (hazard ratio, 2.4; 95% confidence interval, 1.1-5.6; P = .035) was an independent predictor of mortality. There were 50 concurrent non-ICU patients with finger ischemia. Non-ICU patients were more likely to have connective tissue disorders (26% vs 13%; P = .05) and hyperlipidemia (42% vs 24%; P = .03) and to undergo finger amputations (16% vs 5%; P = .03). Conclusions Finger ischemia in the ICU is frequently associated with the presence of arterial lines and the use of vasopressor medications, of which phenylephrine and norepinephrine are most frequent. Anticoagulation or antiplatelet therapy is appropriate treatment. Whereas progression to amputation is rare, patients with finger ischemia in the ICU have a high rate of mortality, particularly in the presence of cancer. Non-ICU patients hospitalized with finger ischemia more frequently require finger amputations, probably because of more frequent connective tissue disorders.
Having Their Cake and Eating It Too: Physician Skepticism of the Open Payments Program.

When the Affordable Care Act was enacted in 2009, it included a section little noticed at the time, Section 6002, that established the Open Payments program (Centers for Medicare & Medicaid Service...
Unconditioned Responding in Mice as a Function of Early Handling and Shock Intensity

The effects of early handling upon three measures of unconditioned responding to various shock intensities in adult mice was investigated. The results indicated that the early handled mice were less responsive to the various intensities of shock than the nonhandled controls. Both the jump and run responses, but not vocalizations, resulted in a significant interaction within a stress situation.
Superior glenoid inclination and rotator cuff tears.

Background The objectives of this study were to determine whether glenoid inclination (1) could be measured accurately on magnetic resonance imaging (MRI) using computed tomography (CT) as a gold standard, (2) could be measured reliably on MRI, and (3) whether it differed between patients with rotator cuff tears and age-matched controls without evidence of rotator cuff tears or glenohumeral osteoarthritis. Methods In this comparative retrospective radiographic study, we measured glenoid inclination on T1 coronal MRI corrected into the plane of the scapula. We determined accuracy by comparison with CT and inter-rater reliability. We compared glenoid inclination between patients with full-thickness rotator cuff tears and patients aged >50 years without evidence of a rotator cuff tear or glenohumeral arthritis. An a priori power analysis determined adequate power to detect a 2° difference in glenoid inclination. Results (1) In a validation cohort of 37 patients with MRI and CT, the intraclass correlation coefficient was 0.877, with a mean difference of 0° (95% confidence interval, −1° to 1°). (2) For MRI inclination, the inter-rater intraclass correlation coefficient was 0.911. (3) Superior glenoid inclination was 2° higher (range, 1°-4°, P Conclusions Glenoid inclination can be accurately and reliably measured on MRI. Although superior glenoid inclination is statistically greater in those with rotator cuff tears than in patients of similar age without rotator cuff tears or glenohumeral arthritis, the difference is likely below clinical significance.
"Protect and Serve Each Other": Contentious Politics and Collective Action in a Police Accountability Organization

This rticle examines the tactics employed by the Peaceful Streets Project (PSP), a police accountability organization in Austin, Texas. Specifically, it explores the activists’ reasons for addressing police accountability and why the majority of the members are men. Drawing on analysis of in-depth interviews, participant observation, and organizational materials, the findings suggest that collective action and contentious politics play roles in the activists’ decisions to address police accountability and their measures for doing so. This study adds to the social movement literature by examining how collective action and contentious politics aid in the tactics for addressing police accountability and the racialized, classed, and gendered dynamics of member participation.
Comparison of Risk Stratification Models to Predict Recurrence and Survival in Pleuropulmonary Solitary Fibrous Tumor.

Abstract Introduction Solitary fibrous tumors (SFTs) are rare mesenchymal neoplasms. Most follow a benign course, but a subset will recur or metastasize. Various risk stratification schemes have been proposed for SFTs, but none has been universally endorsed and few have focused on pleuropulmonary SFTs. Methods Histologic sections from surgically resected pleuropulmonary SFTs were examined, with confirmatory immunohistochemistry. Patients were risk-stratified by using four prediction models as proposed by de Perrot, Demicco (original and modified), and Tapias. Kaplan-Meier analysis was used to estimate overall survival (OS) and progression-free survival (PFS). Results The 147 study patients included 78 females (53.1%) with a median age of 61.5 years (range 25–87). The median follow-up was 5.5 years (range 0–33). Recurrence or metastasis occurred in 15 patients (10.2%), with five deaths from disease. Significant predictors of worse OS included male sex, age at least 55 years, tumor size at least 10 cm, nonpedunculated growth, severe atypia, necrosis, and mitotic count of at least four per 10 high-power fields. Predictors of recurrence included tumor size of at least 10 cm, severe atypia, necrosis, at least four mitoses per 10 high-power fields, and Ki67 labeling index of at least 2%. All systems predicted PFS, but only the Demicco and Tapias systems significantly predicted OS. The modified Demicco system provided the best discrimination for PFS (C-statistic = 0.80 compared with 0.78). Conclusion The risk scoring systems proposed by Tapias et al. and Demicco et al. were both predictive of OS and PFS. The Demicco system has the advantages of simplicity and applicability to SFTs from other sites, as well as provision of the best discrimination for PFS, and thus may be the best system to apply in general practice.
The Arcs Model of Motivational Design

Typically, even though they have years of experience as students and can potentially list motivating versus demotivating events, people feel that they do not have a reasoned, systematic approach to dealing with the motivational aspects of instructional design and teaching. Some people have a great deal of talent and are highly successful based on their experience and, perhaps, charisma, but they might be more limited in their repertoire than they wish they were. The specific aim of the ARCS motivation model is to provide guidance for creating answers to these questions. This chapter provides an introduction to the ARCS model and serves as a foundation for the remaining chapters which are, for the most part, elaborations of the points made in this chapter. The first part of this chapter contains a description of the motivational variables and sample strategies that comprise the four categories of the ARCS model, the second part covers the systematic design process, and the final part discusses the relationship between motivational design and instructional design.
Scatter Correction Strategies in Emission Tomography

Scatter in nuclear medicine imaging usual refers to Compton scattering in which a gamma ray undergoes an interaction with matter (e.g. patient) whereby it changes direction and looses energy. As the change in direction approaches zero, the energy loss also approaches zero. Coherent scattering is often neglected because of its small contribution to the total cross section for the energy range of interest in nuclear medicine but is included in some simulation studies. The scatter counts for which one wishes compensation are those that fall within the photopeak window. In PET or in SPECT, if there is only one emission, they are the ones that don’t loose so much energy as to fall below the lower-energy cut-off of the window. In SPECT, if there are multiple gamma-ray emission energies, a higher energy emission can loose the amount of energy necessary to fall within the photopeak window of a lower-energy emission and be an unwanted scatter event. One must state, and keep in mind, where the scatter occurs when talking about scatter correction. In general, the gamma ray can scatter in the patient, in material outside the patient such as the table or the collimator, in the detector material, or in the material behind the detector. Complicating matters, one may have multiple scatters possibly in the same object, but potentially in two or more places. In considering a scatter-compensation method, one should be aware of which type(s) of scatter is (are) being corrected. The purpose of scatter correction is usually either improved accuracy of activity quantification, contrast enhancement of the image, or both. The purpose may affect the choice of technique. While it is well accepted by the
Conclusion: General Issues

In Western industrial civilization in its formative stages, the entrepreneurs were people who made the key innovations. One thinks of such famous names as Arkwright, Boulton and Bessemer in England; Strousbarg, Thyssen and Krupp in Germany; and Gould, Harriman, Carnegie and Ford in the United States, to cite a few. Besides these clearly exceptional personalities there were men who made minor but still important innovations. Many more were imitators and followers but those imitations involved a considerable degree of initiative and vigor. In sharp contrast, although there has been, for a long time, a number of great entrepreneurial famililies in India (e.g., the Birlas and Tatas) they have had few followers. It seems a characteristic of successful business men in India that they do not stay in a single industry; they start in one and then proceed on to some entirely unrelated industry. In this way the same group may initiate and develop a number of industries, but they do not seem to inspire imitators.
Colimits and Tor

Of the two functors defined in Chapter 3, Ext is the more “universal”; Section 6.6 describes how Tor can, in principle at least, be defined using Ext. On the other hand, Tor has more properties. Up to now, this has only been reflected in the fact that Tor mixes rightR -modules with left R -modules. But there’s more. Tor behaves well with respect to certain colimits, and that is the general subject of this chapter.
Effect of Pasteurella multocida and Haemophilus pleuropneumoniae toxins on swine alveolar macrophages

Abstract Supernatants were obtained from 18 hr. broth cultures of Pasteurella multocida strains D82 and D62 (serotype D, toxigenic), Kobe 6 (type D, non-toxigenic), A50 and X73 (type A, non-toxigenic), Haemophilus pleuropneumoniae serotypes 1, 5 and 6, Haemophilus sp. taxon “minor group” (2 strains) and an avirulent serotype 1 strain of H. pleuropneumoniae . The supernates were filtered, pH-neutralized and tested for cytotoxicity after incubation for 18 hours in the presence of swine alveolar macrophage monolayers. Supernatants from H. pleuropneumoniae serotypes 1, 5 and 6 were cytocidal.
A Survey of Emergent Digital Literacy Inside the Homes of Latino Immigrants in California

This paper examines how Latino immigrant families in California use information technology (IT) tools for their pre-existing personal, educational, and work-related activities inside their homes. In doing so, the paper re-examines the concept of access beyond the acquisition of these technologies, highlighting instead the importance of the local social and economical contexts of users and the implications for the design, implementation, and use of these technologies among immigrant communities. Results indicate that as these new comers appropriate IT tools to develop their personal, educational, and work-related needs and aspirations, they begin to develop important digital and language literacies, as well as new ways of interacting with formal institutions in the USA. In spite of new developments in technologies and social media since the study took place (2002), there is still little or no research that relies on direct observations to examine IT utilization inside the homes of immigrants and in relation to their pre-existing educational or labor-related activities. Results suggest a need for a more detailed study of these practices inside homes and their possible implications for educational and labor-related immigrant reform initiatives.
Strategic Market Game Models of Exchange Economies

Publisher Summary The general equilibrium model of exchange and production is not a process model. There is no indication as to how prices are formed. This chapter presents the list of several limitations of the general equilibrium model. A remodelling of the economy has been suggested as a game in strategic form offers a way to construct a class of process models that among their useful properties cast light upon the role of money and credit mechanisms in an economy. It is both clear and strikingly counterintuitive that money and credit mechanisms play no role in general equilibrium theory. Even casual empiricism is sufficient to indicate that prices are formed in many ways in different parts of an economy. Retail markets often have the merchants setting the offer price, adjusting it as customers come and go. Other sales involve bilateral bargaining. In other instances, price may be set by a variety of auction mechanisms. A literature now exists in economic theory studying price formation through a mixture of search and bargaining by many pairs of traders. The model building approach adopted is that it does not matter too much what price formation mechanism is chosen to remodel the general equilibrium model as a well defined game in extensive or strategic form. Finally, tThe chapter also discusses a sequence of models of exchange using single commodity money.
A modified specimen for evaluating the mixed mode fracture toughness of adhesives

This article introduces a specimen geometry that allows the separation of fracture energy release rates GI and G II in adhesively joined beams made of disparate materials. The analysis is based upon a Green's functions formulation for shear deformable beams and circumvents the need to employ finite element computations. The current method results in a system of non-singular integral equations, that can be discretized and reduced to a system of algebraic equations which may be solved by common numerical techniques. The analysis accounts for the dimensions and properties of the adhesive and provides results for a wide range of GI, G II and their ratio. Those results agree with finite element computational values to within less than 4%.
Transportistas Y Lavadores: El Control Territorial Como Argumento De Poder En El Salvador (Smugglers and Launderers: Territorial Control as an Instrument of Power in El Salvador)

Spanish Abstract: En Centro America existen elites economicas que basan su poder, su capacidad de intercambio comercial y su salud financiera en el control territorial que han logrado establecer sobre amplias zonas de los estados nacionales. Estas elites obtuvieron ese control, en esencia, gracias a la expansion de su influencia a traves de actividades ilicitas que les permitieron acumular suficiente capital economico inicial para comprar voluntades en el aparato estatal,incluso para sustituirlo o en el mejor de los casos mezclarse con el, y para, con el paso de los anos, emprender negocios legales con lo que cubrieron y expandieron sus negocios ilegales. En este ensayo se explora con detenimiento el caso de El Salvador, y de dos de los grupos criminales que conforman esta nueva elite — Los Perrones y el Cartel de Texis. English Abstract: In Central America, new elite groups are emerging whose power, commercial activities, and financial health are based on territorial control over large areas of the region's states. Illicit activities carried out by these elites have led to an accumulation of economic capital that has, in turn, allowed them to directly influence the state apparatus. This penetration of the state has, over time, allowed these new elites to launch legal business enterprises used to finance and expand their criminal operations. Using El Salvador as a case study, this working paper explores two of the criminal groups that make up this new category of elites — Los Perrones and the Texis Cartel.
Microwave conductivity of ferroelectric domains and domain walls in a hexagonal rare-earth ferrite

We report the nanoscale electrical imaging results in hexagonal ${\mathrm{Lu}}_{0.6}{\mathrm{Sc}}_{0.4}{\mathrm{FeO}}_{3}$ single crystals using conductive atomic force microscopy and scanning microwave impedance microscopy. While the dc and ac response of the ferroelectric domains can be explained by the surface band bending, the drastic enhancement of domain wall (DW) ac conductivity is clearly dominated by the dielectric loss due to DW vibration rather than mobile carrier conduction. Our work provides a unified physical picture to describe the local conductivity of ferroelectric domains and domain walls, which will be important for future incorporation of electrical conduction, structural dynamics, and multiferroicity into high-frequency nanodevices.
AC Small-Signal Model for Magnetoresistive Lateral Spin Valves

An ac small signal model for lateral spin valves (LSVs) is developed, and is applied to two different types of devices: spin transmitters and magnetic field sensors. The small signal models explicitly decouple the charge- and spin-dependent components, which describe the intrinsic RC delay and the ac spin accumulation dynamics, separately. The analysis is applied to graphene LSVs as an example to illustrate the optimization strategies for LSV devices. By using the charge-spin circuit model, the scattering parameters and the reflection coefficients at the output terminals are quantitatively calculated as a function of frequency. This model can be used as a guide for future LSV design and to benchmark performance across different material systems.
Heart Rate Variability and Performance of Commercial Airline Pilots during Flight Simulations

Pilots undergo a variety of stressors that may affect their performance during all phases of flight. Heart rate variability (HRV) has been considered as a reliable indicator of the parasympathetic and sympathetic activities of human autonomic nervous system, which can be used to characterize the sympathetic stress response of pilots during flight. In this study, thirty active commercial airline pilots were recruited to fly three flight segments in a Federal Aviation Administration (FAA)-certified A320 flight simulator with each segment at a different carbon dioxide (CO2) concentration on the flight deck. The pilots performed a series of maneuvers of varying difficulty, and their performance was evaluated by FAA designated pilot examiners. The HRV metrics (SDNN, RMSSD and LF/HF ratio) of each pilot both before and during flight simulations were measured with a Movisens EcgMove3 sensor. The average SDNN, RMSSD and LF/HF ratio of the pilots during flight simulations were 34.1 ± 12.7 ms, 23.8 ± 10.2 ms and 5.7 ± 2.8 respectively. Decreased HRV was associated with aging, obesity and performing difficult maneuvers. Both CO2 exposure and HRV had an independent effect on the pilot performance, while their interaction was not significant. The generalized additive mixed effect model results showed that a pilot performed better on a maneuver when his stress response was lower, as indicated by higher SDNN and RMSSD and lower LF/HF ratio. An interquartile range (IQR) increase in SDNN (21.97 ms) and RMSSD (16.00 ms) and an IQR decrease in LF/HF ratio (4.69) was associated with an increase in the odds of passing a maneuver by 37%, 22% and 20%, respectively.
Evaluation of fungicides and biofungicide to control Phytophthora root rot (Phytophthora cinnamomi Rands) and ambrosia beetles (Coleoptera: Curculionidae: Scolytinae) on flowering dogwoods exposed to simulated flood events

Abstract Phytophthora root rot causes major economic losses in woody ornamental nurseries, especially in plants exposed to flooding. Ambrosia beetles, which attack stressed trees, are also important pests of woody plants. In this study, several products were evaluated for control of Phytophthora root rot and ambrosia beetles on containerized flowering dogwoods (Cornus florida L.) exposed to simulated flood events under field conditions. In two trials, preventive (7 days preflooding) or curative (1 day postflooding) sprench (combination spray and drench) treatments were applied to containerized dogwoods artificially inoculated with Phytophthora cinnamomi Rands. The plants were flooded by maintaining standing water for 1, 3, or 7 days. After the trials, plant growth data (dry shoot weight, dry root weight, plant height, plant width, caliper) were recorded, and roots were assessed for disease severity using a scale of 0–100% roots affected, as well as plated on PARPH-V8 medium to determine the percentage of Phytophthora-infected root samples. Ambrosia beetle attacks were recorded throughout the study. Longer flooding duration increased disease pressure from Phytophthora cinnamomi Rands. Preventive treatment of plants with Subdue MAXX consistently reduced disease severity at tested flooding durations of 1, 3, or 7 days. Preventively- (before flooding) or curatively- (after flooding) applied treatments of Empress Intrinsic, Orkestra Intrinsic, and Pageant Intrinsic reduced disease pressure at 1 and 3 days of flooding. Preventive RootShield Plus+ treatment reduced disease pressure on plants flooded 1 day. Longer flooding periods as well as Phytophthora cinnamomi inoculation increased ambrosia beetle attacks on flooded dogwoods, but preventively- and curatively-applied Orkestra Intrinsic as well as preventively-applied Subdue MAXX reduced ambrosia beetle attacks compared to non-treated, inoculated controls. These treatments were effective at reducing both Phytophthora and ambrosia beetle damage. These results can help nursery producers successfully manage Phytophtora root rot and also reduce the risk of ambrosia beetle attacks during flood events.
Prognostic Value of the Lung Immune Prognostic Index for Patients Treated for Metastatic Non–Small Cell Lung Cancer

Importance Previous studies have suggested the importance of the baseline derived neutrophil to lymphocyte ratio (dNLR) and lactate dehydrogenase (LDH) level as prognostic markers. The lung immune prognostic index (LIPI) was shown to be associated with progression-free survival (PFS) and overall survival (OS) among patients with metastatic non–small cell lung cancer (mNSCLC) treated with immune checkpoint inhibitors (ICIs) but not cytotoxic chemotherapy (CCT). Objective To determine whether the LIPI is associated with long-term outcomes in pooled analyses of clinical studies of ICI and targeted therapy (TT) for patients with mNSCLC. Design, Setting, and Participants An exploratory pooled analysis was performed of the LIPI on data from 11 randomized clinical multinational trials evaluating ICIs and TT submitted to the US Food and Drug Administration between January 1, 2013, and December 31, 2017, for 4914 patients with mNSCLC. Lung immune prognostic index scores were calculated based on the dNLR and the LDH level per previous publications to generate good, intermediate, and poor composite scores. Multivariable Cox proportional PFS and OS hazard ratios were generated for the dNLR, the LDH level, age, smoking status, histologic characteristics, and Eastern Cooperative Oncology Group performance score. Main Outcomes and Measures Overall survival and PFS and their association with good, intermediate, or poor prognostic LIPI scores. Results Eleven mNSCLC randomized trials were analyzed, including 3987 patients with available data. In 5 ICI trials comprising 2440 patients, 1368 patients received ICIs and 1072 patients received CCT. In 6 TT trials comprising 1547 patients, 1110 patients received TT and 437 patients received CCT. A good LIPI score was associated with better OS among patients receiving ICIs (hazard ratio, 0.34; 95% CI, 0.28-0.42), TT (hazard ratio, 0.28; 95% CI, 0.21-0.37), and CCT (hazard ratio, 0.49; 95% CI, 0.40-0.60 in ICI trials; hazard ratio, 0.41; 95% CI, 0.27-0.61 in TT trials) than those with poor LIPI scores. Similar findings were observed in terms of PFS (ICIs: hazard ratio, 0.59; 95% CI, 0.48-0.72; TT: hazard ratio, 0.46; 95% CI, 0.37-0.57; and CCT: hazard ratio, 0.56; 95% CI, 0.45-0.68 in ICI trials; hazard ratio, 0.51; 95% CI, 0.38-0.69 in TT trials). Conclusions and Relevance The baseline LDH level and dNLR are important prognostic biomarkers irrespective of treatment modality for patients with mNSCLC. As further prospective clinical trial information is collected, the role of the LIPI score can be better defined.
RFID for Everyone: An Easily-Accessible, Experimental UHF RFID Platform

This paper presents an expandable wireless sensing platform designed to exhibit similar functionality to high-performing RFID devices such as the Intel WiSP while remaining accessible as a learning tool. Towards this end, the platform is designed around components that are stocked by most component suppliers, and physically large enough to be soldered by hand. With an aim to bring more researchers into the RFID community, the system allows for a user to quickly perform wireless power transfer experiments, design and test low-power embedded firmware, quickly prototype backscatter communication protocols, and design fully-functional battery-free sensors. The platform runs a 16-bit MSP430 microcontroller and receives all power from a 915 MHz CW source. It has a measured sensitivity of −6dBm where digital communication is possible and sufficient voltage (1.8 V) is harvested to operate an MSP430 microcontroller. The reader for this system is a custom design that transmits a CW signal and allows output data to be easily seen with an oscilloscope. To showcase the effectiveness of the system, a battery-free sensor designed by a group of undergraduate students with no prior RFID experience is presented. The exemplary sensor is capable of wirelessly telemetering luminance.
Time for a change.

Universities, businesses, students and employees all need to rethink they way they approach training.
Provider perspectives on shared decision-making regarding hypospadias surgery.

Summary Introduction Many parents experience decisional conflict and decisional regret around hypospadias surgery. The utilization of a shared decision-making (SDM) process may mitigate these issues, however addressing the principal components of the SDM process is a complex task that requires the investment of providers. Objective The purpose of this study was to facilitate a discussion about SDM anchored on hypospadias with pediatric urology and general pediatric providers to explore perspectives, clinical applications and barriers to adopting SDM in clinical practice. Study design We conducted two focus groups in order to engage pediatric urology and general pediatric providers in guided discussions about SDM anchored on hypospadias. All activities were audio recorded and professionally transcribed. The transcripts were analyzed by three coders using directed qualitative content analysis techniques to identify themes and relationships between themes to inform the development of an affinity diagram (Extended Summary Figure). Results Two focus groups were held; one with seven pediatric urology providers in November 2018 and one with ten general pediatric providers in January 2019 (median age 51 years, 88.2% Caucasian, 58.8% female, 70.6% physicians and 29.4% nurse practitioners). Both groups identified some of the key components of SDM including engaging families in decision-making, informing them about treatment options and clarifying values/preferences (Extended Summary Figure). They thought that SDM was useful for discussing preference-sensitive conditions (e.g. hypospadias) and addressing parental compliance. General pediatric providers also suggested that SDM helped them avoid unnecessary referrals to specialists. Both groups identified parental, provider and systemic barriers to the adoption of SDM: a) desire for paternalism, b) misperceptions about medical evidence, c) completion of parental decision-making prior to the clinical visit, d) provider bias/lack of interest and e) time constraints/productivity pressures. Discussion Providers who care for hypospadias patients are knowledgeable about SDM and its potential clinical applications. They identified several potentially modifiable barriers to the adoption of a SDM process about hypospadias surgery in a pediatric clinical setting. Conclusions Based on feedback from providers, we plan to implement a hypospadias decision aid early in the parental decision-making process about hypospadias such as in the postpartum unit and at well-child visits in the newborn period and provide a provider training session about SDM to address the identified knowledge gaps. Download : Download high-res image (360KB) Download : Download full-size image Summary Figure . Affinity map of provider perspectives on shared decision-making: components, applications and barriers. Red = pediatric urology providers. Blue = general pediatric providers. Purple = both groups.
Toxocariasis: A neglected infection for the Anthropocene epoch

While ascariasis, trichuriasis, and hookworm infection dominate global efforts to control human soil-transmitted helminth infections, a picture is unfolding to suggest that toxocariasis is now a fourth and perhaps equally important parasitic disease. Toxocara eggs are widespread in the environment and practically ubiquitous in the soils of many subtropical and tropical regions of Asia, Africa, and the Americas. Human zoonotic infection is also highly prevalent in these areas, based on serologic studies to detect anti-Toxocara antibodies. The relevance of these findings to human and animal disease burden estimates is still largely unknown, but some studies implicate exposure to Toxocara eggs and larvae to both pulmonary disease leading to asthma, and neurologic disease resulting in epilepsy and cognitive delays. On that basis, human toxocariasis may emerge as one of the most important neglected parasitic infections of humans. With anticipated global warming and urbanization associated with our modern human-transformed geological epoch, known as the Anthropocene, it is likely that toxocariasis will become a dominant infection and one widely prevalent in our future and projected mega-cities.
Chapter VII – SYMMETRIC GROUPS

Publisher Summary This chapter reviews the properties of the symmetric groups. The symmetric groups are amenable to treatment by the general methods of group theory and the results are specializations of the general theory to the case of symmetric groups. A transposition is a permutation interchanging two symbols. Every permutation can be expressed as a product of transpositions and of transpositions of adjacent symbols. No permutation can be factored into transposition in two ways such that one factorization contains an even number of transpositions and the other an odd number. A permutation is called even if its transposition factorizations contain an even number of transpositions and odd otherwise.
Pavlovian bias in Parkinson's disease: an objective marker of impulsivity that modulates with deep brain stimulation

Impulsivity is a common symptom in Parkinson’s disease (PD). Adaptive behavior is influenced by prepotent action-reward and inaction-avoid loss Pavlovian biases. We aimed to assess the hypothesis that impulsivity in PD is associated with Pavlovian bias, and to assess whether dopaminergic medications and deep brain stimulation (DBS) influence Pavlovian bias. A PD DBS cohort (N = 37) completed a reward-based Go/No-Go task and bias measures were calculated. This DBS cohort completed the task under three conditions: on-med/pre-DBS, off-med/off-DBS, and on-med/on-DBS. Participants also completed self-reported measures of impulsivity. Dopaminergic medication was associated with lower action-reward bias while DBS was associated with higher action-reward bias. Impulsivity was associated with higher action-reward bias but not inaction-avoid loss bias. We furthermore replicated this association in an independent, non-DBS PD cohort (N = 88). Overall we establish an objective behavioral marker of impulsivity and show that DBS affects impulsivity by amplifying automated responding. Our results point to the importance of reward rather than punishment avoidance in driving impulsive behaviors. This work provides insight into the pathophysiological underpinnings of impulsivity and especially medication and DBS-associated impulsivity in PD.
Single-center series report of transforaminal lumbar interbody fusions under spinal anesthesia

Abstract Objective Traditionally surgery for degenerative lumbar pathology is performed under general anesthesia (GA). There have been several studies that have pointed to the negative cognitive effects of general anesthesia, and patients often frequently request alternatives. Considering this, it is advantageous to offer alternative anesthesia strategies. Studies have demonstrated spinal anesthesia (SA) being utilized successfully in decompressive lumbar surgeries; however, there is limited data evaluating use in fusion surgeries. This study presents a single institution’s experience with spinal anesthesia for minimally invasive transforaminal lumbar interbody fusions. Methods This is a retrospective review of a prospectively collected database analyzing 67 patients undergoing SA for lumbar fusion surgeries. Outcomes including data on safety, adverse events, and efficacy of SA were reviewed. In addition, patient demographics, complications, length of stay (LOS), disposition, and OR utilization time were recorded. Comparison to a similar cohort undergoing GA the year prior was completed. Results There was no difference in length of stay (GA 3.2d vs SA 2.9d, p = 0.104). More patients in the SA group were discharged home compared to the GA group (SA-76% vs GA-56%, p = 0.02). There were no occurrences of pneumonia (PNA) or deep vein thromboses/pulmonary embolus (DVT/PE). There was no difference in incidence of urinary tract infections (UTI) (GA-5% vs SA-1%, p = 0.27). Total OR time was decreased in the SA group(SA-164 min vs GA-200 min, p Conclusions SA is a safe alternative to GA and is time-efficient when compared to GA. SA can safely be considered as an option for patients undergoing lumbar instrumented fusion surgeries.
Calibration and Synchronization of Software-Defined-Radio Arrays

Software-defined radio (SDR) arrays require synchronization of separate SDR devices. This paper presents experimental results for an SDR array calibration procedure with automated phase and amplitude calibration of both transmitter and receiver chains, permitting coherent operation of a duplex SDR array.
Diet Alters Entero-Mammary Signaling to Regulate the Breast Microbiome and Tumorigenesis.

Obesity and poor diet often go hand-in-hand, altering metabolic signaling and thereby impacting breast cancer risk and outcomes. We have recently demonstrated that dietary patterns modulate mammary microbiota populations. An important and largely open question is whether the microbiome of the gut and mammary gland mediates the dietary effects on breast cancer. To address this, we performed fecal transplants between mice on control or high-fat diets (HFD) and recorded mammary tumor outcomes in a chemical carcinogenesis model. HFD induced pro-tumorigenic effects, which could be mimicked in animals fed a control diet by transplanting HFD-derived microbiota. Fecal transplants altered both the gut and mammary tumor microbiota populations, suggesting a link between the gut and breast microbiomes. HFD increased serum levels of bacterial lipopolysaccharide (LPS), and control diet-derived fecal transplant reduced LPS bioavailability in HFD-fed animals. In vitro models of the normal breast epithelium showed that LPS disrupts tight junctions (TJ) and compromises epithelial permeability. In mice, HFD or fecal transplant from animals on HFD reduced expression of TJ-associated genes in the gut and mammary gland. Furthermore, infecting breast cancer cells with an HFD-derived microbiome increased proliferation, implicating tumor-associated bacteria in cancer signaling. In a double-blind placebo-controlled clinical trial of breast cancer patients administered fish oil supplements before primary tumor resection, dietary intervention modulated the microbiota in tumors and normal breast tissue. This study demonstrates a link between the gut and breast that mediates the effect of diet on cancer.
Architecture of Allosteric Structure. Demonstration of the Fundamental Element of Allosteric Structure of Human Hemoglobin. O2-Equilibrium Binding Curve of Purified Human Hemoglobin in an Effector-Free Supporting Electrolyte.

The O2-affinity of human hemoglobin, free of effector molecules, was measured in 0.050 M BisTris, pH 7.0 with HCl, 20oC. A Hill plot of O2-equilibrium binding data reveals an initial slope of 2 and fails to demonstrate an upward inflection. The tetrameric hemoglobin structure in an effector-free supporting electrolyte can be described as two cooperative dimeric subunits. Equilibrium constants of these steps are related to intrinsic O2-binding constants for alpha and beta-chains, K(alpha) and K(beta). The equation of state is comprised of four unknown quantities. O2-Binding constants are not expected to be identical for each of the dimeric cooperative subunits. The first cooperative subunit binds O2 while bound to the second O2-free cooperative dimer. The second cooperative dimer binds O2 while bound to a fully oxygenated cooperative dimer. Effecter-free human hemoglobin is half saturated with1.9 micromolar oxygen. Addition of 0.1 M NaCl to the supporting electrolyte results in an approximately 4-fold increase in the concentration of O2 required for half saturation of hemoglobin, 8.1 micromolar oxygen. The mechanism of the response to chloride ions is attributed to neutralization of positively charged residues in the central cavity of Hb4 by the relatively high concentration of chloride ions.
Social Science in the Cold War

ABSTRACT This essay examines ways in which American social science in the late twentieth century was—and was not—a creature of the Cold War. It identifies important work by historians that calls into question the assumption that all social science during the Cold War amounts to “Cold War social science.” These historians attribute significant agency to social scientists, showing how they were enmeshed in both long‐running disciplinary discussions and new institutional environments. Key trends in this scholarship include a broadening historical perspective to see social scientists in the Cold War as responding to the ideas of their scholarly predecessors; identifying the institutional legacies of World War II; and examining in close detail the products of extramural—especially governmental—funding. The result is a view of social science in the Cold War in which national security concerns are relevant, but with varied and often unexpected impacts on intellectual life.
Preparation of P32-labeled Coxiella burnetii cells.

Coxiella burnetii cells labeled with P/sup 32/ were prepared from chicken embryos infected with these rickettsiae in the presence of P/sup 32/- orthophosphate. Procedures are described. (C.H.)
Long-term survival probabilities for childhood rhabdomyosarcoma. A population-based evaluation.

BACKGROUND Evidence from clinical trials has documented improvements in event-free survival from childhood rhabdomyosarcoma (RMS) since the 1970s; however, the survival experience of children enrolled on cancer clinical trials may not reflect the full range of patients treated in community settings. The current study evaluated 5-year survival and 10-year conditional survival for RMS from U.S. population-based cancer registry data. METHODS Public-use data from the Surveillance, Epidemiology, and End Results (SEER) program were used in life table and Cox regression analyses to evaluate RMS survival by patient age at diagnosis, gender, tumor histology, tumor site and stage, and major treatment eras among 848 children who were age < 20 years at the time of diagnosis, were a resident of 1 of 9 geographic reporting regions, and were diagnosed between 1973 and 2000. RESULTS The 5-year survival probabilities were found to be highest for younger-age children (ages 1–4 years: 77%), patients with localized disease (83%), those whose tumors had an embryonal histology (67%), and patients with orbital (86%) and genitourinary (80%) tumor sites. Poor prognosis was associated with diagnosis during infancy (47%) and adolescence (48%); metastatic disease at the time of presentation (31%); alveolar histology (49%); and tumors of the extremities (50%), retroperitoneum (52%), and trunk (52%). Conditional 10-year survival probabilities among those who survived ≥ 5 years were 85% or higher. The probability of survival by stage at the time of diagnosis increased with each successive treatment era, suggesting a stage shift phenomenon over time. CONCLUSIONS Large variations in 5-year survival were evident depending on patient age and tumor characteristics. However, children who survived the first 5 years after diagnosis were found to have an excellent long-term prognosis. The patterns in RMS survival noted from the current population-based evaluation did not appear to differ substantially from those previously reported by major clinical trials. Cancer 2005. © 2005 American Cancer Society.
Cortisol pharmacodynamic response to long-term methylprednisolone in renal transplant recipients.

Study Objective. To examine the pharmacodynamic patterns of cortisol and pharmacokinetic values of long-term methylprednisolone in renal transplant recipients. Design. Twenty-four-hour pharmacokinetic and pharmacodynamic evaluation of patients who participated in a glucocorticoid-monitoring program. Setting. University-based renal transplant clinic. Patients. Fourteen renal transplant recipients studied during a clinically stable period. Interventions. The daily oral methylprednisolone dose for each patient was administered intravenously and serial plasma cortisol and methylprednisolone samples were obtained over 24 hours. Measurements and Main Results. Methylprednisolone was analyzed by high-performance liquid chromatography. The baseline morning cortisol serum concentrations ranged from 9.8–210.7 ng/ml. After the drug was administered, cortisol declined in a linear fashion with a mean suppression half-life of 2.4 ± 0.9 hours. The cortisol nadir was reached at 12–16 hours in 11 of 14 patients. The return cortisol area under the curve (AUC-Cret) was noted in all patients and ranged from 57–987 ng·hr/ml. The total cortisol area under the curve was greater in patients who had been transplanted for longer than 2 years (1676 ± 252 vs 836 ± 405 ng·hr/ml; p<0.05) compared with more recently transplanted patients. Methylprednisolone clearance ranged from 100–1181 ml/hr/kg with a mean volume of distribution of 1.3 ± 0.6 L/kg. The methylprednisolone half-life ranged from 1.2–4.7 hours. The correlation between AUC-Cret and methylprednisolone AUC was −0.64 (p<0.05). Conclusions. The pharmacodynamic response of cortisol in renal transplant recipients may be associated in part with long-term steroid exposure. However, the interrelationship between the endocrine and immune system may also affect cortisol's disposition and subsequent recovery patterns in this population. Considerable interpatient variability was apparent in both the cortisol pharmacodynamic response as well as the pharmacokinetics of methylprednisolone. These findings suggest a more individualized dosing method may be necessary to optimize the immunosuppressive effect of glucocorticoids and minimize clinical toxicity.