cssi/SciSciGPT-SciSciNet huggingface dataset:
Subxiphoid incisional hernias after median sternotomy.

Background Subxiphoid hernias are difficult to repair. This study attempts to identify risk factors associated with incisional hernia formation after median sternotomy. Study design A retrospective review was conducted on patients undergoing subxiphoid incisional hernia repair between 1995 and 2002. The study group was compared with a group undergoing similar cardiothoracic procedures as to body mass index (BMI), comorbidities, complications, tobacco use, length of stay, ICU stay, bypass time, transfusion requirements, and wound infections. Statistical analysis utilized Student's t -test, chi-square, and Kaplan-Meier analysis. Results A total of 117 subxiphoid hernias were repaired; 45 were used for comparison with a matched cohort of 79 patients. Average time between sternotomy and hernia repair was 24.3 months (±16.8) with 22 (49%) patients developing hernias within 2 years. Mean followup was 48 months. The study group differed significantly from the nonhernia group in age (56.6 ± 13.0 versus 62.2 ± 8.9, p=0.01), mean length of stay (16.3 ± 22.8 versus 10.2 ± 6.7, p=0.03), BMI (29.6 ± 4.5 versus 27.2 ± 4.5, p=0.01), number of transplantation patients (10 versus 1, p=0.0003), and presence of sternal wound infection (18% versus 3.9%, p=0.02). Multivariate analysis revealed significance in regard to transfusion requirements (p = 0.015) and approached statistical significance with BMI (p = 0.058). Of the 45 patients undergoing hernia repair, 31(69%) had a mesh repair and 10 (32%) patients recurred. Six (43%) patients without a mesh repair recurred. Seventy-five percent of the patients with sternal wound infections developed recurrent hernias. Conclusions Transfusion requirements, BMI, and sternal wound infections might be associated with subxiphoid hernias after median sternotomy. Sternal wound infection increases the risk of recurrent incisional hernia.
Extensive In Vitro Hyphal Growth of Vesicular-Arbuscular Mycorrhizal Fungi in the Presence of CO(2) and Flavonols.

Various flavonoids were tested for their ability to stimulate in vitro growth of germinated spores of vesicular-arbuscular mycorrhizal fungi. Experiments were performed in the presence of 2% CO(2), previously demonstrated to be required for growth of Gigaspora margarita (G. Becard and Y. Piche, Appl. Environ. Microbiol. 55:2320-2325, 1989). Only the flavonols stimulated fungal growth. The flavones, flavanones, and isoflavones tested were generally inhibitory. Quercetin (10 muM) prolonged hyphal growth from germinated spores of G. margarita from 10 to 42 days. An average of more than 500 mm of hyphal growth and 13 auxiliary cells per spore were obtained. Quercetin also stimulated the growth of Glomus etunicatum. The glycosides of quercetin, rutin, and quercitrin were not stimulatory. The axenic growth of G. margarita achieved here under rigorously defined conditions is the most ever reported for a vesicular-arbuscular mycorrhizal fungus.
Improved lung allograft function after fundoplication in patients with gastroesophageal reflux disease undergoing lung transplantation.

Abstract Objectives: Bronchiolitis obliterans is the greatest limitation to the long-term applicability of lung transplantation. Although alloimmune events are important, nonimmune events, such as gastroesophageal reflux, might contribute to lung injury and the development of bronchiolitis obliterans syndrome. Methods: We retrospectively studied the 396 patients who underwent lung transplantation at the Duke Lung Transplant Program from April 1992 to April 2002. Reflux was assessed for using an ambulatory 24-hour esophageal pH probe. Results: Reflux assessment with an esophageal pH probe was obtained in 128 patients after lung transplantation. Abnormal pH study results were present in 93 (73%) patients. Forty-three patients underwent a surgical fundoplication. There was no in-hospital or 30-day mortality in the patients undergoing fundoplication. At the time of fundoplication, 26 patients met the criteria for bronchiolitis obliterans syndrome. After fundoplication, 16 patients had improved bronchiolitis obliterans syndrome scores, with 13 of these patients no longer meeting the criteria for bronchiolitis obliterans syndrome. In patients at least 6 months after lung transplantation and 6 months after fundoplication, the forced expiratory volume in 1 second improved by an average of 24% (mean forced expiratory volume in 1 second before fundoplication, 1.87 L; mean forced expiratory volume in 1 second after fundoplication, 2.19 L/sec; P Conclusions: Gastroesophageal reflux disease is very common after lung transplantation and appears to contribute to mortality and development of bronchiolitis obliterans syndrome. Fundoplication in lung transplant recipients with gastroesophageal reflux disease is associated with significant improvements in lung function, particularly if performed before the late stages of bronchiolitis obliterans syndrome. J Thorac Cardiovasc Surg 2003;125:533-42
Nodes of Ranvier and axon initial segments are ankyrin G–dependent domains that assemble by distinct mechanisms

Axon initial segments (AISs) and nodes of Ranvier are sites of action potential generation and propagation, respectively. Both domains are enriched in sodium channels complexed with adhesion molecules (neurofascin [NF] 186 and NrCAM) and cytoskeletal proteins (ankyrin G and βIV spectrin). We show that the AIS and peripheral nervous system (PNS) nodes both require ankyrin G but assemble by distinct mechanisms. The AIS is intrinsically specified; it forms independent of NF186, which is targeted to this site via intracellular interactions that require ankyrin G. In contrast, NF186 is targeted to the node, and independently cleared from the internode, by interactions of its ectodomain with myelinating Schwann cells. NF186 is critical for and initiates PNS node assembly by recruiting ankyrin G, which is required for the localization of sodium channels and the entire nodal complex. Thus, initial segments assemble from the inside out driven by the intrinsic accumulation of ankyrin G, whereas PNS nodes assemble from the outside in, specified by Schwann cells, which direct the NF186-dependent recruitment of ankyrin G.
Uncovering the creative dimensions of computer‐graphic design products

Abstract: Does a graphic designer's use of computer graphic technology (CGT) instead of more traditional methods improve the creativeness exhibited by the finished product? In this study, the combination of human interaction with CGT is proposed to enhance creativity in the product. Products were obtained from two undergraduate graphic design courses, one specializing in computer graphic technology, and the other in conventional graphic design methods. Four student assignments in each course produced four successive product sets for evaluation and analysis. Differences were tested with MANOVAs. Data were obtained from professional graphic designers using the Creative Product Semantic Scale (Besemer & O'Quin, 1986, 1987; O'Quin & Besemer, 1989). The results supported the proposition, particularly in the fourth product set with CGT products judged significantly more organic and wellcrafted than traditional products. The results provide insights into the development of future creative human/computer systems.
Comparison of tissue ablation with pulsed holmium and thulium lasers

The ablation rates and tissue effects produced by a pulsed holmium laser (wavelength 2.12 mu m, pulse duration 250 mu s) and a pulsed thulium laser (wavelength 2.01 mu m, pulse duration 250 mu s) were compared. Because the absorption coefficient of water is almost three times greater at the shorter wavelength (65 versus 24 cm/sup -1/), the thulium laser should have a significantly lower threshold of ablation and produce significantly less residual thermal injury. These hypotheses were tested in vitro. Ablation rates were measured using fresh liver and a mass loss technique were found to increase linearly with delivered radiant exposure. The threshold radiant exposure for ablation was derived from the mass loss measurements and found to be 36 J/cm/sup 2/ for the holmium laser and 29 J/cm/sup 2/ for the thulium laser. The corresponding heats of ablation were 10 kJ/cm/sup 3/ for the holmium laser and 9.7 kJ/cm/sup 3/ for the thulium laser. >
Attaining proficiency with endobronchial ultrasound-guided transbronchial needle aspiration

Objectives Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is becoming the preferred method of mediastinal staging for lung cancer. We investigated the learning curve for EBUS-TBNA using risk-adjusted cumulative sum (Cusum). Methods A retrospective study of EBUS-TBNA was performed at a single academic institution for patients with mediastinal or hilar lymphadenopathy in the setting of proven or suspected lung cancer. A sampling pass was defined as a full retraction and repositioning of the aspiration needle. Rapid on-site evaluation was not available. To track proficiency, risk-adjusted Cusum analysis was performed using acceptable and unacceptable failure rates of 10% and 20%, respectively. Failure was defined as false negative or nondiagnostic results. Results During the study period, 231 patients underwent EBUS-TBNA. Prevalence of mediastinal or hilar malignancy was 66.7% (154 out of 231). Sensitivity was 92.2% (142 out of 154), and negative predictive value was 87.9% (58 out of 66). Node size was identified as a significant predictor of EBUS-TBNA success by multiple regression. Risk-adjusted Cusum analysis demonstrated that the first and only unacceptable decision interval was crossed at 22 cases. Individual practitioner learning curves were highly variable, and the operator with the highest volume was the most consistently proficient. Conclusions In our experience, attainment of an acceptable failure rate for EBUS-TBNA required 22 cases. Node size is a predictor of EBUS-TBNA success. Risk-adjusted Cusum proved a powerful evaluative tool to monitor the training process of this new procedure.
DEHYDRATION AND PROCESSING PROBLEMS OF TARO

Taro (Colocasia esculenta L. Schott.) is an underexploited root crop with promising economic value. A study was made to determine the feasibility of producing samples of taro (var. Lehua) in ration dense forms which will be stable at 38°C for a year or more, and to detect problems in dehydration and processing which would affect the palatability and storage quality of the dried products. Taro samples (5 mm thick slices) were freeze dried, air dried and solar dried, then stored in polyethylene bags at 21°C, 38°C and 60°C. Analyzed monthly, most samples showed small changes in acidity, some degradation in anthocyanins, some increase in moisture contents, and a rather large decrease in catalase activities. Taste panel evaluation of eating quality by multiple comparison test resulted in scores averaging 4.5/7.0 for all the dried samples while the control received 5.5/7.0. Energy value was about 4.0 Cal/g and gelatinization temperature was in the upper range as that of rice and slightly higher than wheat. Further assessments are being continued to determine if the physical form chosen was suitable for stability and acceptability tests, the preferred method of dehydration in terms of optimizing quality and energy requirements, and the effects of processing and storage on the eating qualities.
Allogeneic blood cell transplantation following reduced-intensity conditioning is effective therapy for older patients with myelofibrosis with myeloid metaplasia

Standard myeloablative conditioning prior to allogeneic hematopoietic stem cell (HSC) transplantation has been associated with significant toxicity in patients older than 45 years of age with myelofibrosis with myeloid metaplasia (MMM). We sought to evaluate the efficacy of a reduced-intensity conditioning regimen for allogeneic HSC transplantation in this setting. A regimen consisting of fludarabine (30 mg/m(2) intravenously daily for 5 days) and melphalan (70 mg/m(2) intravenously daily for 2 days) followed by transplantation of filgrastim-mobilized peripheral blood cells from HLA-identical siblings was administered to 4 older patients (median age, 56 years; range, 48-58 years) with advanced MMM. All patients achieved prompt neutrophil and platelet engraftment and have experienced a significant regression of splenomegaly and bone marrow fibrosis. All now have normal bone marrow cellularity. With a median follow-up of 13 months (range, 11-19 months), all 4 patients are alive with stable full-donor hematopoietic chimerism. These results support the feasibility and effectiveness of reduced-intensity conditioning prior to allogeneic HSC transplantation for older patients with advanced MMM.
Lexical Principles May Underlie the Learning of Verbs

To examine whether children (mean age 34 months) can fast map and extend novel action labels to actions for which they do not already have names, the comprehension of familiar and novel verbs was tested using colored drawings of Sesame Street characters performing both familiar and unfamiliar actions. Children were asked to point to the character "verbing," from among sets of 4 drawings. With familiar words and actions, children made correct choices 97% of the time. With novel action words, children performed at levels mostly significantly above chance, selecting a previously unlabeled action or another token of a just-names action. In a second, control experiment children were asked to select an action from among the same sets of 4 drawings, but they were not given a novel action name. Here children mainly demonstrated performance at levels not significantly different from chance, showing that the results from the main experiment were attributable to the presence of a word in the request. Results of these studies are interpreted as support for the availability of principles to ease verb acquisition.
Differential transcription of fathead minnow immune-related genes following infection with frog virus 3, an emerging pathogen of ectothermic vertebrates

Frog virus 3 (FV3) and other ranaviruses are responsible for die-offs involving wild, farmed, and captive amphibians, fish, and reptiles. To ascertain which elements of the immune system respond to infection, we explored transcriptional responses following infection of fathead minnow cells with either wild type (wt) FV3 or a knock out (KO) mutant targeting the 18 kDa immediate early gene (18K). At 8h post infection we observed marked upregulation of multiple transcripts encoding proteins affecting innate and acquired immunity. Sequences expressed 4-fold or higher in wt-infected cells included transcripts encoding interferon (IFN), IFN regulatory factors (IRFs), IFN stimulated genes (ISGs) such as Mx and MHC class I, and interleukins IL-1β, IL-8, IL-17C and IL-12. Cells infected with the 18K KO mutant (∆18K) showed qualitative differences and lower levels of induction. Collectively, these results indicate that ranavirus infection induced expression of multiple cellular genes affecting both innate and acquired immunity.
Public perceptions of the ban on tobacco sales in San Francisco pharmacies

Background In October, 2008, legislation was implemented in the city and county of San Francisco, California, prohibiting the sale of tobacco products in pharmacies. Objective To characterise public awareness and perceptions of the ban on tobacco sales in San Francisco community pharmacies. Methods A brief, anonymous survey was used to assess public awareness and perceptions of a ban on tobacco sales approximately 1 year after implementation. Individuals were approached by researchers outside of chain pharmacies in San Francisco. Smokers and nonsmokers were included, and participants did not have to be patrons of the pharmacy. Results Of 198 participants, 56% were in favor of the ban, 27% opposed it and 17% were undecided. A greater proportion of current tobacco users (81%) than former/ never users (48%) were aware of the ban (p<0.001), and a lesser proportion were supportive of the ban (21% of current users vs 66% of former/never users; p<0.001). Most current tobacco users (88% of n=43) had not considered quitting smoking as a result of the ban. The majority of consumers indicated that the ban on cigarette sales did not influence their shopping behaviour at retail pharmacies. Conclusions In the city and county of San Francisco, public support exists for prohibiting the sale of tobacco products in pharmacies.
Synthesis of Oxidized Derivatives of 10‐Deuterobenzo[A]Pyrene

A series of oxidized derivatives of 10-deuterobenzol[a]pyrene (10-D-BaP) were synthesized. Oxidation of 10-D-BaP with sodium dichromate dihydrate yielded the 1,6-, 3,6-, and 6,12-quinones of 10-D-Bap. Upon electrophilic aromatic substitution of 10-D-BaP with sodium nitrate, N-bromosuccinimide, and N-chlorosuccinimide we were afforded 6-nitro-10-D-BaP, 6-bromo-10-D-BaP, and 6-chloro-10-D-BaP, respectively, in high yields. The Vilsmier-Haack reaction of 10-D-BaP provided 6-formyl-10-D-BaP which upon reduction with sodium borohydride, yielded 6-hydroxymethyl-10-D-BaP. Reduction with hydrazine in n-amyl alcohol gave 6-methyl-10-D-BaP. Reduction of 6-nitro-10-D-BaP with hydrazine and Pd/C yielded 6-amino-10-D-BaP. The synthesized compounds, which are known metabolites of benzo[a]pyrene and are useful substrates for metabolism, are important compounds for mechanistic study of the chemical carcinogenesis by benzo[a]pyrene.
Rapid loss of fentanyl citrate admixed with fluorouracil in polyvinyl chloride containers.

ObjectiveTo study the physical compatibility and chemical stability of fluorouracil 1 and 16 mg/mL with fentanyl citrate 12.5 μg/mL in dextrose 5% and in sodium chloride 0.9% injection.DesignTest s...
Records retention: addressing insider threats to data integrity

Inaccurate financial statements from major companies, dead people who still vote in elections, world-class gymnasts with uncertain birth dates: insiders often have the power and ability to make inappropriate changes to the content of electronic records. As electronic records replace paper records, it becomes easy to make such alterations without leaving behind evidence that can be used to detect the changes and determine who made them. The US Sarbanes-Oxley Act is perhaps the most (in)famous law that addresses these problems, but it is just one of many regulations that require long-term high-integrity retention of electronic records, all with the goal of ensuring that societal trust in business and government at reasonable cost.In this talk, we will discuss some of the technical challenges posed by the need for "tamper-proof" retention of records. We will describe how industry has responded to these challenges, the security weaknesses in current product offerings, and the role that researchers and government can play in addressing these weaknesses. We will give an overview of research progress to date and describe the major open research problems in this area.
Family Members of Patients With ARVC: Who Is at Risk? At What Age? When and How Often Should We Evaluate to Determine Risk?∗

Arrhythmogenic right ventricular cardiomyopathy (ARVC) is being recognized with increasing frequency as physicians have become more aware of this entity. Some estimate that ARVC may be present in 1 in 5,000 people. The disease is primarily caused by an autosomal dominant genetic defect. Therefore, a
Ireland and the picturesque: design, landscape, painting and tourism 1700–1840

During the eighteenth century, the aesthetics of the picturesque became a conceptual galaxy (in the McLuhanesque sense), pulling into its orbit aspects of landscape painting and gardening, architec...
The Economic Allocation Method of Energy Storage Capacity for Smoothing Wind Power Fluctuations

In this paper,an approach for determining energy storage capacity is proposed to investigate wind power fluctuations characteristics by analyzing the monthly data of a wind farm in Northeast China. The method aims to maximize the energy storage system investment benefits and smooth wind power output. The result shows that the optimal allocation scheme can be used to smooth wind power considerably. The paper can provide some reference for configuring energy storage system in wind farm and promoting the large-scale applications of energy storage system.
New developments and challenges

This chapter discusses future directions of and opportunities for digital library research and development. It begins with the introduction of social media applications in digital libraries, consisting of their definitions, applications, and functions. Subsequently, the discussion of large-scale digital libraries from Chapter 1 continues, with an emphasis on the characteristics of large-scale digital libraries and the related challenges and problems. After that, the chapter delves into multilingual digital libraries as another new direction of digital library development. In particular, the need for multilingual digital libraries, user studies, and a comparison of language-searching functions in several multilingual digital libraries are explored. Finally, the challenges and problems that researchers and practitioners encounter in the development of digital libraries are discussed. Moreover, further research corresponding to each type of challenge is proposed.
Antenatal Tobacco Use and Secondhand Smoke Exposure in the Home in India

Introduction Antenatal tobacco use and secondhand smoke (SHS) exposure can have grave health consequences. We estimated the prevalence of tobacco use and SHS exposure in the home among pregnant and reproductive age women in India, and identified sociodemographic risk factors. Methods Data were from the National Family Health Survey-3 (2005-2006), a population-based cross-sectional survey. We measured current tobacco use and SHS exposure in the home, and used logistic regression analysis to identify sociodemographic risk factors. Results Nationally, antenatal tobacco use and SHS exposure in the home were reported by 9% and 25% of women, respectively. Tobacco use rates were slightly higher in reproductive age women (11%) than in pregnant women (9%). Common risk factors for tobacco use in pregnant and reproductive age women included older age, lower education, lower socioeconomic status, Scheduled Tribe status, Muslim religion, and rural residence. Being married lowered the risk of tobacco use among pregnant women, but increased the risk among reproductive age women. Antenatal SHS exposure decreased with older age and higher socioeconomic status. Conclusions Antenatal tobacco use and SHS exposure in the home is a significant public health problem in India. Programs should target low socioeconomic status pregnant women, including single pregnant mothers. Implications Antenatal tobacco use and SHS exposure in the home are significant public health problems in India. Intervention strategies should target younger women, single and socioeconomically disadvantaged pregnant women.
Role of Mobile Technology to Improve Diabetes Care in Adults with Type 1 Diabetes: The Remote-T1D Study iBGStar ® in Type 1 Diabetes Management

The role of mobile technology in patient-reported outcomes (PRO) and glycemic control in adults with type 1 diabetes (T1D) needs further evaluation. The single-center, prospective, 6-month, open-label, investigator-initiated study randomized 100 subjects with T1D in a 1:1 fashion to a control group using self-monitoring of blood glucose (SMBG) with Accu-Chek Nano® and an intervention group using SMBG with iPhone plus glucose meter (iBGStar®). The primary endpoint was the change in PRO (hypoglycemia fear score, behavior and worry subscores). Secondary outcomes were the improvement in glycemic variability indices and the reduction in A1c values. Baseline demographics and glycosylated hemoglobin (A1c) values were similar in the two groups. There was a significant decrease in A1c value at 6 months in iBGStar® group compared to the control group (−0.16 vs. −0.51, p = 0.04). The total insulin dose increased significantly in the iBGStar® group at 3 months but did not change at 6 months. The hypoglycemia fear scale (PRO) improved in both groups at 6 months (−1.4 ± 10.0 vs. −3.9 ± 12.5, p = 0.32). The use of iBGStar® resulted in better glycemic control and improvement in some PRO (hypoglycemia fear and behavior scores) compared to the control group at 6 months with no increased risk of hypoglycemia. ClinicalTrials.gov: NCT01825382. Sanofi.
Alum efficacy 11 years following treatment: phosphorus and macroinvertebrates

Steinman AD, Hassett MC, Oudsema M, Rediske R. 2018. Alum efficacy 11 years following treatment: phosphorus and macroinvertebrates. Lake Reserv Manage. 34:167—181.Internal phosphorus loading and be...
Development and Validation of Machine Learning Models for Prediction of 1-Year Mortality Utilizing Electronic Medical Record Data Available at the End of Hospitalization in Multicondition Patients: a Proof-of-Concept Study.

Predicting death in a cohort of clinically diverse, multicondition hospitalized patients is difficult. Prognostic models that use electronic medical record (EMR) data to determine 1-year death risk can improve end-of-life planning and risk adjustment for research. Determine if the final set of demographic, vital sign, and laboratory data from a hospitalization can be used to accurately quantify 1-year mortality risk. A retrospective study using electronic medical record data linked with the state death registry. A total of 59,848 hospitalized patients within a six-hospital network over a 4-year period. The last set of vital signs, complete blood count, basic and complete metabolic panel, demographic information, and ICD codes. The outcome of interest was death within 1 year. Model performance was measured on the validation data set. Random forests (RF) outperformed logisitic regression (LR) models in discriminative ability. An RF model that used the final set of demographic, vitals, and laboratory data from the final 48 h of hospitalization had an AUC of 0.86 (0.85–0.87) for predicting death within a year. Age, blood urea nitrogen, platelet count, hemoglobin, and creatinine were the most important variables in the RF model. Models that used comorbidity variables alone had the lowest AUC. In groups of patients with a high probability of death, RF models underestimated the probability by less than 10%. The last set of EMR data from a hospitalization can be used to accurately estimate the risk of 1-year mortality within a cohort of multicondition hospitalized patients.
What exactly do students learn when they practice equation solving?: refining knowledge components with the additive factors model

Accurately modeling individual students' knowledge growth is important in many applications of learning analytics. A key step is to decompose the knowledge targeted in the instruction into detailed knowledge components (KCs). We search for an accurate KC model for basic equation solving skills, using data from an intelligent tutoring system (ITS), Lynnette. Key criteria are data fit and predictive accuracy based on a standard logistic model called the Additive Factors Model (AFM). We focus on three difficulty factors for equation solving: understanding of variables, the negative sign, and the complexity of the equation. Fine-grained KC models were found to have greater fit and predictive accuracy than an "ideal," more abstract model, indicating that there is substantial under-generalization in students' equation-solving skill related to all three difficulty factors. The work enhances scientific understanding of the challenges students face in learning equation solving. It illustrates how learning analytics could inform the improvement of technology-enhanced learning environments.
A Characterization of the Delaware Sea Breeze Using Observations and Modeling

AbstractSea-breeze circulations are a prominent source of diurnal wind variability along coastlines throughout the world. For Delaware, the sea breeze is the largest source of variability in the co...
Current management and referral patterns of pediatricians for acute otitis media.

Abstract Objective The American Academy of Pediatrics (AAP) has published an evidence-based clinical practice guideline for the management of acute otitis media (AOM), most recently revised in 2013. This study aims to assess current practice patterns and how they compare to the published guideline. Methods An 11 question survey addressing topics included in the 2013 AAP AOM guidelines was mailed to 196 practicing pediatricians. Statistical analysis was performed using Chi-square and ANOVA testing. Results 76 (38%) completed surveys were returned. 75% of respondents were in group practice (non-academic) and 83% were in practice 11 years or more. 93% were members of the AAP. 46% of responding pediatricians use pneumatic otoscopy and/or tympanometry at least once a day to aid in the diagnosis of AOM, while 28% never do. 15% of respondents would choose close observation over antibiotics in a child under the age of 2 years with unilateral non-severe AOM while 50% would choose close observation in a child over age 2. 75% would make a referral to Otolaryngology for recurrent AOM. No significant differences were noted in responses based on practice type, years in practice, or Otolaryngology experience during residency training. Conclusions Current pediatrician practice and referral patterns for AOM are not consistent with 2013 Guidelines from the AAP. As consulting surgeons, Otolaryngologists should have knowledge of management protocols in related specialties that can have an impact on their practice.
Lethal and sub-lethal effects of the insecticide fipronil on juvenile brown shrimp Farfantepenaeus aztecus.

Chemical pesticides are widely used around the world, but at the same time, they may cause direct or indirect risks to many non-target organisms. Recent increased use of insecticides in coastal areas, for example to control invasive tawny crazy ants, raises concern that insecticides may affect ecologically and/or commercially important species found in estuaries. Here, we investigated the lethal and sub-lethal effects of fipronil on juvenile brown shrimp Farfantepenaeus aztecus over 29 days at five different nominal concentrations (0.1, 1.0, 3.0, 6.4, and 10.0 µg/L) in a laboratory experiment. Exposure to all of the fipronil treatments resulted in all individuals dying before the end of the experiment; whereas, no individual died in the control (0.0 µg/L). The 96-hour LC50 was determined to be 1.3 µg/L. Shrimp also experienced weight loss under all of the fipronil treatments. Inter-moult interval was increased from 12.2 ± 1.64 day in the control group to 15.5 ± 0.53 day in the 1.0 μg/L treatment. Lipid content of shrimp increased significantly in a concentration-dependent manner. Finally, behavioral and body color changes were also observed under the fipronil treatments. We conclude F. aztecus is very sensitive to fipronil and monitoring is needed in coastal areas.
BODY CONDITION | Measurement Techniques and Data Processing

Many herbivores such as cattle evolved at the mercy of seasonal variations in food supply, and when nursing young, they have a tremendously increased energy requirement. Therefore, energy is stored as body fat during periods of plenty to be used during scarcity or increased need such as pregnancy and lactation. We routinely measure and manage body fat with a system known as ‘body condition score’. Because body fat plays a critical role in feed intake, reproduction, and many metabolic diseases, it is imperative that body fat be managed well. Body condition describes ‘fleshiness’ or outward signs of fat (and to a lesser extent muscle). Focus is on the ribs, the spine, and the rear quarters where changes in subcutaneous fat are evident. Systems use a numerical rank, with 1 signifying extremely emaciated, 3 or 5 as average, and 5 or 9 (or 10) as obese. Measurements are usually taken when an animal calves, at her peak lactation, once or twice in later lactation, and when she is dried off. Using this system as part of feeding, reproduction, and animal management has helped to eliminate the extremes of body fat and improve overall productive and reproductive efficiency of dairy cattle.
Media Representations of Water Issues as Health Risks

ABSTRACTWater is a critical natural resource for sustaining human life. Media representations are a factor in the formation of public risk perceptions and could influence water conservation and hea...
Geographic distance and intergenerational relationships in Chinese migrant families

This study examines the effect of adult Chinese migrants’ geographic distance from home on their intergenerational relationships with parents who remain behind. We compared monetary and family care...
Sex Hormones and Measures of Kidney Function in the Diabetes Prevention Program Outcomes Study

CONTEXT Despite sex differences in chronic kidney disease (CKD) onset and progression, it is unclear whether endogenous sex hormones are associated with kidney function in persons without CKD. DESIGN AND METHODS We conducted a secondary analysis of the Diabetes Prevention Program (DPP) and its follow-up observational study, the DPP Outcomes Study, over 11 years. Participants included overweight and glucose-intolerant men (n = 889) and pre- and postmenopausal women (n = 1281) not using exogenous sex hormones and whose urine albumin-to-creatinine ratio (ACR) was <30 mg/g and normal estimated glomerular filtration ratio (eGFR) was ≥60 mL/min/1.73 m2 at randomization. We examined the association between sex hormone levels and incidence of low eGFR and/or ACR ≥30 mg/g on at least one measurement. RESULTS At randomization, the mean (SD) eGFR was 94 (15) mL/min/1.73 m2; the median ACR (interquartile range) was 4.5 (3.3 to 7.6) mg/g. During follow-up, 187 men (24.6%) and 263 women (24.2%) had incident albuminuria and 136 men (17.9%) and 123 women (11.3%) had incident low eGFR. Among men, higher baseline sex hormone-binding globulin (SHBG) level was associated with reduced low eGFR risk (hazard ratio per SD, 0.80; 95% CI, 0.57 to 0.90) in adjusted analyses. No significant associations were observed among women. There were significant interactions between sex steroid levels and low eGFR by randomization arm. CONCLUSION Sex steroids were not associated with development of low eGFR or albuminuria. Among men, higher SHBG level was associated with reduced risk of low eGFR on at least one measurement.
Trends in use of echocardiography in hospitalized patients with syncope.

PURPOSE We sought to assess the trends in use, predictors of echocardiography, and its impact on in-hospital mortality in patients admitted with syncope using a large national database. METHODS Utilizing the Nationwide Inpatient Sample (NIS) database from 2001 to 2014, we identified adult patients (>18 years) with a primary discharge diagnosis of syncope and use of echocardiogram was ascertained. RESULTS A total of 3 174 619 patients with a primary discharge diagnosis of syncope were identified, of which 184 167 (5.8%) underwent an echocardiogram. The rate of syncope hospitalization remained constant between 2001 and 2009 (1.1/1000 US population) but has since decreased steadily to about 0.5/1000 US population in 2014. After adjusting for patient and hospital characteristics, the rate of echocardiogram use increased significantly from 5.1% in 2001 to 6.8% in 2014 (2.7% relative increase per year [Ptrend = 0.024]). Predictors of use were cardiac disorders, hypertension, diabetes, peripheral vascular disease, and renal failure. After adjusting for baseline risk, use of echocardiography was not associated with in-hospital mortality (OR = 0.827, P = 0.155), but was associated with a 14.6% increase in adjusted length of stay and a 22.6% increase in adjusted hospital cost compared to no echocardiography use (both P < 0.001). CONCLUSIONS The admission rates for syncope are decreasing and use of echocardiography in hospitalized patients with syncope is appropriately low. Given the lack of any favorable impact on mortality and the association with increased costs, there is a continued need to emphasize evidence-based use of echocardiography in patients presenting with syncope.
Fully Discrete Mixed Finite Element Methods for the Stochastic Cahn-Hilliard Equation with Gradient-type Multiplicative Noise

This paper develops and analyzes some fully discrete mixed finite element methods for the stochastic Cahn-Hilliard equation with gradient-type multiplicative noise that is white in time and correlated in space. The stochastic Cahn-Hilliard equation is formally derived as a phase field formulation of the stochastically perturbed Hele-Shaw flow. The main result of this paper is to prove strong convergence with optimal rates for the proposed mixed finite element methods. To overcome the difficulty caused by the low regularity in time of the solution to the stochastic Cahn-Hilliard equation, the H\"{o}lder continuity in time with respect to various norms for the stochastic PDE solution is established, and it plays a crucial role in the error analysis. Numerical experiments are also provided to validate the theoretical results and to study the impact of noise on the Hele-Shaw flow as well as the interplay of the geometric evolution and gradient-type noise.
Current concepts in vitamin D and orthopaedic surgery.

Abstract Introduction Vitamin D plays an important role in the musculoskeletal system of the human body. Here, we review the most current literature on vitamin D as it relates to orthopaedic surgery and the musculoskeletal system, focusing largely on non-fracture applications. Materials and methods A literature review was performed on the basic science of vitamin D metabolism, epidemiology of vitamin D levels, role of vitamin D within the musculoskeletal system, and the correlation of vitamin D with injuries and orthopaedic surgical outcomes. Results The existing literature suggests vitamin D plays multiple roles in the musculoskeletal system. Recent research has shed light on the importance of vitamin D in the setting of soft tissue healing and recovery in addition to affecting postoperative outcomes after common orthopaedic procedures. Conclusions Given the widespread prevalence of vitamin D deficiency, orthopaedic surgeons should be aware of the current evidence regarding clinical implications in patients with musculoskeletal complaints.
Treating Biliary-Enteric Anastomotic Strictures with Enteroscopy-ERCP Requires Fewer Procedures than Percutaneous Transhepatic Biliary Drains

Biliary-enteric anastomotic strictures (AS) in long-limb surgical biliary bypass (LLBB) require percutaneous transhepatic biliary drains (PTBD), enteroscopy-assisted ERCP (E-ERCP), or surgical revision. To compare E-ERCP and PTBD for AS treatment. E-ERCP stricturoplasty included dilation, cautery, and stent; PTBD included balloon dilation and serial drain upsizing events. From May 2008 to October 2015, 71 patients (37 M, median age 52) had E-ERCP (n = 45) or PTBD (n = 26) for AS in Roux-en-Y hepaticojejunostomy: liver transplant (n = 28), cholecystectomy injury revision (n = 21), other (n = 13) or Whipple’s resection (n = 9). Median follow-up is 11 months (range 1–56) in 67 (94%) patients. Technical success, clinical improvement, and adverse events between E-ERCP and PTBD were similar (76% vs. 77%, p = 0.89; 82% vs. 85%, p = 0.80, and 6% vs. 5%, p = 0.60, respectively). However, E-ERCP had fewer post-procedural hospitalization days (0.2 ± 0.65 vs. 4.5±10, p = 0.0001), mean procedures (4.4 ± 6.3 vs. 9.5 ± 8, p = 0.006), and median months of treatment to resolve AS (1, range 1–22 vs. 7, range 3–23; p = 0.003). Two patients in PTBD group required surgery. (1) Technical success and clinical improvement are seen in the majority of LLBB patients with biliary-enteric AS undergoing E-ERCP or PTBD. (2) E-ERCP is associated with fewer procedures, post-procedure hospitalization days, and months to resolve AS. When expertise is available, E-ERCP to identify and treat AS should be considered as an alternative to PTBD.
Rare tumor with matched germline whole exome sequencing to identify somatic and inherited variants of clinical significance.

1523Background: Rare cancer incidence is defined as <6/100,000 cases. These cases are challenging due to delays in diagnosis, late stage at diagnosis, lack of standard of care and poor outcomes. We...
Law and Strategy and Ethics

This article addresses the vital role that business ethics plays together with law and strategy. It places “values-attentive ethics” at the forefront of the developing law and strategy literature, arguing that the values-attentive ethics approach to organizational ethics is preferable to any alternative, particularly to command-and-control oriented approaches. The article further claims that the purview of values-attentive ethics is so closely allied with law as a resource in strategic management, that the combination of law and values-attentive ethics must be recognized together as perhaps the most vital resource in the law and strategy framework.
Gene therapy in animal models

Abstract Animal safety studies are an integral step of every new therapy before the initiation of human clinical trials. For gene therapeutic approaches, this means that mutation-specific animal models must be generated or identified among livestock or pets. Since the discovery of the first animal models of inherited retinal dystrophy (IRD) many more have been generated and identified in an effort to better understand the underlying cause of blindness. In this chapter, we will focus on retinal gene therapy approaches in animal models. We will discuss the different classes of IRD and their underlying basic biology that leads to the degeneration of the retina. Then, we will review the pros and cons of different animal models used in ocular gene therapy, review the successes achieved in animals, and conclude with the remaining challenges that need to be met for successful translation to human therapies.
Molybdenum-Promoted Synthesis of Isoquinuclidines with Bridgehead CF3 Groups

The preparation of the complex MoTp(NO)(DMAP)(4,5-η2-(2-trifluoromethyl)pyridine) (DMAP = 4-(dimethylamino)pyridine; Tp = tris(pyrazolyl)borate) is described. The CF3 substituent is found to preclude κ-N coordination, allowing for direct coordination without protection of the nitrogen. The dihapto-coordinate complex can be isolated as a single diastereomer, methylated, and reacted with a range of nucleophiles. Oxidative decomplexation affords the free dihydropyridines in good yield (75-90%). As a demonstration of synthetic utility, a series of novel bridgehead CF3-substituted isoquinuclidines was prepared from these decomplexed dihydropyridines.
Encouraging disposal of unused opioid analgesics in Appalachia

The Appalachian region has been disproportionately impacted by the opioid epidemic. This study, informed by the Health Belief Model (HBM), explored Appalachian community members’ perspectives on pr...
Febrile Neutropenia and Bacteremia after High-Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation in Patients Treated Inpatient Versus Outpatient

Introduction Multiple myeloma (MM) is the most common indication for high dose chemotherapy and autologous hematopoietic stem cell transplantation (ASCT). In addition, patients with immunoglobulin light-chain amyloidosis (AL), a related plasma cell disorder, often benefit from ASCT. Objectives: We aimed to compare baseline demographics, peri-transplant mortality, and the incidence of febrile neutropenia and bacteremia between an outpatient transplant cohort at one institution and an inpatient cohort at a second institution. Methods We performed a two-center retrospective chart review of all patients with plasma cell disorders undergoing ASCT between January 2014 and December 2018. All patients at transplant center A. were managed in the outpatient setting unless admission was necessary for febrile neutropenia, gastrointestinal toxicity, cardiac complications, or other adverse events. All patients at transplant center B were managed in the inpatient setting from conditioning regimen to engraftment post transplant. Results A total of 183 patients were included (103 outpatients vs 80 inpatients). There were no significant demographic differences between cohorts [Table 1]. The outpatient cohort (transplant center A) had a higher proportion of patients with AL amyloidosis (61% vs 38%), and a higher proportion of patients who received full high-dose melphalan at 200 mg/m2. Within the outpatient cohort, 48/103 (47%) patients were admitted for febrile neutropenia and 39/103 (38%) required admission for other reasons post-transplant. There were no differences in the incidence of febrile neutropenia or peritransplant mortality between cohorts [Table 1]. However, the incidence of bacteremia was higher in the outpatient cohort (23.3% vs 8.8%, p Conclusion In this contemporary two-center cohort of patients undergoing ASCT, there is no difference in 100-day mortality or incidence of febrile neutropenia between inpatient versus outpatient protocols. In addition, we demonstrate that outpatient transplant is a safe option for patients with AL amyloidosis. Prior studies comparing inpatient versus outpatient ASCT have been single-center studies, in which younger patients or those with fewer comorbidities were selected for outpatient transplant. The increased incidence of gram negative bacteremia in the outpatient cohort is in keeping with at least one prior single-center study, and is associated with a higher incidence of regimen-related gastrointestinal toxicity. Ongoing analysis will explore the impact of induction therapy prior to ASCT and gastrointestinal toxicity grading (correlated with melphalan dosing) on the incidence of bacteremia.