cssi/SciSciGPT-SciSciNet huggingface dataset:
Are psychoanalytic billing practices ethical

The changing climate of "health care reform" and increased third-party intrusion into psychotherapy are raising challenges over the ethics of traditional psychoanalytic practices such as billing for missed sessions. The practice of billing for missed sessions is an integral part of some analytic psychotherapies and forms the basis of the field of operation of many therapies. When used in this way, the billing practices are unique in medicine in that only these therapies use billing as a part of treatment. This practice is used for a variety of practical reasons but especially to emphasize to patients that the therapy occurs in their internal lives and addresses the symbols they use in organizing their world view. The symbolic use of a time commitment and the obligation to pay for that commitment are necessary so as not to present the patient with a contaminated field of operation. In this way the practice is similar to many other areas of medicine, such as surgeries that are viewed as global procedures whose billing allows for time that is not actually spent in contact with patients. This paper discusses the clinical rationale for the ability to bill for missed sessions and its ethics in terms of the newer language of utilization review. By laying down the principle of billing as a practice parameter for an open-ended bundled service that is billed globally the author translates the practice into more modern utilization-review terminology.
Abstract 419: Stim1 is Associated With Calcium Microdomains That are Required for Myofilament Remodeling and Signaling During Cardiac Hypertrophy

Stromal Interaction Protein 1 (STIM1) is the intracellular component of the store operated calcium channels. It is a ubiquitous Ca2+ sensor, prevalently located in the sarcoplasmic reticulum. In non-excitable cells, STIM1 is a key element in the generation of Ca2+signals that lead to gene expression and cell proliferation. A growing body of literature now suggests that STIM1 is important for normal heart function and plays a key role in the development of pathological cardiac hypertrophy. However, the precise mechanisms involving STIM1 and the Ca2+ signaling in excitable cells are not clearly established. We show that in neonatal rat cardiomyocytes, the spatial properties of STIM1-dependent Ca2+ signals determine restricted Ca2+ microdomains that regulate myofilaments remodeling and spatially segregated activation of pro-hypertrophic factors. Indeed, in vivo data obtained from an inducible cardiac restricted STIM1 knockout mouse, exhibited left ventricular dilatation associated with reduced cardiac contractility, which was corroborated by impaired single cell contractility. Furthermore, mice lacking STIM1 showed less adverse structural remodeling in response to pathological pressure overload-induced cardiac hypertrophy (transverse aortic constriction, TAC). We further show that the Ca2+ pool associated with STIM1 is the ON switch for extracellular signal-regulated kinase (ERK1/2)-mediated cytoplasm to nucleus signaling. These results highlight how STIM1-dependent Ca2+ microdomains have a major impact on intracellular Ca2+ homeostasis, cytoskeletal remodeling, signaling and cardiac function, even when excitation-contraction coupling is present.
Lower bounds for natural functions in restricted boolean circuits

The central problem of computational complexity theory is to determine the resource requirements for computing explicit functions in some reasonable model of computation, Boolean circuits being one such model. Although functions requiring exponential resources in this model are known to be plentiful, proving such lower bounds for explicit functions turns out to be very difficult. This difficulty has led researchers into studying restricted models of Boolean computation. Monotone Boolean circuits are an example of such a restricted model for which several non-trivial size and depth lower bounds have been obtained. In this work, we identify three restrictions on Boolean circuits: bijectivity, multilinearity and non-cancellativity. These restrictions are inspired by the restricted models of Boolean computation obtained by withholding certain axioms of the two-element Boolean algebra. We study the problem of proving non-trivial size lower bounds for natural functions in these restricted models. Unlike monotone Boolean circuits which can only compute monotone Boolean functions, these restricted circuits can compute all Boolean functions given enough resources. Moreover, there are natural Boolean functions that these restricted circuits can compute efficiently. Our main results are: (i) bijective Boolean circuits require exponential size to compute the bipartite perfect matching and the Hamiltonian cycle functions; (ii) monotone multilinear Boolean circuits require exponential size to compute the bipartite perfect matching and connectivity functions; (iii) non-cancellative Boolean circuits require super-polynomial size to compute the determinant function interpreted over GF(2) and exponential size to compute several monotone functions; and (iv) in the absence of cancellation, computing the determinant using circuits over reals is as hard as computing the permanent and both functions require exponential size.
Hermeneutics of Rent-Seeking Theory, Social Goal-Objective Formation and Fuzzy-Stochastic Rationality

In the monograph devoted to examining the political economy of social goal objective formation in a democratic decision-choice system [R15.18], we discussed the problem of coalition formations as they relate to the political economy of collective decision-choice actions on national interest, social vision and the formation of their supporting social goal-objective set, on the basis of citizens’ sovereignty. The concept of citizens’ sovereignty relates to the distribution of the decision-making power. The goal-objective set is related to the decision-choice action on private-public sector combinations of the political economy that will show the directions of disappearances of outmoded institutions and the emergence of new institutions in terms of destruction- construction duality. The decision-choice process in the social decision-choice space led us to discuss the structure of coalition formations in the game of the collective choice of an institutional structure that may come to influence the dynamics of the social goal-objective formation.
Pearl Harbor, 9–11, Katrina, Virginia Tech shootings, Deepwater Horizon planning deficiencies: A sense-respond information-sharing solution

The deficiencies of leadership and planning documented in the 1946 Congressional investigation of the 1941 Pearl Harbor attack are also evident in evidence presented at the investigations of 9/11, Katrina, the Virginia Tech shootings, Deepwater Horizon, the Columbine shootings, and Exxon Valdez. Even day-to-day incidents in a major Urban Area Security Initiative (UASI) region with massive technology investment suffers from these deficiencies. Mitigating and eliminating these deficiencies requires detailed information-sharing planning to replace the legacy ad hoc publish-and-subscribe methods pervasive today in public safety and emergency management, which - for many reasons - sustains the causes and effects of these planning deficiencies. This paper presents a conceptual sense-respond information-sharing architecture driven by a nonmonotonic-reasoning-based intelligent kernel. The process of implementing this proactive decision-support capability for day-to-day as well as major incidents/events as well as the use of the tool itself will together mitigate and eventually eliminate the Pearl Harbor deficiencies.
The International Health Regulations: A New Paradigm for Global Health Governance?

The current rapid emergence of large biobanks-major collections of biological, genetic, environmental and health data-has raised some fascinating issues at the nexus of medical law and medical ethics. The Icelandic project entailed creating a population-wide database and linking this to both a genealogical register and to genetic and other information gained from blood samples. The whole rationale of the biobank enterprise means that those enrolling cannot be told precisely what uses will be made of the resource in the future. The Swedish Biobank, referred to above, gained its participants from a clinic setting, in which there were obvious advantages to the people attending, because they were getting a full health check. The only physical risk relates to taking a blood sample, and consent procedures for this are well established. Psychological risks may be of two kinds: unwanted information and research uses, which offend the moral views of some participants.
A hybrid phononic waveguide using multilayer structure at mid-infrared

Surface phonon polaritons, SPhPs, result from the coupling or interaction of light with a phonon resonance. There has been extensive research into utilizing surface plasmon polaritons, SPPs, for subwavelength confinement of propagating waveguide modes for photonic integrated circuits. This work investigates the use of a multilayer system or insulatormetal-insulator (IMI) heterostructure as a SPhP-enhanced infrared waveguide where the metal response is due to phonons in a polar dielectric’s Reststrahlen band. In addition, an IMI heterostructure supports types of modes: an even mode and odd mode that have their own unique trade-offs. For the odd mode as the metal film thickness decreases the confinement of the SPhPs decreases, and thus resulting in an increase in the SPhPs propagation length. Conversely, the even mode shows the opposite behavior with decreasing metal film where the confinement increases as propagation length decreases. This endeavor investigates the trade-off between the even and odd IMI modes, and the characterization of propagation length and model confinement, as applied to a hybrid phononic waveguide.
Clinical skills temporal degradation assessment in undergraduate medical education

Introduction: Medical students’ ability to learn clinical procedures and competently apply these skills is an essential component of medical education. Complex skills with limited opportunity for practice have been shown to degrade without continued refresher training. To our knowledge there is no evidence that objectively evaluates temporal degradation of clinical skills in undergraduate medical education. The purpose of this study was to evaluate temporal retention of clinical skills among third year medical students. Methods: This was a cross-sectional study conducted at four separate time intervals in the cadaver laboratory at a public medical school. Forty-five novice third year medical students were evaluated for retention of skills in the following three procedures: pigtail thoracostomy, femoral line placement, and endotracheal intubation. Prior to the start of third-year medical clerkships, medical students participated in a two-hour didactic session designed to teach clinically relevant materials including the procedures. Prior to the start of their respective surgery clerkships, students were asked to perform the same three procedures and were evaluated by trained emergency medicine and surgery faculty for retention rates, using three validated checklists. Students were then reassessed at six week intervals in four separate groups based on the start date of their respective surgical clerkships. We compared the evaluation results between students tested one week after training and those tested at three later dates for statistically significant differences in score distribution using a one-tailed Wilcoxon Mann-Whitney U-test for non-parametric rank-sum analysis. Results: Retention rates were shown to have a statistically significant decline between six and 12 weeks for all three procedural skills. Conclusion: In the instruction of medical students, skill degradation should be considered when teaching complex technical skills. Based on the statistically significant decline in procedural skills noted in our investigation, instructors should consider administering a refresher course between six and twelve weeks from initial training. Keywords: Clinical skills, Assessment, Medical education
Impact of nitinol stent surface processing on in-vivo nickel release and biological response.

Abstract Although nitinol is widely used in percutaneous cardiovascular interventions, a causal relationship between nickel released from implanted cardiovascular devices and adverse systemic or local biological responses has not been established. The objective of this study was to investigate the relationship between nitinol surface processing, in-vivo nickel release, and biocompatibility. Nitinol stents manufactured using select surface treatments were implanted into the iliac arteries of minipigs for 6 months. Clinical chemistry profile, complete blood count, serum and urine nickel analyses were performed periodically during the implantation period. After explant, stented arteries were either digested and analyzed for local nickel concentration or fixed and sectioned for histopathological analysis of stenosis and inflammation within the artery. The results indicated that markers for liver and kidney function were not different than baseline values throughout 180 days of implantation regardless of surface finish. In addition, white blood cell, red blood cell, and platelet counts were similar to baseline values for all surface finishes. Systemic nickel concentrations in serum and urine were not significantly different between processing groups and comparable to baseline values during 180 days of implantation. However, stents with non-optimized surface finishing had significantly greater nickel levels in the surrounding artery compared to polished stents. These stents had increased stenosis with potential for local inflammation compared to polished stents. These findings demonstrate that proper polishing of nitinol surfaces can reduce in-vivo nickel release locally, which may aid in minimizing adverse inflammatory reactions and restenosis. Statement of significance Nitinol is a commonly used material in cardiovascular medical devices. However, relationships between nitinol surface finishing, in-vivo metal ion release, and adverse biological responses have yet to be established. We addressed this knowledge gap by implanting single and overlapped nitinol stents with different surface finishes to assess systemic impact on minipigs (i.e. serum and urine nickel levels, liver and kidney function, immune and blood count) over the 6 month implantation period. In addition, nickel levels and histopathology in stented arteries were analyzed on explant to determine relationships between surface processing and local adverse tissue reactions. The findings presented here highlight the importance of surface processing on in-vivo nickel release and subsequent impact on local biological response for nitinol implants.
Stemming Lung Disease

Epithelial Cells and the Alveolus Functioning of the alveoli of the lung depends largely on their constituent epithelial cells. Recent studies delineate a mechanism through which these cells are re...
Arterial composition and metabolism: esterified fatty acids and cholesterol.

Publisher Summary This chapter discusses the composition and metabolism of arteries to an understanding of the degeneration of esterified fatty acids and cholesterol. It is possible to distinguish the morphological changes that occur in arteries with age and with atherosclerosis from changes that occur in the chemical composition of the arterial wall. Some progress has been made in explaining changes in the chemical composition through biochemical mechanisms and through the prevalence of different subcellular components, each with its own characteristic composition. Hyperlipemia is not the only mechanism for inducing lesions that indiscriminately take up cholesterol esters from plasma, and hyperlipemia is not required to maintain a net uptake of cholesterol esters once advanced atherosclerotic lesions are established. Cholesterol esters perhaps accumulate in advanced lesions because they are the most prevalent nonpolar constituents of low density lipoproteins. The increase in lecithin concentrations in aortic tissue with experimental atherosclerosis is apparently not an early change and may be considered in association with the second stage in atherogenesis. The increase in lecithin concentrations may be secondary to increased lysolecithin concentrations and increased rates of lysolecithin acylation in the arterial tissue. The increased lysolecithin concentrations in aorta are in part the result of increased concentrations and rates of formation of lysolecithin in plasma. It seems likely that the most interesting and, perhaps, fruitful investigations of arterial lipids in the future will involve the early biochemical and ultrastructural changes prior to the development of the overt morphological changes of atherosclerosis.
Feedback Stabilization of Non Linear End Milling Process

Abstract This paper deals with the design of output feedback control to stabilize the cutting force of the nonlinear end milling process. The control design is based on criteria to be satisfied by the geometric conditions of the nonlinear system. The conditions will ensure that the closed loop of control system is asymptotically stable at the origin. Simulation study of the control design is carried out for the milling process having relative degree of one and the result is extended to the case of relative degree of three. The paper had demonstrated the feasibililty of applying the proposed control method to solve the practical problem in the milling process.
DNA Isolation, Manipulation and Characterization from Old Tissues

Recent advances in molecular techniques have revolutionized our approaches and expanded our vistas in the biomedical and organismal sciences. The development of the Polymerase Chain Reaction (PCR) has been the major reason for this revolution. Nearly every field of biology now owes a great deal to the development of these molecular techniques. The historically oriented sciences are an area of biology that has especially benefitted from PCR technology. This is because deoxyribonucleic acids are molecules that can carry genealogical information. Its double helical complementary nature and method of replication make it a perfect storage receptacle for historical information, whether the history be ancient or recent. In particular, in the organismal sciences, large advances have been made in the fields of evolutionary biology, population biology and systematics.
A Manifold Learning Based Approach to Reveal the Functional Linkages across Multiple Gene Networks

The coordination of functional genomics is a critical and complex process in biological systems, especially across different phenotypes or organism states (e.g., time, disease, organism). Understanding how the interactions of various genomic functions relate to these states remains a challenge. To address this, we have developed a machine learning method, ManiNetCluster, which integrates and simultaneously clusters multiple gene networks to identify cross-phenotype functional gene modules, revealing the genomic functional linkages. Particularly, this method extended the manifold learning to match local and nonlinear structures among networks for maximizing the functional connectivities. For example, we showed that ManiNetCluster significantly better aligns orthologous genes from cross-species gene expression datasets than the linear state-of-art methods. As a demonstration, we have applied our method to temporal gene co-expression networks of an algal day/night cycling transcriptome. This demonstration confirmed i) the validity of our clustering method, and ii) revealed the day-night linkages of photosynthetic functions, providing novel insights of temporal genomic functional coordination in bioproduction.
Measuring Basic Needs Fulfillment and Its Relation to Health and Wellbeing

Prior research proposed five basic needs: belonging, understanding, control, enhancing self, and trust (BUCET). Individually, each has been associated with physical and mental health. To date, basic psychosocial needs have been measured individually. These studies aim to validate a new, short and comprehensive measure of basic psychosocial needs, the Basic Needs Satisfaction Survey (BNSS), and demonstrate its association with physical and mental health. Study 1 confirmed previous EFA results for the BNSS and tested both convergent and predictive validity. Study 2 used CFA and examined divergent validity. Regression models investigated the role of the BNSS subscales as predictors of physical and mental health. Analyses from two studies demonstrated construct validity and predictive ability, providing evidence that the BNSS is reliable and valid and significantly related to both physical and mental health independent of socioeconomic status. Useful for predicting health outcomes, BNSS may be useful as a screener in medical settings.
Substance use outcomes in cocaine-dependent tobacco smokers: A mediation analysis exploring the role of sleep disturbance, craving, anxiety, and depression

Abstract Background Sleep disturbance may play a role in cocaine use outcomes and, hence, may be a potential therapeutic target for cocaine use disorder (CUD). Research in this area, which has largely relied on resource-intensive polysomnography, would be facilitated by identifying a self-report sleep measure predictive of CUD outcomes and by a better understanding of the mechanisms by which sleep may impact CUD outcomes. This study tested the predictive validity of the Pittsburgh Sleep Quality Index (PSQI), a self-report assessment of past-month sleep quality. To better understand potential mechanisms, mediation models relating sleep disturbance to CUD outcomes were evaluated. Methods This is a secondary analysis of data from cocaine-dependent (n = 290) participants in a multi-site trial evaluating smoking-cessation treatment for stimulant-dependent patients. The PSQI was collected at baseline; the outcomes of interest were cocaine and drug abstinence at end-of-treatment (weeks 9–10). Potential mediators, measured in weeks 1–8, were: cocaine craving (Brief Substance Craving Scale); and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Mediation techniques were used to evaluate mediation effects separately and jointly. Results The majority of participants (58.3%) had baseline sleep disturbance. Sleep disturbance was not a significant predictor of end-of-treatment abstinence when regressed without consideration of mediators. Cocaine craving, anxiety, and depression were significant mediators, both separately and jointly, of an effect of baseline sleep disturbance on end-of-treatment abstinence. Conclusion This exploratory analysis suggests that there may be an indirect relationship between self-reported sleep quality and substance use outcomes in cocaine-dependent patients, mediated by craving, anxiety, and depression. Trial registration: ClinicalTrials.gov : NCT01077024
Enhanced Assessment of Power System Behavior during Multiple Contingencies

Cascading failures are often results of a single (initiating) event, followed by inappropriate control action/s. Adequate assessment of power system responses and vulnerabilities can only be achieved with proper modeling and representation of critical elements and crucial control actions in power system analysis tools and procedures. Despite the well-understood importance of representing critical system elements in power system analysis to improve situational awareness and to hedge against Mother Nature and malicious attacks, many research efforts in these directions often employ steady-state analysis. The purpose of this paper is to demonstrate that methods based purely on steady-state analysis may fail to identify the most critical system vulnerabilities. This research also emphasizes that the most essential components of a power system should be investigated and modeled in all transient based studies in order to have a more realistic estimation of system behavior. This paper presents a systematic method to determine critical protective relays that need to be modeled in transient stability studies.
Patient Memory for Psychological Treatment Contents: Assessment, Intervention, and Future Directions for a Novel Transdiagnostic Mechanism of Change

Patient memory for treatment contents is defined as memory for the ideas, concepts, skills, and/or insights (termed treatment points) that the therapist thinks are important for the patient to remember and implement as a part of therapy. This article reviews key findings on patient memory for treatment contents, describes the development and evaluation of the Memory Support Intervention (MSI), and outlines future directions for research. Patient memory for treatment contents is poor, and worse memory is associated with worse treatment outcome. The MSI is composed of eight memory support strategies that therapists incorporate frequently alongside treatment points delivered during treatment-as-usual. Training therapists to deliver the MSI may yield better treatment outcomes by enhancing patient memory for treatment contents. Future research is needed to understand how to best measure patient memory for treatment contents, and the mediators, moderators, and dissemination potential of the MSI.
Quaternary-centre-guided synthesis of complex polycyclic terpenes

The presence of a quaternary centre—a carbon with four other carbons bonded to it—in any given molecule can have a substantial chemical and biological impact. In many cases, it can enable otherwise challenging chemistry. For example, quaternary centres induce large rate enhancements in cyclization reactions—known as the Thorpe–Ingold effect—which has application in drug delivery for molecules with modest bioavailability1. Similarly, the addition of quaternary centres to a drug candidate can enhance both its activity and its metabolic stability2. When present in chiral ligands3, catalysts4 and auxiliaries5, quaternary centres can guide reactions toward both improved and unique regio-, stereo- and/or enantioselectivity. However, owing to their distinct steric congestion and conformational restriction, the formation of quaternary centres can be achieved reliably by only a few chemical transformations6,7. For particularly challenging cases—for example, the vicinal all-carbon8, oxa- and aza-quaternary centres9 in molecules such as azadirachtin10,11, scopadulcic acid A12,13 and acutumine14—the development of target-specific approaches as well as multiple functional-group and redox manipulations is often necessary. It is therefore desirable to establish alternative ways in which quaternary centres can positively affect and guide synthetic planning. Here we show that if a synthesis is designed such that each quaternary centre is deliberately leveraged to simplify the construction of the next—either through rate acceleration or blocking effects—then highly efficient, scalable and modular syntheses can result. This approach is illustrated using the conidiogenone family of terpenes as a representative case; however, this framework provides a distinct planning logic that is applicable to other targets of similar synthetic complexity that contain multiple quaternary centres. An approach in which quaternary centres are leveraged to improve synthetic planning can lead to shorter and optimized syntheses, demonstrated here on a series of polycyclic terpenes.
Rate-dependent crack nucleation in cartilage under microindentation.

Abstract This study investigates rate-dependent crack nucleation in cartilage under microindentation using a poroviscoelastic framework and nano/microscopic images. Localized crack failure was induced at known locations and at different loading rates via microindentation with an axisymmetric sphero-conical indenter. Finite element (FE) modeling was used to reproduce results of microindentation tests within a poroviscoelastic framework. Scanning electron microscopy (SEM) was used to examine nano- and microscale structural features of crack surfaces. Microindentation results showed rate-dependent crack nucleation in cartilage. In particular, critical total work required for crack nucleation was larger at the slow loading rate compared to the fast loading rate. FE results suggested that viscoelastic relaxation of cartilage was a major contributor to the rate dependency and that tensile stresses localized at the indenter tip was a governing factor in crack nucleation. SEM images combined with microindentation and FE results suggested that the solid matrix in the vicinity of the tip experienced relatively large relaxation and kinematic fiber rearrangement at the slow loading rate in comparison to the fast loading rate. These findings extend current understanding of rate-dependent failure mechanisms in cartilage.
Noninvasive glucose detection in exhaled breath condensate

Two-thirds of patients with diabetes avoid regularly monitoring their blood glucose levels because of the painful and invasive nature of current blood glucose detection. As an alternative to blood sample collection, exhaled breath condensate (EBC) has emerged as a promising noninvasive sample from which to monitor glucose levels. However, this dilute sample matrix requires sensors capable of detecting glucose with high resolution at nanomolar and micromolar concentrations. Recent developments in EBC collection methods and highly sensitive glucose biosensors provide a path toward enabling robust and sensitive glucose detection in EBC. This review addresses current and emerging EBC collection and glucose sensing modalities capable of quantifying glucose in EBC samples. We highlight the opportunities and challenges for development and integration of EBC glucose detection systems that will enable clinically robust and accurate EBC glucose measurements for improved glycemic control.
Mechanisms for the Approach/Avoidance Decision Applied to Autism

As a neurodevelopmental disorder with serious lifelong consequences, autism has received considerable attention from neuroscientists and geneticists. We present a hypothesis of mechanisms plausibly affected during brain development in autism, based on neural pathways that are associated with social behavior and connect the prefrontal cortex (PFC) to the basal ganglia (BG). We consider failure of social approach in autism as a special case of imbalance in the fundamental dichotomy between behavioral approach and avoidance. Differential combinations of genes mutated, differences in the timing of their impact during development, and graded degrees of hormonal influences may help explain the heterogeneity in symptomatology in autism and predominance in boys.
Mapping Dynamic Changes in Ventricular Volume onto Baseline Cortical Surfaces in Normal Aging, MCI, and Alzheimer's Disease

Ventricular volume (VV) is a powerful global indicator of brain tissue loss on MRI in normal aging and dementia. VV is used by radiologists in clinical practice and has one of the highest obtainable effect sizes for tracking brain change in clinical trials, but it is crucial to relate VV to structural alterations underlying clinical symptoms. Here we identify patterns of thinner cortical gray matter (GM) associated with dynamic changes in lateral VV at 1-year (N=677) and 2-year (N=536) intervals, in the ADNI cohort. People with faster VV loss had thinner baseline cortical GM in temporal, inferior frontal, inferior parietal, and occipital regions (controlling for age, sex, diagnosis). These findings show the patterns of relative cortical atrophy that predict later ventricular enlargement, further validating the use of ventricular segmentations as biomarkers. We may also infer specific patterns of regional cortical degeneration (and perhaps functional changes) that relate to VV expansion.
Impact of the Patient Protection and Affordable Care Act on cost-related medication underuse in nonelderly adult cancer survivors

BACKGROUND Cost-related medication underuse (CRMU), a measure of access to care and financial burden, is prevalent among cancer survivors. The authors quantified the impact of the Patient Protection and Affordable Care Act (ACA) on CRMU in nonelderly cancer survivors. METHODS Using National Health Interview Survey data (2011-2017) for cancer survivors aged 18 to 74 years, the authors estimated changes in CRMU (defined as taking medication less than prescribed due to costs) before (2011-2013) to after (2015-2017) implementation of the ACA. Difference-in-differences (DID) analyses estimated changes in CRMU after implementation of the ACA in low-income versus high-income cancer survivors, and nonelderly versus elderly cancer survivors. RESULTS A total of 6176 cancer survivors aged 18 to 64 years and 4100 cancer survivors aged 65 to 74 years were identified. In DID analyses, there was an 8.33-percentage point (PP) (95% confidence interval, 3.06-13.6 PP; P = .002) decrease in CRMU for cancer survivors aged 18 to 64 years with income 400% of the FPL. There was a reduction for cancer survivors aged 55 to 64 years compared with those aged 65 to 74 years with income <400% of the FPL (-9.35 PP; 95% confidence interval, -15.6 to -3.14 PP [P = .003]). CONCLUSIONS There was an ACA-associated reduction in CRMU noted among low-income, nonelderly cancer survivors. The ACA may improve health care access and affordability in this vulnerable population.
Sex Hormone-binding Globulin, Cardiometabolic Biomarkers, and Gestational Diabetes: A Longitudinal Study and Meta-analysis.

Objective: This study investigated the prospective associations of circulating levels of sex hormone-binding globulin (SHBG) levels with cardiometabolic biomarkers and risk of gestational diabetes (GDM) during pregnancy. It also examines the longitudinal trajectory of SHBG in women with and without GDM. Methods: We conducted a nested case-control study of 107 incident GDM cases and 214 matched controls within the Eunice Kennedy Shriver National Institute of Child Health and Human Development Fetal Growth Studies-Singleton Cohort. The cohort enrolled non-obese and obese women aged 18-40 years with a singleton pregnancy between 8 and 13 weeks of gestation from 2009 to 2013. GDM was ascertained via medical records review. Blood samples were drawn four times at gestational weeks 10-14, 15-26, 23-31, and 33-39. The prospective associations between SHBG levels and cardiometabolic biomarkers were examined using the Spearman partial correlation among the controls. The longitudinal trajectories of SHBG levels were examined among the cases and the controls. Meta-analysis of prospective studies were performed to examine the association between SHBG levels and GDM risk. Results: SHBG levels at gestational weeks 10-14 were significantly inversely associated with fasting insulin (r= -0.17, P= 0.01) and insulin resistance as measured by HOMA-IR (r= -0.17, P= 0.01) at gestational week 15-26. SHBG at gestational weeks 10-14 and 15-26 was lower in cases than controls (mean ± standard deviation: (204.0±97.6) vs. (220.9±102.5) nmol/L, P= 0.16 and (305.6±124.3) vs. (322.7±105.1) nmol/L, P= 0.14, respectively), yet the differences were not significant. In the meta-analysis, SHBG was 41.5 nmol/L (95% confidence interval: 23.9, 59.1, P < 0.01) significantly lower among women with GDM than without, and each 50 nmol/L increase in SHBG was significantly associated with an odds ratio of 0.85 (95% confidence interval: 0.76-0.95, P= 0.01) for GDM. Conclusion: Lower SHBG levels in early pregnancy were prospectively associated with higher high insulin levels and insulin resistance in mid-pregnancy and subsequent risk of GDM, independent of adiposity. SHBG may serve as a marker for the identification of high-risk pregnancies during early pregnancy. Key words: Diabetes, gestational; Sex binding hormones; Cardiometabolic risk markers; Cohort analysis; Longitudinal measurement; Meta-analysis
Elevated Glucose and Insulin Levels Decrease DHA Transfer across Human Trophoblasts via SIRT1-Dependent Mechanism.

Gestational diabetes mellitus (GDM) results in reduced docosahexaenoic acid (DHA) transfer to the fetus, likely due to placental dysfunction. Sirtuin-1 (SIRT1) is a nutrient sensor and regulator of lipid metabolism. This study investigated whether the high glucose and insulin condition of GDM regulates DHA transfer and expression of fatty acid transporters and if this effect is related to SIRT1 expression and function. Syncytialized primary human trophoblasts were treated with and without glucose (25 mmol/L) and insulin (10−7 mol/L) for 72 h to mimic the insulin-resistance conditions of GDM pregnancies. In control conditions, DHA transfer across trophoblasts increased in a time- and dose-dependent manner. Exposure to GDM conditions significantly decreased DHA transfer, but increased triglyceride accumulation and fatty acid transporter expression (CD36, FABP3, and FABP4). GDM conditions significantly suppressed SIRT1 mRNA and protein expression. The SIRT1 inhibitor decreased DHA transfer across control trophoblasts, and recombinant SIRT1 and SIRT1 activators restored the decreased DHA transport induced by GDM conditions. The results demonstrate a novel role of SIRT1 in the regulation of DHA transfer across trophoblasts. The suppressed SIRT1 expression and the resultant decrease in placental DHA transfer caused by high glucose and insulin levels suggest new insights of molecular mechanisms linking GDM to fetal DHA deficiency.
Middle-Range Future Claims: Constructing the Near-Future Consequences of COVID-19

The extraordinary social and economic impact of the COVID-19 pandemic has generated many claims about the middle-range future-the period beginning in the late summer or early fall of 2020 and projected to last for some months or years This paper surveys those assertions and seeks to explain the factors that led to them Exploring questions about future claims can expand the scope of social problems theory
Prediction of postoperative pulmonary function following thoracic operations. Value of ventilation-perfusion scanning.

Surgical resection of lung cancer is frequently required in patients with severely impaired lung function resulting from chronic obstructive pulmonary disease. Twenty patients with obstructive lung disease and cancer (mean preoperative forced expiratory volume in I second [FEV1] = 1.73 L) were studied preoperatively and postoperatively by spirometry and radionuclide perfusion, single-breath ventilation, and washout techniques to test the ability of these methods to predict preoperatively the partial loss of lung function by the resection. Postoperative FEV, and forced vital capacity (FVC) were accurately predicted by the formula: postoperative FEV1 (or FVC) = preoperative FEV, X percent function of regions of lung not to be resected (r = 0.88 and 0.95, respectively). Ventilation and perfusion scans are equally effective in prediction. Washout data add to the sophistication of the method by permitting the qualitative evaluation of ventilation during tidal breathing. Criteria for patients requiring the study are suggested.
Developing US Elementary Students’ STEM Practices and Concepts in an Afterschool Integrated STEM Project

This chapter explores how six primary school students used their knowledge in science, technology, engineering, and mathematics (STEM) to complete a task in a robotics activity. It was designed to help students learn about programming and to build Lego robots that detect water in a simulated Mars model using Lego Mindstorms EV3. We explored students’ scientific-mathematics discourse to examine their use of scientific words to communicate their thinking through teamwork interactions and their course of actions to solve problems in various situations. We expanded Sfard’s discursive framework to analyze students’ scientific-mathematical discourse regarding their use of words and routines. Our extensive video analyses not only identified the overlapping concepts in STEM but also determined common observable practices in STEM disciplines. We discuss various student learning opportunities in the robotics activity and the challenges that arose in learning the concepts among STEM disciplines.
A Negotiated Relationship: Nuances of “Whitened” Biracial Educator Identities

In this article, we explore our desire to better understand the complexity of multi-ethnic/racial identities, positionality, and how this relates to solidarity building within educative spaces. In ...
School Psychologists' Involvement in the Response to Child Sexual Abuse

School psychologists have been designated as important figures in the schools' response to child sexual abuse. However, no reports are available on how school psychologists have responded to the is...
Thirty-Day Outcomes following Upper Extremity Flap Reconstruction

Introduction Flap reconstructions of upper extremity defects are challenging procedures. It is important to understand the surgical outcomes of upper extremity flap reconstruction, as well as associations between preoperative/perioperative variables and complications. Materials and Methods The National Surgical Quality Improvement Program (NSQIP) database was queried for patients from 2005 to 2016 who underwent flap reconstruction of an upper extremity defect. Patient and perioperative variables were collected for identified patients and assessed for associations with rates of any complication and major complications. Results On multivariate analysis, American Society of Anesthesiologists (ASA) classification >2, bleeding disorder, preoperative steroid use, free flap reconstruction, wound classification other than clean, and nonplastic surgeon specialty were independently associated with any complications. Bleeding disorder, ASA classification >2, male gender, wound classification other than clean, and preoperative anemia were independently associated with major complications. Free flap reconstruction was associated with increased length of stay, operative time, any complications, transfusions, and unplanned reoperations. Conclusion There is an association between complications in patients undergoing upper extremity free flap reconstruction and ASA classification >2, preoperative anemia, preoperative steroid use, bleeding disorders, and contaminated wounds. Male patients may require more thorough counseling in activity restriction following reconstruction. Free flaps for upper extremity reconstruction will require increased planning to reduce the chance of complications.
Deep learning in spine surgery

Abstract Deep learning is increasingly impactful for healthcare research and delivery. In orthopaedics, there has been a significant increase in the number of publications using deep learning for interpreting radiographs; however, there are only a few applications of deep learning specific to spine surgery. In this review, we discuss the potential of deep learning within spine surgery in four contexts: diagnosis (1), prognosis (2), patient management (3) and integration with virtual/augmented reality, robotic surgery and biomedical wearables (4). Additionally, we discuss current literature, future potentials and provide takeaways for clinicians who wish to apply deep learning in their research and practice.
REiNS: Measuring the Impact of Cutaneous Neurofibromas on Quality of Life in Neurofibromatosis Type 1

Objective In order to explore the use of Skindex scoring in patients with neurofibromatosis type 1 (NF1) across multiple clinical sites and inform design of additional quality of life measures, we analyzed correlations between Skindex, site, and clinical measures for 79 patients with NF1 from specialized clinics in Sydney, Australia (Royal North Shore Hospital [RNS]) and Minneapolis, Minnesota (University of Minnesota [UMN]). Methods The relationship between clinical factors and Skindex scores were explored by clinic site and overall. Results A total of 40 participants were recruited from RNS and 39 from UMN. Female sex, total number of cutaneous neurofibroma (cNF), and whether cNF were present on the face correlated highly with Skindex and not Riccardi scores. The UMN site had lower average scores, but these differences were almost entirely removed after adjusting for age, sex, facial cNF, and total cNF number. Conclusions The development of cNF in adolescence and adulthood in NF1 often leads to progressive disfigurement and discomfort and is among one of the most common reasons for patients to seek medical treatment. Skindex has been used to assess skin-related quality of life in NF1 previously but is not specific to NF1. These findings highlight the need for a low threshold for referral to dermatologists for all patients with NF1 regardless of the severity of disease. The finding that facial cNF and higher total number of cNF correlates with poorer skin-related quality of life may benefit design of more specific NF1 skin-related quality of life measures.
A 2-Channel 136-156 GHz Dual Down-Conversion I/Q Receiver with 30 dB Gain and 9.5 dB NF Using CMOS 22nm FDSOI

This paper presents a D-band 2-channel dual downconversion receiver front-end with a sliding IF architecture in 22nm FDSOI process. A fully-differential D-band low-noise amplifier (LNA) followed by an active double-balanced mixer is first used and down-converts the 137–157 GHz RF signal to an intermediate frequency (IF) of 31–40 GHz. The IF signal is split into I and Q channels and is down-converted to zero-IF output I/Q signals using a passive mixer for low 1/f noise. A x6 LO (17.5 GHz to 35 GHz and to 105 GHz) chain is included on the chip and provides the required LO for both mixers. The receiver achieves a measured peak gain of 27-30 dB, a noise figure of 9-10.5 dB at 136–154 GHz, a simulated output flicker noise corner frequency of 25 kHz and consumes 395 mW for both channels and the LO chain. The measured input P1dB is −29 dBm resulting in a high SNR for wide bandwidth signals. A measured EVM of 4.3-4.8% was achieved at 1–2 Gbaud for 16-QAM and 64-QAM waveforms. To the authors' knowledge, this work presents the first D-band CMOS I/Q receiver with application areas in dual-polarized receivers for point-to-point systems and digital beamforming MIMO arrays.
Novel Phased Array Antenna-in-Package Development and Active Module Demonstration for 5G Millimeter-Wave Wireless Communication

This paper presents novel antenna designs and integration methods that enable a low-cost scalable antenna-in-package (AiP) phased-array solution for wideband wireless communication covering 24 GHz - 30 GHz (N257, N258 and N261 5G bands). A total number of 26 dual-polarized antenna variants based on two implementation approaches were fabricated on a $\mathrm{47.5}\text{mm}\times \mathrm{47.5}\text{mm}$ package test vehicle with an element-to-element pitch of 5.9 mm. The first approach consists of integrating a magneto-electric dipole antenna array in a single laminate and the second approach consists of an aperture-coupled patch antenna array implemented in a superstrate forming a 2-laminate structure. Passive measurement results demonstrate the feasibility of achieving more than 5GHz input return loss bandwidth and 7dBi peak antenna gain with over 20dB cross-polarization isolation at 28 GHz, as well as near-identical radiation patterns for both H and V polarizations. In addition, the AiP test vehicle contains two $\mathrm{4}\times \mathrm{4}$ antenna arrays (one for each design approach) that support integration with 28-GHz SiGe phased array RFICs for active testing. Over-the-air active module measurement results are reported, including near-ideal spatial power combining, antenna gain uniformity across elements within +/-2.5dB, as well as 16-element beam-forming and beam-steering in a ±60° range.