cssi/SciSciGPT-SciSciNet huggingface dataset:
Quantifying radiation dose delivered to individual shoulder muscles during breast radiotherapy.

Abstract Background and purpose Radiotherapy is an effective treatment for managing breast cancer, but patients may experience shoulder morbidity after completing radiotherapy. There is a knowledge gap regarding how the inclusion of the regional lymphatics in radiation treatment regimens influence the radiation dose delivered to the underlying shoulder musculature. Material and methods Five standardized radiation treatment regimens were developed from the computed tomography (CT) scans of 11 patients: tangent fields only (T), high tangent fields (HT), T+supraclavicular fossa and axillary apex with an anterior oblique beam (SCV), T+SCV+axillary nodes with an anterior oblique beam (SCV+AX), and T+SCV+AX with the nodal regions treated with a directly opposed beam configuration (DO). The muscle volumes for nine shoulder muscles anatomically located with the treatment regimens were segmented from the same CT scans. The effect of the nine muscles and five treatment regimens on the percentage of each muscle receiving at least 48Gy (V48Gy) was analyzed with two-way and one-way repeated measures ANOVAs. Results A statistically significant interaction existed between the nine shoulder muscles and five treatment regimens ( p p Conclusions These findings highlight the muscles (pectoralis major, pectoralis minor, latissimus dorsi, and teres major) that may exhibit future morbidity after radiation, and indicate that nodal RT delivered with a DO beam arrangement delivers the highest muscle dose.
Precipitation Budget of the Madden–Julian Oscillation

AbstractColumn moisture and moist static energy (MSE) budgets have become common tools in the study of the processes responsible for the maintenance and evolution of the MJO. While many studies have shown that precipitation is spatially correlated with column moisture, these budgets do not directly describe the MJO-related precipitation anomalies. Other spatially varying fields may also play a role in determining the horizontal distribution of anomalous precipitation. In this study, an empirical precipitation anomaly field is derived that depends on three variables in addition to column moisture. These are the low-frequency distribution of precipitation, the low-frequency column saturation water vapor, and the sensitivity of precipitation to changes in column relative humidity. The addition of these fields improves upon moisture/MSE budgets by confining these anomalies to the climatologically rainy areas of the tropics, where MJO activity is strongest. The derived field adequately describes the MJO-relate...
Biological soil crust communities 12–16 years after wildfires in Idaho,USA

Changing fire regimes in western North America may impact biological soil crust (BSC) communities that influence many ecosystem functions, such as soil stability and C and N cycling. However, longer-term effects of wildfire on BSC abundance, species richness, functional groups, and ecosystem functions after wildfire (i.e. BSC resilience) is still poorly understood. We sampled BSC lichen and bryophyte communities at four sites in Idaho, USA, within foothill steppe communities that included wildfires from 12 to 16 years old. We established six plots outside each burn perimeter and compared them with six plots of varying severity within each fire perimeter at each site. BSC cover was most strongly negatively impacted by wildfire at sites that had well-developed BSC communities in adjacent unburned plots. BSC species richness was estimated to be 65 % greater in unburned plots compared with burned plots. In contrast, there was no evidence that vascular plant functional groups or fire severity (as measured by satellite metrics dNBR or RdNBR) significantly affected longer-term BSC responses. Three BSC functional groups (squamulose lichens, vagrant lichens, and tall turf mosses) exhibited a significant decrease in abundance in burned areas relative to adjacent unburned areas. The decreases in BSC cover and richness along with decreased abundance of several functional groups suggest that wildfire can negatively impact ecosystem function in these semi-arid ecosystems for at least one to two decades. This is a concern given that increased fire frequency is predicted for the region due to exotic grass invasion and climate change.
Sulfur and carbon isotopic evidence for metabolic pathway evolution and a four-stepped Earth system progression across the Archean and Paleoproterozoic

Abstract The Earth's mantle has provided a ready redox gradient of sulfur compounds (SO2, H2S) since the stabilization of the crust and formation of the ocean over 4 billion years ago, and life has evolved a multitude of metabolic pathways to take advantage of this gradient. These transitions are recorded in the sulfur and carbon isotope signals preserved in the rock record, in the genomic records of extant microorganisms, and in the changing mantle and crust structure, composition and cycling. Here, we have assembled approximately 20,000 sulfur (δ34S, Δ33S, Δ36S) and carbon (δ13C) isotope data points from scientific publications spanning over five decades of geochemical analyses on rocks deposited from 4.0 to 1.5 Ga. We place these data in the context of molecular clock and tectonic and surface redox indicators to identify overarching trends and integrate them into a holistic narrative on the transition of the Earth's surface towards more oxidizing conditions. The greatest extreme in δ34S values of sulfide minerals (− 45.5 to 54.9‰) and sulfate minerals (− 13.6 to 46.6‰) as well as δ13C values in carbonate minerals (− 16.8 to 29.6‰) occurred in the period following the Great Oxidation Event (GOE), while the greatest extremes in organic carbon δ13C values (− 60.9 to 2.4‰) and sulfide and sulfate mineral Δ33S and Δ36S values (− 4.0 to 14.3‰ and − 12.3 to 3.2‰, respectively) occurred prior to the GOE. From our observations, we divide transitions in Earth's history into four periods: Period 1 (4.00 to 2.80 Ga) during which geochemical cycles were initialized, Period 2 (2.80 to 2.45 Ga) during which S and C isotope systems exhibit changes as conditions build up to the GOE, Period 3 (2.45 to 2.00 Ga) encompassing the GOE, and Period 4 (after 2.00 Ga) after which S and C isotopic systems remained relatively constant marking a time of Earth system geochemical quiescence. Using these periods, we link changes in S and C isotopes to molecular clock work to aid in interpreting emerging metabolic functions throughout Earth's history while underscoring the need for better proxies for robust evolutionary analyses. Specifically, results indicate: 1) an early development of sulfide oxidation and dissimilatory sulfite reduction followed by disproportionation and then sulfate reduction to sulfite resulting in a fully biologically mediated sulfur cycle by ~ 3.25 Ga; 2) support for the acetyl coenzyme-A pathway as the most likely earliest form of biologically mediated carbon fixation following methanogenesis; 3) an increasingly redox-stratified ocean in the Neoarchean with largely oxic surface water and euxinic bottom water during the first half of the Paleoproterozoic; and 4) that secular changes in Earth system crustal cycling dynamics and continent formation likely played a key role in driving the timing of the GOE. Finally, based on geochemical data, we suggest that the Paleoproterozoic be divided into a new Era of the Eoproterozoic (from 2.45 to 2.00 Ga) and the Paleoproterozoic (from 2.00 to 1.60 Ga).
Localized Lysosome Exocytosis Helps Breach Tissue Barriers.

Cell invasion across basement membrane barriers is important in both normal development and cancer metastasis. In this issue of Developmental Cell, Naegeli et al. (2017) identify a mechanism for breaching basement membranes. Localized lysosome exocytosis fuels generation of large, invasive cellular protrusions that expand tiny basement membrane openings.
Pediatric abdominal migraine: current perspectives on a lesser known entity.

Background Abdominal migraine (AM) is a common cause of chronic and recurrent abdominal pain in children. It is characterized by paroxysms of moderate to severe abdominal pain that is midline, periumbilical, or diffuse in location and accompanied by other symptoms including headache, anorexia, nausea, vomiting, or pallor. Despite the presence of comprehensive diagnostic criteria under Rome IV classification of functional gastrointestinal disorders (FGIDs) and International Classification of Headache Disorders, it continues to be an underdiagnosed entity. Overview The average age of diagnosis is 3-10 years with peak incidence at 7 years. Most of the patients have a personal or family history of migraine. Pathophysiology of the condition is believed to be similar to that of other FGIDs and cephalic migraine. It is also well recognized as a type of pediatric migraine variant. A careful history, thorough physical examination, and use of well-defined, symptom-based guidelines are needed to make a diagnosis. Selective or no testing is required to support a positive diagnosis. It resolves completely in most of the patients. However, these patients have a strong propensity to develop migraine later in life. Explanation and reassurance should be the first step once the diagnosis is made. Nonpharmacologic treatment options including avoidance of triggers, behavior therapy, and dietary modifications should be the initial line of management. Drug therapy should be considered only if symptoms are refractory to these primary interventions. Conclusion More research focused on pathophysiology and management of AM needs to be carried out to improve outcomes in affected children.
Genome-Assisted Breeding in the Octoploid Strawberry

The application of genomic information to the breeding of allo-octoploid (2n = 8x = 56) cultivated strawberry (Fragaria × ananassa) has increased rapidly in the last five years. These advances have been fueled by technological improvements in high-throughput genotyping and genome sequencing, as well as concerted efforts to develop DNA tests for routine use in breeding. Genome-wide and subgenome-specific markers have advanced availability of DNA tests for major loci, as well as the development and validation of genomic selection methodology for complex traits in strawberry. Eight DNA tests for fruit quality and disease resistance loci are fully or partially in the public sphere. Genome-wide predictions have delivered genetic gain efficiencies for parent selection larger than 50% of conventional methods but without the need for phenotypic information. Meanwhile, the construction of haploblocks and haplotypes allows increased understanding of genome structure as it relates to breeding applications. With octoploid sequence assemblies merely months away and the development of gene editing technologies, precision manipulation of genes may shape the future of strawberry genetic improvement.
Autopsy 2018: Still Necessary, Even if Occasionally Not Sufficient.

The average autopsy rate in US hospitals was ≈50% in the 1940s and 41% in 1970, just before the Joint Commission on the Accreditation of Hospitals eliminated the requirement for a 20% autopsy rate. Since that time, autopsy rates have been in free fall, with estimated rates currently ≈8% overall, including forensic cases, but only 4% among in-hospital deaths. About 700 000 Americans die in acute-care hospitals each year, so these percentages translate into ≈28 000 hospital autopsies annually. Three explanations are commonly proposed for these falling rates: the lack of reimbursement for autopsies, the fear of disclosing mistakes that would lead to malpractice suits, and the belief that advances in medical technology, including but not limited to computed tomographic scans and magnetic resonance imaging, have made autopsies obsolete. The first 2 rationales could easily be resolved by effective legislation, such as Medicare reimbursement for autopsies, or regulation, such as reinstatement of a minimum required autopsy rate. From a scientific perspective, however, the key issue is whether autopsies remain as critical for measuring the quality of care and advancing medicine as they were 80 or even 50 years ago. The autopsy is the ultimate diagnostic test, typically the gold standard, with an assumed 100% sensitivity for finding causes of death and 100% specificity for excluding them. Of course, no test is perfect; any gold standard is simply the current best. Diagnosis in isolation, although interesting, …
Statistical analysis of stochastic gradient methods for generalized linear models

We study the statistical properties of stochastic gradient descent (SGD) using explicit and implicit updates for fitting generalized linear models (GLMs). Initially, we develop a computationally efficient algorithm to implement implicit SGD learning of GLMs. Next, we obtain exact formulas for the bias and variance of both updates which leads to two important observations on their comparative statistical properties. First, in small samples, the estimates from the implicit procedure are more biased than the estimates from the explicit one, but their empirical variance is smaller and they are more robust to learning rate misspecification. Second, the two procedures are statistically identical in the limit: they are both unbiased, converge at the same rate and have the same asymptotic variance. Our set of experiments confirm our theory and more broadly suggest that the implicit procedure can be a competitive choice for fitting large-scale models, especially when robustness is a concern.
Static Fatigue in Glass

The decrease in the strength of glass under load results from reaction of the glass with water in the surrounding atmosphere. Hillig and Charles have proposed a model to explain the static fatigue of glass in which this reaction is enhanced by the concentration of stress at crack tips in the glass. This stress-enhanced corrosion leads to a sharpening of the crack tip, a still higher stress there, and ultimately failure when the theoretical cohesive stress of the glass is reached. This theory can explain some experimental results on delayed failure in glass but other results, such as the effect of surface treatment on delayed failure, are inconsistent with the theory.
Stone Granuloma: A Cause of Ureteral Stricture

AbstractUreteral stricture is a recognized complication of ureteroscopy and ureteral stone fragmentation. Although most strictures are either asymptomatic or easily dilated, there are some strictures that result in progressive ureteral obstruction, do not respond to ureteral dilation and require operative intervention. A review of 125 percutaneous nephrostolithotomies for staghorn stone disease and 652 ureteroscopic stone fragmentations revealed 5 cases in which refractory ureteral strictures developed, requiring operative intervention. In 4 patients a “stone granuloma,” embedded particles of calcium oxalate associated with macrophages and foreign body giant cells, was found with surrounding fibrosis and ureteral obstruction. In the remaining patient a suture granuloma from a recent ureterolithotomy was the source of the stricture. In each instance of stone granuloma the particles of calcium oxalate had become embedded in the wall as a consequence of ureteroscopic stone fragmentation and partial ureteral ...
Critical Experiments with Highly Enriched Uranium and Matrix Elements (Si, Mg, Al, Gd, and Fe)

Scientists at the Los Alamos National Laboratory measured the critical masses of square prisms of highly enriched uranium diluted in various X/{sup 235}U with matrix material and polyethylene. The configuration cores were 22.86 and 45.72 cm square and were reflected with 8.13-cm-thick and 10.16-cm-thick side polyethylene reflectors, respectively. The configurations had 10.16-cm-thick top and bottom polyethylene reflectors. For some configurations, the Rossi-{alpha}, which is an eigenvalue characteristic for a particular configuration, was measured to establish a reactivity scale based on the degree of subcriticality. These experiments provided critical mass data in the thermal energy range for systems containing Si, Mg, Al, Gd, and Fe. The measured k{sub eff} from these experiments was compared with the calculated k{sub eff} from MCNP using ENDF/B-V and ENDF/B-VI cross-section data. The observed biases were +0.005 {delta}k and +0.008 {delta}k for Si, +0.0006 {delta}k and +0.008 {delta}k for Al, +0.0023 {delta}k for Mg, +0.004 {delta}k and +0.01304 {delta}k for Gd, and +0.0123 {delta}k and -0.00106 {delta}k for Fe.
Angular distributions from shell-model forbidden (d, p) transitions to spin 52 states in 43Ca, 45Ca and 47Ti

Abstract The (d, p) transitions to the ground state and first excited states of 43Ca, 45Ca and 47Ti have been measured at deuteron energies near 7 MeV. The similarity between the shapes of the angular distributions to the weak 374 keV 5 2 − level in 43 Ca , the 176 keV level in 45 Ca and the 5 2 − ground state of 47 Ti suggests that these transitions proceed through a direct-reaction mechanism.
Processes that break baryon number by two units and the Majorana nature of the neutrino

Abstract We employ the simplest possible models of scalar-fermion interactions that are consistent with the gauge symmetries of the Standard Model and permit no proton decay to analyze the connections possible among processes that break baryon number by two units. In this context we show how the observation of n- n ¯ oscillations and of a pattern of particular nucleon–antinucleon conversion processes — all accessible through e-d scattering — namely, selecting from e − p → e + p ¯ , e − p → n ¯ ν ¯ , e − n → p ¯ ν ¯ , and e − n → e − n ¯ would reveal that the decay π − π − → e − e − must occur also. This latter process is the leading contribution to neutrinoless double beta decay in nuclei mediated by new short-distance physics, in contrast to that mediated by light Majorana neutrino exchange. The inferred existence of π − π − → e − e − would also reveal the Majorana nature of the neutrino, though the absence of this inference would not preclude it.
Biobank-wide association scan identifies risk factors for late-onset Alzheimer’s disease and endophenotypes

Dense genotype data and thousands of phenotypes from large biobanks, coupled with increasingly accessible summary association statistics from genome-wide association studies (GWAS), provide great opportunities to dissect the complex relationships among human traits and diseases. We introduce BADGERS, a powerful method to perform polygenic score-based biobank-wide scans for disease-trait associations. Compared to traditional regression approaches, BADGERS uses GWAS summary statistics as input and does not require multiple traits to be measured on the same cohort. We applied BADGERS to two independent datasets for Alzheimer9s disease (AD; N=61,212). Among the polygenic risk scores (PRS) for 1,738 traits in the UK Biobank, we identified 48 significant trait PRSs associated with AD after adjusting for multiple testing. Family history, high cholesterol, and numerous traits related to intelligence and education showed strong and independent associations with AD. Further, we identified 41 significant PRSs associated with AD endophenotypes. While family history and high cholesterol were strongly associated with neuropathologies and cognitively-defined AD subgroups, only intelligence and education-related traits predicted pre-clinical cognitive phenotypes. These results provide novel insights into the distinct biological processes underlying various risk factors for AD.
The Impact of Allograft CXCL9 during Respiratory Infection on the Risk of Chronic Lung Allograft Dysfunction.

The long term clinical significance of respiratory infections after lung transplantation remains uncertain. In this retrospective single-center cohort study of 441 lung transplant recipients, we formally evaluate the association between respiratory infection and chronic lung allograft dysfunction (CLAD). We furthermore hypothesized that bronchoalveolar lavage fluid (BALF) CXCL9 concentrations are augmented during respiratory infections, and that episodes of infection with elevated BALF CXCL9 are associated with greater CLAD risk. In univariable and multivariable models adjusted for other histopathologic injury patterns, respiratory infection, regardless of the causative organism, was a strong predictor of CLAD development (adjusted HR 1.8 95% CI 1.3-2.6). Elevated BALF CXCL9 concentrations during respiratory infections markedly increased CLAD risk in a dose-response manner. An episode of respiratory infection with CXCL9 concentrations greater than the 25th, 50th, and 75th percentile had adjusted HRs for CLAD of 1.8 (95% CI 1.1-2.8), 2.4 (95% CI 1.4-4.0) and 4.4 (95% CI 2.4-8.0), respectively. Thus, we demonstrate that respiratory infections, regardless of the causative organism, are strong predictors of CLAD development. We furthermore demonstrate for the first time, the prognostic importance of BAL CXCL9 concentrations during respiratory infections on the risk of subsequent CLAD development.
Person Identification with Visual Summary for a Safe Access to a Smart Home.

SafeAccess is an integrated system designed to provide easier and safer access to a smart home for people with or without disabilities. The system is designed to enhance safety and promote the independence of people with disability (i.e., visually impaired). The key functionality of the system includes the detection and identification of human and generating contextual visual summary from the real-time video streams obtained from the cameras placed in strategic locations around the house. In addition, the system classifies human into groups (i.e. friends/families/caregiver versus intruders/burglars/unknown). These features allow the user to grant/deny remote access to the premises or ability to call emergency services. In this paper, we focus on designing a prototype system for the smart home and building a robust recognition engine that meets the system criteria and addresses speed, accuracy, deployment and environmental challenges under a wide variety of practical and real-life situations. To interact with the system, we implemented a dialog enabled interface to create a personalized profile using face images or video of friend/families/caregiver. To improve computational efficiency, we apply change detection to filter out frames and use Faster-RCNN to detect the human presence and extract faces using Multitask Cascaded Convolutional Networks (MTCNN). Subsequently, we apply LBP/FaceNet to identify a person and groups by matching extracted faces with the profile. SafeAccess sends a visual summary to the users with an MMS containing a person's name if any match found or as "Unknown", scene image, facial description, and contextual information. SafeAccess identifies friends/families/caregiver versus intruders/unknown with an average F-score 0.97 and generates a visual summary from 10 classes with an average accuracy of 98.01%.
The Empathetic Soldier

Empathy’s relation to the conduct of war is ambiguous. It is mentioned sporadically in international relations theory and, perhaps surprisingly, in official military doctrine. Yet empathy’s role in...
Four versus six cycles of docetaxel and cyclophosphamide in early breast cancer.

e12047Background: ABC trials established the use of non-anthracycline containing regimen, docetaxel and cyclophosphamide (TC) as adjuvant therapy in early breast cancer. In clinical practice, TC is...
Personalization in OELEs: Developing a Data-Driven Framework to Model and Scaffold SRL Processes

This research focuses on developing a data-driven framework for modeling and scaffolding learners’ self-regulated learning (SRL) processes in open-ended learning environments (OELE). The aim of this work is to offer a personalized and productive learning experience by adapting scaffolds to help learners develop self-regulation skills and strategies. This research applies mining techniques on data collected from multiple channels to track learners’ cognitive, affective, metacognitive and motivational (CAMM) processes as they work in Betty’s Brain, a computer-based OELE. The CAMM information is used to derive online models of learners’ SRL processes. These learner models inform the design of personalized scaffolds that help students develop the required SRL process and become more proficient learners. The significance of this research lies in developing and using data-driven learner SRL models to personalize and contextualize the scaffolds provided to learners within the OELE.
Clinical utility of venoarterial-extracorporeal membrane oxygenation (VA-ECMO) in patients with drug-induced cardiogenic shock: a retrospective study of the Extracorporeal Life Support Organizations' ECMO case registry.

Background: Venoarterial-extracorporeal membrane oxygenation (VA-ECMO) is increasingly utilized to treat severe or refractory drug-induced cardiovascular shock. There is limited evidence regarding ...
Comparative structural investigations of nuclear waste glass alteration layers and sol-gel synthesized aerogels

While various glass alteration layer formation mechanisms have been debated in recent years, the glass alteration community generally agrees that more information on physical properties of the alteration layers is needed to further the understanding of their impacts on overall glass alteration. In this work, pore volumes and solid structures of glass (International Simple Glass, ISG) alteration layers formed in solutions of various pH conditions in initially dilute conditions at 90 °C are evaluated with positron annihilation spectroscopy, small-angle X-ray scattering, and scanning transmission electron microscopy. Pore volumes of alteration layers formed at pH 9 were found to be at their lowest near the surfaces of the alteration layers. Solid structures of alteration layers are compared with those of synthetic aerogels of comparable compositions produced under various pH conditions. Alteration layers formed at pH 11 on ISG were shown to contain large structures (>10 nm) similar to synthetic aerogels created under neutral and basic conditions whereas alteration layers formed at pH 9 did not. Available dissolved silica species defined by silica solubility were proposed to have the greatest impact on alteration layer structure.
Dynamics-driven allostery underlies pre-activation of the regulatory Ca2+-ATPase/phospholamban complex

Sarcoplasmic reticulum (SR) Ca2+-ATPase (SERCA) and phospholamban (PLB) are essential for intracellular Ca2+ transport in myocytes. Ca2+-dependent activation of SERCA-PLB provides a rheostat function that regulates cytosolic and SR Ca2+ levels. While experimental and computational studies alone have led to a greater insight into the mechanisms for SERCA-PLB regulation, the structural changes induced by Ca2+ binding and how those are communicated to couple enzymatic activity with active transport remain poorly understood. Therefore, we have performed atomistic simulations totaling 32.7 s and cell-based intramolecular fluorescence resonance energy transfer (FRET) experiments to determine structural changes of PLB-bound SERCA in response to Ca2+ binding. Complementary simulations and experiments showed structural disorder underlies PLB inhibition of SERCA, and Ca2+ binding is sufficient to shift the protein population toward a structurally ordered state of the complex. This structural transition results in a redistribution of structural states toward a partially closed conformation of SERCAs cytosolic headpiece. Closure is accompanied by functional interactions between the N-domain {beta}5-{beta}6 loop and the A-domain. Regulation of these key structural elements indicate that Ca2+ is a critical mediator of allosteric signaling that dictates structural changes and motions that pre-activate SERCA-PLB. These findings provide direct support that dynamically driven protein allostery underlies PLB regulation of SERCA. These functional insights at unprecedented spatiotemporal resolution suggest a general modular architecture mechanism for dynamic regulation of the SERCA-PLB complex. Understanding these mechanisms is of paramount importance to guide therapeutic modulation of SERCA and other evolutionarily related ion-motive ATPases.
Predictive Modelling for Chronic Disease: Machine Learning Approach

Chronic diseases are responsible for half of annual mortality (51%) and almost half of the burden of all diseases (41%) in Bangladesh. Developing countries like Bangladesh are in a probable state of approximate loss of $7.3 trillion due to chronic diseases by 2025. Healthcare industries in Bangladesh now generate, collect, and store large amount of data. With the emergence of big data analytics, the approach to determine the factors causing specific effects on health is increasingly based on machine learning techniques. Therefore, it is important to conduct a predictive big data analysis using machine learning techniques to understand the likelihood of chronic diseases, specifically diabetes, hypertension, and heart diseases that are caused by age, income, and years of diseases. The aim of this research is to develop a predictive analytics tool for chronic diseases using machine learning techniques. The application of machine learning in the healthcare sector can minimize the costs of treatment and can help in taking proactive actions.
Provider Discretion and Variation in Resource Allocation: The Case of Triage Decisions

One of the most challenging environments in health care is the emergency department (ED) A key decision-maker in that context is triage nurses, who assess patient illness severity and influence wait times for medical attention. We gather novel data on the triage process across 108 EDs, including wait times, triage nurse identities and assessments, and detailed patient information and outcomes. Using quasi-random assignment to ED, we find a striking rate of "inversions," where patients who are sicker based on either ex ante information or ex post outcomes are scored as sicker and wait longer than their healthier counterparts.
Combination of ERCP-Based Modalities Increases Diagnostic Yield for Biliary Strictures

Biliary stricture evaluation with brush cytology and intraductal forceps biopsy carries a low sensitivity, but the combination of newer modalities may improve sensitivity. To determine whether the addition of advanced modalities increases diagnostic yield of ERCP-based sampling. This single-center retrospective study evaluates patients with biliary strictures sampled using brush cytology. Operating characteristics were calculated for individual and combinations of modalities including cholangioscopy, fluoroscopy- and cholangioscopy-directed intraductal biopsy, fluorescence in situ hybridization (FISH), and confocal laser endomicroscopy. Analyses under Standard Criteria (SC) included malignant results as “positive” and Expanded Criteria (EC) included “suspicious” and “high-grade dysplasia” results as “positive.” A total of 614 patients were included, and 354 (57.8%) received brush cytology alone, which had a sensitivity of 38.5% (SC) to 40.3% (EC) and a specificity of 97.8% (EC) to 99.3% (SC). Combining brush cytology with fluoroscopy-guided biopsy (n = 259, 42.2%) had a sensitivity of 62.5% (SC) to 67.9% (EC) and specificity of 90.2% (EC) to 96.7% (SC). Adding FISH to brush cytology had a sensitivity of 84.2% (SC) to 87.5% (EC) and specificity of 54.1% (SC and EC), while cholangioscopy visualization addition resulted in a sensitivity of 80.4% (SC) to 92.2% (EC) and specificity of 67.3% (EC) to 89.1% (SC). There were no significant differences in sensitivity and specificity using SC and EC. Brush cytology has a low sensitivity, but the addition of other modalities increases sensitivity. There was no difference in specificity between the SC and the EC, supporting the inclusion of “suspicious” impressions with malignant results at our center.
Sequential Minimally Invasive Fetal Interventions for Two Life-Threatening Conditions: A Novel Approach.

Introduction In utero interventions are performed in fetuses with "isolated" major congenital anomalies to improve neonatal outcomes and quality of life. Sequential in utero interventions to treat 2 anomalies in 1 fetus have not yet been described. Case presentation Here, we report a fetus with a large left-sided intralobar bronchopulmonary sequestration (BPS) causing mediastinal shift, a small extralobar BPS, and concomitant severe left-sided congenital diaphragmatic hernia (CDH). At 26-week gestation, the BPS was noted to be increasing in size with a significant reduction in right lung volume and progression to fetal hydrops. The fetus underwent ultrasound-guided ablation of the BPS feeding vessel leading to complete tumor regression. However, lung development remained poor (O/E-LHR: 0.22) due to the left-sided CDH, prompting fetal endoscopic tracheal occlusion therapy at 28-week gestation to allow increased lung growth. After vaginal delivery, the newborn underwent diaphragmatic repair with resection of the extralobar sequestration. He was discharged home with tracheostomy on room air at 9 months. Discussion/conclusion Sequential in utero interventions to treat 2 severe major anomalies in the same fetus have not been previously described. This approach may be a useful alternative in select cases with otherwise high morbidity/mortality. Further studies are required to confirm our hypothesis.
Genetic contribution to high temperature tolerance in Cryptococcus neoformans

The human fungal pathogen Cryptococcus neoformans relies on a complex signaling network for the adaptation and survival at the host temperature. Protein phosphatase calcineurin is central to proliferation at 37°C but its exact contributions remain ill-defined. To better define genetic contributions to the C. neoformans temperature tolerance, 4031 gene knockouts were screened for genes essential at 37°C and under conditions that keep calcineurin inactive. Identified 83 candidate strains, potentially sensitive to 37°C, were subsequently subject to technologically simple yet robust assay, in which cells are exposed to a temperature gradient. This has resulted in identification of 46 genes contributing to the maximum temperature at which C. neoformans can proliferate (Tmax). The 46 mutants, characterized by a range of Tmax on drug-free media, were further assessed for Tmax under conditions that inhibit calcineurin, which led to identification of several previously uncharacterized knockouts exhibiting synthetic interaction with the inhibition of calcineurin. A mutant that lacked septin Cdc11 was among those with the lowest Tmax and failed to proliferate in the absence of calcineurin activity. To further define connections with calcineurin and the role for septins in high temperature growth, the 46 mutants were tested for cell morphology at 37°C and growth in the presence of agents disrupting cell wall and cell membrane. Mutants sensitive to calcineurin inhibition were tested for synthetic lethal interaction with deletion of the septin-encoding CDC12 and the localization of the septin Cdc3-mCherry. The analysis described here pointed to previously uncharacterized genes that were missed in standard growth assays indicating that the temperature gradient assay is a valuable complementary tool for elucidating the genetic basis of temperature range at which microorganisms proliferate.
Intraoperative hypotension and complications after vascular surgery: A scoping review.

Abstract Background Intraoperative hypotension during major surgery is associated with adverse health outcomes. This phenomenon represents a potentially important therapeutic target for vascular surgery patients, who may be uniquely vulnerable to intraoperative hypotension. This review summarizes current evidence regarding the impact of intraoperative hypotension on postoperative complications in patients undergoing vascular surgery, focusing on potentially modifiable procedure- and patient-specific risk factors. Methods A scoping review of the literature from Embase, MEDLINE, and PubMed databases was conducted from inception to December 2019 to identify articles related to the effects of intraoperative hypotension on patients undergoing vascular surgery. Results Ninety-two studies met screening criteria; 9 studies met quality and inclusion criteria. Among the 9 studies that defined intraoperative hypotension objectively, there were 9 different definitions. Accordingly, the reported incidence of intraoperative hypotension ranged from 8% to 88% (when defined as a fall in systolic blood pressure of >30 mm Hg or mean arterial pressure Conclusion There is no validated, consensus definition of intraoperative hypotension or other hemodynamic parameters associated with increased risk for adverse outcomes. Despite these limitations, the weight of evidence suggests that intraoperative hypotension is common and associated with major postoperative complications in vascular surgery patients.
Sexual Experiences and Perspectives of Adolescents and Young Adults With Intellectual and Developmental Disabilities

The purpose of this study is to understand the sexual experiences and perspectives of adolescents and young adults (AYA) with intellectual or developmental disabilities, how they are receiving sexu...
On the Topology of the Double Staircase

This paper analyzes the double staircase from a topological point of view in three parts. First, it surveys historical archetypes of the double staircase, attending to their evolution and sundry topological varieties. Second, it presents a topological taxonomy for the double staircase which allows its rigorous formal classification. Third, it explores the generative range of algorithmically generated double staircases, particularly those derived directly from schematic circulation schemes. We introduce the medial axis as a technique uniquely suited to produce rich spatial models of double staircases from abstract topological diagrams. Through this investigation, we furnish a framework for the analysis and generation of models of the double staircase that embody various topological and spatial qualities. By interweaving historical taxonomies with contemporary practices of computational design, this study reintroduces the double staircase as an enduringly vital mode of architectural investigation.
Datasets to assess the methanotroph-photoautotroph coculture growth dynamics under a wide range of growth conditions

Abstract This data in brief article is a co-submission accompanying a research article [1]. Methanotroph-Photoautotroph cocultures offer a highly promising technology platform for biogas conversion. A prerequisite to the development of the coculture-based biotechnology is a clear understanding of the coculture growth dynamics under different growth conditions. In this paper, data collected under a wide range of batch growth conditions for the coculture Methylomicrobium buryatense 5GB1 - Arthrospira platensis were reported. The growth conditions include different gas compositions, light intensities, and different initial inoculum concentrations. The collected data include total optical density and gas phase composition over time, as well as individual biomass concentrations, individual substrate uptake rates and product excretion rates determined according a previously published protocol [2].
Shift Work in Law Enforcement: Mental and Physical Outcomes

Shift work is a significant police stressor. Shift work can lead to sleep deprivation and disruption of circadian rhythms which in turn can lead to psychological and physiological health complications. Examples are depression, anxiety, fatigue, and somatic disease. Nighttime shift work can impair cognitive functioning, making it difficult to make rational choices. Based on the untoward effect that shift work can have on officer’s mental health and well-being, it is possible that shift work and suicide may be related. This chapter discusses associations between shift work, police mental and physical health, and suicide potential. Possible risk reduction strategies are also discussed.
Candida spp. in Microbial Populations and Communities: Molecular Interactions and Biological Importance

This chapter emphasizes the underlying mechanisms that govern the physical and chemical interactions between organisms and their potential relevance to disease. Many biofilms within the host are not simply single species assemblages, but rather, dynamic polymicrobial communities. Candida spp. in biofilms on medical devices are most often derived from the host’s own endogenous flora, and other microflora organisms, such as staphylococci, are also often associated with catheters in both the presence and absence of Candida albicans. Direct consequences of mixed infections could include C. albicans enhancement of Pseudomonas aeruginosa biofilm formation, antibiotic resistance or virulence factor production, or changes in immune responses or host tissues that result from simultaneous infection by bacteria and fungi. While C. albicans frequently encounters large numbers of gram-positive bacteria in the oral, intestinal, and skin microfloras, a relatively small number of studies describe the molecular interactions that occur between C. albicans and gram-positive microbes. A series of clinical trials have investigated the use of probiotics for the management of recurrent vulvovaginal candidiasis, and while the data are in conclusive, further in vitro and animal studies are warranted. Unicellular organisms often produce small, diffusible chemical signals, referred to as quorum-sensing molecules (QSMs), that coordinate group behavior within single-species populations.
The Significance of Learning in Wittgenstein's Later Philosophy

‘When a child learns this ....’ ‘What is “learning a rule”?— This.’ Anyone familiar with Wittgenstein’s later philosophy recognizes these phrases as wholly typical of that philosophy. The appeals to the way in which a child learns, to learning in general, and to the italicized use of the indexical – all are familiar themes. In the Philosophical Investigations Wittgenstein develops his position on three crucial philosophical issues by beginning with the way in which a child learns. First, his critique of referential theories of meaning: ‘An important part of the training will consist in the teacher’s pointing to the objects, directing the child’s attention to them, and at the same time uttering a word’ (PI §6). Second, his attack on essentialist theories of understanding: ‘How does [the pupil] get to understand this notation? – First of all the series of numbers will be written down for him and he will be required to copy them .... And here there is a normal and an abnormal learner’s reaction’ (PI §143). And finally, his attack on the Cartesian model of consciousness: ‘A child has hurt himself and he cries; and then adults talk to him and teach him exclamations and, later, sentences’ (PI §244). These three critiques are the cornerstones for his later philosophy, and at the beginning of each he appeals to how children learn. Moreover, Wittgen-stein’s subsequent writings show an increase in the explicit appeal to learning and to a child’s learning. In On Certainty, Wittgenstein’s final work, virtually every page involves appeal to learning. In spite of this, most commentators treat the appeal as incidental.
Going green in the service sector: Social responsibility issues, implications and implementation

Over the past decade there has been an increasing awareness of the many ways that businesses affect the ecology of the planet. Most of the attention, however, has been directed towards activities of organizations in the manufacturing sector of the economy. Argues that service organizations have social responsibilities in the preservation of the environment, too. Presents the importance to a product, such as longevity or specific marketing, of green practices among services, a framework to describe green activities across the service sector, and a pragmatic means to implement a green programme for service organizations.
Data Entry Performance on Color Versus Monochromatic Displays

Two experiments compared data e ntry t asks using color or monochromatic displays. Further analyses pointed out some of t he conOverall, small consistent improvements in throughput rates were demonstrated for subjects (Ss) who used color displays. ditions under which color is beneficial and related the e ffectiveness of color to task complexity and the number of tasks performed. Several guidelines for the use of color displays are offered. Most color coding studies in the literature have been concerned with identification and search tasks and have t ended to use random patterns of letters, numbers, geometric forms, etc. Generally, the displays have not involved organized tasks such as data entry. A recent survey of these studies (Christ, 1975) COLcluded that colors are effective in some situations, but detrimental in others. Krebs (1978) pointed out that many of these conflicting results could be explained in terms of how color was applied. Basically, if color is used properly to locate, alert, or categorize (and is not used to excess), there should b e advantages of color coding. In the research r eported here, color was applied to data e ntry tasks in order to determine if throughput and accuracy were effected. EXPERIMENT 1 Two different types of entry tasks, encompassing two levels of difficulty were prepared so that each could be performed using either a color or monochromatic (MONO) display. The tasks were alternated to allow direct examination of the effects of color on switching from one task to another. Method
Increased intramuscular and intracapsular temperature via ThermaCare Knee Wrap application.

BACKGROUND Knee pain is common among the physically active as well as the older population. Heat is often used to decrease pain in these individuals. Modalities such as hot packs and whirlpools increase tissue temperature, yet are not portable. The portable ThermaCare HeatWrap for the knee has recently been marketed. We wondered if it actually heated the knee joint. MATERIAL/METHODS A 2 x 5 factorial design was used to compare temperature changes in a treatment group (heat wrap) against a control group (no wrap) for two hours. Eleven volunteers (M=3, F=8; age=22.71+/-3.80) served in both groups. An Isothermex computer recorded temperatures to the nearest +/-0.1 degrees C every 30 seconds. Subjects rated heat perception using a 10 cm visual analog scale (VAS). To measure muscle temperature one thermocouple monofilament was inserted 1.5 cm into the vastus medialis oblique (VMO). To measure knee intracapsular temperature (KJC), a thermocouple was inserted 5 cm deep in the suprapatellar pouch. RESULTS The mean temperature increases for the ThermaCare Knee Wrap were: VMO: 3.19+/-1.27 degrees C; KJC: 2.62+/-0.93 degrees C; Surface: 7.48+/-1.35 degrees C. The mean temperature increases for the control were: VMO: -1.99+/-1.01 degrees C; KJC: -2.10+/-0.56 degrees C; Surface: -1.15+/-0.61 degrees C. According to the VAS data, the longer the subjects wore the wrap, the warmer it felt. CONCLUSIONS The ThermaCare Knee Wrap causes significant temperature increases in the VMO, the KJC and the skin. This portable heat product is beneficial for conditions in which intramuscular and intracapsular heating is indicated, such as pain relief.
Centennial Changes of the Global Water Cycle in CMIP5 Models

AbstractThe global water cycle is predicted to intensify under various greenhouse gas emissions scenarios. Here the nature and strength of the expected changes for the ocean in the coming century are assessed by examining the output of several CMIP5 model runs for the periods 1990–2000 and 2090–2100 and comparing them to a dataset built from modern observations. Key elements of the water cycle, such as the atmospheric vapor transport, the evaporation minus precipitation over the ocean, and the surface salinity, show significant changes over the coming century. The intensification of the water cycle leads to increased salinity contrasts in the ocean, both within and between basins. Regional projections for several areas important to large-scale ocean circulation are presented, including the export of atmospheric moisture across the tropical Americas from Atlantic to Pacific Ocean, the freshwater gain of high-latitude deep water formation sites, and the basin averaged evaporation minus precipitation with im...