cssi/SciSciGPT-SciSciNet huggingface dataset:
Coding and reimbursement issues for dual-energy X-ray absorptiometry.

Bone densitometry has a unique and invaluable place in the prevention, diagnosis, and management of osteoporosis. Dual-energy X-ray absorptiometry (DEXA) is currently considered the bone densitometric technique of choice. With this method, the patient at risk for osteoporosis can be identified so that appropriate clinical interventions to prevent fracture can be undertaken. DEXA also allows assessment of the efficacy of these interventions in preventing bone loss. As with any other technology, however, bone densitometry must be properly used in the clinical setting to achieve this benefit. Critical to the proper use of the technology is the realization that a complete assessment of fracture risk requires the measurement of both the spine and the proximal part of the femur, not either site alone, and that assessment of therapeutic efficacy might also require the measurement of both sites, not either site alone. Effective January 1, 1994, the Clinical Procedural Terminology (CPT) code for DEXA has been 7607...
Solving two-point boundary value problems in trajectory formation

An analog network which computes an optimal motion trajectory in real time under a two-point boundary condition is developed. The authors first describe a mathematical formulation using the theorems from the calculus of variation, then develop a method for mapping the problem to the spatial domain. Based on the mapping, building blocks and an analog network are developed. The network has many interconnected nodes operating concurrently in an asynchronous fashion. The energy equilibrium state of the network provides a solution to the boundary value problem. >
Significance of Necrosis in Grading of Oligodendroglial Neoplasms: A Clinicopathologic and Genetic Study of Newly Diagnosed High-Grade Gliomas

Purpose High-grade gliomas (HGGs; WHO grades 3-4) are highly diverse, with survival times ranging from months to years. WHO 2000 grading criteria for high-grade oligodendroglial neoplasms [anaplastic oligoastrocytoma (AOA) and anaplastic oligodendroglioma (AO)] remain subjective, and the existence of grade 4 variants is controversial. Patients and Methods Overall survival (OS) of 1,093 adult patients with a cerebral HGG newly diagnosed between 1990 and 2005 was analyzed by univariate and multivariate models for significance of the following factors: patient age, surgery type, year of diagnosis, endothelial proliferation, necrosis, oligodendroglial histology, treatment center, and chromosome 1p, 19q, 7p (EGFR), and 10q (PTEN) abnormalities by fluorescence in situ hybridization (FISH). Results Necrosis was a statistically significant predictor of poor OS on univariate and multivariate analyses in AOA but not in AO. Median OS for patients with necrotic AOA (22.8 months) was significantly worse than for patie...
Sensory Evaluation and Composition of Spaghetti Fortified with Soy Flour

Spaghetti was prepared from durum wheat supplemented with soy flour in order to make an inexpensive, highly nutritious food and to determine the effects of high levels of soy flour on taste and textural attributes. Up to 50% soy flour was incorporated into spaghetti, resulting in a protein content of 33.5% (compared with 15.4% for control without soy) and a lysine content of 1.75% (compared with 0.41% for control). Sensory analysis of enriched spaghetti containing up to 35% soy flour indicated no significant difference in flavor and texture compared with control without soy, in general. Spaghetti with 50% soy flour had slightly higher beany and bitter flavors compared with control. This study showed that a high-protein and high-lysine spaghetti can be made with 35% soy flour without adverse effect on flavor and texture and should result in greater acceptability of soy-based foods.
Variations in prostate cancer patterns of care: is it the quality of care or the quality of the data?

cancer registries participating in the National Cancer Institute’s Surveillance Epidemiology and End Results (SEER) program to review patterns of care in men diagnosed with localized or regionally advanced prostate cancer from 1995 to 1999. They noted significant geographic variation in the use of surgery, radiation therapy, and conservative (watchful waiting) therapy. For example, surgery or watchfulwaiting rates were significantly higher in the Los Angeles area than in other regions of the United States. Conversely, radiation therapy was employed more commonly in the Detroit area. Interestingly, within registries, there was little variation in treatment rates, indicating local homogeneity in patterns of care. The authors also found that age, race, income, and pathologic differentiation were independently associated with primary surgical or radiation therapy. The authors conclude that their results may suggest “unconscious discrimination on the part of physicians.” Beforeweacceptthisconclusion,wemustconsiderthe limitations of the current study. As the authors rightfully point out in their discussion, the SEER data set does not allow for individual level assessment of socioeconomic status (SES). To account for this, the research team ascribed group characteristics to individuals based on 2000 United States census data for individual’s county of residence and ethnicity. Another limitation stems from the fact that the SEER data set has no information concerning comorbid conditions. Primary choice of therapy in localized prostate cancer has been previously shown to be associated with the numberofcomorbidconditionsatthetimeofdiagnoses. 5,6 Therefore, if one wants to determine the true effect of ethnicity or SES on primary treatment, comorbid disease must be controlled for, as these factors may all be related. 7 Although the lack of this information likely affects the results of the current study, it is my belief that, even if the researchers had been able to completely control for comorbidity and had individual level SES data, ethnicity and SES would still have been associated with choice of primary treatment. Assuming that the true strength of the associations may not be as strong as observed in the study but wouldstillbesignificant,wemustaskwhythesegeographic,
Highlights from the 3rd Breast-Gynecological International Cancer Conference 2011.

The 3rd Breast–Gynecological International Cancer Conference, supported by the European Society of Medical Oncology (ESMO), was held in Cairo (Egypt) on 13–14 January 2011. The meeting was conducted under the patronage of Egypt’s Ministry of Health, with the scientific committee led by Heba El Zawahry from the National Cancer Institute (Cairo, Egypt), and Yasser Abdel Kader from Cairo University (Cairo, Egypt). Several important updates and multifaceted issues in the management of various breast and gynecological cancers were addressed in this conference. Leading physicians and scientists from 12 different countries shared their expertise and views. This meeting was a good opportunity to meet fellow professionals from all parts of the world and discuss complex and interesting case studies. In this article, we highlight pertinent sessions and important topics discussed in this meeting.
Impulse noise removal: Noise detection versus pixel estimation

This paper proposes a new finding regarding the different roles and significance of noise detection and pixel estimation utilized in the majority of impulse noise removing algorithms. Extensive experimental results will be presented to show that the importance of each method depends on the noise ratio. In other words, by particularly examining how the adaptive median filter (AMF) algorithm [18] employs the two aforementioned methods in comparison with their modified versions as well as the ideal-filtering algorithm, this paper will point out the role that each method plays. The significance of noise detection can be realized at low noise ratio while pixel estimation gains its efficiency as noise ratio increases.
Dynamic Competition on Networks: Differential Variational Inequalities, Limited Warfare and Internet Vulnerability

In this paper we are concerned with a class of mathematical problems that arise when modelling dynamic competition among conflicting agents that may or may not reach an equilibrium. We call this class of problems differential variational inequalities. We are further interested in the application of models belonging to this class of problems to the study of (1) policy constrained, limited warfareand (2) Internet vulnerability.
Parathyroidectomy is underused in patients with tertiary hyperparathyroidism after renal transplantation

Background Parathyroidectomy (PTX) is the only curative treatment for tertiary hyperparathyroidism (3HPT). With the introduction of calcimimetics (cinacalcet), PTX can sometimes be delayed or avoided. The purpose of this study was to determine the current incidence of utilization of PTX in patients with posttransplant 3HPT with the advent of cinacalcet. Methods We evaluated renal transplant patients between January 1, 2004, and June 30, 2012, with a minimum of 24 months follow-up who had persistent allograft function. Patients with an increased serum level of parathyroid hormone (PTH) at 1 year after successful renal transplantation with normocalcemia or hypercalcemia were defined as having 3HPT. A multivariate logistic regression model was constructed to determine factors associated with undergoing PTX. Results We identified 618 patients with 3HPT, only 41 (6.6%) of whom underwent PTX. Patients with higher levels of serum calcium ( P P = .002) posttransplant were more likely to be referred for PTX. Importantly, those who underwent PTX had serum calcium and PTH values distributed more closely to the normal range on most recent follow-up. PTX was not associated with rejection ( P = .400) or with worsened allograft function ( P = .163). Conclusion PTX seems to be underused in patients with 3HPT at our institution. PTX is associated with high cure rates, improved serum calcium and PTH levels, and is not associated with rejection.
Effect of Initial Base Motion on Response Spectra

The problems involved in converting earthquake ground acceleration records from analog to digital form for use in structural response calculations are widely recognized. Several different balancing or base line corrections are widely recognized. Several different balancing or base line correction procedures have been proposed over the years. Recent studies have resulted in a standard correction procedure for accelerograms, which was used in producing the EERL.
Energy Efficiency Policies for Local Communities (SSA)

With a tight growing national budget in developing countries and the rising demand for electricity, policymakers are seeking for private capital as a key source for funding energy efficiency and climate change related infrastructure. Developing countries seek to target energy efficiency programs as means of saving significant energy from such programs to distributed to the large number of communities living without access to modern energy for lighting and cooking. Designing Institutional framework to achieving these targets are prime recommendations from several preachers. These institutional frameworks must target institutional investors such as the Global energy fund (GEF), insurance companies and other long term investors whose $71 trillion in assets form one of the largest pools of private capital in the world. These funds can be used to address developing (SSA) country’s energy needs through energy efficiency and climate change mitigation programs. Empirical evidence by several researchers on Climate Policy state that, various attractive investment opportunities exist, if nations could reduce institutional barriers to attract investors for renewable energy and energy efficiency projects. Other investor groups recommended by researchers are the Global Investor Coalition on Climate Change (GIC) and UNEP Finance Initiative (UNEP FI) together represent global institutional investors responsible for over $22 trillion in assets. Thus, the question becomes whether developing countries are prepared to enact and align policies to bridge the financing gap in attracting institutional investments to address their energy shortfalls and climate change challenges?
A Photoelastic Study of Strain Waves Caused by Cavitation

Ultra-high-speed photoelastic techniques have been applied to a study of the transient stresses and strains in a photoelastic plastic when subject to cavitation. A photocell, used to detect the transient strains, indicated that the time duration of the strains was about 2 microseconds. Using an ultra-high-speed motion picture camera, ultrasonic cavitation bubbles have been photographed collapsing on the surface of a photoelastic specimen, and the resulting strain wave in the solid has been photographed. The dynamic properties of a photoelastic material have been obtained in order to permit quantitative interpretation of the transients. This has indicated that the stresses due to cavitation may be as high as 2.8 x 10^5 psi. The photoelastic plastic, CR-39, was found to exhibit strain birefringence, and its strain-optic constant was found to be independent of the rate of loading.
The Surgical Checklist: It Cannot Work If You Do Not Use It

Surgical safety checklists (SSCs) are associated with reductions in postoperativemorbidity andmortality and have now achievedwidespread implementation, although thequalityof implementation remainsunclear inmanysettings.1,2 In this issue of JAMA Surgery, Bock and colleagues3 evaluate the effect of introducing an SSC in a single Italian referral hospital on30-and90-dayall-causemortality,30-dayreadmissionrate, and hospital length of stay. Bock et al3 demonstrate a statistically significant decrease inoverall surgicalmortality at90daysafter surgeryand a reduction in hospital length of stay after implementation of anSSC.Mostpreviouspublications thatexaminedsurgicalmortality focusedonthemoretraditional andwidely accepted 30-daypostoperativemortality and readmission rates. Historically, the 30-day outcomes were chosen because of difficulties with long-term follow-up and issueswith attributing death in the 30to 90-daypostoperative period to the primary surgical procedure.3 We commend the authors for choosing to focus on the 90-day postoperative all-cause mortality rate, and we are reassured that they saw a statistically significant decrease. However, we should also considerwhyno statistically significant change in the 30-day postoperative all-cause mortality rates was observed. This finding could be attributable to inherent differences in the population studied, to the case mix, or to insufficient power to detect change related to sample size. This article also highlights the ongoing challenges of checklist implementation and measurement of the impact of the SSC. First, whether SSC performance underwent direct observation during implementation and whether that observation compared with reported performance are unclear. Checklist performance appears to be measured primarily by checking whether a form was completed. Significant discordance between paper checklist completion and actual completion has been described.4 Second, 80% completion was considered the threshold for complete implementation in this study, whereas recent literature supports that full rather than partial checklist completion provides an opportunity for significant improvement of the effect of the SSC on the quality of patient care and surgical safety.5 With more effective implementation and full SSC use in every case, the improvement in outcomes seen could have been even. If the SSC is not used, it cannot help. Although some investigators question the actual impact of checklists, despite the proliferation of evidence regarding improved patient outcomes and quality of care across countries, these arguments fail to acknowledge fully the difficulty of effectively implementingSSCs ina complexhealth system.6 A focus on the systems of care and promotion of a culture of safety at the institutional level is necessary tooptimize checklist implementation and realize its full potential. Effective implementation is critical tomeaningfuluseofSSCs,whichcan lead to maximally improved outcomes.
Ovarian sympathectomy in the guinea pig. II. Effects on follicular development during the prepubertal period and following exogenous gonadotropin stimulation.

The role of ovarian adrenergic nerves in follicular growth was studied in prepubertal guinea pigs by determining the effect of sympathectomy on 1) follicle populations and 2) follicular development following exogenous gonadotropin administration. Selective unilateral ovarian sympathectomy was achieved by injecting 6-hydroxydopamine into a surgically closed periovarian bursa on day 20 postpartum. The contralateral surgically closed ovarian bursa was injected with the vehicle used for 6-hydroxydopamine. On day 25, animals were injected with pregnant mare serum or saline followed by human chorionic gonadotropin or saline 48 h later. All animals were laparotomized on day 28 and blood from utero-ovarian veins was collected bilaterally for androstenedione determination. Ovaries were processed for morphometric analysis of follicles. The sympathectomized ovary in saline-injected animals had a significant decrease in preantral follicles (characterized by ≤2 layers of granulosa cells without antrum formation), an increase in 310–500 μm diameter atretic follicles and an increase in follicles ≥700 um compared to the contralateral control ovary. There were no differences in androstenedione levels from the two sides, ovarian weights or the total number of follicles per ovary. Neither ovary had corpora lutea. The sympathectomized ovary in animals injected with gonadotropins was not different from the contralateral ovary in any of the parameters measured. Both control and sympathectomized ovaries had newly formed corpora lutea in response to the exogenous gonadotropins. These results suggest that ovarian adrenergic nerves normally participate in follicular development in the prepubertal guinea pig. However, exogenous gonadotropins may override neural influences on the prepubertal ovary.
Metaphase Chromosomes of Culicoides variipennis (Diptera: Ceratopogonidae)

The cytogenetics of Culicoides variipennis (Coquillett) tissue derived from a continuous cell line is presented. The karyotype consisted of 68.5% diploid (2n = 6), 30% tetraploid (4n = 12), and 1.5% octaploid (8n = 24) for the metaphase spreads examined. Distinguishing cytological features were not seen, and the 3 pairs of homomorphic chromosomes were not distinguished from each other.
A Regression Model of National Airspace System Delay

The authors propose a multiple regression model of daily overall airspace system delay that captures the effects of both terminal and en route weather. This type of model facilitates the analysis of a large number of days and associated weather conditions. The model incorporates only four exogenous variables, plus a lagged dependent variable. The dependent variable in this model is the sum of "total" delay, defined as gate departure delay plus taxi and airborne delay relative to the flight plan (as recorded in the Aviation System Performance Metrics (ASPM) system). The independent variables in the model include the number of scheduled arrivals during instrument approach conditions at the ASPM 55 airports, the excess of scheduled arrivals over the recorded airport acceptance rates, an en route weather index that combines lightning strike data with flight plan data, and a dummy variable to capture weekend effects. The authors estimated the model using 334 daily observations from January through November 2005. The model explains a great deal of the day-to-day variability of total delay during the estimation period. The authors then used the model to construct an ex post forecast for December 2005. The forecast is compared to observed delay.
The Ancestral Benders' cutting plane algorithm with multi-term disjunctions for mixed-integer recourse decisions in stochastic programming

This paper focuses on solving two-stage stochastic mixed integer programs (SMIPs) with general mixed integer decision variables in both stages. We develop a decomposition algorithm in which the first-stage approximation is solved by a branch-and-bound algorithm with its nodes inheriting Benders' cuts that are valid for their ancestor nodes. In addition, we develop two closely related convexification schemes which use multi-term disjunctive cuts to obtain approximations of the second-stage mixed-integer programs. We prove that the proposed methods are finitely convergent. One of the main advantages of our decomposition scheme is that we use a Benders-based branch-and-cut approach in which linear programming approximations are strengthened sequentially. Moreover as in many decomposition schemes, these subproblems can be solved in parallel. We also illustrate these algorithms using several variants of an SMIP example from the literature, as well as a new set of test problems, which we refer to as Stochastic Server Location and Sizing. Finally, we present our computational experience with previously known examples as well as the new collection of SMIP instances. Our experiments reveal that our algorithm is able to produce provably optimal solutions (within an hour of CPU time) even in instances for which a highly reliable commercial MIP solver is unable to provide an optimal solution within an hour of CPU time.
Methemoglobinemia Hemotoxicity of Some Antimalarial 8-Aminoquinoline Analogues and Their Hydroxylated Derivatives: Density Functional Theory Computation of Ionization Potentials.

The administration of primaquine (PQ), an essential drug for the treatment and radical cure of malaria, can lead to methemoglobin formation and life-threatening hemolysis for glucose-6-phosphate dehydrogenase deficient patients. The ionization potential (IP, a quantitative measure of the ability to lose an electron) of the metabolites generated by antimalarial 8-aminoquinoline (8-AQ) drugs like PQ has been believed to be correlated in part to this methemoglobinemia hemotoxicity: the lower the IP of an 8-AQ derivative, the higher the concentration of methemoglobin generated. In this work, demethoxylated primaquine (AQ02) was employed as a model, by intensive computation at the B3LYP-SCRF(PCM)/6-311++G**//B3LYP/6-31G** level in water, to study the effects of hydroxylation at various positions on the ionization potential. Compared to the parent AQ02, the IPs of AQ02’s metabolites hydroxylated at N1′, C5, and C7 were lower by 61, 30, and 19 kJ/mol, respectively, while differences in the IP relative to PQ were...
MO-FG-CAMPUS-TeP1-02: Facial Recognition and Recall Using Kinect V2 for Patient Verification

Purpose: Investigate capability and accuracy of the Kinect v2 camera for facial recognition to use as a tool for patient check-in upon arrival, as well as patient verification when entering treatment vault. Methods: The Kinect software has a native facial recognition feature which recognizes major facial landmarks (eyes, nose, mouth, etc). 1347 facial vertices are automatically generated, each located at a specific facial point at standardized distances between points. Through a process of facial contour mapping, the vertices are modified such that their coordinates are specific to the imaged face. 35 of these vertices are labeled with specific landmarks on the face (Nose Tip, Right Cheek Center, Left Eye Mid Top, etc).Using code written in C#, 595 3D vectors are calculated utilizing the 35 native modified vertices. For each initial acquisition, the vector magnitudes are saved to file. For each comparison acquisition, the difference of identical vector magnitudes is calculated between the current face and each face saved to file. The mean of all magnitude differences per face is taken as the determining factor for facial match with the smallest mean value between faces determining the correct match. A database 15 imaged faces was used for comparison. Initial acquisitions kept Pitch, Yaw, and Roll between −10 and 10 degrees and distance between 90–100 cm. Results: Through 25 acquisitions varying Pitch, Yaw, and Roll between −10 to 10 degrees as well 50 acquisitions modifying the distance up to 300 cm for two different test faces, the program obtained 100% true positives. Conclusion: This facial recognition and recall program has excellent potential to function as a clinical tool for patient verification and check-in given these results. Further study is necessary for acquisition of a sufficient database to ensure an acceptable true positive rate with increased population size.
Robust classification of bacterial and viral infections via integrated host gene expression diagnostics

Improved diagnostics for acute infections could decrease morbidity and mortality by increasing early antibiotics for patients with bacterial infections and reducing unnecessary antibiotics for patients without bacterial infections. Several groups have used gene expression microarrays to build classifiers for acute infections, but these have been hampered by the size of the gene sets, use of overfit models, or lack of independent validation. We used multicohort analysis to derive a set of seven genes for robust discrimination of bacterial and viral infections, which we then validated in 30 independent cohorts. We next used our previously published 11-gene Sepsis MetaScore together with the new bacterial/viral classifier to build an integrated antibiotics decision model. In a pooled analysis of 1057 samples from 20 cohorts (excluding infants), the integrated antibiotics decision model had a sensitivity and specificity for bacterial infections of 94.0 and 59.8%, respectively (negative likelihood ratio, 0.10). Prospective clinical validation will be needed before these findings are implemented for patient care.
Qualitative and Quantitative Analysis

Typically, for a teaching experiment, the accepted methodology used to assess learning and conceptual development is based on one-on-one interviews with an observer prompting, recording and analysing the vocalizations of a child engaged in a problem solving activity. The teacher-researcher must extend such an assessment to a classroom environment consisting of many students, not necessarily children, engaged in problem solving.
Implications of quantum ambiguities in $k$=1 loop quantum cosmology: distinct quantum turnarounds and the super-Planckian regime

The spatially closed Friedmann-Lema\^{\i}tre-Robertson-Walker model in loop quantum cosmology admits two inequivalent consistent quantizations: one based on expressing the field strength in terms of the holonomies over closed loops and another using a connection operator and open holonomies. Using the effective dynamics, we investigate the phenomenological differences between the two quantizations for the single-fluid and the two-fluid scenarios with various equations of state, including the phantom matter. We show that a striking difference between the two quantizations is the existence of two distinct quantum turnarounds, either bounces or recollapses, in the connection quantization, in contrast to a single distinct quantum bounce or a recollapse in the holonomy quantization. These results generalize an earlier result on the existence of two distinct quantum bounces for stiff matter by Corichi and Karami. However, we find that in certain situations two distinct quantum turnarounds can become virtually indistinguishable. And depending on the initial conditions, a pure quantum cyclic universe can also exist undergoing a quantum bounce and a quantum recollapse. We show that for various equations of states, connection-based quantization leads to super-Planckian values of the energy density and the expansion scalar at quantum turnarounds. Interestingly, we find that very extreme energy densities can also occur for the holonomy quantization, breaching the maximum allowed density in the spatially flat loop quantized model. However, the expansion scalar in all these cases is bounded by a universal value.
Nanoscale Characterization of Interaction of APOBEC3G with RNA.

The human cytidine deaminase APOBEC3G (A3G) is a potent inhibitor of the HIV-1 virus in the absence of viral infectivity factor (Vif). The molecular mechanism of A3G antiviral activity is primarily attributed to deamination of single-stranded DNA (ssDNA); however, the nondeamination mechanism also contributes to HIV-1 restriction. The interaction of A3G with ssDNA and RNA is required for its antiviral activity. Here we used atomic force microscopy to directly visualize A3G–RNA and A3G–ssDNA complexes and compare them to each other. Our results showed that A3G in A3G–RNA complexes exists primarily in monomeric–dimeric states, similar to its stoichiometry in complexes with ssDNA. New A3G–RNA complexes in which A3G binds to two RNA molecules were identified. These data suggest the existence of two separate RNA binding sites on A3G. Such complexes were not observed with ssDNA substrates. Time-lapse high-speed atomic force microscopy was applied to characterize the dynamics of the complexes. The data revealed ...
Hydrocortisone Therapy in Catecholamine-Resistant Pediatric Septic Shock: A Pragmatic Analysis of Clinician Practice and Association With Outcomes.

OBJECTIVES The 2012 Surviving Sepsis Campaign pediatric guidelines recommend stress dose hydrocortisone in children experiencing catecholamine-dependent septic shock with suspected or proven absolute adrenal insufficiency. We evaluated whether stress dose hydrocortisone therapy in children with catecholamine dependent septic shock correlated with random serum total cortisol levels and was associated with improved outcomes. DESIGN Retrospective cohort study. SETTING Non-cardiac PICU. PATIENTS Critically ill children (1 mo to 18 yr) admitted between January 1, 2013, and December 31, 2013, with catecholamine dependent septic shock who had random serum total cortisol levels measured prior to potential stress dose hydrocortisone therapy. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The cohort was dichotomized to random serum total cortisol less than 18 mcg/dL and greater than or equal to 18 mcg/dL. Associations of stress dose hydrocortisone with outcomes: PICU mortality, PICU and hospital length of stay, ventilator-free days, and vasopressor-free days were examined. Seventy children with catecholamine-dependent septic shock and measured random serum total cortisol levels were eligible (16% PICU mortality). Although 43% (30/70) had random serum total cortisol less than 18 μg/dL, 60% (42/70) received stress dose hydrocortisone. Children with random serum total cortisol less than 18 μg/dL had lower severity of illness and lower Vasopressor Inotrope Scores than those with random serum total cortisol greater than or equal to 18 μg/dL (all p < 0.05). Children with stress dose hydrocortisone had higher severity of illness and PICU mortality than those without stress dose hydrocortisone (all p < 0.05). Mean random serum total cortisol levels were similar in children with and without stress dose hydrocortisone (21.1 vs 18.7 μg/dL; p = 0.69). In children with random serum total cortisol less than 18 μg/dL, stress dose hydrocortisone was associated with greater PICU and hospital length of stay and fewer ventilator-free days (all p < 0.05). In children with random serum total cortisol greater than 18 μg/dL, stress dose hydrocortisone was associated with greater PICU mortality and fewer ventilator-free days and vasopressor-free days (all p < 0.05). CONCLUSIONS Stress dose hydrocortisone therapy in children with catecholamine-dependent septic shock correlated more with severity of illness than random serum total cortisol levels and was associated with worse outcomes, irrespective of random serum total cortisol levels.
Impacts of Inquiry Pedagogy on Undergraduate Students Conceptions of the Function of Proof

Abstract Mathematicians and mathematics educators agree that proof is an important tool in mathematics, yet too often undergraduate students see proof as a superficial part of the discipline. While proof is often used by mathematicians to justify that a theorem is true, many times proof is used for another purpose entirely such as to explain why a particular statement is true or to show mathematics students a particular proof technique. This paper reports on a study that used a form of inquiry-based learning (IBL) in an introduction to proof course and measured the beliefs of students in this course about the different functions of proof in mathematics as compared to students in a non-IBL course. It was found that undergraduate students in an introduction to proof course had a more robust understanding of the functions of proof than previous studies would suggest. Additionally, students in the course taught using inquiry pedagogy were more likely to appreciate the communication, intellectual challenge, and providing autonomy functions of proof. It is hypothesized that these results are a response to the pedagogy of the course and the types of student activity that were emphasized.
Rent Sharing and the Compensation of Head Coaches in Power Five College Football

The monopoly and monopsony power of intercollegiate sports create significant rents, but previous studies of intercollegiate football coaches’ salaries implicitly assume that coaches are paid their marginal revenue products. In a two-stage estimation, we show that coaches share in these rents. The first stage shows that several common measures of coaches’ productivity do not affect an athletic department’s variable revenue. When we include these measures in the second-stage salary equation, their impact on pay reflects bargaining power, not productivity. We also find that several measures of fixed revenue, which are independent of the coach’s performance, increase the coach’s pay.
T cell phenotypes in women with Chlamydia trachomatis infection and influence of treatment on phenotype distributions.

Abstract T cell phenotypes involved in the immune response to Chlamydia trachomatis (CT) have not been fully elucidated in humans. We evaluated differences in T cell phenotypes between CT-infected women and CT-seronegative controls and investigated changes in T cell phenotype distributions after CT treatment and their association with reinfection. We found a higher expression of T cell activation markers (CD38+HLA-DR+), T helper type 1 (Th1)- and Th2-associated effector phenotypes (CXCR3+CCR5+ and CCR4+, respectively), and T cell homing marker (CCR7) for both CD4+ and CD8+ T cells in CT-infected women. At follow-up after treatment of infected women, there were a lower proportion of CD4+ and CD8+ T cells expressing these markers. These findings suggest a dynamic interplay of CD4+ and CD8+ T cells in CT infection, and once the infection is treated, these cell markers return to basal expression levels. In women without reinfection, a significantly higher proportion of CD8+ T cells co-expressing CXCR3 with CCR5 or CCR4 at follow-up was detected compared to women with reinfection, suggesting they might play some role in adaptive immunity. Our study elucidated changes in T cell phenotypes during CT infection and after treatment, broadening our understanding of adaptive immune mechanisms in human CT infections.
Diagnosis and Management of Tendon Disorders in Cattle

Diagnosis and treatment of congenital and acquired tendon disorders in cattle are discussed. A brief discussion of tendon structure, anatomy, biomechanics, and healing is included. Congenital abnormalities presented include hyperextension deformities, flexural deformities, arthrogryposis, and spastic paresis. Acquired abnormalities discussed include tendon displacement, tendinitis, tendon disruption, and tenosynovitis. Antibiotic selection for musculoskeletal infections is briefly discussed.
Multicultural and Intergenerational Teaching and Learning: Current Research

Little empirical research is available about online college teaching and learning across culture or age. Research is needed to ascertain learning environment pedagogies that positively impact a diversity of students in online contexts. Because collegiate instruction, including online forms is often culturally based in Germanic and English based traditions of American higher education (Chavez, A. F., & Guido-DiBrito, F. (1999). Racial and ethnic identity and development. In C. Clark, & R. Caffarella (Eds.), An update on adult development theory: New ways of thinking about the life course. New Directions for Adult and Continuing Education (Vol. 84, pp. 39–48). San Francisco: Jossey-Bass; Chavez et al. American Educational Research Journal, 49(4), 775–806, 2012; Ibarra, R. (2001). Beyond affirmative action: Reframing the context of higher education. Madison: University of Wisconsin; Rich, A. (1993). Toward a woman centered university. In J. Glazer, E. Bensimon, & B. Townsend (Eds.), Women in higher education: A feminist perspective (pp. 121–134). Needham Heights: Ginn Press; Tisdell, E. (1995). Creating inclusive adult learning environments: Insights from multicultural education and feminist pedagogy (Information Series #361). Columbus: Center on Education and Training for Employment. Retrieved from ERIC data base. (ED384827)), it is important to conduct research on all types of instruction across the more diverse cultural, age, and other identities of learners (Chavez, Journal of Excellence in College Teaching, 21 (4), 49–74, 2011; Tisdell, E. (1995). Creating inclusive adult learning environments: Insights from multicultural education and feminist pedagogy (Information Series #361). Columbus: Center on Education and Training for Employment. Retrieved from ERIC data base. (ED384827)). This review of literature covers areas of study found to some extent in the literature including: constructs of culture in higher education, nontraditional student success and intergenerational online instruction, and cross cultural online education, as well as overviews of methodologies, populations studied, research questions of focus, and major findings.
Family Values/Valued Families: Storytelling and Community Formation Among LBG Families with Children

While queer theorists celebrate sexuality as constructed and performed, LBG political activists legitimize their demands for civil rights by claiming that sexual identity is essential, that it is biologically determined. However, stories characteristically told by LBG families with children incorporate both essentializing and performative explanations of sexual identity. Hence, two competing descriptions of sexual identity, one essentialist and the other influenced by theories of social construction, reside together in many LBG family stories. This essay uses rhetorical analysis to examine the ideological juxtaposition in LBG family stories.
Microstructure of PtRh particles on SiO2

The microstructure of 20- to 200-A PtRh alloy particles on amorphous SiO2 have been examined by transmission electron microscopy and electron diffraction following heat treatments in H2, O2, He, and N2 atmospheres. It was observed that, upon formation of particles in H2 at temperatures between 600 and 100 °C, a two-phase structure exists within essentially all particles. One phase is a section of a cube, exactly as noted previously for pure Pt particles. The other phase is a highly twinned region usually with a single set of multiple twin bands <10 ° A wide. When these phase-separated samples were heated in N2 or He, single-phase particles with shapes between polyhedra and spheres were observed. Subsequent heating in H2 restores the two-phased morphology. Mild heating at 300 °C in O2 results in the breakup of the twinned regions but causes no significant change to the cube-shaped regions. Particles grown from metal films or from the salts of RhCl3 and H2PtCl6 or [Pt3(CO)6]2−4 are found to have essentially identical microstructures upon heating to 600 °C.
Autoimmune Lymphoproliferative Syndrome: Types I, II and Beyond

An essential element in the maintenance of homeostasis of the immune system is the capacity for apoptosis, or programmed cell death. Apoptosis limits the accumulation of lymphocytes, and minimizes reactions against self-antigen that can lead to autoimmunity1,2. Lymphocyte apoptosis occurs in at least two major forms: antigen receptor engagement and lymphokine withdrawal. These forms of death are controlled in a negative feedback mechanism termed propriocidal regulation1,3. Antigen-mediated death of lymphocytes is regulated by Fas (CD95/APO-1), tumor necrosis factor receptor (TNFR), and related molecules4-6. Passive apoptosis via lymphokine withdrawal may result from the cytoplasmic activation of caspases that is closely regulated by the mitochondria and the members of the Bcl-2 family of proteins. Apoptosis of other immune cells such as dendritic cells may also contribute to immune homeostasis7.
Prognostic factors for survival in locally advanced NSCLC treated with concurrent chemo- radiation: An institutional analysis.

e20512Title: Prognostic factors for survival in locally advanced NSCLC treated with concurrent chemoradiation (CRT): An institutional analysis Background: CRT is the standard of care for patients w...
Iatrogenic Symmastia: Causes and Suggested Repair Technique.

BACKGROUND Various theories exist to explain the etiology of iatrogenic symmastia. Subglandular over-dissection of the medial breast pocket over the sternum, disruption of midline sternal fascia, oversized implant base diameter, and over-dissection of the medial pectoralis muscle attachments to the sternum are popular explanations. OBJECTIVES The authors hypothesized that the most common risk factor for iatrogenic symmastia is subpectoral breast augmentation. METHODS A retrospective chart review was conducted including all symmastia patients who underwent surgery from January 2008 to April 2018 by a single surgeon (C.L.M.). ASAPS members were also surveyed regarding the etiology and incidence of symmastia in their practice. RESULTS Twenty-three patients with symmastia were included in the retrospective chart review. All had previous subpectoral breast augmentation. In the ASAPS survey, 91 plastic surgeons reported seeing an average of 2.2 consults for acquired symmastia over the preceding year; 1.9 of the 2.2 (84.9%) acquired symmastia consults previously underwent subpectoral breast augmentation. Most surgeons attributed these patients' symmastia to over-dissection of the medial pectoralis muscle attachments to the sternum. CONCLUSIONS Symmastia is most often caused by pectoralis major sternal dehiscence during subpectoral breast augmentation. In the senior author's experience, all patients with iatrogenic symmastia previously had a submuscular breast augmentation. The ASAPS survey supports multiple causes for symmastia with retromuscular breast augmentation occurring in the majority of patients. Repair of symmastia should include securing Scarpa's fascia to the sternum, reattaching the pectoralis major to the sternum, avoiding another subpectoral implant, and using postoperative modalities to protect the repair. LEVEL OF EVIDENCE: 4
The Abnormal Presence of Mitochondria in Circulating Red Blood Cells Cause an Increased Oxygen Consumption Rate, ROS Generation and Hemolysis in Patients with Sickle Cell Disease

Abstract Sickle Cell Disease (SCD) is an inherited blood disorder that affects millions of people worldwide, and it is caused by a mutation of the β-globin gene which results in the polymerization of HbS when deoxygenated. Patients with sickle cell disease experience severe pain, multi organ damage, and shortened life span. Changes arising from sickle hemoglobin (HbS) inside the red blood cell (RBC) leads to an imbalance of the oxidative reactions which increases reactive oxygen species (ROS) generation. ROS causes hemolysis and damages blood vessels. Previously, our lab demonstrated that SCD patients have a significant fraction of mitochondria retaining-RBCs which were associated with excessive levels of ROS. In addition immature mitochondria containing reticulocytes, R1 reticulocytes, are increased in the peripheral blood of SCD patients compared to control subjects. Here we report that the percentage of mitochondria retaining-RBCs directly correlated with the absolute number of reticulocytes (n=18,r=0.69, P Disclosures No relevant conflicts of interest to declare.
Practical Performance Evaluation of Space Optimal Erasure Codes for High-Speed Data Storage Systems

As erasure codes have been widely adopted in most large-scale data storage systems and applications, implementations of high-performance erasure codes have been improved significantly in recent years, especially by employing Intel’s Streaming SIMD Extensions (SSE) instructions. Augmenting the survey work in Plank et al. (Fast, 9:253–65, 2009) conducted almost a decade ago, this paper compares practical performance of three open-source or public domain erasure coding libraries, namely Jerasure and Intel’s ISA-L for RS code, and a STAR code implementation. The goal of this paper is to provide data storage practitioner a guideline when they choose a proper erasure code for storage applications and systems that need high performance in encoding and decoding operations in the order of GBs/s. Additionally, this paper identifies a practical technique that can further improve decoding performance of RS code greatly for both Jerasure and ISA-L for the most frequent disk failure pattern, i.e., one disk failure.
Short- and long-term impacts of variable hypoxia exposures on kelp forest sea urchins

Climate change is altering the intensity and variability of environmental stress that organisms and ecosystems experience, but effects of changing stress regimes are not well understood. We examined impacts of constant and variable sublethal hypoxia exposures on multiple biological processes in the sea urchin Strongylocentrotus purpuratus, a key grazer in California Current kelp forests, which experience high variability in physical conditions. We quantified metabolic rates, grazing, growth, calcification, spine regeneration, and gonad production under constant, 3-hour variable, and 6-hour variable exposures to sublethal hypoxia, and compared responses for each hypoxia regime to normoxic conditions. Sea urchins in constant hypoxia maintained baseline metabolic rates, but had lower grazing, gonad development, and calcification rates than those in ambient conditions. The sublethal impacts of variable hypoxia differed among biological processes. Spine regrowth was reduced under all hypoxia treatments, calcification rates under variable hypoxia were intermediate between normoxia and constant hypoxia, and gonad production correlated negatively with continuous time under hypoxia. Therefore, exposure variability can differentially modulate the impacts of sublethal hypoxia, and may impact sea urchin populations and ecosystems via reduced feeding and reproduction. Addressing realistic, multifaceted stressor exposures and multiple biological responses is crucial for understanding climate change impacts on species and ecosystems.
Making sense of the U.S. COVID-19 pandemic response: A policy regime perspective

On March 26, 2020, 3 months after Chinese authorities admitted to a novel coronavirus outbreak and 10 weeks after the first infection was documented on American soil, the U.S. led the world in COVI...
Airway complications during gastrointestinal endoscopies using propofol in a rural hospital

Simple endoscopies such as esophagogastroduodenoscopy (EGD) and colonoscopies are common procedures that require the use of sedation or general anesthesia. The risk of airway complications for these procedures depends on the type of medications administered. Wide variation exists in reported rates of airway complications for endoscopic procedures.