cssi/SciSciGPT-SciSciNet huggingface dataset:
Breast-Specific γ-Imaging for the Detection of Mammographically Occult Breast Cancer in Women at Increased Risk.

Breast-specific γ-imaging (BSGI) is a physiologic imaging modality that can detect subcentimeter and mammographically occult breast cancer, with a sensitivity and specificity comparable to MRI. The purpose of this study was to determine the incremental increase in breast cancer detection when BSGI is used as an adjunct to mammography in women at increased risk for breast cancer. Methods All patients undergoing BSGI from April 2010 through January 2014 were retrospectively reviewed. Eligible patients were identified as women at increased risk for breast cancer and whose most recent mammogram was benign. Examinations exhibiting focally increased radiotracer uptake were considered positive. Incremental increase in cancer detection was calculated as the percentage of mammographically occult BSGI-detected breast cancer and the number of mammographically occult breast cancers detected per 1,000 women screened. Results Included in this study were 849 patients in whom 14 BSGI examinations detected mammographically occult breast cancer. Patients ranged in age from 26 to 83 y, with a mean age of 57 y. Eleven of 14 cancers were detected in women with dense breasts. The addition of BSGI to the annual breast screen of asymptomatic women at increased risk for breast cancer yields 16.5 cancers per 1,000 women screened. When high-risk lesions and cancers were combined, BSGI detected 33.0 high-risk lesions and cancers per 1,000 women screened. Conclusion BSGI is a reliable adjunct modality to screening mammography that increases breast cancer detection by 1.7% (14/849) in women at increased risk for breast cancer, comparable to results reported for breast MRI. BSGI is beneficial in breast cancer detection in women at increased risk, particularly in those with dense breasts.
Hey You – Outta the Risk Pool

The big question currently pending before the Supreme Court is whether the individual mandate in the Patient Protection and Affordable Care Act of 2010 (PPACA) – better known as ObamaCare – is unconstitutional because Congress has no power under the commerce clause to compel individuals to buy health insurance. In this short essay, I offer a several new arguments as to why the individual mandate is indeed a proper exercise of Congressional power under the Constitution. The essence of the argument against the individual mandate is that although Congress can prohibit just about any sort of action that affects commerce, it cannot compel action or prohibit inaction in the name of regulating commerce because inaction is not commerce. Aside from the fact that the distinction between action and inaction is a slippery one, it is clear that Congress has enacted many statutes ranging from the antitrust laws to the civil rights acts that compel action under the commerce clause as well as the equal protection clause. The market for insurance is unusual. It depends on the cooperation of large groups for its very existence. It entails some disregard for individual preferences. And it often requires regulation because of endemic market failures. Ultimately, the failure of some to purchase health insurance results in a restraint of trade that denies insurance to others, because insurance companies are forced to compete on the basis of price for customers who are less likely on average to file claims. Thus, the individual mandate addresses what amounts to a restraint of trade that would be illegal under the antitrust laws if perpetrated by means of a positive conspiracy. Nonetheless, it is a restraint of trade, and Congress has the power to fix it. Moreover, the Supreme Court itself has effectively compelled consumers join bigger than necessary risk pools – by mandating unisex pricing of insurance products offered to state employees – with the result that insurance products cost more for some consumers than they otherwise would. In short, insurance is not like other forms of commerce. It would be unfortunate for the Supreme Court to strike down the individual mandate without due consideration for the peculiarities of the product of insurance.
Effect of Pharmacist Counseling Intervention on Health Care Utilization Following Hospital Discharge: A Randomized Control Trial.

Reduction in 30-day readmission rates following hospitalization for acute coronary syndrome (ACS) and acute decompensated heart failure (ADHF) is a national goal. The aim of this study was to determine the effect of a tailored, pharmacist-delivered, health literacy intervention on unplanned health care utilization, including hospital readmission or emergency room (ER) visit, following discharge. Randomized, controlled trial with concealed allocation and blinded outcome assessors Two tertiary care academic medical centers Adults hospitalized with a diagnosis of ACS and/or ADHF Pharmacist-assisted medication reconciliation, inpatient pharmacist counseling, low-literacy adherence aids, and individualized telephone follow-up after discharge The primary outcome was time to first unplanned health care event, defined as hospital readmission or an ER visit within 30 days of discharge. Pre-specified analyses were conducted to evaluate the effects of the intervention by academic site, health literacy status (inadequate versus adequate), and cognition (impaired versus not impaired). Adjusted hazard ratios (aHR) and 95 % confidence intervals (CI) are reported. A total of 851 participants enrolled in the study at Vanderbilt University Hospital (VUH) and Brigham and Women’s Hospital (BWH). The primary analysis showed no statistically significant effect on time to first unplanned hospital readmission or ER visit among patients who received interventions compared to controls (aHR = 1.04, 95 % CI 0.78-1.39). There was an interaction of treatment effect by site (p = 0.04 for interaction); VUH aHR = 0.77, 95 % CI 0.51-1.15; BWH aHR = 1.44 (95 % CI 0.95-2.12). The intervention reduced early unplanned health care utilization among patients with inadequate health literacy (aHR 0.41, 95 % CI 0.17-1.00). There was no difference in treatment effect by patient cognition. A tailored, pharmacist-delivered health literacy-sensitive intervention did not reduce post-discharge unplanned health care utilization overall. The intervention was effective among patients with inadequate health literacy, suggesting that targeted practice of pharmacist intervention in this population may be advantageous.
Help Cuba with nuclear power

(1995). Help Cuba with nuclear power. Bulletin of the Atomic Scientists: Vol. 51, No. 5, pp. 4-4.
Optimal operation and time recursion analysis of two-speed circulating water pump unit

Aiming at solving the problems of the optimization of two-speed circulating water pump unit,an optimization model of the cold end system under the simulation working condition was investigated with the analysis of the general features of power income and expense income in a certain circulating water inlet temperature,different load and different water circulating pump operation.Otherwise,to avoid the frequency of water pump's powering on,powering off and switching between high and low speed,a time recursion optimization model was put forward,which can predict the optimal operation mode a day after using the comprehensive power income and expense income the day before.Taking a 600 MW power plant as an example,it was caculated using these two models.The results indicate that the comprehensive power income is up to 1 699.39 kW and the comprehensive expense income is up to 658.26 Yuan per hour.
The pace of vocabulary growth during preschool predicts cortical structure at school age

Children vary greatly in their vocabulary development during preschool years. Importantly, the pace of this early vocabulary growth predicts vocabulary size at school entrance. Despite its importance for later academic success, not much is known about the relation between individual differences in early vocabulary development and later brain structure and function. Here we examined the association between vocabulary growth in children, as estimated from longitudinal measurements from 14 to 58 months, and individual differences in brain structure measured in 3rd and 4th grade (8-10 years old). Our results show that the pace of vocabulary growth uniquely predicts cortical thickness in the left supramarginal gyrus. Probabilistic tractography revealed that this region is directly connected to the inferior frontal gyrus (pars opercularis) and the ventral premotor cortex, via what is most probably the superior longitudinal fasciculus III. Our findings demonstrate, for the first time, the relation between the pace of vocabulary learning in children and a specific change in the structure of the cerebral cortex, specifically, cortical thickness in the left supramarginal gyrus. They also highlight the fact that differences in the pace of vocabulary growth are associated with the dorsal language stream, which is thought to support speech perception and articulation.
The role of uncertainty in systems engineering practice: An empirical analysis of engineering peer reviews

Uncertainty is a theoretical concept that undergirds much of organizational theory and engineering theory. This paper analyzes systems engineering peer review data obtained from a large defense contracting company to better understand the gaps between theory and practice with respect to uncertainty. Preliminary results reveal that in practice uncertainty plays critical roles with respect to language and system ontology that heretofore have been neglected or underrepresented in theory.
Cancers of the Gastrointestinal Tract

Colorectal cancer accounts for about 15% of all cancers in the United States. FDG-PET is used most frequently for restaging in patients who present with rising tumor markers or some equivocal finding on anatomical imaging or who are symptomatic after primary treatment has been completed. The ability of FDG-PET to determine extra-hepatic disease involvement can be limited by physiologically increased mucosal FDG uptake. PET/CT is especially useful for these cases. Further, PET/CT facilitates the characterization of small, mildly hyper-glycolytic liver lesions. This can be difficult with PET alone because of the relatively high physiological hepatic glycolytic activity.
Racial and Socioeconomic Variation in Genetic Markers of Telomere Length: A Cross-Sectional Study of U.S. Older Adults

Abstract Background Shorter telomere length (TL) has been associated with stress and adverse socioeconomic conditions, yet U.S. blacks have longer TL than whites. The role of genetic versus environmental factors in explaining TL by race and socioeconomic position (SEP) remains unclear. Methods We used data from the U.S. Health and Retirement Study ( N =11,934) to test the hypothesis that there are differences in TL-associated SNPs by race and SEP. We constructed a TL polygenic risk score (PRS) and examined its association with race/ethnicity, educational attainment, assets, gender, and age. Results U.S. blacks were more likely to have a lower PRS for TL, as were older individuals and men. Racial differences in TL were statistically accounted for when controlling for population structure using genetic principal components. The GWAS-derived SNPs for TL, however, may not have consistent associations with TL across different racial/ethnic groups. Conclusions This study showed that associations of race/ethnicity with TL differed when accounting for population stratification. The role of race/ethnicity for TL remains uncertain, however, as the genetic determinants of TL may differ by race/ethnicity. Future GWAS samples should include racially diverse participants to allow for better characterization of the determinants of TL in human populations.
Uncertainty and Ambiguity in Health Decisions

Uncertainty is central to health decisions across the entire continuum of medical care—from disease prevention and screening, to disease treatment, to end-of-life care. For numerous decisions in all these domains, uncertainty is the omnipresent problem that makes decisions both possible and necessary. The current chapter provides an overview of important theoretical and empirical work on the effects of uncertainty in healthcare decisions. It first discusses the concept of uncertainty and provides a working definition to guide further analysis and discussion. It then reviews theory and evidence on the effects of one important type of uncertainty, known as “ambiguity” or “epistemic uncertainty,” on health decisions and patient well-being. The chapter puts forth the argument that ambiguity in healthcare decisions has important psychological effects that need to be better understood and accounted for, and suggests potentially fruitful directions for future research in this area.
Resuscitating a Bygone Political Vision through Language: Antoine Furetière and the Resurrection of the Corps Politique1

Antoine Furetiere remains a prominent figure in the history of French lexicography as the inciter of the famous querelle des dictionnaires. In producing his Dictionnaire universel (1690), Furetiere put forth a linguistic vision that contrasted with that of the Academie francaise. This article proposes a refinement to our interpretation of Furetiere's dictionary as a project with not only linguistic but also political scope. Specifically, I argue that the ex-academician's dictionary and literary writings functioned as tools that he mobilized to express and advocate his political vision, namely, a return to pre-absolutist France. I trace the lexicographer's desire to resurrect a bygone corps politique, a configuration in which all individuals are represented, given voice, and respected. Finally, I demonstrate how Furetiere reclaimed the right to question the monarchy through the publication and dissemination of his own voice in the very pages of his dictionary and by means of his literary production.
In Patients with Aortoiliac Occlusive Disease, Does Extra-anatomic Bypass Improve Quality of Life and Limb Salvage?

Aortoiliac occlusive disease (AIOD) often manifests as claudication or, in its advanced forms, as critical limb ischemia (CLI), both of which can worsen a patient’s quality of life and increase the likelihood of limb loss. Surgical correction usually requires either an anatomic, invasive surgery (aortobifemoral bypass) or a less invasive, extra-anatomic approach (femorofemoral bypass, axillofemoral bypass). A patient’s co-morbidities and ability to withstand an invasive surgery often dictate which revascularization technique will be used. Understanding the ability of an extra-anatomic bypass to prolong limb survival and improve a patient’s quality of life compared to anatomic revascularization is crucial to accurately anticipate a patient’s outcome.
Synthesis and modification of titanium containing wrinkled mesoporous silica for cyclohexene epoxidation

Abstract Ti containing wrinkled mesoporous silica (Ti-WMS) has been prepared by direct synthesis with various Si/Ti ratios. Under similar conditions, Ti containing periodic mesoporous organosilicas (Ti-PMO) has been prepared with benzene bridges in the framework while maintaining the wrinkled structure. Both Ti-WMS and Ti-PMO samples have the radial wrinkled structure, and were further modified by trimethylsilylation to adjust the surface hydrophobicity. All catalysts were tested for the oxidation of cyclohexene with and without solvent using tert-butyl hydroperoxide as the oxidant. Ti-WMS catalysts showed superior catalytic performance over conventional Ti-MCM-41 when acetonitrile was used as the solvent. The radial wrinkled structure ensures better diffusion pathways for the reactants. For the catalytic reaction without solvent, Ti-WMS catalysts exhibit similar behavior to the conventional Ti-MCM-41 catalyst. Silylation was demonstrated to be an effective methodology to improve the catalytic activity because of enhanced surface hydrophobicity. The maximum turnover frequency was 1401 h−1 with an epoxide selectivity of 95% obtained using the silylated Ti-WMS catalyst with a Si/Ti ratio of 209.
College Students’ Health and Short-Term Career Outcomes: Examining Work Volition as a Mediator

This study examined the role of work volition in the relation between college students’ health and several short-term career outcome variables. The responses of 393 students to an online survey rev...
Regulation of AMH by oocyte-specific growth factors in human primary cumulus cells

The regulation of AMH production by follicular cells is poorly understood. The purpose of this study was to determine the role of the oocyte-secreted factors, growth differentiation factor 9 (GDF9) and bone morphogenetic protein 15 (BMP15), on AMH production in primary human cumulus cells. Cumulus cells from IVF patients were cultured with a combination of GDF9, BMP15, recombinant FSH and specific signaling inhibitors. Stimulation with GDF9 or BMP15 separately had no significant effect on AMH mRNA levels. In contrast, simultaneous stimulation with GDF9 and BMP15 (G + B) resulted in a significant increase in AMH mRNA expression. Increasing concentration of G + B (0.6, 2.5, 5 and 10 ng/mL) stimulated AMH in a dose-dependent manner, showing a maximal effect at 5 ng/mL. Western blot analyses revealed an average 16-fold increase in AMH protein levels in cells treated with G + B when compared to controls. FSH co-treatment decreased the stimulation of AMH expression by G + B. The stimulatory effect of G + B on the expression of AMH was significantly decreased by inhibitors of the SMAD2/3 signaling pathway. These findings show for the first time that AMH production is regulated by oocyte-secreted factors in primary human cumulus cells. Moreover, our novel findings establish that the combination of GDF9 + BMP15 potently stimulates AMH expression.
Influence of set retarding admixtures on calcium sulfoaluminate cement hydration and property development

Abstract Little published data is available to guide specification calcium sulfoaluminate cement (CSA) mixtures with citric acid retarder dosage rates capable of achieving adequate field working times, nor to understand the effect of retarder dosage on hydration and property development, representing a significant barrier to widespread CSA concrete use. Thus, this study investigated the use of citric acid with two commercially-available CSA cements, tracking the effects of dosage on phase development, hydration, setting, and compressive strengths. Key findings were that: citric acid successfully retarded initial set past 120 min for both cements despite significantly different chemistries; increasing cement anhydrite content reduced retarder effectiveness and altered hardened binder microstructure, reducing compressive strengths; greater retarder dosages did not negatively affect cumulative hydration, nor strengths; and the time at which the maximum rate of heat evolution occurred correlated with final setting, a relationship useful for predicting field mixture behavior based on laboratory testing.
10 – Religion and anxiety: Which anxiety? Which religion?

Publisher Summary This chapter explores the religion and anxiety. There is an argument that religion can be as much a source of anxiety as it is a balm or that religion first creates and then relieves anxiety. The chapter explores the direction of influence may very well depend on which anxiety one has in mind, as well as which religion. Generalized anxiety disorder is characterized by at least 6 months of persistent and excessive anxiety and worry. Anxiety can be defined as a state of dread anticipation in which the object of the dread is vaguely defined. It includes tenseness, restlessness, increased heart rate, and sweating, all of which indicate preparedness for fight or flight. Treatment modalities capitalizing on religiosity may well make good sense for people who are high in religiosity. While it may be true that being religious may be the cause of anxiety, it seemingly is equally true that religion provides peace of mind for a great number of people. It is evident that religiosity is a potent intervention for those who are religious, and that it shapes and buffers the anxieties as one faces what often is a hostile world.
FXR-Mediated Cortical Cholesterol Accumulation Contributes to the Pathogenesis of Type A Hepatic Encephalopathy

Background & Aims Hepatic encephalopathy is a serious neurologic complication of acute and chronic liver diseases. We previously showed that aberrant bile acid signaling contributes to the development of hepatic encephalopathy via farnesoid X receptor (FXR)-mediated mechanisms in neurons. In the brain, a novel alternative bile acid synthesis pathway, catalyzed by cytochrome p450 46A1 (Cyp46A1), is the primary mechanism by which the brain regulates cholesterol homeostasis. The aim of this study was to determine if FXR activation in the brain altered cholesterol homeostasis during hepatic encephalopathy. Methods Cyp7A1-/- mice or C57Bl/6 mice pretreated with central infusion of FXR vivo morpholino, 2-hydroxypropyl-β-cyclodextrin, or fed a cholestyramine-supplemented diet were injected with azoxymethane (AOM). Cognitive and neuromuscular impairment as well as liver damage and expression of Cyp46A1 were assessed using standard techniques. The subsequent cholesterol content in the frontal cortex was measured using commercially available kits and by Filipin III and Nile Red staining. Results There was an increase in membrane-bound and intracellular cholesterol in the cortex of mice treated with AOM that was associated with decreased Cyp46A1 expression. Strategies to inhibit FXR signaling prevented the down-regulation of Cyp46A1 and the accumulation of cholesterol. Treatment of mice with 2-hydroxypropyl-β-cyclodextrin attenuated the AOM-induced cholesterol accumulation in the brain and the cognitive and neuromuscular deficits without altering the underlying liver pathology. Conclusions During hepatic encephalopathy, FXR signaling increases brain cholesterol and contributes to neurologic decline. Targeting cholesterol accumulation in the brain may be a possible therapeutic target for the management of hepatic encephalopathy.
Laboratory evaluation of a low-cost, real-time, aerosol multi-sensor.

ABSTRACTExposure to occupational aerosols are a known hazard in many industry sectors and can be a risk factor for several respiratory diseases. In this study, a laboratory evaluation of low-cost aerosol sensors, the Dylos DC1700 and a modified Dylos known as the Utah Modified Dylos Sensor (UMDS), was performed to assess the sensors’ efficiency in sampling respirable and inhalable dust at high concentrations, which are most common in occupational settings. Dust concentrations were measured in a low-speed wind tunnel with 3 UMDSs, collocated with an aerosol spectrometer (Grimm 1.109) and gravimetric respirable and inhalable samplers. A total of 10 tests consisting of 5 different concentrations and 2 test aerosols, Arizona road dust and aluminum oxide, were conducted. For the Arizona road dust, total particle count was strongly related between the spectrometer and the UMDS with a coefficient of determination (R2) between 0.86–0.92. Particle count concentrations measured with the UMDS were converted to mass ...
Barium titanate nanoparticle based nonlinear optical humidity sensor

Abstract A second harmonic generation humidity sensor was constructed with a sensing layer composed of cubic phase barium titanate nanoparticles. The sensor shows a linear response up to a relative humidity of 80%, with response times of 40 ± 10 s for decreasing, and 39 ± 7 s for increasing humidity. The mechanism of humidity sensitivity is attributed to the modulation of interfacial electric fields due to water vapor adsorption. This research represents the first attempt to bring the surface sensitivity of second harmonic generation to bear on the issue of humidity sensing.
Bayesian reliability analysis for the Gumbel failure model

The Gumbel or double exponential probability distribution is used to characterize the failure times of a given system. The ordinary and Bayesian settings of the reliability functions are being studied. In the Bayesian reliability analysis, we utilize Jeffrey's non-informative prior to obtain estimates of the target time of a system to achieve a desired reliability. Lindley's approximation procedure is used to obtain numerical estimates of the target time.
The Economics of Class Size

Abstract Class-size reduction is a politically popular but relatively expensive education reform. Understanding the causal relationship between class size and student achievement is critical for determining whether class-size reduction can be recommended as a policy to improve student outcomes. We begin with a review of the theory of why class size might matter, followed by a discussion of the empirical strategies for identifying the causal impact of class size on student achievement. Next, the empirical literature on class-size reduction is reviewed, focusing on studies using experimental and quasi-experimental techniques because these rely on the most credible strategies for identifying the true causal relationship between class size and student achievement.
Development and Progression of Auricular Acupuncture as a Treatment for Anxiety and Pain

Auricular acupuncture is commonly used for various clinical conditions. It can be used as a primary mode of treatment or in conjunction with body acupuncture or other forms of interventions. The external auricle is believed to organize as the entire body as an inverted fetus. Every part of the body has a reflect point located on the external body. In other words, every point on the ear represents a specific part or organ of the body. This chapter includes history and development of auricular acupuncture, the potential mechanism of auricular acupuncture, and review of the efficacy of clinical trials.
Stability and weak stability

The stability problem is the question of to what extent the conclusion of a theorem is sensitive to small changes in the assumptions. Such description is, of course, vague until the questions of how to quantify the departures both from the conclusion and from the assumption are answered. The latter is to some extent arbitrary; in the characterization context, typically, stability reasoning depends on the ability to prove that small changes (measured with respect to some measure of smallness) in assumptions of a given characterization theorem result in small departures (measured with respect to one of the distances of distributions) from the normal distribution.
The relative effectiveness of cancer awareness months: A Google trends analysis of the United States from 2004 to 2017.

e13544Background: Internet search traffic provides a proxy measure into patients’ information-seeking behaviors. As the largest search engine in the world, Google’s data provided via Google Trends ...
TNF Family Cytokines Induce Distinct Cell Death Modalities in the A549 Human Lung Epithelial Cell Line when Administered in Combination with Ricin Toxin.

Ricin is a member of the ribosome-inactivating protein (RIP) family of toxins and is classified as a biothreat agent by the Centers for Disease Control and Prevention (CDC). Inhalation, the most potent route of toxicity, triggers an acute respiratory distress-like syndrome that coincides with near complete destruction of the lung epithelium. We previously demonstrated that the TNF-related apoptosis-inducing ligand (TRAIL; CD253) sensitizes human lung epithelial cells to ricin-induced death. Here, we report that ricin/TRAIL-mediated cell death occurs via apoptosis and involves caspases -3, -7, -8, and -9, but not caspase-6. In addition, we show that two other TNF family members, TNF-α and Fas ligand (FasL), also sensitize human lung epithelial cells to ricin-induced death. While ricin/TNF-α- and ricin/FasL-mediated killing of A549 cells was inhibited by the pan-caspase inhibitor, zVAD-fmk, evidence suggests that these pathways were not caspase-dependent apoptosis. We also ruled out necroptosis and pyroptosis. Rather, the combination of ricin plus TNF-α or FasL induced cathepsin-dependent cell death, as evidenced by the use of several pharmacologic inhibitors. We postulate that the effects of zVAD-fmk were due to the molecule’s known off-target effects on cathepsin activity. This work demonstrates that ricin-induced lung epithelial cell killing occurs by distinct cell death pathways dependent on the presence of different sensitizing cytokines, TRAIL, TNF-α, or FasL.
Drawbacks of Heart Rate Variability Analysis and Application of Parasympathetic and Sympathetic Monitoring

In this chapter, the failure of heart rate variability and beat-to-beat blood pressure is delineated and the solution to their failings (P&S monitoring) is introduced and developed. The chapter compares graphically spectral analysis of HRV with the spectral analysis method associated with P&S monitoring. The method of spectral analysis, the Fourier transform, is developed and demonstrated and applied to both HRV and P&S monitoring. This is to demonstrate how spectral analysis quantifies the respective measurement, enabling the primary care physician to assess their patient’s ANS. The shortcomings of the Fourier transform when applied to biological, especially autonomic, signals are then elucidated and their solution in the form of wavelet transforms is introduced and developed. In conclusion, the two transform techniques are then compared graphically.
Prognostic Significance of Preoperative Anemia in Patients Undergoing Surgery for Renal Cell Carcinoma: A Meta-analysis.

Aim To better evaluate the association between preoperative anemia and outcomes in patients following radical or partial nephrectomy for renal cell carcinoma (RCC). Materials and methods A meta-analysis of hazard ratios (HR) was conducted to measure the association between preoperative anemia and all-cause mortality (ACM), cancer-specific mortality (CSM), and disease recurrence (DR) in patients who underwent surgery for RCC. Results A total of 14 studies (8,673 patients) met the eligibility criteria. All studies reported survival outcomes using the multivariable Cox proportional hazards model. Pooled results showed that preoperative anemia was associated with increased ACM [HR=2.13, 95% Confidence Interval (CI)=1.48-3.06], CSM (HR=1.91, 95% CI=1.26-2.90), and DR (HR=1.67, 95% CI=1.16-2.40). Conclusion This meta-analysis indicates that preoperative anemia appears to be associated with earlier recurrence and shorter survival of patients undergoing radical or partial nephrectomy for RCC. Our findings, however, still need to be validated by well-designed prospective studies with larger sample sizes and well-controlled confounding factors.
Increasing Incidence of Left-Sided Colorectal Cancer in the Young: Age Is Not the Only Factor

Recent single-institution studies have shown that colorectal cancer (CRC) in patients 70 having a left-sided CRC (< 50 vs ≥ 70; OR = 2.8; 95% CI 2.7, 2.9). The incidence of CRC in those under 50 increased over the study period due to an increase in left-sided tumors. The distribution of CRC varied with race, with African-Americans having a lower odds for left-sided CRC (OR = 0.89; 95% CI 0.87, 0.91) and Asians/Pacific Islanders having a higher odds (OR = 1.8; 95% CI 1.7, 1.9). In the < 50 age group, the incidence of CRC is increasing, with majority of these tumors left-sided. Tumor location varies with both age and race.
Information Available Online That Answers Common Questions About Breast Pumping: A Scoping Review.

Background: In light of the widespread use of breast milk pumping, or, “pumping,” mothers are seeking clear, adequate breast pumping guidelines. We aimed at characterizing the information in web pa...
Geometric Distance Determination Using Type I X-Ray Bursts

With the excellent angular resolution of the Chandra X-Ray Observatory, it is possible to geometrically determine the distance to variable Galactic sources, based on the phenomenon that scattered radiation appearing in the X-ray halo has to travel along a slightly longer path than the direct, unscattered radiation. By measuring the delayed variability, constraints on the source distance can be obtained if the halo brightness is large enough to dominate the point-spread function (PSF) and to provide sufficient statistics. The distance to Cyg X-3, which has a quasi-sinusoidal light curve, has been obtained with this approach by Predehl et al. Here we examine the feasibility of using the delayed signature of type I X-ray bursts as distance indicators. We use simulations of delayed X-ray burst light curves in the halo to find that the optimal annular region and energy band for a distance measurement with a grating observation are roughly 10''-50'' and 1-5 keV, respectively, assuming Chandra's effective area and PSF, uniformly distributed dust, the input spectrum and optical depth to GX 13+1, and the Weingartner & Draine interstellar grain model. We find that the statistics are dominated by Poisson noise rather than systematic uncertainties, such as the PSF contribution to the halo. Using Chandra, a distance measurement to such a source at 4 (8) kpc could be made to about 23% (30%) accuracy with a single burst with 68% confidence. By stacking many bursts, a reasonable estimate of systematic errors limits the distance measurement to about 10% accuracy.
Resident Opioid Prescribing Habits Do Not Reflect Best Practices in Post-Operative Pain Management: An Assessment of the Knowledge and Education Gap.

Objective To evaluate deficiencies in knowledge and education in opioid prescribing and to compare surgical resident opioid-prescribing practices to Opioid Prescribing Engagement Network (OPEN) procedure-specific guidelines. Design Anonymous web-based survey distributed to all general surgery residents to evaluate prior education received and confidence in knowledge in opioid prescribing. The number of 5 milligram oxycodone tablets prescribed for common procedures was assessed and compared with OPEN for significance using Wilcoxon signed rank tests. Setting General surgery residency program within large university-based tertiary medical center. Participants Categorical general surgery residents of all postgraduate years. Results Fifty-six of 72 (78%) categorical residents completed the survey. Few reported receiving formal education in opioid prescribing in medical school (32%) or residency (16%). While 82% of residents felt confident in opioid side effects, fewer felt the same with regards to opioid pharmacokinetics (36%) or proper opioid disposal (29%). Opioids prescribed varied widely with residents prescribing significantly more than recommended by OPEN in 9 of 14 procedures. Conclusions Tackling the evolving opioid epidemic requires a multidisciplinary approach that addresses prescribing at all steps of the process, starting with trainee education.
Using A Functional Play Intervention to Increase Joint Attention of School-aged, Non-Verbal Children with Autism Spectrum Disorder (ASD)

The vast majority of joint attention interventions for children with autism spectrum disorder (ASD) are geared toward toddlers and preschoolers as it is an early developmental skill. However, many of the youngsters do not acquire joint attention despite these early interventions and subsequently do not exhibit joint attention later in life. In the current study, we used a multiple baseline design across three school-aged, non-verbal children with ASD, to assess the efficacy of a functional play intervention to increase joint attention. During baseline, all three children demonstrated minimal joint attention and appropriate play. Following baseline, the functional play intervention was presented, which consisted of teaching functional play through modeling. Post-intervention probes demonstrated gains in both joint attention and functional play. Furthermore, these behaviors generalized across person, setting, and stimuli. The results of this study provide evidence that functional play interventions may be a promising approach to teach and promote joint attention for older, school-aged children with ASD.
T-cell responses to acute cardiorespiratory or resistance exercise in cohorts of physically active or physically inactive older adults: A randomized complete crossover

Aging is associated with many chronic diseases that are maintained and perpetuated by immune dysregulation and chronic systemic inflammation. T-cells often undergo age-related changes, including an accumulation of memory cells, which places individuals at increased risk for novel infections and may predispose them to increased inflammation. Regular exercise training has been suggested to offset age-related changes in T-cells, but the majority of literature is derived from cardiorespiratory exercise (CRE) studies. Much less is understood about the T-cell response to resistance exercise (RE). The purpose of this study was to examine the effects of acute CRE and acute RE on the T-cell response among a cohort of physically active older adults (PA) compared to a cohort of physically inactive older adults (PI). METHODSTwenty-four healthy older adults (PA n=12; PI n=12; mean {+/-} SD; age (yrs) PA 62 {+/-} 5, PI 64 {+/-} 5; height (cm) PA 170.9 {+/-} 6.9, PI 162.9 {+/-} 8.0; weight (kg) PA 69.3 {+/-} 10.2, PI 68.2 {+/-} 12.8; BMI (kg/m2) PA 23.9 {+/-} 3.0, PI 25.6 {+/-} 3.5) completed one bout of CRE and one bout of RE in a randomized order, both at a moderate intensity, and separated by at least 7 days. Blood samples drawn pre-exercise, post-exercise, and 1h post-exercise (recovery) were analyzed for CD4+ and CD8+ T-cells and their differentiation status using surface markers CD45RA, CD62L, and CD57, as well as for Th17 cells (CD4+ CD161+ CD196+) using flow cytometry. RESULTSPI had higher numbers of circulating CD57+ EMRA CD4+ T-cells (PA, mean {+/-} SE, 1 {+/-} 2 cells/uL; PI, 6 {+/-} 2 cells/uL; p=0.01; z=2.32) than PA at pre-exercise. Both CRE and RE elicited a significant mobilization of highly-differentiated (CD45RA+ CD62L-; CD57+ CD45RA+ CD62L-) CD8+ T-cells into the circulation post-exercise in both PA and PI groups. Furthermore, CRE resulted in a decrease in the number of circulating Th17 cells post-exercise, while RE increased Th17 cell mobilization compared to the CRE response. CONCLUSIONTaken together, T-cells in PA and PI respond similarly to acute CRE and support previously reported data showing a significant mobilization of highly differentiated T-cells. The present study confirms that moderate intensity RE also elicits this response, but highlights potential differences between CRE and RE on the immune responses of T-cells, particularly in PI individuals. Clinical trial registrationThis research study was registered at clinicaltrials.gov NCT03794050
Frontline Work Taking Care of Homeless Veterans

The following are stories and reflections about my efforts and more importantly the efforts of many others and the community to find, house, and care for homeless veterans. There are certain populations that draw one’s attention and care, and for me, caring for this population was natural.
A Web-Based Intervention to Increase Smokers' Intentions to Participate in a Cessation Study Offered at the Point of Lung Screening: Factorial Randomized Trial.

Background: Screen ASSIST is a cessation trial offered to current smokers at the point of lung cancer screening. Because of the unique position of promoting a prevention behavior (smoking cessation) within the context of a detection behavior (lung cancer screening), this study employed prospect theory to design and formatively evaluate a targeted recruitment video prior to trial launch. Objective: The aim of this study was to identify which message frames were most effective at promoting intent to participate in a smoking cessation study. Methods: Participants were recruited from a proprietary opt-in online panel company and randomized to a 2 (benefits of quitting vs risks of continuing to smoke at the time of lung screening; BvR) × 2 (gains of participating vs losses of not participating in a cessation study; GvL) message design experiment (N=314). The primary outcome was self-assessed intent to participate in a smoking cessation study. Message effectiveness and lung cancer risk perception measures were also collected. Analysis of variance examined the main effect of the 2 message factors and a least absolute shrinkage and selection operator (LASSO) approach identified predictors of intent to participate in a multivariable model. A mediation analysis was conducted to determine the direct and indirect effects of message factors on intent to participate in a cessation study. Results: A total of 296 participants completed the intervention. There were no significant differences in intent to participate in a smoking cessation study between message frames (P=.12 and P=.61). In the multivariable model, quit importance (P<.001), perceived message relevance (P<.001), and affective risk response (ie, worry about developing lung cancer; P<.001) were significant predictors of intent to participate. The benefits of quitting frame significantly increased affective risk response (Meanbenefits 2.60 vs Meanrisk 2.40; P=.03), which mediated the relationship between message frame and intent to participate (b=0.24; 95% CI 0.01-0.47; P=.03). Conclusions: This study provides theoretical and practical guidance on how to design and evaluate proactive recruitment messages for a cessation trial. Based on our findings, we conclude that heavy smokers are more responsive to recruitment messages that frame the benefits of quitting as it increased affective risk response, which predicted greater intention to participate in a smoking cessation study.
Blowing the whistle on political interference: the Northern Spotted Owl

Abstract No species has touched off more controversy in the Pacific Northwest than the Northern Spotted Owl. The owl was federally listed under the US Endangered Species Act in 1990 due to widespread destruction of its old-growth forest habitat and inadequate species and habitat protections. A series of legal decisions shut down logging across millions of hectares of forests until the landmark Northwest Forest Plan (NWFP) was adopted by President Bill Clinton in 1994. The NWFP served as a de facto owl recovery plan that also protected habitat for hundreds of other old-growth associated species until 2005 when a lawsuit by Seattle Audubon Society forced the George W. Bush administration to develop a species-specific owl recovery plan. That recovery plan was drafted by a “multistakeholder” group stacked with industry and government representatives. At the time, a series of lawsuits between the timber industry (sue) and the Bush administration (settle) was designed to get the cut out. Consequently, the 2008 Bush administration recovery plan was designed to weaken forest protections in the NWFP. Independent peer review and the investigative branch of government declared the recovery plan scientifically flawed and politically motivated. Citing this information, President Barack Obama overturned the Bush administration’s recovery plan in 2009, initiating a revised plan developed by the US Fish & Wildlife Service. While there were improvements to this plan, it contained controversial assumptions about logging in owl territories to reduce fire intensity. I document an abuse of scientific integrity spanning presidential administrations and agency decisions as the owl remains perilously close to extirpation. This is a case study in why scientists need to be persistent when speaking truth to power.
Thirty-Year Single Institution Experience of Accelerated Partial Breast Irradiation for Early-Stage Breast Cancer.

Purpose/Objective(s) Accelerated partial breast irradiation (APBI) can reduce treatment time and spare normal breast tissue. Techniques for APBI include applicator-based, external beam radiotherapy (EBRT), intra-operative radiotherapy (IORT), and interstitial implant-based. Data comparing these various APBI modalities and associated outcomes are lacking in the literature. We conducted a single-institution retrospective analysis of patients treated with APBI to compare treatment techniques and report outcomes. Materials/Methods Patients treated with APBI between 1990 and 2019 were included. Baseline patient characteristics, clinical and pathological features, treatment details, and clinical outcomes were retrospectively reviewed using a single-institution database. Outcomes were updated through August 2020. Statistical methods included Kruskal-Wallis test, Fisher's exact test, chi-square test of independence, and Kaplan-Meier analysis. Results A total of 926 APBI cases were analyzed, a majority of which were invasive ductal carcinoma (50.6%). Comparing applicator-based to EBRT, IORT, and implant-based, there was no difference in overall survival, freedom from local recurrence, or freedom from mastectomy (Table 1). 5-, 10-, and 25-year cumulative incidence of ipsilateral breast tumor recurrence (IBTR) was 1.5% (0.87-2.5%), 3.3% (2.3-4.7%), and 5.2% (3.9-6.7%), with no difference between treatment techniques. The median follow-up time was 121.6 months (66-165.7 months). Cosmesis was good/excellent in 91%, 84%, and 93%, for applicator, EBRT, and interstitial techniques, respectively. Late toxicities assessed included pigmentary changes, telangiectasias, induration/fibrosis, and fat necrosis. The majority of late toxicities were none or Grade 1, with less than 10% of patients experiencing Grade 2 or greater toxicity. Conclusion With our 30-year single-institution APBI experience using various treatment techniques, long term outcomes of both disease control and local morbidity demonstrate that the various APBI techniques are equally effective for suitable early-stage breast cancer patients. As evolving radiotherapy paradigms incorporate more shortened time-course treatments, these results affirm that APBI remains a viable alternative for such favorable patients.
Large area electron beam generation and propagation for KrF lasers

High energy KrF lasers have optical output apertures ranging from 10×10 cm2 to 1×1 m2. The electron beam must uniformly pump the entire aperture and the length of the laser amplifier. These electron beams are usually mildly relativistic (250–750 keV) and have moderate current densities (10–100 amps/cm2). The NIKE system at NRL incorporates a 20×20 cm2 aperture laser amplifier to drive a 60×60 cm2 aperture final amplifier expected to deliver greater than 4 kJ of laser output. Design considerations, testing, and experimental data from the 20 cm amplifier are presented as well as an overview of some of the models used to understand the results. Particular attention is paid to obtaining a uniform electron beam with minimal small scale structure. Results of the electron beam uniformity and improved electron transmission efficiency to the gas for the 20 cm amplifier will be presented. The design of the 60 cm amplifier being constructed will also be presented.
Discovering the Inner Life of a Child

Abstract Using Winnicott's concept of transitional space, joint attention, theory of mind, and a case vignette, the author describes techniques in elucidating and elaborating a child's play space, hence, psychic life. Explicating the child's theory of mind uncovers the dynamics, motives, conflicts, and unconscious material used by the analyst to form interpretations and encourage the child's self-reflective function (Fonagy & Target, 1996). Finally, a case vignette illustrates the enhancement of play space by elucidating the child's theory of mind.