cssi/SciSciGPT-SciSciNet huggingface dataset:
Association between Vancomycin Day 1 Exposure Profile and Outcomes among Patients with Methicillin-Resistant Staphylococcus aureus Infective Endocarditis

Given the critical importance of early appropriate therapy, a retrospective cohort (2002 to 2013) was performed at the Detroit Medical Center to evaluate the association between the day 1 vancomycin exposure profile and outcomes among patients with MRSA infective endocarditis (IE). The day 1 vancomycin area under the concentration-time curve (AUC0–24) and the minimum concentration at 24 h (Cmin 24) was estimated for each patient using the Bayesian procedure in ADAPT 5, an approach shown to accurately predict the vancomycin exposure with low bias and high precision with limited pharmacokinetic sampling. Initial MRSA isolates were collected and vancomycin MIC was determined by broth microdilution (BMD) and Etest. The primary outcome was failure, defined as persistent bacteremia (≥7 days) or 30-day attributable mortality. Classification and regression tree analysis (CART) was used to determine the vancomycin exposure variables associated with an increased probability of failure. In total, 139 patients met study criteria; 76.3% had right-sided IE, 16.5% had left-sided IE, and 7.2% had both left and right-sided IE. A total of 89/139 (64%) experienced failure by composite definition. In the CART analysis, failure was more pronounced in patients with an AUC0–24/MIC as determined by BMD of ≤600 relative to those with AUC0–24/MIC as determined by BMD of >600 (69.8% versus 54.7%, respectively, P = 0.073). In the logistic regression analysis, an AUC/MIC as determined by BMD of ≤600 (adjusted odds ratio, 2.3; 95% confidence interval, 1.01 to 5.37; P = 0.047) was independently associated with failure. Given the retrospective nature of the present study, further prospective studies are required but these data suggest that patients with an AUC0–24/MIC as determined by BMD of ≤600 present an increased risk of failure.
Xf dependence of psi and Drell-Yan production

We discuss the nuclear dependence of psi and psi' production in hadron-nucleus interactions as a function of longitudinal momentum fraction x{sub F}. Nuclear effects such as final-state absorption, interactions with comovers, shadowing of parton distributions, energy loss, and intrinsic heavy-quark components are described separately and incorporated into the model which is then compared to the preliminary E866 data. The resulting nuclear dependence of Drell-Yan production at 800 GeV and proposed measurements of psi, psi' and Drell-Yan production at 120 GeV are also calculated.
Segmentation of surface curvature using a photometric invariant

Gaussian curvature is an intrinsic local shape characteristic of a smooth object surface that is invariant to orientation of the object in 3-D space and viewpoint. Accurate determination of the sign of Gaussian curvature at each point on a smooth object surface (i.e., the identification of hyperbolic, elliptical and parabolic points) can provide very important information for both recognition of objects in automated vision tasks and manipulation of objects by a robot. We present a multiple illumination technique that directly identifies elliptical, hyperbolic, and parabolic points from diffuse reflection from a smooth object surface. This technique is based upon a photometric invariant involving the behavior of the image intensity gradient under varying illumination. The nature of this photometric invariant allows direct segmentation of a smooth object surface according to the sign of Gaussian curvature independent of knowledge of local surface orientation, independent of diffuse surface albedo, and with only approximate knowledge of the geometry of multiple incident illumination. In comparison with photometric stereo, this new technique determines the sign of Gaussian curvature directly from image features without having to derive local surface orientation, is invariant to incident orientation errors of two of three light sources, and is invariant to the relative strength of incident radiance with respect to each of these light sources. We demonstrate how this segmentation technique works under conditions of simulated image noise, and actual experimental imaging results. >
Interference-aware multipath routing in wireless mesh network

The inherent mesh infrastructure of IEEE 802.11-based wireless mesh networks provides added support to construct multiple robust paths. However, based on geometric locations of wireless nodes, neighborhood interference and channel contention impose challenges on multipath routing schemes. A large body of research has been carried out to maximize aggregate end-to-end throughput using multipath routing; however, interference has not been accurately modeled in majority of the work. Based on the relative location of transmitters and receivers, information asymmetric non-coordinated interference introduces bottleneck links and significantly reduces the aggregate throughput. The impact of this interference is even observed on links several hops away. In this paper, multipath routing is integrated with topology control to manage such multilevel asymmetric interference. An optimization model has been presented with an objective to achieve optimized end-to-end throughput using multiple available paths, considering coordinated and asymmetric non-coordinated interference. The goal of this research is to develop a multipath routing strategy which can achieve better end-to-end throughput by purging badly affected asymmetric non-coordinated interfering links during path construction procedure. The proposed model and routing strategy have been tested through extensive simulations. The results clearly exhibit the efficacy of the proposed approach, which achieves better aggregate end-to-end throughput compared to existing multipath routing schemes.
The effects of the Massachusetts health reform on financial distress

A major benefit of health insurance coverage is that it protects the insured from unexpected medical costs that may devastate their personal finances. In this paper, we use detailed credit report information on a large panel of individuals to examine the effect of a major health care reform in Massachusetts in 2006 on a broad set of financial outcomes. The Massachusetts model served as the basis for the Affordable Care Act and allows us to examine the effect of coverage on financial outcomes for the entire population of the uninsured, not just those with very low incomes. We exploit plausibly exogenous variation in the impact of the reform across counties and age groups using levels of pre-reform insurance coverage as a measure of the potential effect of the reform. We find that the reform reduced the total amount of debt that was past due, the fraction of all debt that was past due, improved credit scores and reduced personal bankruptcies. We also find suggestive evidence that the reform lowered the total amount of debt and decreased third party collections. The effects are most pronounced for individuals who had limited access to credit markets before the reform. These results show that health care reform has implications that extend well beyond the health and health care utilization of those who gain insurance coverage.
Capture Problems For Coupled Random Walks

N predator random walks X k (t) stalk a prey random walk Y(t). By conspiring among themselves and observing their prey, the predators try to minimize the capture time T: $$T = \min \{ t:{X_k}(t) = Y(t)\,{\text{for}}\,{\text{some}}\,k\}.$$
17β-Estradiol-dependent activation of signal transducer and activator of transcription-1 in human fetal osteoblasts is dependent on Src kinase activity

Estrogen is essential for normal growth and remodeling of bone. Although the mechanism of estrogen action on bone cells has been widely investigated, the full spectrum of signal transduction pathways activated by estrogen is unknown. In this report, we investigate the effects of the gonadal hormone 17β-estradiol on the regulation of signal transducer and activator of transcription-1 (Stat1) protein in cultured human fetal osteoblast cells, devoid of the classical estrogen receptors (ERs). 17β-Estradiol (10 nm) led to rapid (within 15 min) activation of Stat1 protein as indicated by increases in tyrosine phosphorylation and DNA binding activity. Also, 17β-estradiol increased γ-activated sequence-dependent transcription in transient transfection assays, suggesting an increase in Stat protein-dependent transcription. Estrogen-dependent Stat1 activation was blocked in cells that transiently express dominant-negative Stat1 mutant protein. Activation of Stat1 by 17β-estradiol was not inhibited by ER antagonist ...
Mechanisms of Chromium Carcinogenicity and Toxicity

Chromium, like many transition metal elements, is essential to life at low concentrations yet toxic to many systems at higher concentrations. In addition to the overt symptoms of acute chromium tox...
Application of empirical mode decomposition in removing fidgeting interference in doppler radar life signs monitoring devices

Empirical Mode Decomposition has been shown effective in the analysis of non-stationary and non-linear signals. As an application in wireless life signs monitoring in this paper we use this method in conditioning the signals obtained from the Doppler device. Random physical movements, fidgeting, of the human subject during a measurement can fall on the same frequency of the heart or respiration rate and interfere with the measurement. It will be shown how Empirical Mode Decomposition can break the radar signal down into its components and help separate and remove the fidgeting interference.
Augmented Inhibition from Cannabinoid-Sensitive Interneurons Diminishes CA1 Output after Traumatic Brain Injury

The neurological impairments associated with traumatic brain injury include learning and memory deficits and increased risk of seizures. The hippocampus is critically involved in both of these phenomena and highly susceptible to damage by traumatic brain injury. To examine network activity in the hippocampal CA1 region after lateral fluid percussion injury, we used a combination of voltage sensitive dye, field potential and patch clamp recording in mouse hippocampal brain slices. When the stratum radiatum was stimulated in slices from injured mice we found decreased depolarization in stratum radiatum and increased hyperpolarization in stratum oriens, together with a decrease in the percentage of pyramidal neurons firing stimulus-evoked action potentials. Increased hyperpolarization in stratum oriens persisted when glutamatergic transmission was blocked. However, we found no changes in stratum oriens responses when the alveus was stimulated to directly activate stratum oriens. These results suggest that the increased stratum oriens hyperpolarization evoked by stratum radiatum stimulation was mediated by interneurons that have cell bodies and/or axons in stratum radiatum, and form synapses in stratum pyramidale and stratum oriens. A low concentration (100 nM) of the synthetic cannabinoid WIN55,212-2,restored CA1 output in slices from injured animals. These findings support the hypothesis that increased GABAergic signaling by cannabinoid sensitive interneurons contributes to the reduced CA1 output following traumatic brain injury.
Sex Differences in Kappa Opioid Receptor Function and Their Potential Impact on Addiction

Behavioral, biological, and social sequelae that lead to drug addiction differ between men and women. Our efforts to understand addiction on a mechanistic level must include studies in both males and females. Stress, anxiety, and depression are tightly linked to addiction, and whether they precede or result from compulsive drug use depends on many factors, including biological sex. The neuropeptide dynorphin (DYN), an endogenous ligand at kappa opioid receptors (KORs), is necessary for stress-induced aversive states and is upregulated in the brain after chronic exposure to drugs of abuse. KOR agonists produce signs of anxiety, fear, and depression in laboratory animals and humans, findings that have led to the hypothesis that drug withdrawal-induced DYN release is instrumental in negative reinforcement processes that drive addiction. However, these studies were almost exclusively conducted in males. Only recently is evidence available that there are sex differences in the effects of KOR activation on affective state. This review focuses on sex differences in DYN and KOR systems and how these might contribute to sex differences in addictive behavior. Much of what is known about how biological sex influences KOR systems is from research on pain systems. The basic molecular and genetic mechanisms that have been discovered to underlie sex differences in KOR function in pain systems may apply to sex differences in KOR function in reward systems. Our goals are to discuss the current state of knowledge on how biological sex contributes to KOR function in the context of pain, mood, and addiction and to explore potential mechanisms for sex differences in KOR function. We will highlight evidence that the function of DYN-KOR systems is influenced in a sex-dependent manner by: polymorphisms in the prodynorphin (pDYN) gene, genetic linkage with the melanocortin-1 receptor (MC1R), heterodimerization of KORs and mu opioid receptors (MORs), and gonadal hormones. Finally, we identify several gaps in our understanding of “if” and “how” DYN and KORs modulate addictive behavior in a sex-dependent manner. Future work may address these gaps by building on the mechanistic studies outlined in this review. Ultimately this will enable the development of novel and effective addiction treatments tailored to either males or females.
Evaluation of Soft Tissue Under Ultrasound

Until recently, radiological evaluation of the soft tissue was best accomplished with expensive, time-intensive modalities, like magnetic resonance imaging and computer tomography. With the advent of bedside ultrasound the provider can rapidly image the soft tissue space with remarkable clarity and at little cost to the patient, both in terms of money and in radiation exposure. As the use of ultrasound has expanded throughout the medical field so too has its use in soft tissue applications. Today, soft tissue ultrasound comprises an entire field of medical ultrasonography. In this text we will only be covering the highlights of soft tissue ultrasound. These areas include (1) evaluation of soft tissue infections, (2) localization of foreign bodies, (3) musculoskeletal imaging, (4) evaluation of abdominal wall hernias, (5) fracture assessments, (6) evaluation of maxillary sinusitis, (7) and assessment of the airway.
The role of microtubules during the cytokinetic events of cell wall ontogenesis and papilla development inCarteria crucifera

An ultrastructural study of cytokinesis, cell wall ontogenesis, and papilla development/form inCarteria crucifera Korsh. andChloromonas rosae Ettl was undertaken. After typical phycoplast-mediated cytokinesis, wall ontogenesis begins at the level of Golgi apparatus activation and secretion to the outside of the daughter cells of fibrillar wall precursors which self assemble into the typical chlamydomonad wall (sensuRoberts 1974). As wall ontogenesis approaches the flagellar region of the cell, several precisely timed events occur: flagellar apparatus formation, flagellar emergence, protoplasmic extension in the future papilla area underlined by series of parallel aligned microtubules, wall formation (at least the W2–W6 layers), retraction of the protoplasmic extension and loss of underlying microtubules, and final wall modification (gap filling by W1 material) to yield the characteristic wall papilla. The transient cytoplasmic extensions mimic the shape of the future wall papilla and are maintained, at least inCarteria, by underlying microtubules. Structural and developmental properties of the papilla are characterized and phylogenetic implications are discussed.
An electrophoretic comparison of laboratory colonies and natural populations of four species of Toxorhynchites (Diptera: Culicidae)

An electrophoretic comparison of 13 enzyme systems, consisting of the isozymes coded at 17 loci, was made between laboratory colonies of Toxorhynchites rutilus, Tx. theobaldi, Tx. amboinensis , and Tx. brevipalpis and 4 natural populations representing both subspecies of Tx. rutilus that occur in the United States. Identity values obtained from comparisons of the natural populations of Tx. rutilus were large, suggesting that the morphological differences by which these subspecies are defined arose with little differentiation of enzyme polymorphisms. Comparisons of the laboratory colonies of the different species both to one another and to the natural populations of Tx. rutilus yielded very small identity values. Most of the colonies had heterozygosity and polymorphism values in the range observed in wild populations of Tx. rutilus and other wellstudied species of mosquitoes. These observations are discussed in relation to the choice of one of the colonized species for release to control vector mosquito species in the United States.
Fly control, chronic toxicity, and residues from feeding propyl thiopyrophosphate to laying hens.

The effects of administering technical propyl thiopyro-phosphate at a concentration of 200 ppm in the feed of laying hens were studied over a 52-week period. The estimated mean daily intake of this insecticide was 23.4 mg per hen. This treatment resulted in excellent control of larvae of the house fly, Musca domestica L., and of Chrysomya megacephala (F.) in the droppings from these hens, but poor control of larvae of Parasarcophaga argyrostoma (Robineau-Desvoidy) and Fannia pusio (Wiedemann). No hen mortality occurred that could be attributed to the insecticidal treatment. Inhibition of plasma cholinesterase activity was rapid and fluctuated between 20 and 50%. but recovery of enzyme activity also was rapid after removal of the birds from treatment. Overall feed consumption, weight-gain, egg production, egg weight, interior egg quality, and shell thickness were normal. Feed efficiency was greater, on the other hand, in the propyl thiopyrophosphate-treated hens than in the control hens. Eggs from treated hens had no detectable off-flavors or off-odors. Eggs and tissues from hens slaughtered while on treatment and 7, 14, and 21 days after removal from treatment were analyzed by the potentiometric method for residue analysis by cholinesterase inhibition after oxidation with hydrogen peroxide-acetic acid. The corrected limits of detectability for the various tissues were: yolk 0.03, albumin 0.07, breast muscle 0.05, fat 0.07, and liver 0.22 ppm. No propyl thiopyrophosphate residues beyond the sensitivity of the analytical method were detected.
‘If I only had a little humility, I would be perfect’: Children’s and adults’ perceptions of intellectually arrogant, humble, and diffident people

AbstractIntellectual humility is usually regarded as a virtue. In this paper, we conceptualized intellectual humility along two dimensions: (1) placing an adequate level of confidence in one’s own beliefs; (2) being willing to consider other people’s beliefs. We tested whether children (ages 4 to 11 years) and adults perceived intellectual humility as positive and how these perceptions changed across development. To do so, we asked participants to evaluate an intellectually humble person as compared to an intellectually arrogant person, who readily dismissed other people’s beliefs, or to an intellectually diffident person, who was unsure of a well-supported belief. Young children did not favor the intellectually humble person over the others, but older children and adults liked this person better and tended to consider her nicer than the arrogant one and smarter than the diffident one. These findings suggest that the virtuousness of intellectual humility in others is recognized from mid-childhood on.
Commentary on Stiers and colleagues' guidelines for competency development and measurement in rehabilitation psychology postdoctoral training.

Abstract Comments on the article, "Guidelines for competency development and measurement in rehabilitation psychology postdoctoral training," by Stiers et al. (see record 2014-55195-001). Stiers and colleagues have provided a thorough and well-conceived set of guidelines that lay out the competencies expected for graduates of postdoctoral residencies in rehabilitation psychology, accompanied by a set of more specific, observable indicators of the residents' competence level. This work is an important aspect of the broader project of the Rehabilitation Psychology Specialty Council (APA Division 22, the American Board of Rehabilitation Psychology, the Foundation for Rehabilitation Psychology, the Academy of Rehabilitation Psychology, and the Council of Rehabilitation Psychology Postdocotral Training Programs) to develop overall guidelines for programs providing postdoctoral training in this field (Stiers et al., 2012).
Why Governments Cede Sovereignty: Evidence From Regional Human Rights Courts

This study examines a government’s decision to cede authority over fundamental questions of policy to international organizations. Explanations for delegation to international institutions focus on the benefits of “locking in” domestic political institutions and signaling intentions to the public. This line of reasoning suggests that partly democratic and democratizing governments have the strongest incentive to participate in international human rights institutions. I evaluate this claim by analyzing patterns of participation in two regional human rights courts: the European Court of Human Rights and the Inter-American Court of Human Rights. The decision to join a regional court is a more valid indicator of delegation than those used in previous empirical studies and to date has not been examined in systematic fashion. I find strong evidence in support of the claim that governments grant authority to institutions to credibly commit to maintaining democracy.
Clinical rheumatology training of primary care physicians: the resident perspective.

Because nonspecialized physicians provide care for the vast majority of patients with rheumatic disorders, we surveyed 327 internal medicine and family medicine residents with respect to the nature of their training in rheumatology. Although most internal medicine residents had access to rheumatologists for training and had taken formal rheumatology rotations, this was often not the case for family medicine residents. Deficiencies evident in both types of programs included limited access to rheumatology electives; insufficient exposure to certain major categories of rheumatic disease, e.g., the spondyloarthropathies and systemic autoimmune disorders; and lack of direct participatory experience in orthopedics, rehabilitation, and psychosocial aspects of rheumatology.
Perception, Learning, and Engram Formation

Perception and cognition subsume all the processes by which multiple simple, apparently unrelated sensory stimuli from the environment are categorized, analyzed, consolidated, and finally utilized in the brain in their new neural representations to permit effective behavioral responses. Perception and cognition are effectuated anatomically through a complex sensory apparatus and functionally through a genetic set of neurophysiological abilities: to abstract, to remember, to learn, and to use symbols. These anatomical and functional organizations create an innate grammar, syntax, and logic which are reflected in man as the universal abilities of language and mathematics (Chomsky, 1965).
Improving Diagnostic Resolution of Failing ICs Through Learning

Diagnosis is the first analysis step for uncovering the root cause of failure for a defective integrated logic circuit. The conventional objective of identifying failure locations has been augmented with various physically-aware diagnosis techniques that are intended to improve both resolution and accuracy. Despite these advances, it is often the case, however, that resolution, i.e., the number of locations or candidates reported by diagnosis, exceeds the number of actual failing locations. To address this major challenge, a novel, machine-learning-based resolution improvement methodology named physically-aware diagnostic resolution enhancement (PADRE) is described. PADRE uses easily-available tester and simulation data to extract features that uniquely characterize each candidate. PADRE applies machine learning to the features to identify candidates that correspond to the actual failure locations. Through various experiments, PADRE is shown to significantly improve resolution with virtually no negative impact on accuracy. Additional experiments demonstrate that PADRE is robust against data set variation and feature-data availability.
Sub- $10^{-9}~\Omega $ -cm2 n-Type Contact Resistivity for FinFET Technology

We report record low $8.4\times 10^{-10}~\Omega $ -cm2 n-type S/D contact resistivity with laser-induced solid/liquid phase epitaxy of Si:P inside nano-scale contact trenches. Significant reduction of device resistance and resultant great gain of drain current has been demonstrated in scaled n-FinFETs with a contact length of 20 nm.
Scratching the surface? Taxonomic revision of the subgenus Schizoptera ( Odontorhagus ) reveals vast undocumented biodiversity in the largest litter bug genus Schizoptera Fieber (Hemiptera: Dipsocoromorpha)

Schizoptera Fieber, currently the largest genus of litter bugs (Hemiptera: Dipsocoromorpha), comprises 61 extant species in 4 subgenera. Specimens are abundant in New World bulk and residue samples. Schizoptera species showcase stunning morphology including intricate, asymmetrical genitalia in males that have proven to provide excellent species diagnostic features in the past. Recent bulk sample sorting efforts have revealed a vast number of Schizoptera specimens from across the New World, with the majority representing undescribed species. We here taxonomically revise the subgenus Schizoptera ( Odontorhagus ) that has recently been shown to form a monophyletic group within Schizoptera . Characterized by the blunt tooth on the posterior margin of the propleuron, Schizoptera ( Odontorhagus ) previously comprised 10 species from Central and the northern part of South America. We here describe 20 new species in S. ( Odontorhagus ): S. acuta , n. sp., S. angularis , n. sp., S. ansata , n. sp., S. aspera , n. sp., S. brevis , n. sp., S. dentata , n. sp., S. dolosa , n. sp., S. enigmatica , n. sp., S. exacta , n. sp., S. gorgonensis , n. sp., S. insidiosa , n. sp., S. monstrosa , n. sp., S. piscicaudata , n. sp., S. quasicompleta , n. sp., S. radicata , n. sp., S. serrata , n. sp., S. simpla , n. sp., S. singularis , n. sp., S. trivialis , n. sp., S. ungulata , n. sp., increasing the species count of Schizoptera to 81. We provide morphological documentation including digital habitus images and genitalic drawings for all new species and document and redescribe existing species where feasible. Distribution maps and a key to the species of Schizoptera ( Odontorhagus ) are also presented. We predict that similar increases in species numbers are to be expected for the remaining subgenera of Schizoptera , making this genus a very diverse lineage of minute litter bugs.
Monotonicity in asymmetric first-price auctions with affiliation

I study monotonicity of equilibrium strategies in first-price auctions with asymmetric bidders, risk aversion, affiliated types, and interdependent values. Every mixed-strategy equilibrium is shown to be outcome-equivalent to a monotone pure-strategy equilibrium under the “priority rule” for breaking ties. This provides a missing link to establish uniqueness in the “general symmetric model” of Milgrom and Weber (Econometrica 50:1089–1122, 1982). Non-monotone equilibria can exist under the “coin-flip rule” but they are distinguishable: all non-monotone equilibria have positive probability of ties whereas all monotone equilibria have zero probability of ties. This provides a justification for the standard empirical practice of restricting attention to monotone strategies.
Cancer diagnostics: On-target probes for early detection

Optical probes that are activated only in the tumour microenvironment dramatically improve the sensitivity of cancer detection.
Catheter placement in the external jugular vein

This chapter discusses the case of a patient with a glomerular filtration rate (GFR) of 7 ml/min who was referred to Interventional Nephrology for placement of a tunneled hemodialysis catheter due to the onset of uremic symptoms.
Optimizing Tabletting Processes with Quality by Design: An Overview

The elements of quality by design are examined and a consistent nomenclature for quality by design, critical quality attribute, critical process parameter, critical material attribute, and control strategy is proposed. A process is well understood when all critical sources of variability are identified and explained, variability is managed by the process, and product quality attributes can be accurately and reliably predicted over the design space. Quality by Design (QbD) is a systematic approach to development of products and processes that begins with predefined objectives and emphasizes product and process understanding and process control based on sound science, statistical methods and quality risk management. In an attempt to curb rising development costs and regulatory barriers to innovation and creativity, the FDA and ICH have recently started promoting QbD in the pharmaceutical industry [1, 3, 7,]. QbD is partially based on the application of multivariate statistical methods [2, 4, 6] and a statistical Design of Experiments strategy [4, 5, 6] to the development of both analytical methods and pharmaceutical formulations. The talk will review the basics of QbD with case studies from the pharmaceutical industry
Design patterns for silent player characters in narrative-driven games

The silent player character (SPC) is a reoccurring but not well-understood type of player character in narrative-driven games. In this paper, we present our findings from an analysis of SPC development in popular narrative games. We identify two main types of SPCs: projective and expressive characters. Then, we synthesized a list of methods designers can use to effectively communicate a SPC's story.
Short course radiation as a component of definitive multidisciplinary treatment for select patients with metastatic rectal adenocarcinoma.

Background: Select patients with rectal adenocarcinoma with metastatic disease at presentation can be cured with multimodality management. However, the optimal components and sequencing of therapy is unknown. The aim of this study is to evaluate outcomes for patients treated with chemotherapy, short course radiation therapy (SCRT) and surgical resection. Methods: Patients with newly diagnosed metastatic rectal adenocarcinoma who received SCRT from 2010–2016 were identified. All patients were evaluated by a multidisciplinary team and deemed candidates for treatment with curative intent. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method. Patient, tumor and treatment characteristics were evaluated as prognostic factors using a Cox proportional hazards model. Results: Thirty-four patients were included with a median [interquartile range (IQR)] follow-up of 25 (14.75–42.25) months; 26 patients (76.5%) received definitive surgery for their rectal tumor, and 24 patients (70.6%) received definitive local management of metastatic disease. One-, 2- and 3-year OS were 97%, 86.2% and 76.0%, respectively, and 1-, 2-, and 3-year PFS were 52.1%, 22.7% and 17%, respectively. On multivariate analysis, definitive management of metastases was associated with improved OS [hazard ratio (HR) 0.03, 95% confidence interval (CI): 0.01–0.33]; P=0.003, and ≤2 months of neoadjuvant chemotherapy was associated with decreased OS (HR 11.7, 95% CI: 2.11–106; P=0.004). Conclusions: These findings suggest that SCRT can be successfully integrated into a definitive, multidisciplinary approach to metastatic rectal adenocarcinoma. Benefits to this approach include decreased time off systemic therapy as compared to standard course RT. Further study is needed to determine the optimum interval between SCRT and surgery.
Model-Based Engineering: Analysis of Alternatives for Optical Satellite Observation

This paper describes a research effort to employ modern Systems Modeling Language (SysML) tools to inform early architecture-level analysis of alternatives by integrating existing performance calculations through parametric diagrams. The purpose of this effort is twofold. First, it serves as a proving ground for the use of SysML to capture both the system architecture and the corresponding analysis framework. Second, it illustrates how to support specialty engineering performance calculations for a range of architectural options. The findings are illustrated using a collection of heterogeneous optical systems located at the Air Force Institute of Technology and used for observation of satellites. The model will include system elements decomposed to the level at which they are generally purchased, e.g., telescopes, cameras, telescope mounts, computers, etc. The range of options explored will be based on varying telescope aperture, sensor responsivity and noise, total system coverage, and background light as they affect systems performance. Metrics are examined based on calculation of the dimmest object detectable and time required to survey a band of sky containing geostationary satellites.
Predicting total secondary electron emission from porous surfaces using a 3D pore geometry

Multipactor is a critical problem in satellites and vacuum electron devices (VEDs). Described as an “avalanche” of electrons in radio frequency (RF) and microwave devices under vacuum, multipactor is caused by repeated secondary electron emission (SEE) stimulated by a time-varying electric field. Its effects range in severity from a temporary disruption in device operation to arcing, melting, cracking, or destruction of the device. A new and promising field of multipactor suppression research is engineering the internal surface topography of a VED to limit the secondary electron yield (SEY) to unity or less. Such low values of SEY render impossible the growth in electron population that is necessary to initiate the electron avalanche in a multipactor. We have developed a new model to predict the SEY of a porous surface which is useful to determine optimal topographies to control SEY. In order to assess how porous surfaces will be effected by extreme temperatures encountered in space we performed thermomechanical simulations of single gold pores. Finally, we discuss the design and fabrication of various microporous and nanoporous surfaces that will be used to validate the model in a future experimental SEY study.
Effect of size confinement on skyrmionic properties of MnSi nanomagnets

Bulk magnetic materials with the noncentrosymmetric cubic B20 structure are fascinating due to skyrmion spin structures associated with Dzyaloshinskii–Moriya interactions, but the size of skyrmions are generally larger than 50 nm. The control of such spin structures in the 10 nm size ranges is essential to explore them for spintronics, ultra-high-density magnetic recording, and other applications. In this study, we have fabricated MnSi nanoparticles with average sizes of 9.7, 13.1 and 17.7 nm and investigated their structural and magnetic properties. X-ray diffraction and transmission electron microscope studies show that the MnSi nanoparticles crystallize in the cubic B20 structure. Field-dependent dc susceptibility data of the MnSi samples with average particle sizes of 17.7 and 13.1 nm show anomalies in limited field (about 25–400 Oe) and temperature (25 K–43 K) ranges. These features are similar to the signature of the skyrmion-like spin structures observed below the Curie temperature of MnSi. Our results also show that this anomalous behavior is size-dependent and suppressed in the smallest nanoparticles (9.7 nm), and this suppression is interpreted as a confinement effect that leads to a truncation of the skyrmion structure.
Looking Beyond Representation: How Women Develop Their Leadership Perceptions During the Introductory Computing Course

While the gender gap in undergraduate computing is often discussed in reference to the representation of women in the computing major, less is known about leadership and other affective outcomes for women and men in computing. This study examines how gender shapes (a) introductory computing students' perceptions of their leadership, including measures of both general self-rated leadership ability and perceived capacity for leadership in computing, (b) how these perceptions change during the introductory computing course, and (c) the experiences that are related to change in leadership outcomes. Findings reveal gender differences in how incoming introductory course students report both their general leadership abilities and their perceived capacity for leadership in computing. Additionally, both women and men experienced a decline in their perceived capacity for leadership in computing during the introductory course. These and other findings are discussed, with attention given to the implications for both researchers and instructors seeking to broaden women's participation in computing.
Exstrophy-Epispadias Complex (Epispadias Classic Bladder Exstrophy and Cloacal Exstrophy), Prune-Belly Syndrome, and Bladder Augmentation

The exstrophy-epispadias complex, Prune-belly syndrome, and patients with bladder augmentation require imaging for diagnosis, evaluation, and follow-up. Ultrasonography (both prenatal and antenatal), CT, MRI, cystourethrography, and nuclear renal imaging are modalities included in this discussion. Clinical characteristics of each disease process and their radiologic findings are discussed.
Hemoglobin Concentration in Acute Decompensated Heart Failure: A Marker of Volume Status?

Anemia is common in patients with chronic heart failure across the spectrum of ejection fraction and is a powerful predictor of rehospitalization rates and mortality ([1–5][1]). Prevalence estimates vary widely according to heart failure severity, ranging from
Joint pain and falls among women with breast cancer on aromatase inhibitors

Arthralgia is common among women with breast cancer on adjuvant aromatase inhibitor (AI) therapy. Pain is associated with falls in the general population; however, little is known about the relationship between arthralgia and falls among AI users. Our objective was to determine whether joint pain severity and interference predict future falls. We conducted a prospective cohort study of postmenopausal women with stage I-III estrogen receptor-positive breast cancer who were prescribed a third-generation AI. Arthralgia symptoms were measured at baseline using a modified version of the Brief Pain Inventory. Fall occurrence was obtained at 24-month follow-up. Among 667 participants (median age 63 years, interquartile range 57–69 years), 232 (35%, 95% CI 31 to 39%) reported falls 12–24 months after baseline. Among women who fell, 65 (28%) reported seeking medical assistance. After controlling for multiple fall risk factors, we found significant non-linear associations between baseline joint pain severity and risk of falls (p = 0.001). Women with joint pain severity scores ≥ 4 had a more than twofold increase in fall risk compared to those without pain (41% vs. 20%). We observed a similar relationship for pain interference and fall risk (p < 0.001). Fewer than half of participants reported having been asked about falls in the past 12 months by their primary care physician (44%) or oncologist (36%). Joint pain increases the risk of falls among women with breast cancer on adjuvant AI therapy. Health care providers should evaluate and manage arthralgia symptoms and implement fall-prevention strategies for those who are at increased risk.
Comparison of Wide Bandwidth Conventional and Interferometric GNSS-R Techniques for Possible CYGNSS Follow-On Mission

The current generation of spaceborne GNSS-R instruments, such as CYGNSS, utilize only narrowband GPS Ll CIA-coded signals at a 1575.42 MHz center frequency. A next-generation instrument being developed will also support Galileo E1bc signals as well as wideband GPS L5 and Galileo E5 signals. The additional bandwidth in the L5/E5 band should significantly improve the spatial resolution and range accuracy of measured reflections and the corresponding scientific products. In the proposed implementation, these reflection measurements will be made using a locally generated reference signal (i.e. conventional GNSS-R). However, the use of wideband, high-spatial-resolution, high-range-accuracy measurements are often cited as a benefit of the interferometric GNSS-R approach. In this work, we develop a simulator to compare the performance of the two approaches, both in terms of measurement quality and implementation complexity.
Monitoring bivalirudin therapy in children on extracorporeal circulatory support devices: Thromboelastometry versus routine coagulation testing.

Abstract Introduction Bivalirudin is an alternative to heparin anticoagulation in infants and children in the setting of extracorporeal life support (ECLS). While activated partial thromboplastin time (aPTT) is widely accepted as the standard test to monitor bivalirudin therapy, the usefulness of thromboelastometry (ROTEM) to monitor bivalirudin infusion in the setting of ECLS is unknown. Objective We aimed to assess the utility of ROTEM in monitoring hemostasis and bivalirudin effect in children on either extracorporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD) compared to standard plasma based coagulation assays. Methods A retrospective study of children undergoing bivalirudin infusion for ECMO/VAD support from a tertiary care pediatric hospital (January 2017–June 2018) was performed. ROTEM assays for extrinsic (EXTEM) and intrinsic (INTEM) coagulation pathways, INTEM with heparinase (HEPTEM), fibrin formation (FIBTEM) with measurement of the clotting time (CT) and maximum clot firmness (MCF) were compared to routine hemostasis testing including: aPTT, aPTT Hepzyme (HPTT), prothrombin time (PT), fibrinogen and platelet count. Results One hundred and six blood samples from 18 children were tested. There was a strong positive correlation between HPTT and HEPTEM CT, and moderate correlation between aPTT and INTEM CT. The bivalirudin dose did not correlate with any test, but displayed strong age-dependence, with infants requiring higher doses of bivalirudin to maintain therapeutic targets. Excellent correlation was found between FIBTEM MCF values and fibrinogen, but FIBTEM overestimated fibrinogen level when platelet count was >300 × 109/L. Heparin-like effect was identified in 39% of specimens, and an improved correlation between aPTT and INTEM CT was observed in specimens without heparinoids. Conclusions In the setting of bivalirudin therapy, prolongation of CT on INTEM and HEPTEM showed moderate to strong correlation with aPTT and HPTT, and therefore, may provide a good alternative to these assays. In addition, HPTT and HEPTEM CT might be preferable for monitoring bivalirudin in the setting of ECLS due to frequent detection of heparin-like effect.
Bidirectional relationship between opioids and disrupted sleep: putative mechanisms

Millions of Americans suffer from opiate use disorder, and over 100 die every day from opioid overdoses. Opioid use often progresses into a vicious cycle of abuse and withdrawal, resulting in very high rates of relapse. Although the physical and psychologic symptoms of opiate withdrawal are well-documented, sleep disturbances caused by chronic opioid exposure and withdrawal are less well-understood. These substances can significantly disrupt sleep acutely and in the long term. Yet poor sleep may influence opiate use, suggesting a bidirectional feed-forward interaction between poor sleep and opioid use. The neurobiology of how opioids affect sleep and how disrupted sleep affects opioid use is not well-understood. Here, we will summarize what is known about the effects of opioids on electroencephalographic sleep in humans and in animal models. We then discuss the neurobiology interface between reward-related brain regions that mediate arousal and wakefulness as well as the effect of opioids in sleep-related brain regions and neurotransmitter systems. Finally, we summarize what is known of the mechanisms underlying opioid exposure and sleep. A critical review of such studies, as well as recommendations of studies that evaluate the impact of manipulating sleep during withdrawal, will further our understanding of the cyclical feedback between sleep and opioid use. SIGNIFICANCE STATEMENT: We review recent studies on the mechanisms linking opioids and sleep. Opioids affect sleep, and sleep affects opioid use; however, the biology underlying this relationship is not understood. This review compiles recent studies in this area that fill this gap in knowledge.
Pressure-Regulated Ventilator Splitting (PReVentS) – A COVID-19 Response Paradigm from Yale University

Abstract In the current COVID-19 crisis, the US and many countries in the world are suffering acute shortages of modern ventilators to care for desperately ill patients. Since modern ICU ventilators are powerful devices that can deliver very high gas flow rates and pressures, multiple physicians have attempted to ventilate more than one patient on a single ventilator – so-called “vent splitting”. Early applications of this approach have utilized simple concatenations of ventilator tubing and T-pieces, to provide flow to more than one patient. Additional approaches using custom flow splitters – sometimes made using 3D printing technologies – have also advanced into the clinic with FDA approval. However, heretofore there has been less progress made on controlling individual ventilatory pressures for patients with severe lung disease. Given the inherent variability and instability of lung compliance amongst patients with COVID-19, there remains an important need to provide a means of extending ventilator usefulness to more than one patient, but in a way that provides more tailored pressures that can be titrated over time. In this descriptive report, we provide the basis for a ventilator circuit that can support two patients with individualized peak inspiratory and end-expiratory pressures. The circuit is comprised of exclusively “off the shelf” materials and is inexpensive to produce. The circuit can be used with typical ICU ventilators, and with anesthesia ventilators used in operating rooms. Inspiratory and end-expiratory pressures for each patient can be titrated over time, without changes for one patient affecting the ventilation parameters of the other patient. Using in-line spirometry, individual tidal volumes can be measured for each patient. This Pressure-Regulated Ventilator Splitting (PReVentS) Yale University protocol operates under a pressure-control ventilatory mode, and may function optimally when patients are not triggering breaths from the ventilator. This method has been tested thus far only in the laboratory with mock lungs, and has not yet been deployed in animals or in patients. However, given the novelty and potential utility of this approach, we deemed it appropriate to provide this information to the broader critical care community at the present time. In coming days and weeks, we will continue to characterize and refine this approach, using large animal models and proof-of-principle human studies.