cssi/SciSciGPT-SciSciNet huggingface dataset:
The Politics of Invasive Weed Management: Gender, Race, and Risk Perception in Rural California.

"Biological invasions" are now recognized as the cause of significant ecological and economic damage. They also raise a series of less visible social issues. Management of invasive species is often a political process raising questions such as who decides which organisms are to be managed, and who benefits or is affected by different management techniques. In a rural region of northern California, the proposed use of herbicides on spotted knapweed sparked an intense social controversy. This research uses participant observation, interviews, and archival material to understand how members of the Karuk Tribe of California, the non-Indian community, and the U.S. Forest Service developed different perceptions of safety and risk regarding herbicide use. I describe interconnected factors that frame the interpretation of risk: institutional trust, proximity to exposure, gender, and race. Gender and race, in turn, form the basis of anti-herbicide mobilization. The larger sociological question highlighted is, who pays the price for species invasions? Use of herbicides on invasive species is increasing. Many people who face increased exposure to herbicides are members of racial minority groups. When the poor or racial minorities face disproportionate exposure, differences in risk perception become matters of environmental justice. This paper discusses the broader social implications of differences in risk perception among communities and land managers.
Yoga for Pain and Anxiety in Pediatric Hematology- Oncology Patients: Case Series and Review of the Literature

In response to rising interests from patients, many comprehensive cancer centers now offer an integrative model of care which includes the provision of complementary medicine. Yoga is one such intervention that has been used in children. We performed an Institutional Review Board (IRB) approved chart review of pediatric hematology-oncology patients who received yoga. Patients with sickle cell vaso-occlusive pain crises or cancer were offered bedside yoga by a certifi ed yoga instructor. Pain before and after yoga was reported using the 10-point Wong-Baker FACES pain scale. Anxiety before and after yoga was assessed with the State-Trait Anxiety Inventory. Qualitative patient quotes were extracted from the yoga therapist’s notes. Twenty patient’s charts were reviewed, 50% were male. The mean age was 18 years, (range 11–26 years.) Most common diagnoses were sickle cell vaso-occlusive pain crises (45%), and sarcoma (40%.) The mean reduction in pain score was 0.94 (SD ± 1.68), p = .005, and the mean reduction in anxiety T-score was 9.62 (SD ± 6.74), p = .0001. Patient quotes suggest that yoga was benefi cial, especially for relaxation. Literature review offers preliminary support for the use of yoga for anxiety in children. Our data suggest that further research on yoga as an effective intervention for pediatric hematology-oncology patients for pain and anxiety is needed.
Trajectories and Determinants of Elder Care in Rural China During an 8-Year Period: Why Having Sons Makes a Difference

Using 8-year panel data for 1,355 older adults in rural Anhui province, China, this study examined the trajectories and determinants of elder care provided by adult children to their older parents. The results of two-level latent variable growth models showed that trajectories of elder care differed by the gender of children, with an increase in care from sons but a decrease in care from daughters over time. Children’s life stages influenced their care provision but differed by gender. Functional impairment of parents and care provided by siblings in the family also affected the care provided by each child. The findings reflect the patrilineal nature of Chinese family systems and demonstrate the linkages between critical life events and caregiving behaviors of adult children. Findings of this study can inform the formulation of elder care policies that meet the needs of families with different structures and at different life stages.
Metabolism of the chemopreventive retinoid N-(4-hydroxyphenyl)retinamide by mammary gland in organ culture.

N-(4-Hydroxyphenyl)retinamide (4-HPR) is considered to be the most effective chemopreventive retinoid for chemically induced mammary carcinogenesis in rats. However, the mechanism of 4-HPR action in mammary cells is poorly understood. In the present study we examined the metabolism of 4-HPR in the mouse mammary gland in organ culture. Mammary glands excised from BALB/c mice were incubated with 4-HPR in the presence of insulin, prolactin and steroid hormones for 6 days. The glands were extracted with chloroform/methanol (2:1, v/v), and the metabolites were separated on a reversed-phase h.p.l.c. column. Three metabolites were separated in addition to 4-HPR; one of the metabolites, M2, was co-eluted with 13-cis-4-HPR, M3 was co-eluted with N-(4-methoxyphenyl)retinamide (4-MPR) and M1 remains unidentified. There appeared to be some hormonal regulation in the distribution of metabolites in the glands. Increased levels of 4-MPR and M1 were observed in insulin-plus-prolactin-treated glands as compared with the glands incubated with steroid hormones. Furthermore, it was observed that M1 isolated from the livers of 4-HPR-treated rats competed for the cellular retinoic acid-binding protein (CRABP) sites; however, 4-HPR did not bind to CRABP. These results indicate that mouse mammary gland can metabolize 4-HPR and that the metabolites which compete for CRABP sites may have physiological significance in the retinoid inhibition of mammary carcinogenesis.
Practical Quality Improvement Implementation in Orthopaedic Clinical Practice

The passage of the Medicare Access and Children's Health Insurance Program Reauthorization Act of 2015 (HR 2) helps ensure patient access to care and stable physician reimbursement for the near future. HR 2's underlying theme is the improvement of value to address the unsustainable rise in national healthcare spending. Quality improvement and performance improvement, which affect outcomes and costs as well as address variation, are the keys to improve the value of orthopaedic healthcare delivery. Orthopaedic surgeons should examine quality and performance strategies as well as several examples before they begin to implement these processes to improve quality and performance in their practices.
Effectiveness of building climbing lane on expressway

In order to scientifically analyzing the effectiveness of building climbing lane on expressway and provide a basis for decision making in road construction,this paper improved vehicle acceleration and deceleration probability rules in NS car-following rules and took the minimum value of vehicle running speed and safety lane change pitch as the speed of next vehicle closely on adjacent lane in lane-changing rules,and built the traffic flow cellular automaton model suitable for driving on climbing lane.The influence of number of lanes,slope,slope length,speed and mixed rate of heavy vehicles on traffic capacity in climbing section was analyzed and 240simulation programs were established.The results show that after a climbing lane is built on expressway which has two lanes in one direction,the capacity increases by 8%to 16%,and reaches maximum when mixed rate of heavy vehicles is 30%;after a climbing lane is built on expressway which has three lanes in one direction,the capacity increases by 6%to15%,and reaches maximum when mixed rate of heavy vehicles is 20%.3tabs,10figs,12refs.
Clinical efficacy of inhaletion of budesonide and epinephrine on acute infectious laryngitis in children

Objective To observe the effect of inhalation of budesonide and epinephrine in treatment of acute infectious laryngitis in children.Methods The children with acute infectious laryngitis during the period of March 2012-March 2013 were randomly divided into three groups.The children in group A were treated with injection of dexamethasone,the children in group B were treated with injection of dexamethasone combined with inhalation of epinephrine,and the children in group C were treated with inhalation of budesonide and epinephrine.The therapeutic effects were observed after treatment.Results A hundred and sixteen cases of acute infectious laryngitis children were selected into the experiment.The time of symptoms improved and course of disease in group C were obviously shorter than those in group A(P 0.05).The significant difference in total effective rate was detected between group A and C(P 0.05).The course of disease in group C was obviously shorter than that in group B.The total effective rates of three groups were 81.58%,90.00%,97.36%respectively.Conclusions The effect of budesonide and epinephrine inhalation is better than those of dexamethasone injection,injection of dexamethasone combined with inhalation of epinephrine.Budesonside and epinephrine inhalation is worth to be applied in clinic,which is safe and reliable.
The influence of thermal contact resistance on the relative performance of heat pipe-fin array systems

Abstract Externally-finned heat pipes (HPs) using individual fins (a HP-fin configuration) or a finned heat sink (HP-heat sink) are subject to thermal contact resistances at the HP-fin or HP-heat sink interfaces. A detailed HP model is used to quantify the influence of the contact resistances on the heat transfer and fluid flow within the HP, as well as on the overall heat transfer rate. For similar area-averaged contact resistance values, the HP-heat sink typically provides a lower overall thermal resistance than the HP-fin configuration. Under off-design operating conditions, however, the HP-heat sink option can underperform the HP-fin geometry. A thermal resistance model is also developed and its predictions compare qualitatively to those of the HP model. It is shown that the overall resistance of the HP-fin configuration is proportional to the number of fins in the array that are subject to a contact resistance. Using the detailed model it is also demonstrated that the order in which the fins (fins without versus fins with contact resistances) are placed within the array has little effect on the overall thermal resistance of the HP system.
Magnetic resonance contrast agents for neuroimaging. Safety issues.

Abstract As physicians, we have an obligation to ensure the safety of our patients as well as to inform them of any potential risks associated with diagnostic procedures. The overall safety profile of the magnetopharmaceuticals with current FDA approval is good with regard to acute toxicity. For gadopentetate dimeglumine, toxicity. For gadopentetate dimeglumine, the agent with the greatest clinical experience, the overriding majority of adverse events consists of transient and relatively minor symptoms and reactions. Clinical trials of the newer agents reflect a similar experience but on a much smaller scale. Continued post-marketing surveillance programs should provide more information in the near future. Severe adverse reactions do occur after the administration of magnetopharmaceuticals. These often idiosyncratic and anaphylactoid reactions may cause permanent injury or death. In the two reported cases to date, the patients had a history of reactive airway disease. The incidence of severe reactions is estimated at 1 in 350,000 to 450,000 for gadopentetate dimeglumine. The rate is considerably lower than that for iodinated contrast agents, both ionic and nonionic. Magnetopharmaceuticals should be considered safe but not innocuous. The small risk must be weighed against the additional diagnostic information that is obtained with magnetopharmaceuticals. Radiologists should be aware of potential complications and have on site equipment and skilled personnel for management should an adverse event occur. The benefits to the patient of reduced morbidity and mortality from improved diagnosis with magnetopharmaceuticals will ensure continued use of current agents as well as development of additional agents.
Classification of Nemata

The classification of Nemata presented here gives characters only to the superfamily level. The reader should bear in mind that I believe many of the superfamilies listed are likely to be families when the concepts of nematology mature to those of other zoological sciences. This classification follows the skeletal structure proposed by Filipjev in 1934. It further incorporates the internal framework of Chitwood. The higher categories include the proposals I made in 1982.
Biomarkers in Head and Neck Cancer

Biomarker research provides the opportunity to risk stratify patients based on identified prognostic and predictive markers. The need for such biomarkers is ­evident to improve response and survival outcomes in head and neck cancer through more rational patient selection for intensive curative regimens as well as palliative treatments. Increasing numbers of molecularly targeted therapeutics are in preclinical and clinical evaluation in head and neck cancer. These compounds, added to current chemotherapy and radiotherapy regimens, are costly and potentially add to normal tissue toxicity. This chapter focuses on markers with potential for testing in large validation clinical trials. As yet, no one marker has validated predictive capacity of utility in the selection of therapy for individuals with head and neck cancer. HPV-16 appears to be prognostic for better outcome while high EGFR expression is prognostic for poor outcome. Validated diagnostic tests that are widely available and collaboration among investigators are additional future challenges in biomarker research for head and neck cancer.
Towards Superheavies: Spectroscopy of 94 < Z < 98, 150 < N < 154 Nuclei

The heaviest nuclei where excitations above the ground state can be studied lie near Z ~ 100. These nuclear structure studies are important testing grounds for theoretical models that aim to describe superheavy nuclei. To study the highest neutron orbitals (150 ≤ N ≤ 154), we have populated high angular momentum states in a series of Pu (Z = 94), Cm (Z = 96) and Cf (Z = 98) nuclei, via inelastic and transfer reactions, with heavy beams on long-lived radioactive actinide targets. Multiple collective excitation modes and structures were identified, and their configurations deduced. Quasiparticle alignments are mapped, with odd-A band structures helping identify specific orbital contributions via blocking arguments. Higher-order multipole shapes are observed to play a significant role in disentangling competing neutron and proton alignments. The N > 152 data provide new perspectives on physics beyond the N = 152 sub-shell gap.
The Online Economy: Strategy and Entrepreneurship — Course Architecture Note

This note provides an overview of the Harvard Business School course "The Online Economy: Strategy and Entrepreneurship." It covers the framework for the course, key principles within each course module, and a synopsis of each case, along with the lessons the case is meant to convey. Learning Objective: Provides an overview of "The Online Economy: Strategy and Entrepreneurship," a course designed for students planning entrepreneurial ventures in online businesses, or for students whose careers as managers, investors, or consultants will focus on online businesses.
Alcohol a double-edged sword: Health benefits with moderate consumption but a health hazard with excess alcohol intake

United States Department of Agriculture guidelines suggest up to 2 drinks a day for men and for women up to 1 drink per day. Moderate alcohol consumption has many health benefits including lowering the risk of heart disease and stroke. Recent research indicates that drinking red wine may lower not only the risk of myocardial infarction and stroke but also Alzheimer’s disease due to beneficial effect of resveratrol present in red wine. However, all these benefits disappear with excess alcohol consumption (over 60 g/day; 4–5 drinks per day) and alcoholic liver cirrhosis may be even fatal. This chapter will address both the health benefits and the health hazards of alcohol.
Reduction in time to treatment in prehospital telemedicine evaluation and thrombolysis

Objective: To compare the times to evaluation and thrombolytic treatment of patients treated with a telemedicine-enabled mobile stroke treatment unit (MSTU) vs those among patients brought to the emergency department (ED) via a traditional ambulance. Methods: We implemented a MSTU with telemedicine at our institution starting July 18, 2014. A vascular neurologist evaluated each patient via telemedicine and a neuroradiologist and vascular neurologist remotely assessed images obtained by the MSTU CT. Data were entered in a prospective registry. The evaluation and treatment of the first 100 MSTU patients (July 18, 2014–November 1, 2014) was compared to a control group of 53 patients brought to the ED via a traditional ambulance in 2014. Times were expressed as medians with their interquartile ranges. Results: Patient and stroke severity characteristics were similar between 100 MSTU and 53 ED control patients (initial NIH Stroke Scale score 6 vs 7, p = 0.679). There was a significant reduction of median alarm-to-CT scan completion times (33 minutes MSTU vs 56 minutes controls, p Conclusion: Compared with the traditional ambulance model, telemedicine-enabled ambulance-based thrombolysis resulted in significantly decreased time to imaging and treatment.
Abstract 2258: Ambulance Directed Care for Acute Stroke Patients at Cedars-Sinai Medical Center

Quality Improvement Study: Background: Advances over the last decade highlight the important role of Emergency Medical Services (EMS) agencies in optimizing stroke care. Los Angeles County’s Department of Health Services (LA County DHS) Stroke Patient Policy was instituted on November 16, 2009. As a result, ambulances now transport suspected stroke patients directly to approved Stroke Centers. In a single institution-TJC certified as a PSC since 2008, we studied the effect of the Stroke Patient Destination Policy and ambulance-directed care on the percentage of ischemic stroke patients receiving acute stroke treatments (IV tPA, intra-arterial thrombolysis or clot-retrieval, or bridge therapy). Methods: 2, 156 patient charts were retrospectively reviewed from the 16 months prior to the implementation of ambulance-directed care compared to a 16-month period between after implementation of ambulance-directed stroke care. Results: In the pre-policy period, 344 suspected stroke patients arrived by EMS versus 491 suspected stroke patients arriving by EMS in the post-policy period - a 30% increase. (Chi 2 p=0.07). Of 344 patients, 34 (9.9%) received acute stroke treatment in the pre-policy period, compared to 63 of 491 patients receiving acute stroke treatments in the post-policy period (12.8%, NS). The median age of patients pre and post policy change was 69.5 years old. The median gender distribution was 46% male and 54% female. Neither age nor gender differed before or after the policy change. Conclusions: Implementation of the LA County DHS Stroke Patient Destination Policy appeared to cause a higher volume of acute stroke patients receiving treatment at one Joint Commission certified academic medical center. The data suggests that 29 additional patients were treated with acute stroke treatments due to ambulance directed care. Additional confirmatory data is needed from other centers.
Patterns of conserved gp120 epitope presentation on attached HIV-1 virions

A complete picture of HIV antigenicity during early replication is needed to elucidate the full range of options for controlling infection. Such information is frequently gained through analyses of isolated viral envelope antigens, host CD4 receptors, and cognate antibodies. However, direct examination of viral particles and virus-cell interactions is now possible via advanced microscopy techniques and reagents. Using such methods, we recently determined that CD4-induced (CD4i) transition state epitopes in the HIV surface antigen, gp120, while not exposed on free particles, rapidly become immunoreactive upon virus-cell binding. Here, we use 3D direct stochastic optical reconstruction microscopy (dSTORM) to show that certain CD4i epitopes specific to transition state structures are exposed across the surface of cell-bound virions, thus explaining their immunoreactivity. Moreover, such structures and their marker epitopes are dispersed to regions of virions distal to CD4 contact. We further show that the appearance and positioning of distal CD4i exposures is partially dependent on Gag maturation and intact matrix-gp41 interactions within the virion. Collectively, these observations provide a unique perspective of HIV during early replication. These features may define unique insights for understanding how humoral responses target virions and for developing related antiviral countermeasures.
An Exploratory Study of Narrative Experiences of Music

Listeners frequently talk about music in terms of imagined stories, but little empirical research has investigated this tendency. In this study, 47 participants listened to eight 90-second musical excerpts—four of which featured programmatic music composed between 1857-1935 and were selected by music theorists to feature high contrast, and four of which featured Baroque and minimal music and were selected by music theorists to feature low contrast. After each one, they answered a variety of questions intended to assess their narrative engagement with the music. Brief assessments of personality and general listening tendencies were administered at the end of the session. Results showed qualified support for the notion that contrast makes people likelier to hear music in terms of narrative, with stylistic familiarity and enjoyment seeming to play a greater role. The most striking aspect of the results was the emergence of broad areas of consensus among the free descriptions of imagined narratives. People with high AIMS scores also tended to experience more narrative engagement with the music, as did people low in Extraversion and Conscientiousness.
The Cure for Young Prosecutors' Syndrome

Although legal scholars treat prosecutors like interchangeable parts, we argue – based on interviews and surveys of over 200 state prosecutors in eight offices – that scholars should be alert to differences among them, because new prosecutors perceive their professional roles differently than their veteran colleagues do. As new prosecutors gain experience, their professional identity shifts: they become more balanced. This article explores the prosecutor’s professional transformation and its possible causes. When experienced prosecutors describe their career trajectories, they regret the highly adversarial posture they adopted earlier in their careers. They even give a name to this early collection of beliefs about the importance of every case, the constant quest for trials, and the aggressive posturing with defense attorneys: “young prosecutors’ syndrome.” While these attitudes may help new prosecutors build trial skills, they also cause real harm. A rookie might goad defendants into trials to prove the prosecutor’s professional worth, aggravating crowded trial dockets and subjecting defendants, victims and witnesses to unnecessary courtroom drama and delay. Such a prosecutor might also skirt the edges of disclosure obligations. Seasoned prosecutors embrace a more restrained, pragmatic approach to the job. They see the true variety of cases on their docket and calibrate their responses in individual cases, saving the most costly and severe responses for a handful of defendants. Moreover, veteran prosecutors appreciate the value that defense attorneys add to the criminal justice system. Our interviewees offered several explanations for their transformation toward balance: increasing confidence, lessons learned from past mistakes, the ability to distinguish small crimes from large, and life experience. Because the institutional features of the prosecutor’s office can facilitate or impede a new prosecutor’s professional transformation, we offer suggestions for chief prosecutors who aim for balance in their workforce. These measures include hiring prosecutors with a mix of experience levels, exposing new prosecutors to case studies of situations that most often lead to regrettable prosecutor choices, and organizing attorneys into units that place senior and junior prosecutors alongside one another on the same teams. We also explain how law schools can plant the seeds of balance before graduation.
Diabetic Ketoacidosis and Hyperosmolar Hyperglycemic Syndrome

Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) are two serious acute complications of diabetes that require immediate medical attention. Patients with DKA present with hyperglycemia, ketonemia, and anion gap metabolic acidosis. Patients with HHS present with extreme hyperglycemia, increased osmolality, and severe dehydration. Some patients share features of both conditions. These acute complications can be life threatening and it is critical that the healthcare providers recognize them and provide appropriate clinical care. This chapter reviews the pathophysiology, diagnosis, and treatment of these disorders.
Mussolini Woos the Intellectuals

Mussolini was no anti-intellectual; he was actually widely read and a brilliant polemical newspaper writer. During the last months of his reign, he tried to turn the tables on a general economic decline by seeking the advice of economic reformers. Without hesitation they urged him to spread the Fascist net to cover believers ranging from moderate to radical. Important “innovative” writers persuaded him to take up novel, almost “anti-Fascist” solutions that aimed at compromise. In the end, however, Pavolini prevailed on Mussolini to swat down reconciliation proposed by these “bridge builders.” Falling in with this advice, Mussolini remained at heart an incorrigible Fascist.
Tensile Creep Rupture and Subcritical Crack Growth of Silicon Nitride

There are two regions in a fracture mechanism map of silicon nitride at temperatures higher than 1200°C; slow crack growth failure and creep damage rupture. This study intends to clarify the difference between these two fracture mechanisms in terms of creep behaviors, microstructural changes, fatigue life properties and fracture surfaces. Two grades of silicon nitrides were used; one is hot-pressed silicon nitride which contains a continuous glassy phase at the interfaces, and the other is HIP-ed silicon nitride with a discontinuous glassy phase. It was demonstrated that the transition from the slow crack growth fracture regime to the creep damage rupture one occurred when the applied stress decreases to a range of 200 to 250 MPa for both materials.
The Sanitized Workplace Revisited

Title VII prohibits discrimination based on sex; it says nothing about sexuality. Despite this fact, the Equal Employment Opportunity Commission (EEOC) and the lower federal courts historically have defined sex harassment, a form of sex discrimination, primarily in terms of unwanted sexual advances and sexual conduct-an approach I call the sexual model. In earlier work (Schultz, 1998), I showed that the sexual model of sex harassment is too narrow, because the focus on sexual conduct has led to a neglect, if not an active disregard, of equally pernicious forms of gender-based harassment and hostility that are not primarily sexual in content or design. In addition, the legal system’s emphasis on unwanted sexual conduct obscures and diverts anti-discrimination efforts from the more fundamental patterns of workplace sex segregation and hierarchy that often underlie and foster sex discrimination and harassment (Schultz, 1998).
Formation and evolution of aqueous organic aerosols via concurrent condensation and chemical aging.

Abstract We review recent results on the formation and evolution of aqueous organic aerosols via concurrent nucleation/condensation and chemical aging processes obtained mostly using the formalism of classical nucleation theory In this framework, an aqueous organic aerosol was modeled as a spherical particle of liquid solution of water and hydrophilic and hydrophobic condensable organic compounds; besides these compounds, the surrounding air contained some chemically reactive, non-condensable species. Hydrophobic organic molecules on the aerosol surface can be processed by chemical reactions with some atmospheric species; this affects the hygroscopicity of the aerosol and hence its ability to become a cloud droplet. Such processing is most probably triggered by atmospheric hydroxyl radicals that abstract hydrogen atoms from surfactant molecules located on the aerosol surface (first step), resulting radicals being quickly oxidized by ubiquitous atmospheric oxygen molecules to produce surface-bound peroxyl radicals (second step). These two reactions play a crucial role in the enhancement of the Kohler activation of the aerosol. Taking them and a third reaction (next in the multistep chain of relevant heterogeneous reactions) into account, one can derive an explicit expression for the free energy of formation of a four-component aqueous droplet on a ternary aqueous organic aerosol as a function of four independent variables of state of a droplet. This approach was also applied to study a large subset of primary marine aerosols which can be initially treated using an “inverted micelle” model whereof the core consists of aqueous “salt” solution. Numerical evaluations suggest that the formation of cloud droplets on such (both aqueous hydrophilic/hydrophobic organic and marine) aerosols is most likely to occur via Kohler activation rather than via nucleation. The models allow one to determine the threshold parameters necessary for the Kohler activation of such aerosols. Furthermore, heterogeneous chemical reactions involved in the chemical aging of aerosols are most likely exothermic. Due to the release of the enthalpy of these reactions, the temperature of an aerosol particle during its chemical aging may become greater than the ambient (air) temperature. The analysis of the characteristic timescales of four most important processes involved suggests that this effect may play a significant impeding role in the formation of an ensemble of aqueous secondary organic aerosols via nucleation and, hence, must be taken into account in atmospheric aerosol and global climate models.
Improving the Time to Antibiotics in Febrile Children with Sickle Cell Disease in the Emergency Department

Background: Children with sickle cell disease are at increased risk for serious bacterial infections due to functional asplenia. When presenting with fever, early empiric antibiotics help reduce morbidity and mortality. Local Problem: The American Academy of Pediatrics recommends that antibiotics be administered within 60 minutes of presentation to the hospital. Baseline measurement revealed that the mean time to first dose of antibiotics in our institution’s pediatric emergency department was over 2 hours. The aim of our quality improvement project was to reduce this time to 1 hour for 100% of qualified patients. Methods: Data for pre- and post-intervention …
Access Point Location Design in Cell-Free Massive MIMO Systems

Cell-free massive multiple-input multiple-output (MIMO) is a special deployment of massive MIMO systems with a large number of distributed single antenna access points (APs) serving a much smaller number of users, whose performance is largely influenced by the AP locations. We formulate two AP location optimization problems to maximize the sum-throughput and the minimum-throughput in uplink transmission of cell-free systems with an arbitrary user distribution using zero-forcing detector. Numerical results show that the proposed algorithm for the sum-throughput criterion provides significantly higher sum-throughput over a cell-free system with randomly located users. However, the simple Lloyd algorithm can provide higher 95%-likely per-user rates. An AP location design algorithm is also presented in an alternative small-cell system in which each AP serves only one user. The proposed algorithm is based on the k-means clustering algorithm with a cost function defined according to the average interference from other users in addition to the distances between APs and the served users. The algorithm improves the 95%-likely and minimum rates over the Lloyd algorithm, while the latter remains an attractive approach due to its simplicity and good performance.
The influence of biological sex and cuff width on muscle swelling, echo intensity, and the fatigue response to blood flow restricted exercise

The purpose was to determine if the muscle swelling, echo intensity, and fatigue responses to blood flow restriction differs based on cuff width (Experiment 1), applied pressure (Experiment 2), and...
Changes in hospital service demand, cost, and patient illness severity following health reform.

OBJECTIVE To estimate the effects of the health insurance exchange and Medicaid coverage expansions on hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity, and also to test the association between changes in outcomes and the size of the uninsured population eligible for coverage in states. DATA SOURCES Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases, 2011-2015, Nielsen Demographic Data, and the American Community Survey. STUDY DESIGN Retrospective study using fixed-effects regression to estimate the effects in expansion and nonexpansion states by age/sex demographic groups. FINDINGS In Medicaid expansion states, rates of uninsured inpatient discharges and ED visits fell sharply in many demographic groups. For example, uninsured inpatient discharge rates across groups, except young females, decreased by ≥39 percent per capita on average in expansion states. In nonexpansion states, uninsured utilization rates remained unchanged or increased slightly (0-9.2 percent). Changes in all-payer and private insurance rates were more muted. Changes in inpatient costs per discharge were negative, and all-payer inpatient costs per discharge declined <6 percent in most age/sex groups. The size of the uninsured population eligible for coverage was strongly associated with changes in outcomes. For example, among males aged 35-54 years in expansion states, there was a 0.793 percent decrease in the uninsured discharge rate per unit increase in the coverage expansion ratio (the ratio of the size of the population eligible for coverage to the size of the previously covered population within an age/sex/payer/geographic group). CONCLUSIONS Significant shifts in cost per discharge and patient severity were consistent with selective take-up of insurance. The "treatment intensity" of expansions may be useful for anticipating future effects.
Robotic repair of iatrogenic prostatosymphyseal fistula following photoselective vaporization of the prostate

Abstract Introduction Prostatosymphyseal fistula is a rare but serious complication following transurethral procedures for benign prostatic hyperplasia such as transurethral resection of the prostate (TURP) or photoselective vaporization of the prostate (PVP). To our knowledge, only nine cases have been reported in the literature, and all have been treated with either radical prostatectomy or open fistula repair using omental or peritoneal interposition flaps. Here we describe a novel prostate-sparing robotic-assisted laparoscopic Y–V fistula repair with perivesical fat interposition flap. Methods A 73 year old gentleman presented with pelvic and musculoskeletal pain two months after undergoing PVP for obstructive voiding symptoms. Imaging and cystoscopy revealed a large prostatosymphyseal fistula, and after discussion of the risks and benefits, the patient opted to proceed with operative repair. The patient was positioned in low lithotomy, transperitoneal access was obtained with a Veress needle, and port placement was done in the standard "W" configuration used in robotic prostatectomy. The bladder was dissected free from the anterior abdominal wall. At the level of the pubis the planes were obliterated and tissues were indurated. The endopelvic fascia was cleared using electrocautery and the lateral prostate and urethra were exposed and well defined at the apex. The fistula tract was carefully dissected off the pubis and necrotic areas were cauterized. The urethra was then mobilized around the fistula tract to prepare a good edge for anastomosis. A Y–V repair using two running 3-0 V-loc sutures was then performed in the prostatic capsule to allow for a wide anastomosis to the distal urethral defect. A Foley catheter was placed. A perivesical fat flap was then secured over the anastomosis with a V-loc suture and a drain was placed. Results Operative time was 115 min. Estimated blood loss was 50 ml and hospital stay was 2 days. The Foley was removed 4 weeks post-operatively after a cystogram demonstrated no leakage. At 3 months follow up he was doing well with complete resolution of his pelvic and musculoskeletal pain. He was voiding with good stream with post-void residual of 25 ml. He remained symptom-free at 2 years. Conclusions Prostatosymphyseal fistula following PVP can be successfully repaired using a robotic-assisted laparoscopic, prostate-sparing approach. In the carefully selected patient without prostate cancer, this offers an efficacious and attractive alternative to more radical surgical approaches and avoids the urinary and potency complications associated with radical prostatectomy.
Sparing Cardiac Substructures With Optimized Volumetric Modulated Arc Therapy and Intensity Modulated Proton Therapy in Thoracic Radiation for Locally Advanced Non-small Cell Lung Cancer.

Abstract Purpose Increasing radiation dose to the heart is associated with worse survival in stage III non-small cell lung cancer. We sought to evaluate the ability of optimized volumetric modulated arc therapy (VMAT) and intensity modulated proton therapy (IMPT) to spare cardiac substructures. We also wanted to determine how a cardiac optimization treatment planning algorithm influences dose distribution to other thoracic organs at risk (OARs). Methods and Materials Cardiac substructures were retrospectively contoured for all patients with stage III non-small cell lung cancer who were treated at our institution with VMAT to 60 Gy in 2-Gy fractions. The structures included valves, atrioventricular node, coronary arteries, chambers, and great vessels. New cardiac-optimized VMAT plans were created to spare these structures while preserving planning target volume coverage and maintaining standard dose constraints to OARs. Dosimetry variables for the new cardiac-optimized VMAT plans were compared via paired t test with the original VMAT plans. IMPT plans were also created, and the cardiac-optimized VMAT plans were then similarly compared with the IMPT plans. Results Twenty-six patients who were treated from July 2013 to September 2017 were included. Compared with the original VMAT plans, statistically significant improvements were demonstrated for all cardiac structures for the new cardiac-optimized VMAT plans while maintaining or improving appropriate lung, esophagus, and spinal cord constraints and planning target volume coverage goals. Compared with cardiac-optimized VMAT, IMPT demonstrated additional statistically significant improvements for some cardiac dosimetry metrics while maintaining or improving other thoracic OAR constraints. Conclusions VMAT is now widely available, and high-quality VMAT plans that incorporate cardiac substructures into the optimization process can provide overall improvements in dose to OARs and, in particular, substantial sparing of critical cardiac structures. IMPT provides some incremental dosimetric improvements beyond cardiac-optimized VMAT, the clinical significance of which remains uncertain.
Knowledge Management System: Designing a Virtual Community of Practice for Higher Education

This paper investigated if participating in a virtual community of practice (VCoP) would influence faculty’s knowledge contribution, knowledge seeking, and the development of a knowledge repository. The research problem in this study would be of theoretical interest by comparing knowledge seeking, knowledge contribution, and developing a repository of knowledge by group (experimental and control group). The research method was a quasi-experimental design study. The results of the study are beneficial in extending the body of knowledge by quantitatively validating the importance of VCoP in knowledge seeking and contribution. Results of the study brought forward recommendations for future research, such as expanding the focus of the research to include measuring the quality of the knowledge transfer, impact of information and communications technologies (ICTs), etc.
Articulation constrained learning with application to speech emotion recognition

Speech emotion recognition methods combining articulatory information with acoustic features have been previously shown to improve recognition performance. Collection of articulatory data on a large scale may not be feasible in many scenarios, thus restricting the scope and applicability of such methods. In this paper, a discriminative learning method for emotion recognition using both articulatory and acoustic information is proposed. A traditional l1-regularized logistic regression cost function is extended to include additional constraints that enforce the model to reconstruct articulatory data. This leads to sparse and interpretable representations jointly optimized for both tasks simultaneously. Furthermore, the model only requires articulatory features during training; only speech features are required for inference on out-of-sample data. Experiments are conducted to evaluate emotion recognition performance over vowels /AA/, /AE/, /IY/, /UW/ and complete utterances. Incorporating articulatory information is shown to significantly improve the performance for valence-based classification. Results obtained for within-corpus and cross-corpus categorical emotion recognition indicate that the proposed method is more effective at distinguishing happiness from other emotions.
Successful treatment of calcinosis cutis of fingertip in the setting of CREST syndrome with topical 20% sodium thiosulfate.

Calcinosis cutis (CC) is a rare chronic process characterized by deposition of insoluble calcium salts in the skin and subcutaneous tissues. There are 5 subtypes of CC: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis.1 Dystrophic calcinosis is the most common type of CC and is seen in association with autoimmune connective tissue diseases such as systemic sclerosis, dermatomyositis, lupus erythematosus, and lupus panniculitis. CC is thought to occur as a result of chronic local tissue injury and is a common complication of systemic sclerosis especially the limited form (CREST syndrome: calcinosis, Reynaud phenomenon, esophageal dysmotility, sclerodactyly, and telangiectasia), affecting approximately 25% of these patients.2 It usually presents as subcutaneous nodules in fingers or areas of pressure such as elbows, knees, or ischial tuberosities and might be associated with pain, soft tissue swelling, ulcers, or deformities, which may lead to functional limitations. There may be a toothpaste-like material protruding from the skin, predisposing to infection.3 Treatment of CC is difficult and challenging, and there is no consensus on the suggested treatments. Because CC is a rare condition, there is a significant absence of controlled clinical trials on its treatment and, the available data for all suggested therapies are generally reported in case reports or small case series.4 Sodium thiosulfate (STS) is an inorganic salt, which increases calcium solubility and has been reported to be helpful in treating calcinosis.2, 3 Here we report a case of CC of the fingertip in the setting of CREST syndrome that responded to treatment with topical STS 20%.
OCULAR MANIFESTATIONS OF PORETTI-BOLTSHAUSER SYNDROME: FINDINGS FROM MULTIMODAL IMAGING AND ELECTROPHYSIOLOGY.

Background/purpose Poretti-Boltshauser syndrome is a rare, nonprogressive neurologic syndrome with characteristic cerebellar cysts on neuroimaging due to mutations in LAMA1. The ophthalmic findings in Poretti-Boltshauser syndrome are not well described. Here, we report the ophthalmic findings from multimodal imaging and electrophysiology of a patient with genetically confirmed Poretti-Boltshauser syndrome. Methods A 3-year-old boy with confirmed mutations in LAMA1 underwent examination under anesthesia with electroretinography and multimodal imaging including fundus photography, fluorescein angiography, optical coherence tomography, and optical coherence tomography angiography. Results Dilated fundus examination was notable for retinal vascular anomalies, including a large area of nonperfusion in the temporal macula with corresponding retinal thinning on optical coherence tomography. There was an absence of a distinct foveal avascular zone and decreased density of both the superficial and deep vascular plexuses in the macula on optical coherence tomography angiography. There was diffuse loss of choriocapillaris architecture and decreased choroidal thickness. Conclusion Patients with Poretti-Boltshauser syndrome may possess chorioretinal thinning and retinal vascular abnormalities appreciable on examination and multimodal imaging. These findings suggest a role for LAMA1 in retinal and choroidal vascular development.
Combined petrosal approach for resection of petroclival chondrosarcoma: Microsurgical 2-D video.

Background Petroclival lesions pose a significant neurosurgical challenge due to involvement or close proximity to important neurovascular structures. Chondrosarcomas are rare lesions that can affect these areas. Case description A 24-year-old male with 3 months history of poor coordination, imbalance, left-sided face hypoesthesia, facial palsy House-Brackmann Grade 2, and 6th cranial nerve palsy with diplopia. Hearing was preserved. Preoperative images showed a 5.5 cm multilobulated enhancing extra-axial mass centered in the left petroclival region with extension into middle and posterior fossa causing severe (Stage 3) brainstem compression.[1] After a lengthy discussion of treatment options, the patient consented for the procedure. We performed a presigmoid retrolabyrinthine combined petrosal approach. We used cranial nerves monitoring (VII, VIII, IX, X, XI, XII), frameless stereotaxy, and a lumbar drain. Due to the tumor size and location (petroclival region with extension into the posterior and middle cranial fossa), we chose this approach to achieve a maximal safe resection of the tumor and preserve hearing. Alternative approaches of use are expanded middle fossa with transcavernous extension or expanded endonasal approach. The selected approach achieved wide exposure of the tumor which was highly vascular. The tumor was carefully dissected off the brainstem, cranial nerves (IV, V, VI, VII, VIII), and basilar artery trunk. A gross total resection was achieved (Multimedia 1). The patient did well after surgery and was extubated on postoperative day (POD) 1 and the lumbar drain removed on POD 5. Pathology reported low-grade chondrosarcoma (WHO grade I). At 3 months follow-up, the patient improved neurologically, including facial nerve weakness (House-Brackmann Grade 1) except for his left 6th cranial nerve palsy which mildly improved. Conclusion Petroclival chondrosarcomas are rare tumors that are usually treated with surgical resection followed by stereotactic radiosurgery. The tumor size, location, and extension dictate approach selection. For lesions involving the petroclival region with extension into the middle fossa and posterior fossa, the combined petrosal approach is reasonable.