cssi/SciSciGPT-SciSciNet huggingface dataset:
Caries Risk Assessment and Prevention: Strategies for Head Start, Early Head Start, and WIC

Objective: This review updates the evidence regarding caries risk assessment for infants, toddlers, and preschool children and formulates recommendations for preventive strategies for WIC, Head Start, and Early Head Start. Methods: Literature on caries risk assessment and preventive strategies for infants, toddlers, and preschool children were reviewed and synthesized. Recommendations for WIC, Head Start, and Early Head Start were made based on the review. Results: Individual caries risk for children in WIC, Head Start, and Early Head Start should be based on: (1) previous caries experience, (2) precavity lesions, (3) visible plaque, and (4) perceived risk by examiners. Recommended preventive strategies for WIC and Head Start populations include: (1) daily toothbrushing in Head Start centers using fluoridated toothpaste; (2) fluoride varnish application to children enrolled in WIC, Head Start, and Early Head Start; (3) use of chlorhexidine gets and varnishes (following FDA approval); and (4) increased use of sealants on children with precavity pit and fissure lesions. Conclusions: Early screening, risk assessment, and preventive programs in WIC, Head Start, and Early Head Start populations hold a great deal of promise for preventing dental decay in high-risk children.
Performance Modeling and Tuning of an Unstructured Mesh CFD Application

This paper describes performance tuning experiences with a three-dimensional unstructured grid Euler flow code from NASA, which we have reimplemented in the PETSc framework and ported to several large-scale machines, including the ASCI Red and Blue Pacific machines, the SGI Origin, the Cray T3E, and Beowulf clusters. The code achieves a respectable level of performance for sparse problems, typical of scientific and engineering codes based on partial differential equations, and scales well up to thousands of processors. Since the gap between CPU speed and memory access rate is widening, the code is analyzed from a memory-centric perspective (in contrast to traditional flop-orientation) to understand its sequential and parallel performance. Performance tuning is approached on three fronts: data layouts to enhance locality of reference, algorithmic parameters, and parallel programming model. This effort was guided partly by some simple performance models developed for the sparse matrix-vector product operation.
EXPERIMENTAL AND NUMERICAL INVESTIGATION OF TRANSIENT SOOT BUILDUP ON A CYLINDRICAL CONTAINER IMMERSED IN A JET FUEL POOL FIRE

Soot buildup and its effects on heat transfer have been investigated as part of an effort to understand the thermal response of containers of high-energy materials immersed in fires. Soot deposition rates were measured for cooled and uncooled cylindrical containers immersed in a jet fuel pool fire. The soot buildup was measured at different time intervals with a wet film gage with an uncertainty of 20%. These rates were compared with those calculated by solving the boundary layer equations along the cylinder surface including the thermophoretic transport of soot particles. Thermophoresis was the dominant soot transport mechanism controlling the deposition of soot on the container wall and gave deposition rates in good agreement with the measured values. The soot buildup was found to have an important insulating effect on the heat transfer to the container. A soot deposit thickness of 1.2 mm resulted in as much as a 35% reduction in heat flux.
Insulin stimulates sodium-dependent phosphate transport by osteoblast-like cells

The rat osteosarcoma cell line UMR-106-01 has an osteoblast-like phenotype. When grown in monolayer culture, these cells transport Pi via a Na(+)-dependent carrier. The Na(+)-Pi cotransport system is stimulated by parathyroid hormone (PTH). Because there are insulin receptors on osteoblast-like cells, we determined possible effects of insulin on Na(+)-Pi cotransport in UMR-106-01 cells. Incubation of cells with 10(-8) M insulin for 3 h produced a 73% increase (P less than 0.025) in Na(+)-Pi cotransport. There was no significant change in Na(+)-L-alanine cotransport or in Na(+)-independent uptake of Pi and alanine. The stimulatory action of insulin on Na(+)-Pi cotransport was present within 2 h and was dose dependent in the range 10(-10) to 10(-7) M. The increase in Na(+)-Pi cotransport was accompanied by an increase in apparent maximal velocity with no change in apparent Michaelis constant for Pi. Use of cycloheximide to block de novo protein synthesis did not interfere with this action of insulin. We conclude that insulin, like PTH, directly stimulates the Na(+)-Pi cotransport system in osteoblast-like cells. The mechanism remains to be determined.
PICK1/Calcineurin Suppress ASIC1-mediated Ca2+ Entry in Rat Pulmonary Arterial Smooth Muscle Cells

Acid-sensing ion channel 1 (ASIC1) contributes to Ca2+ influx and contraction in pulmonary arterial smooth muscle cells (PASMC). ASIC1 binds the PDZ (PSD-95/Dlg/ZO-1) domain of the protein interact...
Management of Noninfectious Diarrhea Associated With HIV and Highly Active Antiretroviral Therapy

In geographic locations where highly active antiretroviral therapy (HAART) is widely available, the nature of HIV-related diarrhea has shifted from being predominantly a consequence of opportunistic infection to being largely a side effect of HAART agents. With this shift has come a smaller risk for the life-threatening wasting and weight loss, although serious instances of noninfectious diarrhea remain a concern. While estimates vary, in part due to the lack of a standard diarrhea definition, over a quarter of patients receiving HAART experience diarrhea. The negative effect on quality-of-life in patients with HAART-related diarrhea is profound; diarrhea may also increase the risk of poor adherence to treatment, with potentially serious effects on viral suppression and increased risk of drug resistance. Diagnosis of HAART-related diarrhea largely involves ruling out pathogen involvement, which, in addition to laboratory testing, may require endoscopic examination. Treatment was, until recently, mainly supportive in nature. The recent US Food and Drug Administration approval of crofelemer offers the first reliably effective treatment for HAART-related diarrhea.
Defining the Learning Curve for Robotic-Assisted Endoscopic Harvesting of the Left Internal Mammary Artery:

ObjectiveRobotic-assisted techniques are continuing to cement their role in coronary surgery, particularly in facilitating the endoscopic harvesting of the left internal mammary artery (LIMA), rega...
Mycoplasmal (PPLO) polyarthritis and tumor regression in rats.

SummarySporadic polyarthritis in rats observed during spontaneous and induced regression of a lymphosarcoma has been investigated. Cultural studies of the involved periarticular tissues and the tumor yielded PPLO, Mycoplasma arthritidis. The respective roles of PPLO, tumor-necrotizing bacterial polysaccharide, and tumor regression in production of the polyarthritic lesions have been evaluated. Arthritis occurred only in PPLO-infected rats with concurrent or prior necrosis of tumor tissue. Bacterial polysaccharide and viable tumor were not essential.
Primary care practices are full of surprises

Primary care practices are complex adaptive systems facing the need to respond to internal and external uncertainty and surprise. For clinicians and practices to maximize their ability to proactively evolve as they respond to uncertainty and surprise, they need to understand that their practices are nonlinear systems and create the time and space for learning and reflection. This article provides principles for clinicians and staff for negotiating uncertainty and surprise in an ever-changing health care environment.
Extracellular pH changes and accompanying cation shifts during ouabain-induced spreading depression.

Interstitial ionic shifts that accompany ouabain-induced spreading depression (SD) were studied in rat hippocampal and cortical slices in the presence and absence of extracellular Ca2+. A double-ba...
Polyomavirus and Naturally Occuring Neuroglial Tumors in Raccoons (Procyon Lotor)

Polyomavirus (PyV) infections are widespread in human populations and, although generally associated with silent persistence, rarely cause severe disease. Among diseases convincingly associated with natural PyV infections of humans, there are remarkably different tissue tropisms and outcomes, including progressive multifocal leukoencephalopathy, transient or progressive nephropathy, and cancer. The variable character and unpredictable outcomes of infection attest to large gaps in our basic understanding of PyV biology. In particular, the rich history of research demonstrating the oncogenic potential of PyVs in laboratory animals begs the question of why cancer is not more often associated with infection. Raccoon polyomavirus (RacPyV), discovered in 2010, is consistently identified in neuroglial tumors in free-ranging raccoons in the western United States. Exposure to RacPyV is widespread, and RacPyV is detected in tissues of raccoons without tumors. Studying the relationship of RacPyV with its natural host is a unique opportunity to uncover cogent cellular targets and protein interactions between the virus and its host. Our hypothesis is that RacPyV, as an intact episome, alters cellular pathways within neural progenitor cells and drives oncogenesis.
Reparing the nose deformity in the cleft lip operation

Objective To explore satisfactory repairing effects for the cleft lip through reconstructing the nosal deformity simultaneously during repairing the pediatric cleft lip .Method Correction operation of the cleft lip were analysisied retrospectively in 100 cases which were randomly divided into two groupes preoperatively: A grope , reconstructing the nosal deformity simultaneously during repairing the cleft lip in 50 case ; B groupe , only repairing the cleft lip in 50 case.they were followed up 3 months, 6 months and 1 year after operation .Results comparing the two gropes, A groupe were recovered more satisfactory than B groupe .Conclusion It is necessary to reconstruct the nosal deformity simultaneously during repairing the cleft lip.
Research on Modeling of Submarine’s Position Distribution and Search Probability in Antisubmarine Warfare

On the basis of analyzing command problems in current ASW (antisubmarine warfare) effectiveness evaluation, the model of submarine’s position distribution for antisubmarine patrol and call search missions was put forward, and then the search probability estimate models of the sonobuoys established. In the end, an empirical example was illustrated to validate by computer simulation. The results also show that search probability is correlative with submarine’s position distribution.
Why Has the History of the U.S. Congress Been Unpopular

(1986). Why Has the History of the U.S. Congress Been Unpopular? Congress & the Presidency: Vol. 13, No. 1, pp. 119-122.
Interspersing Additional Brief, Easy Problems to Increase Assignment Preference on Mathematics Reading Problems

We extended previous research on student preference for academic assignments by presenting college students with a control assignment containing eight, two-digit × two-digit + two-digit × two-digit (2 × 2 + 2 × 2) mathematics reading problems and an experimental assignment that contained eight equivalent, 2 × 2 + 2 × 2 problems plus three additional interspersed four-digit + four-digit mathematics reading problems. After spending 9 min 15 s working on each assignment, significantly more students ranked the experimental assignment as being less difficult and requiring less effort to complete. When given a choice between the two assignments for homework, significantly more students chose the experimental assignment. No differences between assignments were found on target problem (i.e., 2 × 2 + 2 × 2) accuracy levels. Results support earlier research that showed how students' preference for assignments could be improved by interspersing additional brief tasks among more time consuming target tasks. In addition to applied implications, theoretical implications related to task completion as a reinforcing event, choice, and relative rates of reinforcement are discussed.
Intimate partner violence and women’s cancer quality of life

Because intimate partner violence (IPV) may disproportionately impact women’s quality of life (QOL) when undergoing cancer treatment, women experiencing IPV were hypothesized to have (a) more symptoms of depression or stress and (b) lower QOL as measured with the Functional Assessment of Cancer Therapy (FACT-B) and Functional Assessment of Chronic Illness Therapy—Spiritual Well-being (FACIT-SP) Scales relative to those never experiencing IPV. Women, aged 18–79, who were included in one of two state cancer registries from 2009 to 2015 with a recent incident, primary, invasive biopsy-confirmed cancer diagnosis were recruited and asked to complete a phone interview, within 12 months of diagnosis. This interview measured IPV by timing (current and past) and type (physical, sexual, psychological), socio-demographics, and health status. Cancer registries provided consenting women’s cancer stage, site, date of diagnosis, and age. In this large cohort of 3,278 women who completed a phone interview, 1,221 (37.3%) disclosed lifetime IPV (10.6% sexual, 24.5% physical, and 33.6% psychological IPV). Experiencing IPV (particularly current IPV) was associated with poorer cancer-related QOL defined as having more symptoms of depression and stress after cancer diagnosis and lower FACIT-SP and FACT scores than women not experiencing IPV and controlling for confounders including demographic factors, cancer stage, site, and number of comorbid conditions. Current IPV was more strongly associated with poorer QOL. When compared with those experiencing past IPV (and no IPV), women with cancer who experienced current IPV had significantly higher depression and stress symptoms scores and lower FACIT-SP and FACT-G scores indicating poorer QOL for all domains. While IPV was not associated with being diagnosed at a later cancer stage, current IPV was significantly associated with having more than one comorbid physical conditions at interview (adjusted rate ratio = 1.35; 95% confidence interval 1.19–1.54) and particularly for women diagnosed with cancer when <55 years of age. Current and past IPV were associated with poorer mental and physical health functioning among women recently diagnosed with cancer. Including clinical IPV screening may improve women’s cancer-related QOL.
Evaluation of Silicon Phthalocyanine 4 Photodynamic Therapy Against Human Cervical Cancer Cells In Vitro and in Mice.

Background: Cervical cancer is the second most common cancer in women worldwide [1]. Photodynamic therapy has been used for cervical intraepithelial neoplasia with good responses, but few studies have used newer phototherapeutics. We evaluated the effectiveness of photodynamic therapy using Pc 4 in vitro and in vivo against human cervical cancer cells. Methods: CaSki and ME-180 cancer cells were grown as monolayers and spheroids. Cell growth and cytotoxicity were measured using a methylthiazol tetrazolium assay. Pc 4 cellular uptake and intracellular distribution were determined. For in vitro Pc 4 photodynamic therapy, cells were irradiated at 667 nm at a fluence of 2.5 J/cm2 at 48 h. SCID mice were implanted with CaSki and ME-180 cells both subcutaneously and intracervically. Forty-eight hours after Pc 4 photodynamic therapy was administered at 75 and 150 J/cm2. Results: The IC50s for Pc 4 and Pc 4 photodynamic therapy for CaSki and ME-180 cells as monolayers were, 7.6 μM and 0.016 μM and >10 μM and 0.026 μM; as spheroids, IC50s of Pc 4 photodynamic therapy were, 0.26 μM and 0.01 μM. Pc 4 was taken up within cells and widely distributed in tumors and tissues. Intracervical photodynamic therapy resulted in tumor death, however mice died due to gastrointestinal toxicity. Photodynamic therapy resulted in subcutaneous tumor death and growth delay. Conclusions: Pc 4 photodynamic therapy caused death within cervical cancer cells and xenografts, supporting development of Pc 4 photodynamic therapy for treatment of cervical cancer. Support: P30-CA47904, CTSI BaCCoR Pilot Program.
Intervention with VG1177, a MHC Class II Invariant Peptide Chain (CLIP) Antagonist, Restores Afferent Arteriolar Autoregulatory Behavior during Chronic 14 Day Lipopolysaccharide Treatment

Lipopolysaccharide (LPS) is a cell wall component of gram-negative bacteria that is a known ligand for toll-like receptor 4, which, in turn, activates the innate immune system. MHC Class II-associa...
Insights on Interfacial Structure, Dynamics, and Proton Transfer from Ultrafast Vibrational Sum Frequency Generation Spectroscopy of the Alumina(0001)/Water Interface

Steady-state and time-resolved vibrational sum frequency generation (vSFG) were used to investigate the structure and dynamics of water at the α-Al2O3(0001) surface. The vSFG spectra of the O—H stretch of water next to the Al2O3(0001) surface are blue-shifted compared to the Al2O3(1120) surface, indicating its weaker hydrogen bonding network. Consequently, the vibrational dynamics of the O—H stretch of the neutral Al2O3(0001) surface is two times slower than the neutral Al2O3(1120) surface. Furthermore, the vibrational dynamics of the O—H stretch of water next to charged Al2O3 surfaces is observed to be faster than that in bulk water and at charged SiO2 surfaces, which could be due to (a) fast proton transfer dominating the vibrational relaxation and/or, (b) efficient coupling between the O—H stretch and the bend overtone via the presence of low frequency (∼3000 cm–1) O—H stretching modes. Lastly, the addition of excess ions (0.1 M NaCl) seems to have little to no effect on the time scale of vibrational...
Heat Transfer in a Rod: Arrays

Imagine that we have a silver rod 10 centimeters long with a constant cross section. The rod is encased in thermal insulation along its entire length so that no heat can enter or leave except at its ends. It is initially at a temperature of 0°C. At time t = 0, heat sources are placed in contact with its left and right ends. The left heat source has a temperature of 100°C, and the right heat source has a temperature of 50°C.
Childhood Lead Exposure and Adult Outcomes

The discovery that the water in Flint, Michigan, was contaminated with lead shows that excessive exposure to this toxic metal remains a threat to human health. The episode resulted from a series of poor decisions by politicians that allowed lead to leach from pipes and fixtures into the water flowing into residents’ homes. But Flint is by no means unique with regard to lead hazards. A 2016 report identified 3000 US communities in which the percentage of children with a blood lead concentration greater than 5 μg/dL, the current Centers for Disease Control and Prevention (CDC) reference value, exceeded that among affected children in Flint.1
"Iustitia": educar para una ciudadanía responsable

This lecture analyses how the dimension of Iustitia can be integrated into Jesuit universities. To orient the study, the text is organised into a series of statements and clarifications; among others: the very concept of justice itself is used; the profile of the student to be educated; the emergence of the individual into a new social paradigm; the need to put into motion mechanisms of social imagination and to fill the dimension of “iustitia” with a cordial sense of rightness; the consideration of a temporal dimension and of the inevitable gradualness of political upshots. Finally, the author underlines five features that should orient its educational application in a Jesuit university centre: the perspective of globalization, participation in international cooperation, formation of leadership, well– developed solidarity, and preferential consideration for the poor.
Regulating distal tip cell migration in space and time

Gonad morphogenesis in the nematode C. elegans is guided by two leader cells, the distal tip cells (DTC). The DTCs migrate along a stereotyped path, executing two 90° turns before stopping at the midpoint of the animal. This migratory path determines the double-U shape of the adult gonad, therefore, the path taken by the DTCs can be inferred from the final shape of the organ. In this review, we focus on the mechanism by which the DTC executes the first 90° turn from the ventral to dorsal side of the animal, and how it finds its correct stopping place at the midpoint of the animal. We discuss the role of heterochronic genes in coordinating DTC migration with larval development, the role of feedback loops and miRNA regulation in phenotypic robustness, and the role of RNA binding proteins in the cessation of DTC migration.
Non-functional tricuspid valve disease

Only 75% of severe tricuspid regurgitation is classified as functional, or related primarily to pulmonary hypertension, right ventricular dysfunction, or a combination of both. Non-functional tricuspid regurgitation occurs when there is damage to the tricuspid leaflets, chordae, papillary muscles, or annulus, independent of right ventricular dysfunction or pulmonary hypertension. The entities that cause non-functional tricuspid regurgitation include rheumatic and myxomatous disease, acquired and genetic connective tissue disorders, endocarditis, sarcoid, pacing, RV biopsy, blunt trauma, radiation, carcinoid, ergot alkaloids, dopamine agonists, fenfluramine, cardiac tumors, atrial fibrillation, and congenital malformations. Over time, severe tricuspid regurgitation that is initially non-functional, can blend into functional tricuspid regurgitation, related to progressive right ventricular dysfunction. Symptoms and signs, including a falling right ventricular ejection fraction, cardiac cirrhosis, ascites, esophageal varices, and anasarca, may occur insidiously and late, but are associated with substantial morbidity and mortality. Attempted valve repair or replacement at late stages carries a high mortality. Crucial to following patients with severe non-functional tricuspid regurgitation is attention to echo quantification of the tricuspid regurgitation and right ventricular function, patient symptoms, and the physical examination.
Towards a metaphor-annotated corpus of Mandarin Chinese

Building on the success of the VU Amsterdam Metaphor Corpus, which comprises English texts annotated with metaphor following the Metaphor Identification Procedure Vrjie Universiteit (MIPVU; Steen et al. in Cogn Linguist 21(4):765–796, 2010a; Steen et al. in A method for linguistic metaphor identification: from MIP to MIPVU. John Benjamins, Amsterdam/Philadelphia, 2010b), this study has three aims: (1) to adapt and evaluate the transferability and reliability of MIPVU for Mandarin Chinese; (2) to construct a corpus of Chinese texts annotated for metaphor using the adapted procedure; and (3) to examine the distribution of metaphor-related words across Chinese texts in three different written registers: academic discourse, fiction, and news. The results of our inter-annotator reliability test show that MIPVU can be reliably applied to linguistic metaphor identification in Chinese texts. Our metaphor-annotated corpus consists of texts randomly sampled from the Lancaster Corpus of Mandarin Chinese, totaling 30,012 words (about 10,000 for each register). Data analysis reveals that approximately one out of every nine lexical units in our Chinese corpus is related to metaphor, that there is considerable variation in metaphor density across different registers and lexical categories, and that metaphor density is significantly lower in Chinese than in English texts. Our assessment of the replicability of MIPVU for Mandarin Chinese adds to the groundbreaking methodological contribution that Steen et al. (2010a, b) has made to metaphor research. The metaphor-annotated corpus of Mandarin Chinese contributes a valuable language resource for Chinese metaphor researchers, and our analysis of the distribution of metaphor-related words in the corpus offers useful new insights into the extent and use of metaphor in Chinese discourse.
Do elections matter for private-sector healthcare management in Brazil? An analysis of municipal health policy

This study analyzed several political determinants of increased private-sector management in Brazilian health care. In Brazil, the poor depend almost exclusively on the public Unified Health System (the SUS), which remains severely underfunded. Given the overhead costs associated with privately contracted health services, increased private management is one driver of higher expenditures in the system. Although left parties campaign most vocally in support of greater public control of the SUS, the extent to which their stated positions translate into health care policy remains untested. Drawing on multiple publicly available data sources, we used linear regression to analyze how political party-in-power and existing private sector health care contracting affect the share of privately managed health care services and outsourcing in municipalities. Data from two election periods—2004 to 2008 and 2008 to 2012—were analyzed. Our findings showed that although private sector contracting varies greatly across municipalities, this variation is not systematically associated with political party in power. This suggests that electoral politics plays a relatively minor role in municipal-level health care administration. Existing levels of private sector management appear to have a greater effect on the public-private makeup of the Brazilian healthcare system, suggesting a strong role of path dependence in the evolution of Brazilian health care delivery. Despite campaign rhetoric asserting distinct positions on privatization in the SUS, factors other than political party in power have a greater effect on private-sector health system management at the municipal-level in Brazil. Given the limited effect of elections on this issue, strengthening participatory bodies such as municipal health councils may better enfranchise citizens in the fundamental debate over public and private roles in the health care sector.
Applicability of neural networks to etalon fringe filtering in laser spectrometers

Abstract We present a neural network algorithm for spectroscopic retrievals of concentrations of trace gases. Using synthetic data we demonstrate that a neural network is well suited for filtering etalon fringes and provides superior performance to conventional least squares minimization techniques. This novel method can improve the accuracy of atmospheric retrievals and minimize biases.
Versatile CAR T-cells for cancer immunotherapy

Chimeric antigen receptor (CAR) T-cell therapy has been clinically proven to efficiently combat haematological malignancies. However, continuous efforts are required to increase the specificity of CAR T-cells against tumour versus normal tissues, and are essential to improve their antitumour activity in solid tumours. This review summarises the structure of major CAR designs, and strategies to overcome immunosuppressive tumour microenvironment, and reduce toxicities. Along with reviewing currently available techniques that allow the elimination of CAR T-cells after they fulfil their desired functions, using suicide genes, drug elimination strategies are also introduced. A better understanding of the strengths and pitfalls of CAR T-cell therapy will provide fundamental knowledge for the improvement of engineered T-cell therapy in the near future.
A Rare Case of Clear Cell Carcinoma, Müllerian Type in the Renal Pelvis of a 21-Year-Old Woman

Clear Cell Carcinomas of Mullerian origin are extremely rare within the upper urinary system. Their morphology is identical to that of the Clear Cell Carcinomas of the female genital tract. When they arise in the urinary tract, it is thought to be due to ectopic Mullerian embryogenesis. Here, we present a case of a 21-year-old woman with a Clear Cell Carcinoma, Mullerian type, arising from the renal pelvis. Histologically, it consisted of tubulopapillary architecture with associated foamy macrophages and a mucinous background. The neoplastic cells exhibited variably sized round nuclei with prominent nucleoli, eosinophilic to vacuolated cytoplasm with occasional intracytoplasmic mucin vacuoles, and a hobnail appearance. Immunohistochemical stains showed that the neoplastic cells were positive for Pax-8, p53, CK7, HMWK 903, and INI-1 and focally positive for p504s (AMACR). The neoplastic cells were negative for GATA-3, CK5/CK6, p63, CK20, and CDX-2 immunostains, ruling out urothelial or enteric phenotype. Additional immunostains performed by an outside institution showed that the neoplastic cells were positive for HNF-1β. The overall morphology and immunophenotype were consistent with Clear Cell Carcinoma of Mullerian origin arising from the renal pelvis. Follow-up revealed no metastasis or other tumor sites, supporting that this was the primary location.
Community Models to Enhance Adaptive Instruction

This paper discusses the need and methods to develop community-based persona (learner models) to tie together key learner attributes and learning outcomes (e.g., knowledge acquisition) with the goal of facilitating the validation of adaptive instructional strategies and tactics. Adaptive instruction, sometimes referred to as differentiated instruction, is a learning experience tailored to the needs and preferences of each individual learner or team in which strategies (recommendations and plans for action) and tactics (actions by the tutor) are selected with the aim of optimizing learning, performance, retention, and the transfer of skills between the instructional environment (usually provided by an Intelligent Tutoring System or ITS) and the work or operational environment where the skills learned will be applied. Adaptive instructional systems (AISs) use human variability and other learner attributes along with instructional conditions to select appropriate strategies and tactics. This is usually accomplished through the use of machine learning techniques, but large amounts of data are needed to reinforce the learning of these algorithms over time. We propose a method to develop community models more quickly by enabling diverse groups to contribute the results of their experiments and training data in a common instructional domain to a cloud-based model that could be shared by various instructional applications.
Case 17: An Ambulatory Surgical Patient with No Escort

Today you are in a “stand alone” ambulatory center. A 25 year old man is scheduled for a knee arthroscopy for a medial meniscus tear. You see the patient preoperatively, take a history, and examine him. You declare him a healthy ASA 1. He weighs 83 kg and is 5 ft 11 in. tall. The nurse tells you he has no escort. A friend who was to escort him home is now unavailable. You reaffirm the need for him to be safely transported home with an escort. The patient is however very keen to proceed and agrees to a have the procedure done under local anesthesia. The surgeon gives the patient an injection in the surgical site, 20 mL of lidocaine 1% and 20 mL bupivacaine 0.5%. Everything goes well until after an hour the patient becomes restless and agitated. You give him IV midazolam 2 mg, fentanyl 50 μg, and incremental doses of 50 mg of propofol. The total dose of propofol is 150 mg.
Attempts to Ban Nuclear Tests

From the onset of the nuclear age, the need for some control of nuclear weapons was evident. But for the dominant powers of the day (the permanent members of the UN Security Council), developing a nuclear capability unencumbered by any treaty constraint was much too tempting. Not only did nuclear weapons provide military power, but they were also symbols of superior national status. Accordingly, these nations proceeded as quickly as they could to develop and to expand their nuclear capability based on the premise that though arms control would eventually be necessary, there was a pressing and immediate need to develop a substantial nuclear capability.
In Vitro Diffusion of Lidocaine across Endotracheal Tube Cuffs

Smooth emergence from general endotracheal anesthesia is frequently complicated by coughing induced by stimulation from an endotracheal tube. Lidocaine and other local anesthetics have been shown to anesthetize important rapidly adpating stretch receptors in the dog trachea. With the aim of providing a reservoir for continuous lidocaine release to adjacent tracheal tissue, we examined the ability of clinically used concentrations of lidocaine to diffuse across a commonly used endotracheal tube cuff. Cuffs were filled with either 2% or 4% lidocaine and placed in a 200 mL bath with samples drawn at time intervals up to 360 minutes. Samples were then analyzed for lidocaine concentration. Another set of endotracheal tube cuffs were prefilled for one or 2.5 hours with 2% or 4% lidocaine, emptied, and then refilled with 2% lidocaine. They were then bathed and sampled as above. Cuffs exposed to 4% lidocaine during the prefilling or the diffusion stages resulted in significantly higher concentrations of lidocaine in the baths throughout the time course of the experiment, although all groups demonstrated a rise in the concentration of lidocaine in the baths with time. The highest concentration obtained was 17.49 ± 2.03 μg/mL after 360 minutes. We conclude lidocaine diffuses across endotracheal tube cuffs in a fashion that may enable the cuff to serve a potentially useful role as a reservoir for local anesthetic. This in turn appears to have the potential to smooth emergence from general endotracheal anesthesia in those patients in whom tracheal stimulation may be a complicating factor.
INITIAL SHEAR STRESSES IN THE VISCOELASTIC HALF-PLANE

ABSTRACT This paper presents frontal solutions for a disturbance propagating in a viscoelastic half-plane. The material is arbitrary, and the source of motion is a step point loading normal to the boundary.
Acute Stenting During Acute Ischemic Stroke

Failed recanalization may be seen in up to one-fourth of mechanical thrombectomy (MT) cases despite new devices and rapidly advancing endovascular technology. Stenting during acute ischemic stroke is considered by neurointerventionalists as salvage therapy after unsuccessful thrombectomy attempts due to refractory vessel occlusion. While stenting carries the promise of immediate flow restoration, there are associated risks including hemorrhage, reocclusion with progressive ischemia, vessel injury/dissection, and others. The evolution and applications of intracranial and extracranial stenting and review of literature including various stent types are discussed in this chapter.
Qualitative exploration of cultural factors influencing diet among African-, Caribbean- and US-born Blacks living in the northeast USA.

Limited research considers the ethnic and cultural diversity among the US Black population, and how this diversity influences diet. The purpose of the present qualitative study is to (1) explore the influence of culture, nativity and ethnicity on the diet of US-born, African-born and Caribbean/Latin American-born Blacks and (2) explore a model of dietary acculturation among the African-born and Caribbean/Latin American-born Blacks. The purposive sample included twenty-two US-born, fifteen Caribbean/Latin American-born and ten African-born Blacks (n 47) living in Boston, who participated in either an in-depth interview (n 12) or a focus group (five groups, size 5–9). Satia-Abouta's model of dietary acculturation informed the interview and focus group questions, which explored the influence of psychosocial factors, taste preferences and environmental factors on dietary changes. NVivo 10 software was utilised for the coding and analysis. Topics based on a priori and posteriori analyses included differences in psychosocial factors and taste preferences and environmental factors by nativity. Caribbean/Latin American-born and African-born Blacks expressed the importance of cultural identity in their dietary preferences and found adaptive strategies to maintain cultural diet, while US-born Blacks demonstrated a variety of preferences for traditionally African American foods. Environmental factors varied by place of birth and residence, with US-born Blacks citing poorer quality and limited affordability of foods. These findings suggest the importance of psychosocial and environmental factors in shaping the diet of the ethnically diverse US Black population and underscore the dietary diversity within and across the different ethnic groups of Blacks.
Trustworthy and profit: A new value-based neighbor selection method in recommender systems under shilling attacks

Abstract User-based collaborative filtering recommender systems are widely deployed by e-retailers to facilitate customer’ decision-making and enhance e-retailers' profitability. Despite the advantages these systems provide, their recommendation effectiveness is vulnerable to attacks from malicious users who inject biased ratings. Such attacks against recommender systems are called shilling attacks. Although several shilling attack detection mechanisms have been proposed in previous studies, their detection performance is limited in various attack conditions. Furthermore, few of these mechanisms consider the value-dimension associated with recommendations, which is crucial for e-retailers. This research proposes a novel approach called Value-based Neighbor Selection (VNS) to address the above limitations. The objective of this approach is to protect recommender systems from shilling attacks while improving e-retailers' profitability. It alleviates the aforementioned problems through strategically selecting neighbors whose preferences are then used to make recommendations. We have performed a series of empirical validations in various attack conditions to compare the performance of the proposed method and three benchmark methods, in terms of both recommendation accuracy and e-retailer profitability. The results show the advantages of the proposed method in balancing customer satisfaction and e-retailer profitability.
Stacked DBC Cavitied Substrate for a 15-kV Half-bridge Power Module

High-voltage (3.3 – 10 kV) SiC power switching devices are on the verge of commercialization, while devices rated 15 kV and above are expected in the future. Consequently, there is an increasing demand for power modules that reliably packages them in common topologies for high-performance, while using standard manufacturing processes. This paper presents a solution to utilize direct-bonded-copper (DBC), which is a conventional low-voltage power module substrate, for highvoltage (15 kV) half-bridge power module packaging. The concept involves stacking multiple DBCs with the top-surface metallization pattern replicated on each inter-layer and the bottom-surface metallization. The consequent formation of the interlayer cavities within the stacked substrate creates a series-connected multi-layer capacitor under the DC+, DC−, and AC top-surface metallization. The multi-layer capacitors, where the DBC ceramic acts as the dielectric, equally distribute the high-voltage on the top-surface metallization across each ceramic under it. The voltage distribution enables minimization of the electric fields at the critical triple-point and within the bulk of ceramic. The proposed stacking allows bypassing the need for a voltage-clamped interlayer metallization. A multi-domain (electrical, thermal, mechanical) parametric analysis was performed to determine the number of ceramic layers and total ceramic thickness in the stack. The performed analysis qualitatively demonstrated the effectiveness of the proposed solution with an underlying trade-off.
Self-Mixing Interferometric Signal Enhancement Using Generative Adversarial Network for Laser Metric Sensing Applications

Measurement performance of self-mixing interferometric (SMI) laser sensor can be significantly affected due to the presence of noise. In this case, conventional signal enhancement techniques yield compromised performance due to several limitations which include processing signals in frequency domains only, relying mainly on first order statistics, loss of important information present in higher frequency band and handling limited number of noise types. To address these issues, we propose a solution based on using generative adversarial network, a popular deep learning scheme, to enhance SMI signal corrupted with different noise types. Thus, taking advantage of the deep networks that can learn arbitrary noise distribution from large example set, our proposed method trains the deep network model end-to-end, able to process raw waveforms directly, learn 51 different noise conditions including white noise and amplitude modulation noise for 1,140 different types of SMI waveforms made up of 285 different optical feedback coupling factor (C) values and 4 different line-width enhancement factor α values. The results show that the proposed method is able to significantly improve the SNR of noisy SM signals on average of 19.49, 16.29, 10.34 dB for weak-, moderate-, and strong-optical feedback regime signals, respectively. For amplitude modulated SMI signals, the proposed method has corrected the amplitude modulation with maximum error (using area-under-thecurve based quantitative analysis) of 0.73% for SMI signals belonging to all optical feedback regimes. Thus, our proposed method can effectively reduce the noise without distorting the original signal. We believe that such a unified and precise method leads to enhancement of performance of SMI laser sensors operating under real-world, noisy conditions.
Pediatric Resuscitation Practices During the Coronavirus Disease 2019 Pandemic.

Objectives While most pediatric coronavirus disease 2019 cases are not life threatening, some children have severe disease requiring emergent resuscitative interventions. Resuscitation events present risks to healthcare provider safety and the potential for compromised patient care. Current resuscitation practices and policies for children with suspected/confirmed coronavirus disease 2019 are unknown. Design Multi-institutional survey regarding inpatient resuscitation practices during the coronavirus disease 2019 pandemic. Setting Internet-based survey. Subjects U.S. PICU representatives (one per institution) involved in resuscitation system planning and oversight. Interventions None. Measurements and main results Of 130 institutions surveyed, 78 (60%) responded. Forty-eight centers (62%) had admitted coronavirus disease 2019 patients; 26 (33%) reported code team activation for patients with suspected/confirmed coronavirus disease 2019. Sixty-seven respondents (86%) implemented changes to inpatient emergency response systems. The most common changes were as follows: limited number of personnel entering patient rooms (75; 96%), limited resident involvement (71; 91%), and new or refined team roles (74; 95%). New or adapted technology is being used for coronavirus disease 2019 resuscitations in 58 centers (74%). Most institutions (57; 73%) are using enhanced personal protective equipment for all coronavirus disease 2019 resuscitation events; 18 (23%) have personal protective equipment policies dependent on the performance of aerosol generating procedures. Due to coronavirus disease 2019, most respondents are intubating earlier during cardiopulmonary resuscitation (56; 72%), utilizing video laryngoscopy (67; 86%), pausing chest compressions during laryngoscopy (56; 72%), and leaving patients connected to the ventilator during cardiopulmonary resuscitation (56; 72%). Responses were varied regarding airway personnel, prone cardiopulmonary resuscitation, ventilation strategy during cardiopulmonary resuscitation without an airway in place, and extracorporeal cardiopulmonary resuscitation. Most institutions (46; 59%) do not have policies regarding limitations of resuscitation efforts in coronavirus disease 2019 patients. Conclusions Most U.S. pediatric institutions rapidly adapted their resuscitation systems and practices in response to the coronavirus disease 2019 pandemic. Changes were commonly related to team members and roles, personal protective equipment, and airway and breathing management, reflecting attempts to balance quality resuscitation with healthcare provider safety.
History of drug use in allogeneic hematopoietic cell transplant recipients.

Allogeneic hematopoietic cell transplant (HCT) is a curative therapy for malignant and non-malignant blood diseases. Drug use may be associated with adverse outcomes. We performed a retrospective analysis to assess non-relapse mortality (NRM) and overall survival (OS) in HCT patients with drug use. The medical charts of 232 patients were reviewed. Recipients of matched unrelated donor (MUD) or matched related donor (MRD) transplants were included. Drug use was defined by either metabolic evidence or provider documentation prior to transplant. Transplants were MUD (n = 148) or MRD (n = 84). Median follow-up duration was 15.5 months. There were 35 (15%) patients in the drug use group and 197 (85%) patients in the control group; 49% and 60.4% were in remission at the time of transplant, respectively. In univariate analysis, drug use was associated with a 3-year cumulative incidence of NRM of 43% vs 29% for the control group (p = 0.048), and an HR of 1.75, (95% CI: 1.02–2.99). After controlling for age, sex, disease status, and graft type, drug use was associated with a hazard ratio (HR) of 1.6 (95% CI: 0.95–2.92) for NRM, and an HR 1.2 (95% CI: 0.74–1.94) for OS. Larger cohorts may be needed to further evaluate this association.
Senior Center Service Utilization: Do Social Ties Affect Participation Patterns?

PurposeA better understanding of service utilization patterns at senior service centers can improve program development and constituent usageTheoryThis research examines whether participation in se...
Sociosexual Organization and the Expression of Behavioral Flexibility

Most vertebrate populations are structured, and population structure will be an emergent property of decisions made by individuals concerning where to reside and where to reproduce. Individuals of mammalian species, then, are generally not organized randomly with respect to features of the habitat or to one another (but see Caughley, 1964). Students of social organization seek to explain patterns of interindividual organization within the framework of organismic and evolutionary biology and to identify and measure the causes and effects of population dispersions. For most species of mammals, including primates, the determinants of population distribution and abundance are poorly understood. However, most investigators assume that these patterns are a function of the dispersion and quality of limiting resources (e.g., food, mates), dispersal costs ( Johnson et al., 2003), as well as pressures from predation (Dunbar, 1988; Sterck et al., 1997; Nunn, 2003; also see Smuts et al., 1987).
Anisotropic Cahn-Hilliard free energy and interfacial energies for binary alloys with pairwise interactions

Abstract The original Cahn-Hilliard derivation of the contribution of compositional inhomogeneity to the free energy of a binary alloy with pairwise interactions is extended to include higher-order inhomogeneity terms. For alloys on a cubic lattice, the coefficient of the first inhomogeneity is a second-rank tensor and reduces to a scalar, but it is shown that the second order and the third order inhomogeneity terms are weighted by fourth-rank and sixth-rank tensors, thus resulting in anisotropic contributions. Furthermore, each interaction shell generates a unique set of inhomogeneity coefficients that is determined by the set of vectors connecting an atom to its neighbors on that shell. These coefficients are calculated for fcc and bcc alloys with interactions up fourth nearest neighbors. Phase field simulations based on these extended Cahn-Hilliard free energies are performed to measure interface free energies along specific crystallographic directions as a function of temperature, and to obtain the equilibrium shape of precipitates. Interface free energies, and the resulting anisotropies, are compared to those obtained by discrete models and Monte Carlo simulations.