cssi/SciSciGPT-SciSciNet huggingface dataset:
A novel technique of upper extremity revascularization: The retrohumeral approach ? ??

Although the standard approach for inflow to the brachial artery is directly from the subclavian or the carotid artery, unusual scenarios exist when this direct route is not accessible. We present a case of a patient after right radical mastectomy and radiation therapy for breast cancer with severe ischemic symptoms of the dominant right upper extremity. Angiography revealed an occluded right subclavian artery with a paucity of distal collaterals across the right shoulder. A reversed vein graft was constructed from the right common carotid artery to the right brachial artery and was tunneled with a retrohumeral approach to avoid the previously operated and irradiated field. The patient has remained asymptomatic with a patent graft at 2 years.
Temperature dependent electron transport in graphene

We have investigated the electron transport in graphene at different carrier densities. Single layer graphene was fabricated into Hall bar shaped devices by mechanical extraction onto a silicon oxide/silicon substrate followed by standard microfabrication techniques. From magnetoresistance and Hall measurements, we measure the carrier density and mobility at different gate voltages. Different temperature dependent resistivity behaviors are found in samples with high and low mobilities.
Methods and Tools for Collaboration in GSE Environments

As researchers and practitioners gain more experience with global software engineering (GSE), we are beginning to move from individual tools and practices that help with particular aspects of GSE toward integrated solutions that attempt to cover the full range of needs of distributed projects. The fundamental GSE problem is that collocated projects make very effective use of coordination mechanisms and communication channels that are not available or effective for distributed teams [1] [2]. The fact that these mechanisms often operate so naturally and invisibly within collocated projects has made adjusting to GSE all the harder, since we tend to underestimate the difficulties and to be unsure about what additional collaboration tools GSE projects require.
Partitioning of Printing Ink Solvents on Chocolate

Partitioning (Kp) of printing ink solvents was studied in three types of chocolate with different fat content and degrees of crystallinity. At 25°C, chocolate liquor (48% fat and medium crystallinity) showed a higher Kp than chips (25% fat and higher crystallinity), but cream (29% fat and lowest crystallinity) showed the highest Kp. Order appeared to depend on degree of crystallinity. At 35°C and 45°C as samples became increasingly molten, effect of crystallinity diminished and order of increasing Kp depended on fat content. Kp order of solvents was the same in all chocolates and temperatures: toluene > isopropanol > methyl ethyl ketone > ethyl acetate > hexane in accord with Hildebrand solubility parameter differences.
Dietary Flavonoid Intake and Breast Cancer Risk among Women on Long Island

Flavonoids are found in a variety of foods and have anticarcinogenic properties in experimental models. Few epidemiologic studies have examined whether flavonoid intake is associated with breast cancer in humans. In this study, the authors investigated whether dietary flavonoid intake was associated with reduced risk of breast cancer in a population-based sample of US women. They conducted a case-control study among women who resided in Nassau and Suffolk counties on Long Island, New York. Cases and controls were interviewed about known and suspected risk factors and asked to complete a food frequency questionnaire regarding their average intake in the prior 12 months. A total of 1,434 breast cancer cases and 1,440 controls provided adequate responses. A decrease in breast cancer risk was associated with flavonoid intake; the decrease was most pronounced among postmenopausal women for flavonols (odds ratio (OR) = 0.54, 95% confidence interval (CI): 0.40, 0.73), flavones (OR = 0.61, 95% CI: 0.45, 0.83), flavan-3-ols (OR = 0.74, 95% CI: 0.55, 0.99), and lignans (OR = 0.69, 95% CI: 0.51, 0.94). The authors conclude that intake of flavonols, flavones, flavan-3-ols, and lignans is associated with reduced risk of incident postmenopausal breast cancer among Long Island women. These results suggest that US women can consume sufficient levels of flavonoids to benefit from their potential chemopreventive effects.
Faster and more accurate wiring evaluation in interconnect-centric floorplanning

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Neurotrophin-4 is required for tolerance to morphine in the mouse.

Tolerance is an important component of opiate addiction, but the molecular basis for this phenomenon remains obscure. Here, we report that mice lacking neurotrophin-4 (NT4) display substantially reduced tolerance to morphine compared to wild-type. However, there were no deficits in sensitization and withdrawal, other behaviors relevant to drug addiction. Since NT4 knockout mice also show abnormalities in long-term but not short-term memory, our findings suggest common molecular pathways for some of the enduring changes of drug addiction and memory consolidation.
DataFed: An Architecture for Federating Atmospheric Data for GEOSS

DataFed is a distributed web-services-based computing environment for accessing, processing, and rendering environmental data in support of air quality management and science. The flexible, adaptive environment facilitates the access and flow of atmospheric data from provider to users by enabling the creation of user-driven data processing value chains. The approach of DataFed is mediation between users and data providers. DataFed non-intrusively wraps datasets for access by standards-based Web services. The mediator software, composed of Web services, provides homogeneous data views (e.g., geospatial, time views) using a global multi-dimensional data model. Application software written using Web services are data browsers, including Google Earth, and analysis tools for distributed AQ data. Its federated data pool consists of over 100 datasets and the tools have been applied in several air pollution projects. From the point of view of GEOSS, DataFed contributes air quality data (as services) to the shared data pool through the GEOSS Common Infrastructure. It also hosts a decision support system (DSS) in the societal benefit area of air quality. The developers of DataFed actively participate in the GEOSS process included work with Architecture and Data Committee (ADC) and the User Interface Committee (UIC) as well as in interoperability experiments.
Roentgen: radiation therapy and case-based reasoning

Roentgen is a case-based aid to radiation therapy planning. It relies on an archive of past therapy cases to suggest plans for new therapy patients. Roentgen supports therapy planning by: (1) retrieving the case which best matches the geometry and treatment constraints of the new patient; (2) tailoring the plan to the specific details of the patient; (3) evaluating the results of applying the plan; and (4) repairing the plan to avoid any discovered faults in treatment results. This final plan is the system's suggestion to the human planner. Roentgen breaks new ground in solving problems in a domain dominated by spatial reasoning and the satisfying of constraints. >
Experimental Studies of Defense

In addition to the studies of defense mechanisms reviewed in the previous chapters, which discuss various methods used to measure defenses and their relationship to other psychological or demographic variables, a smaller number of studies have attempted to influence defense use through experimental manipulation.
Relationships in Multicultural Contexts

The study of relationships has greatly benefited from positive psychology’s emphasis on human strengths. There remains a need, however, to better understand the cultural shaping of positive relationship processes. This chapter describes positive processes in family and couple relationships in a U.S. multicultural context. We focus on three U.S. cultural heritage backgrounds – European, Latino, and East Asian – that share the universal need to belong but vary in their approaches to meeting this need in family and couple relationships. For family, we focus on familism, the relative priority placed on family over individual. For couples, we focus on formation processes, such as attraction and courtship, and maintenance processes, such as positive emotion, social support, and effective conflict management. We conclude by suggesting that the study of the cultural shaping of positive relationship processes offers an opportunity to understand the multiple routes that can lead to thriving family and couple relationships.
Understanding the Relationship Between Asthma and Sleep in the Pediatric Population

The Centers for Disease Control and Prevention reports that 9.5% of children have been diagnosed with asthma. Sleep disturbances affect 20% to 30% of the pediatric population. The prevalence of nocturnal symptoms of asthma is high, and most children regularly experience nighttime symptoms. Sleep is important for growth and development, and untreated sleep disturbances have adverse effects on school performance, mental health, physical health, and functioning. This review will explore the relationship between asthma and sleep disturbances. Clinicians need to assess children with asthma for sleep disturbance.
IIT Delhi’s Synthesis System

IIT Delhi’s synthesis system includes design iteration, scheduling and data path synthesis. See alsoUniv. of Kiel’s MIMOLA System—Marwedel is also involved with that system.
Membrane Analysis of Shells

Membrane shell equations are derived in a form applicable to any system of curvilinear surface or projected plane coordinates. Only elementary reasoning is used, and all terms have a clear physical significance. Thus, the engineer is provided with insight for the selection of the most opportune coordinate net for the surface to be analyzed. The equations are interpreted through a discussion of their use to find membrane stresses in several categories of shell surfaces. For specific examples, new formulas are found for three surfaces: The tangent developable; the hyperboloid (with elliptical cross section); and the right helicoid.
Mastering the Art of Visual Storytelling

As a visual journalist who also really enjoys writing, I have often said that information graphics reporting provides the best of both worlds. At once a “word” person and a “design” junkie, I have always been fascinated by the notion that the combination of words and visuals within a story package have an extreme impact on catching a reader's attention, keeping it and even ensuring that he or she retains the information much longer than when a story is provided in the form of words alone. Information graphics generally stimulate more brainpower because they appeal to both the literal and visual regions of the brain. Information graphics can tell stories with a degree of detail that is often otherwise impossible. Information graphics provide consumers with an incredibly rich “reading” experience. And, information graphics provide journalists with a powerful tool for telling a variety of different kinds of stories.
Changes in activities of some enzymes during in vivo aging of mouse erythrocytes.

SummaryRed cell G-6-PD, 6-PGD, and GOT were studied in mice during and after prolonged arrest of erythropoiesis by means of repeated subcutaneous injections of actinomycin D. No clear downward trend in the activities of any of these enzymes in the progressively aging cells was found except for GOT, which initially declined as the reticulocytes disappeared and then stabilized at a new lower level. Discontinuation of the drug evoked a marked reticulocytosis accompanied by a sharp increase of G-6-PD and GOT activity. These data suggest that the major factor determining the red blood cell enzymes level is the presence or absence of reticulocytes.
Evaluating Digoxin and Theophylline Intoxication in the Emergency Setting

Digoxin and theophylline, widely prescribed therapeutic drugs, can cause life-threatening cardiac dysrhythmias when overdosed, typically bradycardia (digoxin) or tachycardia (theophylline). The level of drug does not always correlate with the severity of illness. Thus, patients are managed differently, depending on whether the overdose is acute or chronic. The clinical laboratory provides quantitative levels for each drug that initially help guide patient management. Because several pathophysiologic factors can increase the risk of toxicity, the clinician often must rely on other laboratory tests, such as electrolytes and renal function, to monitor the patient effectively. This is especially true with administration of antidotal therapy in a digoxin overdose
Cotton Bud Drying: A Theoretical Model

This paper presents a theoretical analysis of the rate of water loss from abscissed flower buds of cotton, Gassypium hirsutum L., under any given set of environmental conditions. The bud drying model provides a link between larval boll weevil, Anthonomm grandis Boheman, mortality, and crop environment. Derived from assumptions relating to diffusive water loss, the model shows excellent agreement with experimental results for buds ranging in initial weight from 0.2–0.7 grams. The bud drying model provides a means of calculating the drying time of abscissed cotton buds for any given microclimate.
Cultural Responses to Environmental Catastrophes: Post-El Niño Subsistence on the Prehistoric North Coast of Peru

Recent debate about the development of complex societies on the north coast of Peru has turned on the relative importance of marine vs. terrestrial resources and the extent to which different resource zones are upset by El Nino/Southern Oscillation (ENSO) events. While ENSO events are cited frequently as having important consequences for Prehispanic Andean societies, in fact there are few archaeological data about the nature of cultural responses to a specific ENSO event. Archaeological data from two Chimu settlements in the Casma Valley, Peru—Quebrada Sta. Cristina and Manchan—document the occurrence of a fourteenth-century A.D. ENSO event and some of the cultural responses to that prehistoric El Nino.
Lack of predictivity of the rat lethality (LD50) test for ecological and human health effects

The relationship between acute toxicity in rats (LD50 values) and indicators of potential health hazards in humans was investigated, based on a chemical population-based paradigm (i.e. the "chemical diversity approach"). These structure-activity relationship-based analyses indicate that high toxicity in rats (i.e. a low LD50 value) is not a good predictor of health effects in humans. In fact, it was found that high acute toxicity to minnows, as well as toxicity to cultured cells, showed significantly greater associations with the potential for health effects than rat LD50 values.
Conclusion: The Persistence of Fiction

Edmund Morgan, tracing the rise of popular sovereignty in England and America, starts with a telling quotation from David Hume: ‘ “as Force is always on the side of the governed, the governors have nothing to support them but opinion”.’ Expressing that reality another way, Morgan posits that all government is ultimately based on the consent of the governed, the achievement of which has forever been dependent upon the employment of fictions. ‘Government,’ he asserts, ‘requires make-believe. Make believe that the king is divine, make believe that he can do no wrong or make believe that the voice of the people is the voice of God.’1 In this respect the American and the English experiences were similar, but there were also noticeable differences. To dignify their fictions and to protect them from challenge Americans tended to speak of self-evident truths;2 the English more often dressed them in the mantle of an ancient constitution or an equally mythic fundamental law.
Detecting black bear source-sink dynamics using individual-based genetic graphs.

Source–sink dynamics affects population connectivity, spatial genetic structure and population viability for many species. We introduce a novel approach that uses individual-based genetic graphs to...
Self-trapping of light through red blood cell suspensions

We observe self-trapping and deep penetration of a laser beam in human red blood cell (RBC) suspensions under isotonic, hypotonic, and hypertonic conditions, in spite of the intrinsic absorption and scattering loss due to RBCs.
Characterization of intrinsic material properties of a model lipoproteic emulsion gel by oscillatory and creep compliance rheometry.

The effects of varying formulation and processing parameters on rheological properties in a model lipid/protein-based emulsion gel were studied. Heat-set model lipoproteic emulsion gels were prepared with varying levels of protein, lipid, and NaCl contents and high pressure homogenization treatments. Small deformation oscillatory rheometry, creep compliance, and pore size analysis experiments were used to characterize intrinsic structural properties, matrix interactions, and microstructure. Creep compliance behavior of the gel system was successfully modeled by a four-component Burgers model. Shear storage and loss moduli and Newtonian viscosity increased while instantaneous compliance, retarded compliance, and pore size decreased with increasing protein or fat content or homogenization pressure. The data obtained in this study provide information on factors affecting protein network structure and strength, properties may be useful for creating desirable attributes in lipid/protein-based foods with a further optimization process. This article is protected by copyright. All rights reserved.
Chondrocyte primary cilium is mechanosensitive and responds to low-intensity-ultrasound by altering its length and orientation.

Abstract The primary cilium has been implicated in mechanotransduction, however, its mechanosensory role in transducing signals under low-intensity ultrasound (LIUS) which has the potential to repair fractures and cartilage, remains uninvestigated. This study examined the impact of continuous-wave US, at the cell resonance frequency of 5.0 MHz and pressure amplitude of either 14 or 60 kPa, on the incidence, length and orientation of primary cilium in bovine articular chondrocytes. Visualization of primary cilium with acetylated α-tubulin staining demonstrated that the primary cilium was elongated, bent under US and these changes were reversible. Basal expression of phospho-ERK1/2 was lower in deciliated chondrocytes, thus implicating the role for the primary cilium in transducing signals via the MAPK/ERK pathway. This study demonstrates that the chondrocyte primary cilium is mechanosensitive and responds to US by altering its length and orientation.
Axiomatizing Changing Conceptions of the Geometric Continuum II: Archimedes-Descartes-Hilbert-Tarski

In Part I [Bal14a], we defined the notion of a modest complete descriptive axiomatization and showed that HP5 and EG are such axiomatizations of Euclid’s polygonal geometry and Euclidean circle geometry1. In this paper we argue: 1) Tarski’s axiom set E is a modest complete descriptive axiomatization of Cartesian geometry (Section 2; 2) the theories EGπ,C,A and E π,C,A are modest complete descriptive axiomatizations of Euclidean circle geometry and Cartesian geometry, respectively when extended by formulas computing the area and circumference of a circle (Section 3); and 3) that Hilbert’s system in the Grundlagen is an immodest axiomatization of any of these geometries. As part of the last claim (Section 4), we analyze the role of the Archimdedean postulate in the Grundlagen, trace the intricate relationship between alternative formulations of ‘Dedekind completeness’, and exhibit many other categorical axiomatizations of related geometries.
Interphysician Differences in Emergency Department Length of Stay.

Abstract Background Emergency physicians differ in many ways with respect to practice. One area in which interphysician practice differences are not well characterized is emergency department (ED) length of stay (LOS). Objective To describe how ED LOS differs among physicians. Methods We performed a 3-year, five-ED retrospective study of non-fast-track visits evaluated primarily by physicians. We report each provider's observed LOS, as well as each provider's ratio of observed LOS/expected LOS (LOSO/E); we determined expected LOS based on site average adjusted for the patient characteristics of age, gender, acuity, and disposition status, as well as the time characteristics of shift, day of week, season, and calendar year. Results Three hundred twenty-seven thousand, seven hundred fifty-three visits seen by 92 physicians were eligible for analysis. For the five sites, the average shortest observed LOS was 151 min (range 106–184 min), and the average longest observed LOS was 232 min (range 196–270 min); the average difference was 81 min (range 69–90 min). For LOSO/E, the average lowest LOSO/E was 0.801 (range 0.702–0.887), and the average highest LOSO/E was 1.210 (range 1.186–1.275); the average difference between the lowest LOSO/E and the highest LOSO/E was 0.409 (range 0.305–0.493). Conclusion There are significant differences in ED LOS at the level of the individual physician, even after accounting for multiple confounders. We found that the LOSO/E for physicians with the lowest LOSO/E at each site averaged approximately 20% less than predicted, and that the LOSO/E for physicians with the highest LOSO/E at each site averaged approximately 20% more than predicted.
The Perceived Entrepreneurial Competence, Employment, and Satisfaction of Arts Alumni

Entrepreneurship scholars and educators posit that the utility of competencies gained through entrepreneurship education complements competencies in other domains, yet empirical evidence is scant. ...
Judging International Judgments

This article explores the Supreme Court's decision last term in Sanchez-Llamas v. Oregon. In Sanchez-Llamas, the Court considered the effect that rulings of international tribunals - what I call "international judgments" - should have in American courts. The main opinions in the case mirror a scholarly debate that has raged for the last decade. The Court's opinion adopts a dualist position, under which international judgments have only information value. The dissent, by contrast, adopts the comity model that has gained considerable academic support in recent years. Under that model, American courts defer to international judgments, where possible, in the interests of global uniformity. I argue that the Court's position is the better one. The dualist approach allows domestic courts to balance the competing demands of international order and local autonomy. The comity model, by contrast, draws support from inapposite regional analogies and fails to solve the legitimacy problems that international courts present. In rejecting the comity model, the Sanchez-Llamas Court casts doubt on the long-term prospects of comity scholarship and assures that the American approach to international judgments will be a sensible one.
The tick endosymbiont Candidatus Midichloria mitochondrii and selenoproteins are essential for the growth of Rickettsia parkeri in the Gulf Coast tick vector

Pathogen colonization inside tick tissues is a significant aspect of the overall competence of a vector. Amblyomma maculatum is a competent vector of the spotted fever group rickettsiae, Rickettsia parkeri. When R. parkeri colonizes its tick host, it has the opportunity to dynamically interact with not just its host but with the endosymbionts living within it, and this enables it to modulate the tick’s defenses by regulating tick gene expression. The microbiome in A. maculatum is dominated by two endosymbiont microbes: a Francisella-like endosymbiont (FLE) and Candidatus Midichloria mitochondrii (CMM). A range of selenium-containing proteins (selenoproteins) in A. maculatum ticks protects them from oxidative stress during blood feeding and pathogen infections. Here, we investigated rickettsial multiplication in the presence of tick endosymbionts and characterized the functional significance of selenoproteins during R. parkeri replication in the tick. FLE and CMM were quantified throughout the tick life stages by quantitative PCR in R. parkeri-infected and uninfected ticks. R. parkeri infection was found to decrease the FLE numbers but CMM thrived across the tick life cycle. Our qRT-PCR analysis indicated that the transcripts of genes with functions related to redox (selenogenes) were upregulated in ticks infected with R. parkeri. Three differentially expressed proteins, selenoprotein M, selenoprotein O, and selenoprotein S were silenced to examine their functional significance during rickettsial replication within the tick tissues. Gene silencing of the target genes was found to impair R. parkeri colonization in the tick vector. Knockdown of the selenogenes triggered a compensatory response from other selenogenes, as observed by changes in gene expression, but oxidative stress levels and endoplasmic reticulum stress inside the ticks were also found to have heightened. This study illustrates the potential of this new research model for augmenting our understanding of the pathogen interactions occurring within tick hosts and the important roles that symbionts and various tick factors play in regulating pathogen growth.
Gender, Feedback, and Learners' Decisions to Share Their Creative Computing Projects

Although informal online learning communities are made possible by users' decisions to share their creations, participation by females and other marginalized groups remains stubbornly low in technical communities. Using descriptive statistics and a unique dataset of shared and unshared projects from over 1.1 million users of Scratch-a collaborative programming community for young people-we show that while girls share less initially, this trend flips among experienced users. Using Bayesian regression analyses, we show that this relationship can largely be attributed to differences in the way boys and girls participate. We also find that while prior positive feedback is correlated with increased sharing among inexperienced users, this effect also reverses with experience or with the addition of controls. Our findings provide a description of the dynamics behind online learners' decisions to share, open new research questions, and point to several lessons for system designers.
Glossary of Relevant Genetic and Molecular/Cell Biology

The basic physical and functional unit of heredity; made up of DNA, they act as instructions to make proteins. There are about 20,000–25,000 genes in humans, with size varying from a few hundred DNA bases to more than 2 million bases. Most genes are the same in all people; less than 1% differ. Each person has two copies of each gene, one inherited from each parent. Each chromosome contains many genes.
Behavioral Interventions for Those Living with Dementia

Behavior disturbance in people with neurocognitive disorders is a major challenge for caregiving and quality of life. Common neuropsychiatric symptoms include sleep disturbance, aggression, anxiety, depression, and agitation. As a part of patient-centered care, individual needs of the person must be considered when attempting behavioral interventions. By reviewing the evidence regarding short- and long-term outcomes of nonpharmacological choices for behavioral interventions, care providers can make patient-centered choices. Sensory, cognitive, emotional and environmental interventions are explored in reference to major neurocognitive disorder (dementia). An emphasis is placed on the importance of caregiver education and environmental modifications.
A general-purpose time-step criterion for simulations with gravity

We describe a new adaptive time-step criterion for integrating gravitational motion, which uses the tidal tensor to estimate the local dynamical time-scale and scales the time-step proportionally. This provides a better candidate for a truly general-purpose gravitational time-step criterion than the usual prescription derived from the gravitational acceleration, which does not respect the equivalence principle, breaks down when a=0⁠, and does not obey the same dimensional scaling as the true time-scale of orbital motion. We implement the tidal time-step criterion in the simulation code GIZMO, and examine controlled tests of collisionless galaxy and star cluster models, as well as galaxy merger simulations. The tidal criterion estimates the dynamical time faithfully, and generally provides a more efficient time-stepping scheme compared to an acceleration criterion. Specifically, the tidal criterion achieves order-of-magnitude smaller energy errors for the same number of force evaluations in potentials with inner profiles shallower than ρ ∝ r⁻¹ (i.e. where a → 0⁠), such as star clusters and cored galaxies. For a given problem these advantages must be weighed against the additional overhead of computing the tidal tensor on-the-fly, but in many cases this overhead is small.
Maternal thyroid disease and twinning.

INTERRELATIONSHIPS suggested by various workers among thyroid function, twinning and chromosomal abnormalities1–4 have prompted this study of thyroid disease in mothers of twins.
Comparing Operative Performance between Independent and Integrated Plastic Surgery Residents.

BACKGROUND Anecdotally, faculty report that independent residents' operative skills differ from those of their integrated peers. This study compared operative competency between integrated (postgraduate years 4 to 6) and independent plastic surgery residents. METHODS The authors compared independent (postgraduate years 1 to 3) and integrated (postgraduate years 4 to 6) plastic surgery residents at their institution using operative performance data from the Operative Entrustability Assessment, a validated five-point assessment tool that provides residents with real-time feedback about their operative performance, documenting performance at the point of care. Independent postgraduate year 1, 2, and 3 residents were categorized as postgraduate year 4, 5, and 6 residents, respectively, for comparison. The authors analyzed attending physician (evaluator) Operative Entrustability Assessment scores over time using the independent t test. RESULTS From July 1, 2013, to June 30, 2018, Operative Entrustability Assessments were completed at one training program for residents in postgraduate years 4 to 6: 1886 (47.4 percent) by independent [n = 12 (37.5 percent)] and 2094 (52.6 percent) by integrated [n = 20 (62.5 percent)] residents. Evaluator scores were lower for independent track residents throughout the first two quarters of postgraduate year 4 (quarter 1 delta, -0.49 point, p < 0.001; quarter 2 delta, -0.36 point, p < 0.001). However, this difference was no longer statistically significant during the third and fourth quarters of postgraduate year 4 (p = 0.192 and p = 0.228, respectively). No difference was detectable at postgraduate year 5 (p = 0.095) or postgraduate year 6 (p = 0.877). CONCLUSIONS Operative Entrustability Assessment data demonstrate that differences between independent and integrated plastic surgery residents regarding operative skills (0.49 of 5 points) and amount of time needed for independent residents to catch up (6 months) is minimal and resolves during the third quarter of independent postgraduate year 1. Programs can design curricula to facilitate independent residents' plastic surgery skill acquisition during their first two quarters.
An institutional assessment of sperm cryospreservation and fertility counselling in pubertal male cancer survivors.

Summary Introduction Improved survivorship after treatment of pediatric malignancies has dramatically increased, while pre-treatment fertility preservation in this population has not kept pace. New guidelines emphasize fertility preservation in young adolescents, but the impact of these guidelines is unknown. Objectives We sought to evaluate the rate of fertility preservation among at-risk adolescents diagnosed with cancer at our institution, as well as evaluate barriers to fertility preservation. Design We performed an IRB-approved historical cohort study of adolescent males 13 years and older evaluated in the Pediatric Hematology-Oncology clinic at Doernbecher Children's Hospital from 2010 to 2018. Electronic chart review was used assess discussion of fertility preservation and barrier to successful preservation in boys with a new diagnosis of cancer who received systemic chemotherapy and/or gonadal or pelvic irradiation. Results 82 boys were included in the study. Forty-two (51%) received counselling about fertility preservation, and of those 29 (70%) successfully banked sperm. Neither counseling for fertility preservation nor success at sperm banking differed by patient age, but both differed by malignancy. Patients with Hodgkin's lymphoma had the highest rate of counselling, while those with leukemia had the lowest. Acute illness as a barrier to preservation was found in 40% of those who did not receive counselling. Discussion Our study demonstrates a stagnant rate of fertility counseling and preservation despite increased advocacy. The retrospective nature of our study limited our ability to assess the counselling that occurred, and the lack of granular race data limited study of the implicit selection bias that may be involved in such counseling. As more institutions move toward a multi-disciplinary care model, we believe that pediatric urologists or fertility specialists must play a vocal role in the care of these at-risk adolescents. Conclusion Despite increasing advocacy for fertility preservation, our data shows no significant change in previously reported trends. Patients with Hodgkin's lymphoma have a higher rate of counseling and cryopreservation in comparison to those with other malignancies. Download : Download high-res image (113KB) Download : Download full-size image Summary Figure
Assessing Functional Language in School-Aged Children Using Language Sample Analysis

Purpose The goal of this clinical focus article is to illustrate how speech-language pathologists can document the functional language of school-age children using language sample analysis (LSA). A...
Late‐onset epilepsy and 25‐year cognitive change: The Atherosclerosis Risk in Communities (ARIC) study

Objective To define the association between late-onset epilepsy (LOE) and 25-year change in cognitive performance. Methods The Atherosclerosis Risk in Communities (ARIC) study is a multicenter longitudinal cohort study with participants from four U.S. communities. From linked Medicare claims, we identified cases of LOE, defined as ≥2 seizure-related diagnostic codes starting at age ≥67. The ARIC cohort underwent evaluation with in-person visits at intervals of 3-15 years. Cognition was evaluated 4 times over >25 years (including before the onset of seizures) using the Delayed Word Recall Test (DWRT), Digit Symbol Substitution Test (DSST), and Word Fluency Test (WFT); a global z-score was also calculated. We compared the longitudinal cognitive changes of participants with and without LOE, adjusting for demographics and LOE risk factors. Results From 8033 ARIC participants with midlife cognitive testing and Medicare claims data available (4523 [56%] female, 1392 [17%] Black), we identified 585 cases of LOE. The rate of cognitive decline was increased on all measures in the participants who developed LOE compared to those without LOE. On the measure of global cognition, participants with LOE declined by -0.43 z-score points more over 25 years than did participants without epilepsy (95% confidence interval [CI] -0.59 to -0.27). Prior to the onset of seizures, cognitive decline was more rapid on the DWRT, DSST, and global z-scores in those who would later develop LOE than it was in non-LOE participants. Results were similar after excluding data from participants with dementia. Significance Global cognition, verbal memory, executive function, and word fluency declined faster over time in persons developing LOE than without LOE. Declines in cognition preceding LOE suggest these are linked; it will be important to investigate causes for midlife cognitive declines associated with LOE.
Backward Walking and Dual-Task Assessment Improve Identification of Gait Impairments and Fall Risk in Individuals with MS.

Background Individuals with multiple sclerosis (MS) experience deficits in motor and cognitive domains, resulting in impairment in dual-task walking ability. The goal of this study was to compare performance of forward walking and backward walking in single- and dual-task conditions in persons with MS to age- and sex-matched healthy controls. We also examined relationships between forward and backward walking to cognitive function, balance, and retrospective fall reports. Methods All measures were collected in a single session. A 2 × 2 × 2 mixed model ANOVA was used to compare differences in forward and backward walking in single- and dual-task conditions between MS and healthy controls. Spearman correlations were used to examine relationships between gait and cognitive function, falls, and balance. Results Eighteen individuals with relapsing-remitting MS and 14 age- and sex-matched healthy controls participated. Backward walking velocity revealed significant differences between groups for both single-task (p = 0.015) and dual-task (p = 0.014) conditions. Persons with MS demonstrated significant differences between single- and dual-task forward and backward walking velocities (p = 0.023; p = 0.004), whereas this difference was only apparent in the backward walking condition for healthy controls (p = 0.004). In persons with MS, there were significant differences in double support time between single- and dual-task conditions in both backward (p < 0.001) and forward (p = 0.001) directions. More falls at six months were significantly associated with shorter backward dual-task stride length (r = -0.490; p = 0.046) and slower velocity (r = -0.483; p = 0.050). Conclusion Differences in MS and age- and sex-matched healthy controls are more pronounced during backward compared to forward walking under single- and dual-task conditions. Future work with a larger sample size is needed to validate the clinical utility of backward walking and dual-task assessments and mitigate the limited sensitivity of the current dual-task assessments that primarily rely upon forward walking.
Maintaining rejected distractors in working memory during visual search depends on search stimuli: Evidence from contralateral delay activity

The presence of memory for rejected distractors during visual search has been heavily debated in the literature and has proven challenging to investigate behaviorally. In this research, we used an electrophysiological index of working memory (contralateral delay activity) to passively measure working memory activity during visual search. Participants were asked to indicate whether a novel target was present or absent in a lateralized search array with three visual set sizes (2, 4, or 6). If rejected distractors are maintained in working memory during search, working memory activity should increase with the number of distractors that need to be evaluated. Therefore, we predicted the amplitude of the contralateral delay activity would be larger for target-absent trials and would increase with visual set size until WM capacity was reached. In Experiment 1, we found no evidence for distractor maintenance in working memory during search for real-world stimuli. In Experiment 2, we found partial evidence in support of distractor maintenance during search for stimuli with high target/distractor similarity. In both experiments, working memory capacity did not appear to be a limiting factor during visual search. These results suggest the role of working memory during search may depend on the visual search task in question. Maintaining distractors in working memory appears to be unnecessary during search for realistic stimuli. However, there appears to be a limited role for distractor maintenance during search for artificial stimuli with a high degree of feature overlap.
Lights off, camera on! Laparoscopic cholecystectomy improves outcomes in cirrhotic patients with acute cholecystitis

BACKGROUND The best surgical approach to treat acute cholecystitis (AC) in cirrhotic patients is controversial. This study aimed to evaluate treatment options in cirrhotic patients with AC. We hypothesized that laparoscopic cholecystectomy (LC) would lead to better clinical outcomes when compared to non-operative management (NOM) and open cholecystectomy (OC), independent of the severity of liver cirrhosis. METHODS Patients from the National Inpatient Sample diagnosed with AC were stratified into no cirrhosis (NC), compensated cirrhosis (CC), and decompensated cirrhosis (DC) and analyzed according to treatment: NOM, OC, and LC. Primary outcome was in-hospital mortality. Secondary outcomes included hospital length of stay (HLOS), cost, and surgical complications. Univariate and multivariate analyses using generalized linear models were performed. A P < 0.05 was deemed significant. RESULTS Of 1 367 495 AC patients, 49 030 (3.6%) had cirrhosis; 23 260 had CC, and 25 770 had DC. LC (12 080 in CC group and 4840 in DC group) was accompanied by significantly lower mortality, HLOS, complications, and cost when compared to OC and NOM. OC was significantly associated with higher mortality, increased HLOS, total cost, and postoperative complications, independent of the presence or severity of cirrhosis. CONCLUSIONS LC in cirrhotic patients leads to superior outcomes compared to OC and NOM regardless of the severity of cirrhosis.
Twenty Years of the Ryan Residency Training Program in Abortion and Family Planning.

Abstract Objective To summarize the effects of routine, opt-out abortion and family planning residency training on obstetrics and gynecology (ob-gyn) residents’ clinical skills in uterine evacuation and intentions to provide abortion care after residency. Methods Data from ob-gyn residency programs supported during the first 20 years of the Kenneth J. Ryan Residency Training Program in Abortion and Family Planning were analyzed. Postrotation surveys assessed residents’ training experiences and acquisition of abortion care skills. Residency program director surveys assessed benefits of the training to residents and the academic department from the educators’ perspectives. Results A total of 2775 residents in 89 ob-gyn programs completed postrotation surveys for a response rate of 72%. During the rotation, residents – including those who only partially participated – gained exposure to and skills in first- and second-trimester abortion care. Sixty-one percent intended to provide abortion care in their postresidency practice. More than 90% of residency program directors (97.5% response rate) reported that training improved resident competence in abortion and contraception care and 81.3% reported that the training increased their own program's appeal to residency applicants. Conclusion Over 20 years, the Ryan Program has supported programs to integrate abortion training to give ob-gyn residents the skills and inspiration to provide comprehensive reproductive health care, including uterine evacuation and abortion care, in future practice. Residency program directors noted that this integrated training meets resident applicants’ expectations. Implications Ryan Program residents are trained to competence and are prepared, both clinically and in their professional attitudes, to care for women's reproductive health.
Predictors of the Size and Surgical Freedom of the Trans-Cribriform and Trans-Clival Corridors, a Radiographic Analysis

Introduction The transcribriform and transclival corridors are endoscopic endonasal approaches used to treat pathologies of the skull base. We present a predictive model that uses the clival length and ethmoidal width to predict the size and surgical freedom (SF) of these corridors. Methods Adult facial computed tomography scans were reviewed. Exclusion criteria included patients Results A total of 103 patients were included with an average age of 44.9 years and 47% males. Females had a smaller clival surface area (8 vs. 9.2 cm2, p = 0.001). For transclival corridor, clival length correlated positively with SF in the sagittal plane (rho = 0.44, p Conclusion A significant variability of the bony anatomy of the anterior and central skull base was found. The use of clival length and ethmoidal width as part of preoperative surgical planning might help to overcome the anatomical variability which could affect the adequacy of surgical corridors.