cssi/SciSciGPT-SciSciNet huggingface dataset:
Confrontation and politeness strategies in physician-patient interactions

The therapeutic success of physician-patient interactions depends in large part on how physicians interpret and respond to patients' implicit and explicit messages. Using a hypothetical vignette, in which a patient refuses to comply with a recommended therapeutic regimen, we found that first-year medical students with no classroom training in medical interviewing implicitly recognized that the situation called for face preserving or polite linguistic behavior. Ninety percent of them used culturally sanctioned politeness forms to repair the conversational breakdown depicted in the vignette. They responded to this clinical scenario, however, with linguistic behaviors borrowed from their everyday interactions, some of which were culturally appropriate, but not necessarily therapeutic. We suggest that students can learn to adapt their culturally appropriate behaviors and engage in therapeutic communication as physicians if they are given the necessary conceptual tools. We discuss how Brown and Levinson's theories of politeness and strategic language usage can (1) provide a framework for interpreting communication in general and physician-patient interaction in particular, (2) illuminate some of the problems inherent in doctor-patient encounters, and (3) be used prescriptively for teaching students and health professionals how to avoid some communication difficulties.
Cooperative Monitoring for Internet Data Centers

Recent outages in several Web services have demonstrated the potential damage of availability disruptions, since millions of end users rely on these services powered by thousands of servers in large-scale Internet data centers. As Internet data centers continue to grow in scale and complexity, it has become a daunting task to monitor and manage thousands of servers simultaneously. This paper presents a cooperative monitoring framework to continuously monitor availability of thousands of servers in Internet data centers. We propose a simple yet effective algorithm for locating monitor nodes for the purposes of load balancing and resilience, and demonstrate the performance of this method through simulations based on dataset collected from a large Internet content provider. The results show that the monitoring load are well divided among the servers in the data centers, and cooperative monitoring adapts gracefully to the events of monitoring node failures.
The non-linear pharmacokinetics of prednisone and prednisolone

Intravenous zero order infusions were administered to New Zealand white rabbits. In a pilot study using one rabbit, prednisone and prednisolone clearance values increased with increase in either prednisone or prednisolone infusion rates. In the second study, prednisone was infused until both prednisone and prednisolone achieved steady-state concentrations. In the third study, prednisone was infused until only prednisone achieved steady-state concentrations. The results of the three experiments support the use of a non-linear reversible metabolism model to describe the pharmacokinetic relationship between prednisone and prednisolone.
Socialization and Aging Group Consciousness: The Effect of Neighborhood Age Concentration

In order to test hypotheses regarding effects of age concentration upon socialization and aging group consciousness, 1,185 persons 60 years of age and over living in areas representing low, average, and high concentrations of older persons were interviewed. Results indicated that age concentration was associated with knowledge of services and with age of persons in formal and informal neighborhood networks but was not related to attitude toward older persons in the abstract, to own age identification, to associational preference, or to taking political action. It appears that age concentration influences access to, more than choice of age peers. Both socialization and aging group consciousness are associated with age, health and socioeconomic status. It may be concluded that the ecological variable of age concentration in the range encountered by most older persons has only limited effects.
The Mortimer M. Bortin Lecture: to destroy by the reaction of immunity: the search for separation of graft-versus-leukemia and graft-versus-host.

Abstract The graft-versus-leukemia effect of allogeneic blood or marrow transplantation is a dramatic example of the power of the immune system to eradicate malignant disease. In this personal essay, adapted from the inaugural Mortimer M. Bortin Lecture presented at the 2004 Tandem BMT Meetings, the author recounts early efforts by Bortin and others to manipulate the graft-versus-leukemia effect and separate it from the potentially fatal complications of graft-versus-host disease.
MKP-8: a novel molecular target for neuroblastoma

at 13 days, while not visible by ultrasound until 21 days. Bioluminescent signal intensity at both sites was then found to parallel tumor growth measured by calipers and ultrasound. After intravenous administration of tumor cells, bioluminescent imaging allowed detection of disseminated disease in the liver at 5 days and bone marrow at 9 days. Additional sites of metastasis included lungs, kidneys, and vertebrae. Although gross or microscopic tumor could not be appreciated at these early time points, the presence of tumor was confirmed by RT-PCR. Furthermore, increases in tumor burden at these sites could be monitored and quantified over time in the same animal.
Community-based anomaly detection in evolutionary networks

Networks of dynamic systems, including social networks, the World Wide Web, climate networks, and biological networks, can be highly clustered. Detecting clusters, or communities, in such dynamic networks is an emerging area of research; however, less work has been done in terms of detecting community-based anomalies. While there has been some previous work on detecting anomalies in graph-based data, none of these anomaly detection approaches have considered an important property of evolutionary networks--their community structure. In this work, we present an approach to uncover community-based anomalies in evolutionary networks characterized by overlapping communities. We develop a parameter-free and scalable algorithm using a proposed representative-based technique to detect all six possible types of community-based anomalies: grown, shrunken, merged, split, born, and vanished communities. We detail the underlying theory required to guarantee the correctness of the algorithm. We measure the performance of the community-based anomaly detection algorithm by comparison to a non---representative-based algorithm on synthetic networks, and our experiments on synthetic datasets show that our algorithm achieves a runtime speedup of 11---46 over the baseline algorithm. We have also applied our algorithm to two real-world evolutionary networks, Food Web and Enron Email. Significant and informative community-based anomaly dynamics have been detected in both cases.
Models for network design, servicing and monitoring of ATM networks based on the virtual path concept

Virtual Path (VP) concept has gained attention in terms of effective deployment of ATM networks for wide-area environment. In this paper, we present models and algorithms for network design and management of ATM networks based on virtual path concept from a network planning perspective. Our approach is based on statistical multiplexing of traffic within a traffic class by using a virtual path for the class and deterministic multiplexing of different virtual paths, and on providing dynamic bandwidth and reconfigurability through virtual path concept depending on traffic load during the course of the day. For some realistic example networks, we observe that considering network dynamism through variation of traffic during the course of a day by doing dynamic bandwidth and virtual path reconfiguration can save between 10 to 14% in network design costs compared to a static network based on maximum busy hour traffic.
Pacing interventions for falls and syncope in the elderly

There is a high prevalence of cardiovascular disorders among elderly patients with recurrent falls or syncope, and cardiovascular causes are implicated in a significant proportion of three cases. Common cardiovascular causes of falls and syncope include carotid sinus syndrome, vasovagal episodes, sick sinus syndrome, and atrioventricular block. A comprehensive history and physical examination supplemented by electrocardiographic monitoring, carotid sinus massage, and tilt-table testing in appropriately selected patients form the basis of the diagnostic evaluation to exclude a significant cardiovascular disorder. Patients with documented symptomatic bradycardia often benefit from pacemaker implantation, as evidenced by a reduction in recurrent events and improved quality of life. Although dual-chamber pacemakers, particularly those with rate responsiveness, provide more physiologic pacing than single-chamber ventricular devices, the superiority of dual-chamber pacemakers in reducing major clinical events has not been demonstrated. The efficacy of an aggressive evaluation and patient-management strategy that includes pacemaker implantation for elderly patients with recurrent falls has been validated only by one prospective clinical trial; however, available data are compelling. For a variety of cardiovascular conditions, permanent pacemaker implantation has a demonstrated efficacy to prevent symptoms that arise from transient hypotension and decreased cerebral perfusion. The implication of these data is that many falls may be preventable through permanent pacemaker implantation in appropriately selected patients.
Prevention of Alcohol Misuse: A Review of Health Promotion Efforts Among American Indians

Abstract Purpose. The purpose of this review is to provide an overview of a wide range of potentially useful strategies to address the prevention of alcohol misuse among American Indians. This broad approach to the review is useful because the extreme heterogeneity of the American Indian population requires that health promotion professionals explore many options and tailor their activities to specific communities. Search Method. A literature search was initiated through MEDLINE using the following key words: prevention, alcohol, substance abuse, American Indian, and Native American. The search yielded 29 articles from the years 1982 through 1994. These articles, along with 45 previously identified in three overview articles, form the basis of the review and discussion in this paper. Summary of findings. As a group, American Indians experience many health problems that are related to alcohol misuse. Comparison of Indians to non-Indians shows that the age of first involvement with alcohol is younger, the f...
A dicentric Robertsonian translocation in a Holstein cow

A new dicentric Robertsonian translocation is described in a Holstein cow. The translocation appears to have arisen spontaneously from the centric fusion of autosomal acro centrics 14 and 28 which resulted in a diploid chromosome number of 59. Behavioral and phenotypic anomalies of the affected cow are discussed.
Multicentric chordoma: a case report and review of the literature.

BACKGROUND AND IMPORTANCE Chordomas are relatively rare tumors that arise from the neuraxis. Most often, chordomas are single lesions that metastasize late. There have been very few cases of chordomas arising from multiple foci along the neuraxis. Here, we present a case of a multicentric chordoma. CLINICAL PRESENTATION The patient presented with pain in her right neck and soreness in her right shoulder that she had experienced for about 2.5 years that she attributed to a muscle strain. She experienced worsening of her symptoms, which prompted her to seek medical care. The patient underwent an occiput-to-C6 posterolateral fusion with autograft and an occiput-to-C6 posterior segmental instrumentation, along with decompression of the spinal cord. One month after the initial surgery, the patient underwent a second surgery. The C2 and C3 vertebral bodies were completely resected, and a C1-C4 anterior fusion was then carried out. A C5 vertebrectomy and C4-C6 fusion were also performed at this time. The patient then received proton beam radiation to the entire affected area. CONCLUSION Recent studies have suggested that chordomas arise from benign notochordal tumors. We suggest that our patient suffered from multicentric chordomas with possible benign notochordal tumors. Although benign notochordal tumors do not require surgical resection, the possibility of transformation to a malignant lesion requires close follow-up.
Larval Hemolymph Protein Patterns in Tobacco Hornworms Parasitized by Apanteles congregatus

Quantitative changes in hemolymph proteins from each physiological phase of the last 3 larval instars of the tobacco hornworm, Manduca sexta (L.), parasitized by the gregarious parasitoid, Apanteles congregatus (Say), were studied by means of acrylamide gel electrophoresis. Six of the 10 observed anodical migrating protein bands occurred in all phases and instars. Total protein concentration was lowest in phase I of the 3rd and 4th instars and increased to a maximum in phase IV. Total protein also was low in phase I, 5th instar; however, levels increased only in phase II, then decreased in phases III and IV. Concentrations of mucoproteins, polysaccharides and phospholipids, associated with certain bands, were much reduced in parasitized larvae. Sterol-protein complexes were found in the hemolymph of certain aged unparasitized larvae but not in parasitized larvae. Gas chromatographic analysis demonstrated reduction of hemolymph sterols by at least a factor of 103 in parasitized larvae.
The effect of acetylcholine on single embryonic chick ventricle cells.

SummaryThe effect of acetylcholine on the beating rate of single chick embryo heart cells cultured from 8 to 10 day ventricles was determined using a new television monitor optical system. Acetylcholine had a clear negative chronotropic effect on these cells, with a threshold at 10-8-10-7 g/ml. The slowing in beating rate after the addition of acetylcholine was reversible, and was not associated with any detectable change in the inotropic state of the cells. These findings are consistent with the effect of acetylcholine on non-cultural chick embryo ventricular tissue of the same age.
Convolutional sparse representation of color images

Convolutional sparse representations differ from the standard form of sparse representations in their composition from coefficient maps convolved with dictionary filters instead of linear combinations of dictionary vectors. When applied to images, the standard form is usually independently computed over a set of overlapping image patches. The advantage of the convolutional form is that it provides a single-valued representation optimized over an entire signal, but this comes at a substantial computational cost. A recent algorithm for sparse coding via a convolutional form of Basis Pursuit DeNoising, however, has substantially reduced the computational cost of computing these representations. The present paper extends this algorithm to multi-channel signals such as color images, which has not previously been reported in the literature.
Gangrenous cholecystitis in the decade before and after the introduction of laparoscopic cholecystectomy.

BACKGROUND Gangrenous cholecystitis is a severe form of acute cholecystitis with high morbidity. This study investigate the outcomes for patients undergoing cholecystectomy for gangrenous cholecystitis in the decade before and after the introduction of laparoscopic technology at our institution. METHODS From 1982 to 2002, all patients undergoing cholecystectomy for gangrenous cholecystitis were prospectively entered into a database. Demographic data, method of surgery, and outcome variables were assessed and compared over time. RESULTS Cholecystectomy was performed to treat gangrenous cholecystitis in 238 patients (mean age, 54 years). From 1982 to 1992, 98 patients underwent cholecystectomy for gangrenous cholecystitis, and from 1992 to 2002, 140 patients underwent the procedure. Ninety-seven patients underwent laparoscopic cholecystectomy, and 33 patients (34%) required conversion. The open and laparoscopic cholecystectomy group differed in the number of intensive care unit admissions (13% vs. 5%, P < 0.05), overall length of hospital stay (10 vs. 5.7 days, P < 0.001) and rate of intraabdominal abscesses (8% vs. 0.7%). CONCLUSION Gangrenous cholecystitis remains a disease with high morbidity. Laparoscopic cholecystectomy shortened hospital stay and can be offered without increasing morbidity. Methods to decrease intraabdominal abscess formation in patients undergoing laparoscopic cholecystectomy for gangrenous cholecystitis are needed.
Early Rehabilitation in the Medical and Surgical Intensive Care Units for Patients With and Without Mechanical Ventilation: An Interprofessional Performance Improvement Project

Abstract Background Most early mobility studies focus on patients on mechanical ventilation and the role of physical and occupational therapy. This Performance Improvement Project (PIP) project examined early mobility and increased intensity of therapy services on patients in the intensive care unit (ICU) with and without mechanical ventilation. In addition, speech-language pathology rehabilitation was added to the early mobilization program. Objective We sought to assess the efficacy of early mobilization of patients with and without mechanical ventilation in the ICU on length of stay (LOS) and patient outcomes and to determine the financial viability of the program. Design PIP. Prospective data collection in 2014 (PIP) compared with a historical patient population in 2012 (pre-PIP). Setting Medical and surgical ICUs of a Level 2 trauma hospital. Patients There were 160 patients in the PIP and 123 in the pre-PIP. Interventions Interprofessional training to improve collaboration and increase intensity of rehabilitation therapy services in the medical and surgical intensive care units for medically appropriate patients. Measurements Demographics; intensity of service; ICU and hospital LOS; medications; pain; discharge disposition; functional mobility; and average cost per day were examined. Main Results Rehabilitation therapy services increased from 2012 to 2014 by approximately 60 minutes per patient. The average ICU LOS decreased by almost 20% from 4.6 days (pre-PIP) to 3.7 days (PIP) ( P = .05). A decrease of over 40% was observed in the floor bed average LOS from 6.0 days (pre-PIP) to 3.4 days (PIP) ( P P Conclusions The results of the PIP indicate that enhanced rehabilitation services in the ICU is clinically feasible, results in improved patient outcomes, and is fiscally sound. Most early mobility studies focus on patients on mechanical ventilation. The results of this PIP project demonstrate that there are significant benefits to early mobility and increased intensity of therapy services on ICU patients with and without mechanical ventilation. Benefits include reduced hospitalization LOS, decreased health care costs, and decreased need for postacute care services. Level of Evidence III
The Royal Playground (1866–1870)

The southern shores of the Caspian had figured prominently in the development of the Qajar political identity and power. The Qajar rose from Mazandaran and Astarabad eventually to rule all of Persia. Many of the princes also cut their teeth in the art of state administration while on assignment at various governorships in this region. This might explain in part the love that Naser ed-Din Shah (1848–1896) had for the Caspian coast. But, much of his attraction to the North was owed to his own appreciation of the outdoors, the wildlife,1 and his keen sense of curiosity about the world that could be satisfied only by travel and observation.
Some open problems on locally finite or locally nilpotent derivations and ℰ-derivations

Let R be a commutative ring and &#x1d49c; an R-algebra. An R-ℰ-derivation of &#x1d49c; is an R-linear map of the form I − ϕ for some R-algebra endomorphism ϕ of &#x1d49c;, where I denotes the identity map of &#x1d49c;. In this paper, we discuss some open problems on whether or not the image of a locally finite (LF) R-derivation or R-ℰ-derivation of &#x1d49c; is a Mathieu subspace [W. Zhao, Generalizations of the image conjecture and the Mathieu conjecture, J. Pure Appl. Algebra 214 (2010) 1200–1216; Mathieu subspaces of associative algebras, J. Algebra 350(2) (2012) 245–272] of &#x1d49c;, and whether or not a locally nilpotent (LN) R-derivation or R-ℰ-derivation of &#x1d49c; maps every ideal of &#x1d49c; to a Mathieu subspace of &#x1d49c;. We propose and discuss two conjectures which state that both questions above have positive answers if the base ring R is a field of characteristic zero. We give some examples to show the necessity of the conditions of the two conjectures, and discuss some positive cases known in the literature. We also show some cases of the two conjectures. In particular, both the conjectures are proved for LF or LN algebraic derivations and R-ℰ-derivations of integral domains of characteristic zero.
Differential effects of air conditioning type on residential endotoxin levels in a semi‐arid climate

Residential endotoxin exposure is associated with protective and pathogenic health outcomes. Evaporative coolers, an energy-efficient type of air conditioner used in dry climates, are a potential source of indoor endotoxins; however, this association is largely unstudied. We collected settled dust biannually from four locations in homes with evaporative coolers (n=18) and central air conditioners (n=22) in Utah County, Utah (USA), during winter (Jan-Apr) and summer (Aug-Sept), 2014. Dust samples (n=281) were analyzed by the Limulus amebocyte lysate test. Housing factors were measured by survey, and indoor temperature and relative humidity measures were collected during both seasons. Endotoxin concentrations (EU/mg) were significantly higher in homes with evaporative coolers from mattress and bedroom floor samples during both seasons. Endotoxin surface loads (EU/m2 ) were significantly higher in homes with evaporative coolers from mattress and bedroom floor samples during both seasons and in upholstered furniture during winter. For the nine significant season-by-location comparisons, EU/mg and EU/m2 were approximately three to six times greater in homes using evaporative coolers. A plausible explanation for these findings is that evaporative coolers serve as a reservoir and distribution system for Gram-negative bacteria or their cell wall components in homes.
Proximal Subungual Onychomycosis

PSO can be caused by dermatophytes, non-dermatophytic molds, and Candida spp. PSO due to dermatophytes is rare. Most often seen in immunocompromised patients (e.g., AIDS, diabetes, transplant recipients). T. rubrum is the most common cause of infection. Infection starts at the proximal nail and progresses distally.
Validation of GEMCaP as a DNA Based Biomarker to Predict Prostate Cancer Recurrence after Radical Prostatectomy

Purpose: We aimed to validate GEMCaP (Genomic Evaluators of Metastatic Cancer of the Prostate) as a novel copy number signature predictive of prostate cancer recurrence.Materials and Methods: We randomly selected patients who underwent radical prostatectomy at Cleveland Clinic or University of Rochester from 2000 to 2005. DNA isolated from the cancer region was extracted and subjected to high resolution array comparative genomic hybridization. A high GEMCaP score was defined as 20% or greater of genomic loci showing copy number gain or loss in a given tumor. Cox regression was used to evaluate associations between the GEMCaP score and the risk of biochemical recurrence.Results: We report results in 140 patients. Overall 38% of patients experienced recurrence with a median time to recurrence of 45 months. Based on the CAPRA-S (Cancer of the Prostate Risk Assessment Post-Surgical) score 39% of the patients were at low risk, 42% were at intermediate risk and 19% were at high risk. The GEMCaP score was high (...
The Role of Nutrition in Wound Healing

It is generally recognized that a relationship exists between wound healing and the nutritional status of the patient, and it has been appreciated by surgeons for centuries that wound healing is impaired in patients with obvious malnutrition. Moreover, it was demonstrated more than 200 years ago that the wounds and poor wound healing associated with scurvy could be obviated or treated by the prevention or correction of a nutritional deficiency. Subsequently, knowledge of the mechanisms by which specific nutrient substrates and metabolites influence wound healing has ranged from virtually no data regarding some nutrients to a fairly well defined comprehension of the basic roles and kinetics of others. However, from a practical standpoint, clinicians in the industrialized nations such as the United States have the capability of rehabilitating depleted patients nutritionally by various means so that only rarely should nutritional deficiencies preclude major operations or give rise to serious wound complications. Indeed, ever since proteins were first discovered, it has been obvious clinically that normal protein metabolism and nutrition are essential for optimal wound healing.1 Moreover, the wound healing process is better understood today to a large extent because of the extraordinary advances made in surgical nutrition in the second half of this century as a result of extensive investigations in basic and clinical nutrition. However, our knowledge concerning the wound healing mechanism in humans is still incomplete, primarily because of the difficulties inherent in designing and carrying out prospective, randomized, double-blind studies in this area either in patients or volunteer subjects. On the other hand, much valuable information has been accrued from wound healing experiments in animals and from empiric observations of human wound healing after surgery or trauma.
Stimulation of Hepatic Purine Biosynthesis by Orotic Acid

The role of erotic acid as a precursor in the biosynthesis of pyrimidine nucleotides is well established (2). However, little is known about the mechanism by which erotic acid produces a grossly fatty liver in rats when it is fed as 1% of their diet (3). Livers from erotic acid-fed rats contain high levels of triglycerides (4)) cholesterol (5), and acid-soluble uridine nucleotides but depressed levels of adenine and pyridine nucleotides (6). Furthermore, in such livers there is an inhibition of pyridine nucleotide synthesis (7, 8), cholesterol biosynthesis (5), and lipoprotein secretion (9, lo), the latter being an apparent cause of hepatic fat accumulation. These effects can be prevented or rapidly reversed by addition of a small amount of adenine to the diet (8, 10-12). A deficiency of hepatic adenine nucleotides may be a primary factor in the chain of erotic acid-induced effects. Several compounds which depress hepatic adenine nucleotide concentrations, such as ethionine (13), 4-aminopyrazolopyrimidine (14), and others (15), produce changes in liver similar to those produced by erotic acid. It is not known why erotic acid feeding depresses the concentration of adenine nucleotides. The suggestion has been made (6, 7) that because large amounts of PPribose-P are utilized for conversion of erotic acid to uridine 5’-phosphate, other PP-ribose-P-requiring biosynthetic reactions, including purine biosynthesis, may be inhibited. Therefore, it was of interest to determine the rate of purine biosynthesis in livers of erotic acid-fed rats. To this end, incorporation in viva of formate-14C and of glycine-2-14C into liver purines was determined. Incorporation into liver protein and lipid was also measured, primarily to detect any erotic acid-induced changes in the endogenous hepatic pools of formate and glycine. It was found that erotic acid, rather than being inhibitory, stimulated incorporation of 14C into acid-soluble as well as into nucleic acid purines. Furthermore, this effect of erotic acid was completely nullified by the addition of small amounts of adenine to the diet.
Altered brainstem responses to modafinil in schizophrenia: Implications for adjunctive treatment of cognition

Candidate pro-cognitive drugs for schizophrenia targeting several neurochemical systems have consistently failed to demonstrate robust efficacy. It remains untested whether concurrent antipsychotic medications exert pharmacodynamic interactions that mitigate pro-cognitive action in patients. We used functional MRI (fMRI) in a randomized, double-blind, placebo-controlled within-subject crossover test of single-dose modafinil effects in 27 medicated schizophrenia patients, interrogating brainstem regions where catecholamine systems arise to innervate the cortex, to link cellular and systems-level models of cognitive control. Modafinil effects were evaluated both within this patient group and compared to a healthy subject group. Modafinil modulated activity in the locus coeruleus (LC) and ventral tegmental area (VTA) in the patient group. However, compared to the healthy comparison group, these effects were altered as a function of task demands: the control-independent drug effect on deactivation was relatively attenuated (shallower) in the LC and exaggerated (deeper) in the VTA; in contrast, again compared to the comparison group, the control-related drug effects on positive activation were attenuated in LC, VTA and the cortical cognitive control network. These altered effects in the LC and VTA were significantly and specifically associated with the degree of antagonism of alpha-2 adrenergic and dopamine-2 receptors, respectively, by concurrently prescribed antipsychotics. These sources of evidence suggest interacting effects on catecholamine neurons of chronic antipsychotic treatment, which respectively increase and decrease sustained neuronal activity in LC and VTA. This is the first direct evidence in a clinical population to suggest that antipsychotic medications alter catecholamine neuronal activity to mitigate pro-cognitive drug action on cortical circuits.
EUGLYCEMIC DIABETIC KETOACIDOSIS WITH SGLT2 INHIBITOR USE IN A PATIENT ON THE ATKINS DIET: A UNIQUE PRESENTATION OF A KNOWN SIDE EFFECT

ABSTRACT Objective: Euglycemic diabetic ketoacidosis (DKA) is a known potential complication from sodium-glucose cotransporter 2 (SGLT2) inhibitor use. We present a unique case presentation of a 44-year-old, male patient on an SGLT2 inhibitor who developed euglycemic DKA while following a carbohydrate-restricted diet, the Atkins diet. Methods: The patient was on sitagliptin and metformin after a hemoglobin A1c result of 9.3% (78 mmol/mol). Motivated to obtain better glycemic control and weight loss, he started on the Atkins diet, but stayed in the carbohydrate-restricted first phase of the diet. Canagliflozin was added to his regimen 1 month later. Three to four days after starting on the medication, he developed severe abdominal pain. Results: The patient was found to have anion gap metabolic acidosis with an elevated beta-hydroxybutyrate level of 75.50 mg/dL (the reference range is 0.20 to 2.80 mg/dL) and a blood glucose value of 180 mg/dL. Conclusion: The low-carbohydrate diet likely predisposed our pa...
Caspase Inhibition During Cold Storage Improves Graft Function and Histology in a Murine Kidney Transplant Model.

Background Prolonged cold ischemia is a risk factor for delayed graft function of kidney transplants, and is associated with caspase-3-mediated apoptotic tubular cell death. We hypothesized that treatment of tubular cells and donor kidneys during cold storage with a caspase inhibitor before transplant would reduce tubular cell apoptosis and improve kidney function after transplant. Methods Mouse tubular cells were incubated with either dimethyl sulfoxide (DMSO) or Q-VD-OPh during cold storage in saline followed by rewarming in normal media. For in vivo studies, donor kidneys from C57BL/6 mice were perfused with cold saline, DMSO (vehicle), or QVD-OPh. Donor kidneys were then recovered, stored at 4°C for 60 minutes, and transplanted into syngeneic C57BL/6 recipients. Results Tubular cells treated with a caspase inhibitor had significantly reduced capsase-3 protein expression, caspase-3 activity, and apoptotic cell death compared with saline or DMSO (vehicle) in a dose-dependent manner. Treatment of donor kidneys with a caspase inhibitor significantly reduced serum creatinine and resulted in significantly less tubular cell apoptosis, BBI, tubular injury, cast formation, and tubule lumen dilation compared with DMSO and saline-treated kidneys. Conclusions Caspase inhibition resulted in decreased tubular cell apoptosis and improved renal function after transplantation. Caspase inhibition may be a useful strategy to prevent cold ischemic injury of donor renal grafts.
Treating bugs as allergies: a safe method for surviving software failures

Many applications demand availability. Unfortunately, software failures greatly reduce system availability. Previous approaches for surviving software failures suffer from several limitations, including requiring application restructuring, failing to address deterministic software bugs, unsafely speculating on program execution, and requiring a long recovery time. This paper proposes an innovative, safe technique, called Rx, that can quickly recover programs from many types of common software bugs, both deterministic and non-deterministic. Our idea, inspired by allergy treatment in real life, is to rollback the program to a recent checkpoint upon a software failure, and then to reexecute the program in a modified environment. We base this idea on the observation that many bugs are correlated with the execution environment, and therefore can be avoided by removing the "allergen" from the environment. Rx requires few to no modifications to applications and provides programmers with additional feedback for bug diagnosis.
Baylor's contribution to thoracic surgery and cardiac stem cell therapy for heart failure

In honor of Ronald C. Jones, MD, I offer some thoughts on leadership and review Bay lor University Medical Center (BUMC) surgeons' contributions in thoracic surgery and cardiac stem cell therapy for heart failure. First, I must comment: Ron Jones pretended to be from the backwoods of the Ozarks, but he was really a “city slicker” from Harrison, Arkansas (population 12,000) (Figure ​(Figure1a1a) (1). I was the real hillbilly from Rush Creek, Arkansas, on the Buffalo River 52 miles from an indoor toilet (Figure ​(Figure1b1b). Figure 1 Two boys from Arkansas: (a) Dr. Ron Jones at age 8; (b) Dr. Hal Urschel at age 6.
Autofocals: gaze-contingent eyeglasses for presbyopes

Presbyopia, the loss of accommodation due to the stiffening of the crystalline lens, affects nearly 20% of the population worldwide. Traditional forms of presbyopia correction use fixed focal elements that inherently trade off field of view or stereo vision for a greater range of distances at which the wearer can see clearly. However, none of these offer the same natural refocusing enjoyed in youth. In this work, we built a new presbyopia correction, dubbed Autofocals, which externally mimics the natural accommodation response by combining data from eye trackers and a depth sensor, and then automatically drives focus-tunable lenses. In our testing, wearers generally reported that the Autofocals compare favorably with their own current corrective eyewear.
A Significant Proportion of Small Bowel Obstructions Require >48 Hours to Resolve After Gastrografin.

Abstract Background Gastrografin (GG)-based nonoperative approach is both diagnostic and therapeutic for partial small bowel obstruction (SBO). Absence of X-ray evidence of GG in the colon after 8 h is predictive of the need for operation, and a recent trial used 48 h to prompt operation. We hypothesize that a significant number of patients receiving the GG challenge require >48 h before an effect is seen. Methods A post hoc analysis of an Eastern Association for the Surgery of Trauma multi-institutional SBO database was performed including only those receiving GG challenge. Successful nonoperative management (NOM) was defined as passage of flatus or nasogastric tube (NGT) removal. NOM was considered a failure if operative intervention was required. Multiple logistic regression was performed to identify predictors of delayed (>48 h) GG challenge effect and expressed as odds ratios with 95% confidence intervals. Results Of 286 patients receiving GG, 208 patients (73%) were successfully managed nonoperatively. A total of 60 (29%) NOM patients had NGT decompression for >48 h (n = 54) or required >48 h to pass flatus (n = 34), with some requiring both (n = 28). Prior abdominal operations and SBO admission were protective of delayed GG effect (0.411 [0.169-1.00], P Conclusions A significant proportion of patients at 48 h (29%) “failed” the GG challenge as they had yet to pass flatus or still required NGT but were nonetheless successfully managed nonoperatively. Extending the GG challenge beyond 48 h may help avoid unnecessary operations. Level of evidence Level II.
100 Years of Progress in Understanding the General Circulation of the Atmosphere

AbstractSome of the advances of the past century in our understanding of the general circulation of the atmosphere are described, starting with a brief summary of some of the key developments from ...
A Study of the Effects of Certificate of Need Law on Inpatient Occupancy Rates

Increasing healthcare costs and the deterioration of healthcare quality have always been major concerns to policy makers in the United States, and Certificate of Need (CON) law has been implemented...
SENIOR INVESTIGATOR WORKSHOP: Session 404

Abstract The Research Committee will organize this workshop in collaboration with program officers from the NIMH and NIA, who will serve as presenters. All independent researchers and interested research trainees are invited to participate.
Effectiveness of Reflection on Programming Problem Solving Self-Assessments

This Research Work in Progress Paper presents our ongoing work to encourage student to reflect while participating in a distributed self-assessment process. We shed light on the case of low reflect participation and the change in process we made that led to a significant increase in both the quantity and quality of students reflects. To evaluate the effect of the intervention, we conducted two classroom study for an introductory Java course with over 500 students. From the latest enhancements in the current study, we observed that the overall reflecting engagement from the students has significantly increased compared to our initial work. To evaluate the reflects quality, we deployed an automated measure that classifies the constructiveness of the comment based on its relevant and subjectivity to the domain. This work describes the details of the interventions along with the resulted observations. The main objective was to encourage learners to provide thoughtful reflects which we were able to increase along with the positive effect on their performance.
The lysosomal GPCR-like protein GPR137B regulates Rag and mTORC1 localization and activity

Cell growth is controlled by a lysosomal signalling complex containing Rag small GTPases and mammalian target of rapamycin complex 1 (mTORC1) kinase. Here, we carried out a microscopy-based genome-wide human short interfering RNA screen and discovered a lysosome-localized G protein-coupled receptor (GPCR)-like protein, GPR137B, that interacts with Rag GTPases, increases Rag localization and activity, and thereby regulates mTORC1 translocation and activity. High GPR137B expression can recruit and activate mTORC1 in the absence of amino acids. Furthermore, GPR137B also regulates the dissociation of activated Rag from lysosomes, suggesting that GPR137B controls a cycle of Rag activation and dissociation from lysosomes. GPR137B-knockout cells exhibited defective autophagy and an expanded lysosome compartment, similar to Rag-knockout cells. Like zebrafish RagA mutants, GPR137B-mutant zebrafish had upregulated TFEB target gene expression and an expanded lysosome compartment in microglia. Thus, GPR137B is a GPCR-like lysosomal regulatory protein that controls dynamic Rag and mTORC1 localization and activity as well as lysosome morphology.
Ignorance Isn't Bliss: Retaining a Meaningful Comprehension Requirement for Consent to Research.

In their summary of an impressive program of research on consent to biobanking studies, Beskow and Weinfurt (2019) adumbrate a key dilemma in research ethics: Informed consent to research would see...
Bidirectional roles of Dhh1 in regulating autophagy

Macroautophagy/autophagy activity is carefully modulated to allow cells to adapt to changing environmental conditions and maintain energy homeostasis. This control notably occurs in part through the regulation of autophagy-related (ATG) gene expression. Others and we have jointly shown that under nutrient-rich conditions Dhh1 mediates the degradation of certain ATG mRNAs, most significantly that of ATG8, through a Dcp2-dependent decapping pathway to maintain gene expression and autophagy activity at a basal level. More recently, we illustrated that under nitrogen-starvation conditions Dhh1 switches its role to become a positive regulator of autophagy, and promotes the translation of ATG1 and ATG13 mRNAs to meet the increased demand for autophagy activity. This regulation helps selected ATG mRNAs to escape the general repression in translation that occurs when nutrients are limited and TOR is inhibited. Our studies also suggest that Dhh1's nutrient-dependent bidirectional regulation of auto-phagy is conserved in more complex eukaryotes. Abbreviations: ATG: autophagy related; EIF4EBP: EIF4E binding protein; UTR: untranslated region.
lncRNA FAM99A is downregulated in preeclampsia and exerts a regulatory effect on trophoblast cell invasion, migration and apoptosis

Preeclampsia (PE) is a complication of pregnancy, and a leading cause of maternal mortality and morbidity worldwide. Recently, the dysregulation of long non‑coding RNAs (lncRNAs) has been reported to contribute to the pathogenesis and progression of PE. This study aimed to examine the alterations in the lncRNA family with sequence similarity 99 member A (FAM99A) in PE and its effects on trophoblasts. The results of reverse transcription‑quantitative PCR indicated that the expression levels of FAM99A were downregulated in placental tissues from women with severe PE compared with in those from controls. A Transwell invasion assay and wound healing assay revealed that overexpression of FAM99A promoted invasion and migration of HTR‑8/SVneo cells; conversely, knockdown of FAM99A suppressed the invasive and migratory abilities of HTR‑8/SVneo cells. Flow cytometry demonstrated that FAM99A overexpression induced a decrease in the apoptotic rate of cells, whereas knockdown of FAM99A increased the apoptotic rate of HTR‑8/SVneo cells. Western blot analysis revealed that overexpression of FAM99A decreased the protein expression levels of cleaved caspase‑3, cleaved caspase‑9 and Bax, and increased Bcl‑2 protein expression, whereas knockdown of FAM99A had the opposite effects on these protein levels. Overexpression of FAM99A also decreased caspase‑3 activity in HTR‑8/SVneo cells; however, knockdown of FAM99A increased caspase‑3 activity. In addition, overexpression of FAM99A enhanced Wnt/β‑catenin signaling activity, whereas FAM99A knockdown exerted an inhibitory effect on the Wnt/β‑catenin signaling activity in HTR‑8/SVneo cells. In conclusion, these results indicated that FAM99A may serve a role in modulating the functions of trophoblasts, partially via targeting Wnt/β‑catenin signaling.
Impact of Educational Technology-Based Learning Environment on Students' Achievement Goals, Motivational Constructs, and Engagement

Passive learning environment to teach programming concepts, especially in large lecture classes hinders students' motivation, performance and may adversely affect their achievement goals. The study presents the use of two instructional strategies teamwork and reflective thinking using educational technologies introduced in a class of 120 first year engineering students. This study also presents the impact of educational technologies based learning environment on students' motivation, achievement goals, and engagement
A Study Comparing the Effects of Targeted Intra-Arterial and Systemic Chemotherapy in an Orthotopic Mouse Model of Pancreatic Cancer

Systemic chemotherapy is the first line treatment for patients with unresectable pancreatic cancer, however, insufficient drug delivery to the pancreas is a major problem resulting in poor outcomes. We evaluated the therapeutic effects of targeted intra-arterial (IA) delivery of gemcitabine directly into the pancreas in an orthotopic mouse model of pancreatic cancer. Nude mice with orthotopic pancreatic tumors were randomly assigned into 3 groups receiving gemcitabine: systemic intravenous (IV) injection (low: 0.3 mg/kg and high: 100 mg/kg) and direct IA injection (0.3 mg/kg). Treatments were administered weekly for 2 weeks. IA treatment resulted in a significantly greater reduction in tumor growth compared to low IV treatment. To achieve a comparable reduction in tumor growth as seen with IA treatment, gemcitabine had to be given IV at over 300x the dose (high IV treatment) which was associated with some toxicity. After 2 weeks, tumor samples from animals treated with IA gemcitabine had significantly lower residual cancer cells, higher cellular necrosis and evidence of increased apoptosis when compared to animals treated with low IV gemcitabine. Our study shows targeted IA injection of gemcitabine directly into the pancreas, via its arterial blood supply, has a superior therapeutic effect in reducing tumor growth compared to the same concentration administered by conventional systemic injection.
A Risk Retirement Pathway for Potential Effects of Underwater Noise and Electromagnetic Fields for Marine Renewable Energy

Commercial marine renewable energy (MRE) developments can take extended periods of time to progress, in part due to complicated permitting processes that require expensive data collection and data review. Much of this delay is associated with uncertainty around potential effects of MRE on marine animals and habitats, leading regulators and stakeholders to believe that significant risks may exist. This paper acknowledges the state of scientific knowledge around MRE environmental effects and puts forward a process for risk retirement associated with early MRE developments, with a focus on the potential effects from underwater noise from wave and tidal devices, as well as potential effects of electromagnetic fields (EMF) from export power cables on marine animals and habitats. This process was developed as part of the Ocean Energy Systems (OES) OES-Environmental task.
Unusual occurrences of fishes in the Southern California Current System during the warm water period of 2014–2018

Abstract An unusually long period of warm-water temperatures occurred off southern California (USA) in 2014–2018, and the highest sea-surface temperature ever recorded in a 103-year span of continuous data collection occurred in August 2018. Poleward distributional shifts in the geographic range of hundreds of marine organisms worldwide have been documented during or just after this and similar anomalously warm periods. We report on the unusual occurrences of 36 fish species (most initially reported by citizen scientists) recorded from the Southern California Current System (SCCS) during this recent period. In combination with previous literature, a remarkable 14 species are reported in the SCCS for the first time. The number of species and families represented is comparable to the number recorded during the 1997–1998 El Nino, widely regarded as the most impactful warming event for this area in the past century.