cssi/SciSciGPT-SciSciNet huggingface dataset:
New Paradigms in Hypertrophic Cardiomyopathy: Insights from Genetics

Abstract Understanding the genetic basis of hypertrophic cardiomyopathy (HCM) provides a remarkable opportunity to predict and prevent disease. HCM is caused by mutations in sarcomere genes and is the most common monogenic cardiovascular disorder. Although unexplained left ventricular hypertrophy (LVH) is considered diagnostic, LVH is not always present. LV wall thickness is often normal until adolescence or later, even in individuals known to carry pathogenic sarcomere mutations. In contrast, genetic testing can identify both individuals who carry pathogenic sarcomere mutations and have a clinical diagnosis of HCM, as well as mutation carriers who have not yet manifested LVH but are very likely to develop disease. Studying this important new patient subset, designated early or preclinical HCM, allows characterization of the initial consequences of sarcomere mutations, prior to the onset of overt hypertrophic remodeling. Such study has defined novel early phenotypes, including impaired left ventricular relaxation, myocardial energetic deficiencies, and altered collagen metabolism, in mutation carriers with apparently normal cardiac morphology. These results indicate that sarcomere mutations have substantial impact on myocardial function and biochemistry before the onset of frank hypertrophy. Furthermore, animal models of preclinical HCM have identified promising new treatment strategies that may diminish the emergence of overt disease. We can now begin to reshape the paradigm for treating genetic disorders. With improved mechanistic insight and the capability for early diagnosis, genetic advances can lead to new approaches for disease modification and prevention.
Students that Benefit from Educational 3D Games

We describe an educational 3D game called Rashi Game. Rashi Game features a fully functional, and open-ended, 3D environment for students backed by a domain-independent inquiry-learning tutor. We present pilot work that directly compares Rashi's classic 2D interface against the 3D game environment. We compare both the student's work within the system, as well as their reported sense of presence. Specifically, we notice some interesting patterns in student behavior within the game, dependent on the student's preference for games, and argue that there may be potential for modeling when and how to present a student with an educational game based on simple factors such as whether or not the student plays games regularly, or based on student affect (e.g. a lack of motivation).
Crystal and Molecular Structures of ( E )-(2-Phenylethenyl)cyclooctatetraene and ( E )-(2-(4-Nitrophenyl)ethenyl)cyclooctatetraene. Conformations of Substituted Cyclooctatetraenes

The single crystal x-ray structures of (E)-(2-arylethenyl)cyclooctatetraenes 1 and 2 have been determined. The nitro group in 2 does not influence the geometry of the COT ring relative to that of 1. The influence of various substituents on several structural parameters of the COT ring are analyzed in terms of steric/electrostatic and electronegativity effects of the substituent.
Study of Crystallization of Glass Coatings on Metal by Electron Microscopy

Controlled growth of crystals and immiscible phases in glass coatings on steel increased their resistance to mechanical and thermal shock. The electron microscope was used to follow crystal and immiscible phase development during heat treatment and to study the effect of crystals on fracture propagation in several complex glass compositions applied to metals by standard enameling techniques. Initial firing temperature, heating rates, heat treatment, and other enamel processes were found to affect the nature of the phases developed in the coatings. Crystals and immiscible phases caused fracture paths to be disrupted, resulting in nonconchoidal types of failure. A correlation is made between resistance to thermal shock and fracture properties.
Electrochemical Synthesis of Perfluorinated Ion Doped Conducting Polyaniline Films Consisting of Helical Fibers and their Reversible Switching between Superhydrophobicity and Superhydrophilicity

Superhydrophobic conducting polyaniline (PAni) films were electrochemically deposited in acetonitrile-H 2 O electrolyte containing aniline monomer and perfluorooctanesulfonic (PFOS) acid. The films exhibited an extended network structure composed of helical PAni sub-micron fibers. The helical fibrous structure is thought to form through a supermolecular templating process. The surface of the PFOS-doped PAni films showed a water contact angle of 153°. Reducing the PFOS-doped PAni (in emeraldine salt form) by negative potential led to de-doped PAni films (in leucoemeraldine base form) which were superhydrophilic (water contact angle close to 0°). By controlling the electrical potential, PAni films were changed between the doped state and de-doped state, resulting in reversibly switchable superhydrophobic and superhydrophilic surfaces.
Review; Immune Status: Normal Expression of MHC Class I in the Placenta and What Is Expected in Clones

Major histocompatibility complex (MHC) class I genes are highly polymorphic, widely expressed genes that play a vital role in immune responses. Because of their involvement in tissue transplant rejection there has been much interest in their expression during pregnancy. This review examines the evidence for their role in livestock reproduction, and speculates that the process of creating clones may modify their expression with deleterious results.
Ventilatory response to rowing and cycling in elite oarswomen

Rowing is a unique exercise for humans, and the imposed biomechanical motion may alter both respiratory mechanics and timing. To investigate the ventilatory patterns of competitive rowers while row...
ANP receptors in neurons and astrocytes from spontaneously hypertensive rat brain

In this study we compared the levels and responsiveness of atrial natriuretic peptide (ANP) receptors in neuronal and astrocyte glial cultures from spontaneously hypertensive (SH) and normotensive (Wistar-Kyoto: WKY) rat brain. Both neuronal and astrocyte glial cultures from the hypothalamus and brain stem of 1-day-old SH and WKY rats display specific high-affinity binding sites for 125I-labeled ANP. The presence of a large population of ANP-C receptors in each type of culture is indicated by the strong competition of 125I-ANP binding by the ring-deleted analogue of ANP [C-ANF-(4-23)]. In neuronal cultures from both strains, C-type natriuretic peptide (CNP-22) was the most effective natriuretic peptide in stimulating guanosine 3',5'-cyclic monophosphate (cGMP) levels, suggesting the presence of ANP-B receptors in these cells. By contrast, ANP was the most effective stimulator of cGMP levels in SH and WKY rat astrocyte glial cultures, suggesting the presence of ANP-A receptors. Here, we have determined that there is a decrease in the maximum binding capacity for 125I-ANP-specific binding in both SH rat neuronal and astrocyte glial cultures compared with their respective control cells. The stimulatory effects of CNP-22 on cGMP levels in SH rat neurons and of ANP on cGMP levels in SH rat astrocytes were significantly reduced compared with their respective WKY rat cultures. Our data suggest that the lower number of ANP receptors in SH rat neuronal and astrocyte glial cultures includes a reduction in the guanylate cyclase-coupled ANP receptors.
Improving methods of chordal-sparing mitral valve replacement--Part II: Optimal tension for chordal resuspension.

BACKGROUND AND AIMS OF THE STUDY: Although chordal-sparing mitral valve replacement (MVR) is popular, the optimal tension for preserved or reattached chordae tendineae (CT) or for synthetic (ePTFE) CT is unknown. METHODS: Changes in left ventricular (LV) systolic and diastolic function in nine dogs with anterior CT preservation with different levels of end-diastolic chordal tension (0, 10, 20, 30, and 40 gm, measured by spring scale) were compared using an isovolumic double-balloon technique. RESULTS: LV function data at each level of tension were compared to control data using 0 gm of tension. Systolic function assessed as Emax (mmHg/ml) at 10, 20, 30, and 40 gm versus control was: 5.7 +/- 2.6/4.9 +/- 2.7, 4.7 +/- 2.2/4.7 +/- 2.7, 4.8 +/- 3.1/4.7 +/- 2.8, and 5.0 +/- 3.5/5.1 +/- 2.9; delta improvement from the control at 10 gm was larger than that at 20 gm (p < 0.05 by paired t-test). Diastolic function assessed as diastolic stiffness (Sd, mmHg/ml) at the same CT tensions versus control was: 0.56 +/- 0.23/0.56 +/- 0.34, 0.53 +/- 0.30/0.57 +/- 0.37, 0.56 +/- 0.39/0.52 +/- 0.38, and 0.60 +/- 0.36/0.58 +/- 0.39; delta Sd was smaller at 20 gm than at 30 gm (p = 0.05 by ANOVA). LV equilibrium volume (Veq, ml) was: 10.7 +/- 3.9/10.1 +/- 3.9, 9.6 +/- 3.4/9.9 +/- 3.8, 10.8 +/- 4.0/10.3 +/- 3.4, and 10.6 +/- 4.0/10.6 +/- 3.5; delta Veq was larger (i.e., more compliant chamber) at 10 gm than at 40 gm (p < 0.05 by rm-ANOVA). Arrhythmias precluding satisfactory measurements occurred in two dogs at 30 or 40 gm CT tension. CONCLUSIONS: With chordal tension exceeding 10 gm, which is barely palpable, there was no additional enhancement in LV systolic function compared to zero CT tension. Veq was largest at the lowest tension; LV diastolic function (assessed as Sd) deteriorated with tensions of 30 gm or higher. The optimal end-diastolic tension of preserved CT should enhance systolic LV performance without adversely affecting diastolic function; in this isovolumic model, minimal CT tension (10 gm) best met these goals. Excessive tension may negate the potential hemodynamic benefits of chordal preservation during mitral valve replacement.
OPERATIONAL CONSIDERATIONS—TANK BARGE MORRIS J. BERMAN SPILL1

ABSTRACT The tank barge Morris J. Berman grounded on January 7, 1994, spilling at least 750,000 gallons of low API fuel oil onto the most heavily used beaches of San Juan, Puerto Rico, at the height of tourist season. The vessel's condition deteriorated rapidly due to heavy ocean swells. Most of the discharged oil was blown directly ashore into three natural containment basins. The rest beached in varying quantities along 65 kilometers of shoreline on the north coast from Loiza to Punta Borinquen. On January 8, lightering and salvage operations commenced, the barge was removed from strand on January 15, towed offshore, and scuttled approximately 28 kilometers north of San Juan in 1,000 fathoms of water. Response operations were complicated by the large quantities of oil that sank while retaining its original viscosity and remaining highly mobile. This required a technically, logistically, and financially demanding cleanup operation involving diving, dredging, sand removal, sand washing, sand replacement, ...
Endosonography of the Mediastinum

Endosonography is a highly effective method of evaluating patients with lung cancer, malignant lymphadenopathy, and other mediastinal conditions such as cysts and masses. Due to the central location of the esophagus within the chest, transesophageal EUS offers reliable access to the posterior and inferior mediastinum. Endosonography can be used to assess non-specific generalized lymphadenopathy in the absence of a known primary. Interventional endosonography in the mediastinum with transesophageal drainage of mediastinal fluid collections has also been reported.
Infection of Horses with St. Louis Encephalitis Virus, Experimental and Natural.∗:

SummaryHorses from many of the Western States and from Massachusetts have antibodies, in varying proportion, to the St. Louis encephalitis virus. Inoculation in non-immune horses by the subcutaneous, intranasal or intracerebral routes, of a St. Louis virus freshly isolated from mosquitoes, failed to produce clinical disease. It did produce inapparent infection resulting in the presence of virus in the blood, in 2 instances in which suitable tests were made, and in all 4 inoculated animals induced a high titer of serum antibody. We conclude that in horses, inapparent infection occurs frequently in many widely scattered areas of the United States.
Olanzapine Treatment of Adolescent Rats Alters Adult D2 Modulation of Cortical Inputs to the Ventral Striatum

Background: The striatal dopamine system undergoes vast ontogenetic changes during adolescence, making the brain vulnerable to drug treatments that target this class of neurotransmitters. Atypical antipsychotic drugs are often prescribed to children and adolescents for off-label treatment of neuropsychiatric disorders, yet the long-term impact this treatment has on brain development remains largely unknown. Methods: Adolescent male rats were treated with olanzapine or vehicle for 3 weeks (during postnatal day 28–49) using a dosing condition designed to approximate closely D2 receptor occupancies in the human therapeutic range. We assessed D2 receptor modulation of corticostriatal inputs onto medium spiny neurons in the adult ventral striatum using in vitro whole-cell current clamp recordings. Results: The D2/D3 agonist quinpirole (5 µM) enhanced cortically driven medium spiny neuron synaptic responses in slices taken from adult rats treated with vehicle during adolescence, as in untreated adult rats. However, in slices from mature rats treated with olanzapine during adolescence, quinpirole reduced medium spiny neuron activation. The magnitude of decrease was similar to previous observations in untreated, prepubertal rats. These changes may reflect alterations in local inhibitory circuitry, as the GABA-A antagonist picrotoxin (100 µM) reversed the effects of quinpirole in vehicle-treated slices but had no impact on cortically evoked responses in olanzapine-treated slices. Conclusions: These data suggest that adolescent atypical antipsychotic drug treatment leads to enduring changes in dopamine modulation of corticostriatal synaptic function.
The Consequences of a Week of Insomnia II: Patients with Insomnia

Insomnia patients present with a consistent set of complaints that they generally report as secondary to their poor sleep, including increased tension/confusion, decreased vigor, personality disturbance, subjective overestimation of poor sleep, increased body temperature, increased 24-hour whole-body metabolic rate, and longer MSLT latencies. If there is a relationship between the poor sleep and the secondary symptoms, then particularly poor sleep should exacerbate those symptoms. Ten patients with insomnia were identified on the basis of a 2-night screening protocol, then slept in the laboratory for 10 additional nights. On 7 of the nights, the insomnia patients had their wake-after-sleep-onset increased so that their total sleep time was 80% of that on their second screening night, resulting in an average of 254 minutes (of 480 minutes in bed) of sleep. The spectrum of changes seen in these patients with insomnia who had very poor sleep for a week was characteristic of mild partial sleep deprivation, and not consistent with exacerbation of symptoms found in patients with primary insomnia. Specifically, (1) these patients had a reduction as opposed to an increase in the MSLT values, but the MSLT values at the end of the week remained within normal limits; (2) these patients had decreased (as opposed to increased) whole metabolic rate following nights of particularly poor sleep; (3) these patients tended to underestimate (rather than overestimate) their subjective sleep latency while being given particularly poor sleep; and (4) these patients displayed no significant change in body temperature, subjective anxiety, or MMPI scores following particularly poor sleep. It was concluded that the secondary symptoms reported by patients with primary insomnia are probably not related to their poor sleep per se. Data from previous studies that varied physiological arousal were used to support the contention that the secondary symptoms of patients with insomnia, and perhaps the poor sleep itself, occur secondary to central nervous system hyperarousal.
Nursing Informatics Competencies for Emerging Professionals: International Leaders Panel.

To achieve a cursory review of the competencies necessary for acquire a successful career in a competitive job market, the panel will bring together leaders from renowned academic, successful health corporations, and international leaders in nursing informatics to the table for discussion, dialogue, and make recommendations. Panelists will reflect on their experiences within the different types of informatics organizations and present some of the current challenges when educating skillful professionals. The panel will provide personal experiences, thoughts, and advice on the competencies development in nursing informatics from their lens
Caring for Refugees with Cancer: A Case for Training of US Oncology Professionals

Refugees and asylum seekers face cultural, language, literacy, and economic barriers that may result in negative experiences with the healthcare system and may interfere with the provision of state-of-the-art care. Refugee medicine is an emerging area of specialty care that is mostly confined to academic centers, but refugees are settling and resettling across the country. Oncologists need training in order to handle the complex social and psychological needs of this vulnerable population. The major challenge remains the mental health problems, ranging from post-traumatic stress to depression, that add another level of complexity to treatment plans for patients with both early stage and advanced cancer. Ultimately, efforts to improve the health of refugees and asylum seekers who require cancer care including palliative services, must involve community health workers and interpreters, who can escort and advocate for these patients and shed light on how their life experiences impact on their preferences for care.
The normal variants in the left bundle branch system

Abstract This article reviewed the main anatomic and physiopathological aspects of the left bundle branch from its origin in the His bundle and its intraventricular distribution on the left endocardial surface. The results are based on the relevant literature and on personal observations executed on 206 hearts distributed as follows: 67 dogs, 60 humans, 45 sheep, 22 pigs, 10 cows, 2 monkeys, 1 guanaco, and 1 sea lion. The main anatomical features of the His-Purkinje conducting system may be summarized as follows: The bundle of His is composed by two segments: the penetrating and branching portions. LBB originates in the branching portion located underneath the membranous septum. There is no true bifurcation of the bundle of His in a human heart. Short after its origin the LBB gives rise to its two main fascicles, anterior and posterior, both heading the anterior and posterior papillary muscles, respectively. The anterior division is thinner and longer than the posterior one. The RBB and the most anterior fibers of the LBB arise at the end of the branching portion. In some cases a well-defined left septal fascicle can be identified, usually arising from the posterior division. Each division gives off small fibers and false tendons crossing the left ventricular cavity connecting the papillary between them or the papillary muscles with the septal surface. From each division of the LBB, their corresponding Purkinje networks emerge covering the subendocardium of the septum and the free wall of the left ventricles. There are critical relationships of the proximal segments of the His-Purkinje system with the surrounding cardiac structures whose pathologic processes may damage the conducting tissue.
Shared VH1-46 antibody gene usage in pemphigus vulgaris predicts antibody cross-reactivity to desmoglein 3 and rotavirus VP6 (HUM1P.271)

Pemphigus vulgaris (PV) is a potentially fatal skin blistering disease caused by autoantibodies (autoAbs) to desmoglein 3 (Dsg3). Previously, we identified shared VH1-46 gene usage in the anti-Dsg3 repertoire among 4 PV patients via high throughput B cell receptor (BCR) cloning. Somatic mutation reversion studies indicated that VH1-46 BCRs require few to no acidic amino acid mutations to bind Dsg3, which may favor their early selection in the immune response. Interestingly, shared VH1-46 gene usage also occurs in the B cell response to rotavirus protein VP6, and similarly, few somatic mutations are required to bind VP6. We thus investigated whether Dsg3-reactive VH1-46 BCRs cross-react to VP6 which may explain the tolerance of these autoreactive clones. We screened ~108 combinatorial IgM clones from a PV patient, which identified 13 heavy chain CDR3 clonotypic families that cross-react to Dsg3 and VP6. 7/13 used VH1-46, indicating enrichment by Dsg3/VP6 antigen selection. ELISA and human skin immunofluorescence using purified soluble Abs confirmed VP6 and Dsg3 reactivity. Additionally, 3 of 5 VH1-46 anti-Dsg3 IgG clonotypes previously isolated from 3 different PV patients cross-reacted to VP6 in either their somatically mutated or unmutated form. Our data suggest that a VH1-46 B cell response to rotavirus may be an initiating event that develops into an autoimmune response to Dsg3 in susceptible individuals.
Prospective Trial of House Staff Time to Response and Intervention in a Surgical Intensive Care Unit: Pager vs. Smartphone

Objective The objective of the study was to characterize house staff time to response and intervention when notified of a patient care issue by pager vs. smartphone. We hypothesized that smartphones would reduce house staff time to response and intervention. Design Prospective study of all electronic communications was conducted between nurses and house staff between September 2015 and October 2015. The 4-week study period was randomly divided into two 2-week study periods where all electronic communications between intensive care unit nurses and intensive care unit house staff were exclusively by smartphone or by pager, respectively. Time of communication initiation, time of house staff response, and time from response to clinical intervention for each communication were recorded. Outcomes are time from nurse contact to house staff response and intervention. Setting Single-center surgical intensive care unit of Cedars-Sinai Medical Center in Los Angeles, California, an academic tertiary care and level I trauma center. Participants All electronic communications occurring between nurses and house staff in the study unit during the study period were considered. During the study period, 205 nurse-house staff electronic communications occurred, 100 in the phone group and 105 in the pager group. Results House staff response to communication time was significantly shorter in the phone group (0.5 [interquartile range = 1.7] vs. 2 [3] min, p Conclusions Dedicated clinical smartphones significantly decrease time to house staff response after electronic nursing communications compared with pagers.
Working Hands and Critical Minds: A Paulo Freire Model for Job Training:

Students in present-day classrooms commonly resist intellectual work and show a strong impatience to finish school and begin a career. This is one result of a culture war over curriculum which began after the 1960s, both inside and outside schooling, over an aggressive vocational policy imposed from the top down. A participatory and dialogic method for job-training courses, derived from Paulo Freire's ideas, can offer a critical and animating alternative to the current methods of technical instruction.
SMAD3 expression and regulation of fibroplasia in vocal fold injury.

Objective Recent reports highlight the efficacy of small interfering RNA (siRNA) targeting SMAD3 to regulate transforming growth factor β (TGF-β)-mediated fibroplasia in vocal fold fibroblasts. The current study sought to investigate SMAD3 expression during wound healing in vivo and quantify the downstream transcriptional events associated with SMAD3 knockdown in vitro. Study Design In vivo and in vitro. Methods Unilateral vocal fold injury was created in a rabbit model. SMAD3 and SMAD7 mRNA expression was quantified at 1 hour and 1, 3, 7, 14, 30, 60, and 90 days following injury. In vitro, multi-gene analysis technology was employed in our immortalized human vocal-fold fibroblast cell line following TGF-β1 stimulation ± SMAD3 knockdown across time points. Results SMAD3 mRNA expression increased following injury; upregulation was significant at 3 and 7 days compared to control (both P < 0.001). SMAD7 mRNA was also upregulated at 3, 7, and 14 days (P = 0.02, P < 0.001, and P < 0.001, respectively). In vitro, SMAD3 knockdown reduced the expression of multiple profibrotic, TGF-β signaling, and extracellular matrix metabolism genes at 6 and 24 hours following TGF-β1 stimulation. Conclusion Cumulatively, these data support SMAD3 as a potential master regulator of TGF-β-mediated fibrosis. SMAD3 transcription peaked 7 days following injury. Multi-gene analysis indicated that the therapeutic effectiveness of SMAD3 knockdown may be related to regulation of downstream mediators of fibroplasia and altered TGF-β signaling. Level of Evidence NA. Laryngoscope, 2017
More Medicine, Fewer Clicks: How Informatics Can Actually Help Your Practice

In the information age, we expect data systems to make us more effective and efficient-not to make our lives more difficult! In this article, we discuss how we are using data systems, such as electronic health records (EHRs), to improve care delivery. We illustrate how US Oncology is beginning to use real-world evidence to facilitate trial accrual by automatic identification of eligible patients and how big data and predictive analytics will transform the field of oncology. Some information systems are already being used at the point of care and are already empowering clinicians to improve the care of their patients in real time. Telehealth platforms are being used to bridge gaps that currently exist in expertise, geography, and technical capability. Optimizing virtual collaboration, such as through virtual tumor boards, is empowering communities that are geographically disparate to coordinate care. Informatics methods can provide solutions to the challenging problems of how to manage the vast amounts of data confronting the practicing oncologist, including information about treatment regimens, side effects, and the influence of genomics on the practice of oncology. We also discuss some of the challenges of clinical documentation in the modern era, and review emerging efforts to engage patients as digital donors of their EHR data.
Description and Evaluation of the Implementation of a Weight-Based, Nurse-Driven Heparin Nomogram in a Tertiary Academic Medical Center:

Weight-based, nurse-driven heparin nomograms are reported in the medical literature to improve the time it takes to reach a minimum threshold for anticoagulation without compromising patient safety in specific indications or patient populations. This is the first report in the literature of an institution-wide protocol implementation and evaluation of effectiveness with simultaneous transition to an electronic health record. The purpose of implementing this practice change at our institution was to standardize practice, improve time to reach therapeutic anticoagulation, and improve patient safety. We conducted a retrospective analysis utilizing a pre/postimplementation design to compare outcomes. The primary end point evaluated was the time to reach minimum threshold value for therapeutic anticoagulation. Additionally, we assessed the percentage of patients who reached minimum threshold therapeutic anticoagulation within 24 hours, the percentage of patients with a critically supratherapeutic activated partial thromboplastin time (aPTT) value (≥120 seconds) during therapy, and a description of heparin titration for the first 4 aPTT results with nomogram use. Overall time to therapeutic anticoagulation decreased from a mean 18.7 to 11.7 hours (hazard ratio [HR] 1.59; 95% confidence interval 1.22-2.08; P < .0005). Percentage of patients receiving therapeutic anticoagulation within 24 hours increased from 74.4 to 88.5 (odds ratio [OR 2.97, P = .002) and the percentage of patients with an aPTT ≥120 seconds remained constant at 49.9 versus 46.8 (OR 0.92, P = .73). This practice change reduced time to therapeutic anticoagulation without an increase in the proportion of patients with a critically supratherapeutic aPTT at our institution.
Does advanced chronic kidney disease impact transjugular intrahepatic portosystemic shunt efficacy and safety

BACKGROUND AND STUDY AIMS There are currently limited data available summarizing the clinical outcomes and safety of transjugular intrahepatic portosystemic shunts (TIPS) in cases of advanced chronic kidney disease (CKD). The study aimed to assess efficacy and safety of TIPS in patients with advanced CKD. PATIENTS AND METHODS Seventeen patients (M :F 8 :9, age 55 years, MELD 24) with grade 4-5 CKD who underwent TIPS for ascites (n = 7) or varices (n = 10) were analyzed. The primary outcome was TIPS efficacy - assessed by comparing paracentesis frequency and diuretic regimen pre- and post-TIPS among ascites patients - and through bleeding cessation in variceal bleeding patients. Other outcomes included hepatic encephalopathy (HE), GFR increase, and mortality. RESULTS Median baseline GFR was 19.9 mL/min. No patients were hemodialysis dependent. Median post-TIPS pressure gradient was 8 mm Hg. Among ascites patients, 5/6 (83%) were TIPS responsive, with reduced or stable diuretics in 4/5 (80%). Among variceal hemorrhage cases, bleeding cessation rate was 90% (9/10). New or worsening HE incidence was 47% (8/17), and one patient required shunt reduction. Of 8 patients with lab follow-up, 6 (75%) demonstrated significant GFR increase (42.2 versus 20.0 mL/min, P = 0.028). The 90-day mortality incidence was 29% (5/17). CONCLUSIONS In conclusion, TIPS can potentially address ascites and variceal bleeding in advanced CKD patients, though HE incidence may be increased. Further investigation in larger cohorts may corroborate these results.
Automation and applications of the tolerance limit method in estimating meat withdrawal periods for veterinary drugs

Abstract A program was written in R to facilitate the implementation of the tolerance limit method (TLM) for establishing regulatory withdrawal times for limiting drug residues in meat, milk, and eggs. The developed computer source code can use pharmacokinetic and regulatory data to calculate the drug withdrawal period according to United States Food and Drug Administration (U.S. FDA) guidelines. The code called the “Withdrawal Time Calculator (WTC)” applied this TLM method to meat samples. The program was tested with the data provided by the U.S. FDA guidance and other published data collected from in vivo studies. Additional algorithm validation data were flunixin and sulfamethazine liver concentration data from peer-reviewed publications generated by our laboratory. This manuscript reports the withdrawal period results from testing the developed WTC code. Moreover, the source code for the WTC contains a data removal algorithm, constructed according to U.S. FDA data elimination recommendations if the user chooses. The power of the WTC is that it bypasses the use of multiple platforms typically required to perform the TLM, including standard commercial spreadsheet software (i.e., Microsoft Excel) and Statistical Analysis System (SAS) while providing speed and usability. This novel program provides a platform to calculate a withdrawal period recommendation for any drug in any class of animal for various regulatory body standards and could be very helpful in cases of extra-label drug use in food animals.
Leading-color fully differential two-loop soft corrections to QCD dipole showers

We compute the next-to-leading-order corrections to soft-gluon radiation differentially in the one-emission phase space. We show that their contribution to the evolution of color dipoles can be obtained in a modified subtraction scheme, such that both one- and two-emission terms are amenable to Monte Carlo integration. The two-loop cusp anomalous dimension is recovered naturally upon integration over the full phase space. We present two independent implementations of the new algorithm in the two event generators Pythia and Sherpa, and we compare the resulting fully differential simulation to the Catani--Marchesini--Webber (CMW) scheme.
Sharpening the Aim: Making Strides to Create an Assessment Culture in Schools

This chapter is in response to Mari Pearlman’s chapter, Aiming at Learning: Assessment as the Critical Link. Viewing assessment as a critical link to learning is an assertion strongly supported through my experiences in the field. There must be a significant shift in thinking and practices of teachers, as well as school leaders, to strengthen this link. The suggestion that National Assessment Tasks from NAEP be used to develop a focal point using national benchmarks rather than just state level standards is also supported. The creation of a culture of assessment in any classroom and school is indeed a challenging venture, but one that must be engaged in routinely and with precision. The evidence focused teaching approach is advocated in which teachers use real-time, multiple assessments of their students and plan targeted interventions that address students’ learning gaps.
Administrative aspects of ambulatory surgery

“Administration” of an ambulatory surgery center is an amalgamation of ownership and management responsibilities, which are an integration of both the clinical and business aspects of running an ambulatory surgery center. Effective, efficient, and profitable management of an ambulatory surgery center is a challenging task that rests on the shoulders of the administrative team. The late Peter Drucker, the “father of modern corporate management,” is quoted as saying nearly half a century ago, “there is only one valid definition of business purpose: to create a customer.”1 He believed in an empowerment of people as an organization’s most valuable business management strategy. In his 1950 book, The Practice of Management, he posed three seminal questions that should be asked by every manager: “what is our business, who is our customer, and what does our customer consider valuable?” This is the type of thinking that has spurred the development of ambulatory surgery centers. As one sets forth to establish an administrative framework for an ambulatory surgery center, it is important to realize that while structure is important, the key to success is an understanding that the physicians are the primary customers of any ambulatory surgery center, as well as an innate understanding of what motivates employees and retains patients. Effective management requires vision, sacrifice, integrity, and emotional intelligence. It is important that we not become “caught up” in the complicated and complex issues of daily management of a busy ambulatory surgery center and lose sight of these basic core concepts.
The Paranoid-Erotic Syndromes

The paranoid-erotic syndromes are examples of psychiatric entities that defy precise classification. While all present with a dominant paranoid flavor and are primarily delusional in nature, the erotic overtones are variably manifest. Furthermore, each of the syndromes excites legitimate controversy as to its ability to stand alone diagnostically. The syndromes are generally considered rare, and the literature, especially in recent years, is correspondingly sparse. The Capgras syndrome is an exception and will be discussed in detail. Other syndromes described are the Fre-goli syndrome, the intermetamorphosis syndrome, the syndrome of Cotard, and de Clerambault’s syndrome.
Mind and function in animal communication

Functional hypotheses about animal signalling often refer to mental states of the sender or the receiver. Mental states are functional categorizations of neurophysiological states. Functional questions about animal signals are intertwined with causal questions. This interrelationship is illustrated in regard to avian distraction displays. In purposive signalling, the sender has a goal of influencing the behavior of the receiver. Purposive signalling is innovative if the sender's goal is unrelated to the biological function of the signal. This may be the case in some instances of false alarm calling. Biological functionalism differs from philosophical functionalism in its concept of identity and in the specification of relevant inputs and outputs.
Risk Assessment for Chemicals & Radionuclides: Some Characteristics, Similarities and Differences

Risk assessment is an important tool in the evaluation of potential harm related to environmental contamination, and may be used to develop criteria for remedial actions at contaminated sites of many types. The environmental risk assessment process for chemicals or for radionuclides involves consideration of exposure potential and dose/response for biological effects. These two components are combined to develop a quantitative or qualitative measure of range and degree of projected adverse effects. Methods have been developed to assess such risks which, while similar, are different in practice and in their endpoints. Risk assessment can be used in conjunction with other techniques, such as risk management, to deal with practical issues at radiologically and chemically contaminated sites. This paper presents, in an abbreviated way, principles, similarities and differences of risk evaluation in these two related areas.
Brief announcement: leaderless byzantine paxos

The role of leader in an asynchronous Byzantine agreement algorithm is played by a virtual leader that is implemented using a synchronous Byzantine agreement algorithm.
EXOSOME RELEASE PROMOTES INFLAMMATORY RESOLUTION IN ACTIVATED AND AGED MICROGLIA

Proper regulation of inflammatory responses is critical for effective function of microglia, in both physiological and disease states. While the mechanisms that drive microglia activation are well characterized, the pathways leading to inflammatory resolution and immune homeostasis have yet to be fully elucidated. Using RNA interference, pharmacological inhibition and genetic knockout mouse model approaches, we show that exosome release promotes immune homeostasis in activated and aged microglia. We demonstrate that induction of anti-inflammatory pathways enhances release of exosomes containing immune proteins and microRNAs. Functionally, inhibition of exosome release alters trafficking of exosome cargo, such as miR-155, in activated microglia resulting in increased cellular retention. Concordantly, we identify increased miR-155 activity leading to sustained activation of pro-inflammatory pathways as a potential mechanism underlying impaired inflammatory resolution due to inhibition of microglia exosome release. Similarly, inhibition of augmented exosome release in aged microglia exacerbates inflammatory activation, demonstrating conservation of the immune modulatory effects of exosome release. Taken together, our study identifies exosomes as novel components of an anti-inflammatory mechanism utilized by activated and aged microglia to restore immune homeostasis.
Efficient certificate revocation management schemes for IoT-based advanced metering infrastructures in smart cities

Abstract Advanced Metering Infrastructure (AMI), which refers to the communication network for the collection of power data from smart meters in a Smart Grid, is expected to be used in the service of many Smart City applications such as gas and water data collection or electric vehicle charging. As the communication within the AMI needs to be secure to protect user’s power data, key management becomes a challenge due to its overhead and limited resources on smart meters. While using public-keys eliminate some of the overhead of key management as opposed to symmetric-key management, there are still challenges regarding the management of certificates that store and certify the public-keys. In particular, distribution and storage of certificate revocation list (CRL) is major a challenge due to cost of distribution and storage in AMI networks which is envisioned to utilize wireless mesh networks. Motivated by the need of keeping the CRL distribution and storage cost effective and scalable, in this paper, we present a distributed CRL management scheme by utilizing distributed hash trees (DHTs) that have been heavily employed in peer-to-peer (P2P) networks. The basic idea is to share the burden of storage of CRLs among all the smart meters by exploiting the convenient wireless communication capability of the smart meters among each other. Using DHTs not only reduces the space requirements for CRLs but also makes the CRL updates more convenient. We implemented DHT-based CRL structure both on ns-3 and testbed using IEEE 802.11s mesh standard as a model for AMI and demonstrated its superior performance with respect to traditional methods of CRL management through extensive simulations.
Kinematic Effects of Varying Adolescents' Attentional Instructions for Standing Long Jump:

Studies examining attentional focus in the motor performance of children and young adolescents have produced mixed results. We studied 26 seventh-grade physical education student volunteers (Mage =...
Basal Cell Adenocarcinoma

Basal cell adenocarcinoma is the malignant counterpart of basal cell adenoma. Basal cell adenocarcinoma affects primarily adults and presents at a mean age of approximately 65 years. Women and men are involved with similar frequency. The majority of cases involve the parotid gland, presenting as single or multiple masses. Basal cell adenocarcinoma is infiltrative, comprised of multiple cell types (ductal and basal), and may exhibit a variety of architectural patterns (solid, trabecular, tubular, and membranous) (Figs. 9.1, 9.2, 9.3, 9.4, 9.5, 9.6, 9.7, 9.8, 9.9, 9.10, 9.11, 9.12, 9.13, 9.14, 9.15, 9.16, 9.17, 9.18, 9.19, 9.20, 9.21, 9.22 and 9.23).
Effect of antibiotic use and composting on antibiotic resistance gene abundance and resistome risks of soils receiving manure-derived amendments.

Manure-derived amendments are commonly applied to soil, raising questions about whether antibiotic use in livestock could influence the soil resistome (collective antibiotic resistance genes (ARGs)) and ultimately contribute to the spread of antibiotic resistance to humans during food production. Here, we examined the metagenomes of soils amended with raw or composted manure generated from dairy cows administered pirlimycin and cephapirin (antibiotic) or no antibiotics (control) relative to unamended soils. Initial amendment (Day 1) with manure or compost significantly increased the diversity (richness) of ARGs in soils (p < 0.01) and resulted in distinct abundances of individual ARG types. Notably, initial amendment with antibiotic-manure significantly increased the total ARG relative abundances (per 16S rRNA gene) in the soils (2.21 × unamended soils, p < 0.001). After incubating 120 days, to simulate a wait period before crop harvest, 282 ARGs reduced 4.33-fold (median) up to 307-fold while 210 ARGs increased 2.89-fold (median) up to 76-fold in the antibiotic-manure-amended soils, resulting in reduced total ARG relative abundances equivalent to those of the unamended soils. We further assembled the metagenomic data and calculated resistome risk scores, which was recently defined as a relative index comparing co-occurrence of sequences corresponding to ARGs, mobile genetic elements, and putative pathogens on the same scaffold. Initial amendment of manure significantly increased the soil resistome risk scores, especially when generated by cows administered antibiotics, while composting reduced the effects and resulted in soil resistomes more similar to the background. The risk scores of manure-amended soils reduced to levels comparable to the unamended soils after 120 days. Overall, this study provides an integrated, high-resolution examination of the effects of prior antibiotic use, composting, and a 120-day wait period on soil resistomes following manure-derived amendment, demonstrating that all three management practices have measurable effects and should be taken into consideration in the development of policy and practice for mitigating the spread of antibiotic resistance.
Technology Maturity in NASA’s Small Business Innovation Research Program

We study the technology readiness levels (TRLs) of projects funded by the National Aeronautics and Space Administration (NASA) Small Business Innovation Research (SBIR) program from two perspectives: (1) program management and the distribution of technology maturities and (2) inconsistencies between the principal investigator (PI) and NASA in determining the actual maturity. We find that NASA funds technologies almost independent of the initial TRL, but that in the initial funding round, standard small businesses (6–499 employees) are funded almost 20% more frequently than so-called microfirms (1–5 employees). These differences largely disappear in Phase II, and firms of all sizes are equally likely to be funded, with technologies at all levels of maturity. In addition, the PI and NASA’s representative disagree on the technology’s status approximately 20% of the time in preparing for project continuation; this represents one of the few measurements of behavioral biases measured “in the wild.” This analysis has important contributions to the literature on technology management and risk assessment.
Prognostic Implications of a Point‐of‐Care Ultrasound Examination on Hospital Ward Admission

OBJECTIVES Few data exist regarding the use of ultrasound (US) to risk stratify ward admissions. Therefore, we evaluated associations between a cardiopulmonary limited ultrasound examination (CLUE) on admission and subsequent hospital outcomes. METHODS Over a 22-month period in a 300-bed hospital, CLUE data reviewed from a series of nonelective ward admissions were correlated with the composite outcome of a hospital stay of longer than 2 days, disposition to hospice, or death. The CLUE included 5 quick-look signs of left ventricular dysfunction, left atrial enlargement, lung B-lines, pleural effusions, and inferior vena cava plethora and had been performed as warranted by 1 of 31 US-trained admitting residents and then repeated by a cardiologist as the reference standard. The admitting condition, medical history, results of routine admission testing, and CLUE were assessed for an association with the outcome in univariate and multivariable models. RESULTS Of 547 patients, the mean age ± SD was 62.9 ± 15.5 years; 59% were male; and the mean stay was 5.6 ± 8.1 days, with 355 (65%) lasting longer than 2 days and 21 (4%) having hospice disposition or death. An abnormal CLUE exam was found in 368 (67%) of patients, was related to the outcome (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.23-2.68; P = .001) when obtained by a resident or cardiologist, and was included in a best-fit multivariable model with renal failure (OR, 2.44; 95% CI, 1.44-4.14; P < .001), infection/sepsis (OR, 2.25; 95% CI, 1.17-4.32; P = .02), and chest pain (OR, 0.36; 95% CI, 0.21-0.61; P < .001). CONCLUSIONS An abnormal admission point of care ultrasound exam was related to complex hospitalization, specifically a longer length of stay.