cssi/SciSciGPT-SciSciNet huggingface dataset:
Construction of attenuated HIV-1 accessory gene immunization cassettes

Delivery of genetic expression cassettes into animals can effectively induce both humoral and cellular immunity to the expressed gene product. Previously, we used this strategy to immunize against HIV-1 structural and enzymatic proteins in mice, non-human primates and in humans. In contrast, the use of the accessory genes including vif, vpr, vpu and nef as immunotherapeutic vaccine targets has not been well characterized. Our goal is to design an effective genetic HIV vaccine, which includes the accessory genes as part of a multi-component immunogen. In order to develop accessory genes as genetic vaccines, we have molecularly cloned and analysed the sequence variation and immunogenic potential present in these genes derived from viral isolates obtained from HIV-1 infected patients and laboratory isolates. Prototype genetic variants were selected and their ability to induce humoral and cellular immune responses was studied in animal models. We observed that attenuated accessory genes can effectively induce both humoral and cellular responses in mice and the resulting immune response is directly correlated with DNA concentrations delivered and the number of boosts. This strategy can be used generally to develop an effective, safe DNA vaccine for any pathogen.
Cell and biomolecule delivery for regenerative medicine

Regenerative medicine is an exciting field that aims to create regenerative alternatives to harvest tissues for transplantation. In this approach, the delivery of cells and biological molecules plays a central role. The scaffold (synthetic temporary extracellular matrix) delivers cells to the regenerative site and provides three-dimensional environments for the cells. To fulfil these functions, we design biodegradable polymer scaffolds with structural features on multiple size scales. To enhance positive cell‐material interactions, we design nano-sized structural features in the scaffolds to mimic the natural extracellular matrix. We also integrate micro-sized pore networks to facilitate mass transport and neo tissue regeneration. We also design novel polymer devices and self-assembled nanospheres for biomolecule delivery to recapitulate key events in developmental and wound healing processes. Herein, we present recent work in biomedical polymer synthesis, novel processing techniques, surface engineering and biologic delivery. Examples of enhanced cellular/tissue function and regenerative outcomes of these approaches are discussed to demonstrate the excitement of the biomimetic scaffold design and biologic delivery in regenerative medicine.
A fully integrated switched-capacitor DC-DC converter with dual output for low power application

This paper presents a fully integrated on-chip switched-capacitor (SC) DC-DC converter that supports two regulated power supply voltages of 2.2V and 3.2V from 5V input supply and delivers the maximum load currents up to 8mA at both of the outputs. The entire converter system uses two 2-to-1 converter blocks. The upper output voltage (3.2V) is generated from the 2-to-1_up converter by means of averaging the 5V input and the generated lower output voltage (2.2V), which is generated from 2-to-1_dw converter. Since 2-to-1_up converter is less sensitive to the bottom-plate parasitic capacitance loss, they are implemented with MOS capacitors, which show higher capacitance density (2.7fF/μm2, α=6.5%) than MIM capacitors (1fF/μm2, α=2.5%) while they have bigger bottom-plate parasitic capacitance ratio (α). The proposed implementation saves the area and quiescent currents for the control blocks since each block shares required analog and digital control blocks. The proposed converter is designed using high-voltage 0.35μm BCDMOS technology. Both output voltages are regulated by means of pulse frequency modulation (PFM) technique using 18-bit shift registers and digitally controlled oscillators (DCOs). Over the wide output power ranges from 5.4mW to 43.2mW, the converter achieves the average efficiency of 70.0% and the peak efficiency of 71.4%. 10-phase interleaving technique enables the output voltage ripples of the both outputs less than 1% (
On the computation of Mahalanobis' generalized distance (D2)

It is suggested that, while use of many statistical techniques is facilitated by electronic aids, a computer is not always a necessity. A simple guide to the calculation of Mahalanobis' D2 statistic, intended for those with limited mathematical background and no access to computing equipment, is presented in hopes that such a procedure will permit application of this statistic, by anthropologists, with a minimum of effort.
Home Is Where the Triggers Are: Increasing Asthma Control by Improving the Home Environment

Asthma remains the most common chronic condition of childhood. Strong evidence has linked exposure to allergens and other triggers commonly found in homes to allergen sensitization and asthma incidence and morbidity. A growing body of evidence has demonstrated that a home visit strategy that includes an environmental component that addresses multiple triggers through multiple interventions is effective. Such home visits reduce exposure to triggers, decrease symptoms and urgent health-care use, and increase quality of life. To make home visits widely available will require health-care payor reimbursement, government and health plan funding, training and certification of home visitors, and active referrals from health-care providers. However, a strategy based solely on education and behavior change is limited, because it cannot adequately reduce exposures due to adverse housing conditions. Therefore, approaches that address substandard housing are needed. These include remediation of existing housing and construction of new asthma-friendly homes. Most studies of remediation have made relatively narrow and focused improvements, such as insulation, heating, or ventilation. Outcomes have been mixed. Studies of new asthma-friendly homes are in their infancy, with promising pilot data. Further investigation is needed to establish the effectiveness of improving housing. A final strategy is improving housing quality through policy change, such as implementation of healthy housing guidelines for new construction, enhancement and increased enforcement of housing codes, and assuring smoke-free multi-unit homes. The combination of home visits, improved housing construction, and policy change has great potential for reducing the global burden of asthma.
Deep Brain Stimulation, Autonomy, and Harm

Gilbert (2015) is correct to have worries about the implications of deep brain stimulation (DBS) on patient autonomy. However, it is not clear just how extensive these worries should be, for two re...
Injury Mortality among Iowa Farmers, 1980–1988: Comparison of PMR and SMR Approaches

State and provincial proportional mortality studies in the United States and Canada have found increased ratios of overall injury mortality among farmers, including occupational injuries and other unintentional injuries, such as those from motor vehicle crashes and fires, as well as suicides. In contrast, Scandinavian standardized mortality (morbidity) studies have found no increase in the injury fatality or morbidity ratios of farmers in comparison with the rest of the population. This study reviews the injury mortality of Iowa farmers for the years 1980-1988. Among white male farmers, we found an increased proportional mortality ratio for all injuries of 1.26 (95% confidence interval (CI) 1.21-1.31). In part, this was a result of the increased proportional mortality ratio for at-work injuries of 3.77 (95% CI 3.35-4.24), but there were also elevated proportional mortality ratios for such nonoccupational injuries as suicides, 1.20 (95% CI 1.09-1.32), motor vehicle crashes, 1.23 (95% CI 1.12-1.34), and electrocutions, 1.78 (95% CI 1.08-2.95). For younger farmers aged 20-64 years, we calculated standardized mortality ratios as well. The standardized mortality ratios were generally within 10% of the proportional mortality ratios, which suggests that the differences between North America and Scandinavia are not the result of methodological differences, but are more likely related to differences in environmental exposures and safety practices.
Coding, Designing, and Logistics: How Modes Affect Equity in Computer Science Education (Abstract Only)

This poster delves into the interactions of pair programming students to observe the equality or inequality across three modes of discussion. These three modes are coding, designing and logistics. Coding being when students are discussing code, designing being the discussion of aesthetic aspects, and logistics being the discussion of saving or manipulating files. The students whose interactions are reviewed and assessed in this poster are participants in a three-week elementary computer science program taking place in Northern California in the years 2009, 2012, and 2013. The students' ages range between ten and eleven years old. This poster will compare and contrast specific interactions and examples to highlight how modes can present an interaction as equitable, inequitable, or both. The poster will also present tables to aid in the explanation of how one mode in an interaction can be equitable while the other two modes are not.
Coupling of oxytocin receptor to G proteins in rat myometrium during labor: Gi receptor interaction

Occupancy of oxytocin receptor (OTR) binding sites in pregnant rat myometrial membranes with iodinated oxytocin antagonist (OTA), followed by detergent solubilization and size selection, showed that radioactivity eluted in two distinct peaks: one corresponding in size to the isolated receptor (approximately 60 kDa) and the other ranging from 240 to 320 kDa. The unliganded 240- to 320-kDa fraction contained OTRs coupled to G proteins, as the addition of oxytocin (OT) increased guanosine 35S-labeled 5'-O-(3-thiotriphosphate) binding up to twofold in a dose-dependent manner. The effects of OT were blocked by coincubation with OTA. G protein alpha-subunits associated with OTRs in the 240- to 320-kDa peak were identified by immunoadsorption. Significant amounts of both G alpha q/11 and G alpha i3 were associated with the OTR; a lesser amount of G alpha s was complexed. Using the same approach but with antibodies to effector enzymes, we observed that phospholipase C beta 1 (PLC beta 1) and PLA2 were also associated with the OTR. The results corroborate the well-established interaction of OTR with Gq and further show that Gi coupling might be an important component of OTR signal transduction. To further investigate the interaction of Gi with the OTR, we showed that OT stimulation of guanosine 5'-triphosphatase activity in intact myometrial membranes was inhibited by pertussis toxin. Pertussis toxin-stimulated ADP ribosylation of G alpha i in myometrial membranes was also decreased by OT treatment. These findings with pertussis toxin strongly indicate that OTR is coupled to Gi in rat myometrial membranes. The 60-kDa OTR peak (noncoupled receptor) was demonstrable in the myometrium only before the end of gestation and after parturition and accounted for about one-half the 125I-OTA binding activity. At term, there was about a fivefold increase in binding and almost a complete shift to the 240- to 320-kDa-size complex. Thus the established increased sensitivity of the myometrium to OT at term could be the result of both upregulation of OTRs and an increase in the fraction of receptors coupled to signal transduction components, one of which is Gi.
Fabrication and Characterization of Molybdenum Oxide Nanofibers by Electrospinning

Molybdenum oxide/ Poly (ethylene oxide) composite nanofibers were prepared by combining the sol-gel process and electrspinning technique. An ethanol solution of Poly(ethylene oxide) (PEO) was mixed with molybdenum isopropoxide to form a precursor solution. Composite nanofibers were obtained by electrspinning this viscous solution. By calcination of the composite fibers, pure molybdenum oxide nanofibers and nano-rods were obtained with diameters of 100-nanometer scale. Morphology of the fibers has been characterized by scanning electric microscopy. Components and structures of the final products have been identified by EDAX and grazing incidence XRD. Calcination process has been studied by DSC and TG analysis. The real time dynamics of the structural evolution from composite fibers to nanocrystalline metal oxide fibers has been investigated by synchrotron-based in-situ x-ray diffraction.
Implications of Domain Specificity for Creativity Theory

To the extent that creativity is domain specific, most domain-general theories of creativity simply don’t make sense. A theory of creativity may work in one domain (such as the domain or domains in which it has been tested) but not work at all in others, which is perhaps why creativity research is rife with conflicting results. And even when a theory seems to work in multiple domains, the content of the theory is likely to be completely different as one moves across those different domains. This chapter explains why domain specificity dooms most theories of creativity and also explains the promise of what I have called metatheories: ways of thinking about creativity that look like domain-general processes but are actually describing domain-specific processes that merely appear similar from the outside.
30-day readmission after pediatric upper extremity surgery: Analysis of the NSQIP database.

Abstract Purpose To determine the incidence and risk factors of complications, reoperations and 30-day unplanned readmission after pediatric upper extremity surgery. Methods Retrospective analysis of the 2013 National Surgery Quality Improvement Program pediatric database to identify procedures that met the CPT code of a primary upper extremity procedure. A univariate and multivariate analysis was performed to identify patient- and surgery-related risk factors for complications, reoperations and 30-day unplanned readmissions. Results Upper extremity pediatric surgeries have low complication (1.70%), reoperation (0.5%) and readmission rates (0.78%). Procedures requiring reoperation, inpatient procedures, and those complicated by surgical site infection were more likely to be readmitted. Patients with complex medical histories such as cardiac disease, gastrointestinal disease, pulmonary disease, or a central nervous system disorder were more likely to be readmitted. Conclusions Pediatric upper extremity surgery is safe and associated with low complication and readmission rates. Algorithms focusing on decreasing surgical site infection and optimizing complex pediatric medical problems may limit or further decrease complication and readmission rates. Type of study/level of evidence Prognostic III
Increase HDL-C level over the menopausal transition is associated with greater atherosclerotic progression.

Background Experimental and observational evidence demonstrates that high-density lipoprotein (HDL) can lose its well-documented atheroprotective functions and even adopt a paradoxically proinflammatory nature in certain conditions. Hormonal alterations, especially estradiol reduction, influence the accumulation of risk factors that could potentially impair the quality of HDL during the menopausal transition (MT). Limited data exist to evaluate the relationship between changes in HDL-cholesterol (HDL-C) and its main carried protein, apolipoprotein A (apoA), over the MT, and atherosclerosis development. Objective To evaluate the associations of changes in HDL-C and apoA with progression of carotid intima-media thickness (cIMT), carotid adventitial diameter (cAD), and presence of carotid plaque relative to the onset of the postmenopause. Methods A total of 213 participants (age [mean (SD)]: 45.7 [2.5] years at baseline; 70% white) from the Study of Women's Health Across the Nation Pittsburgh site were included. Participants had up to 5 measures of cIMT, cAD, and carotid plaque over a maximum of 9 years of follow-up. Results Adjusting for sociodemographic, cardiovascular disease risk factors, cardiovascular disease medication use, and C-reactive protein, a larger increase in HDL-C since baseline was significantly associated with a greater cIMT progression ( P = .008). Additionally, a higher apoA level at baseline was significantly associated with a lower cIMT progression ( P = .03). No significant associations were found with cAD or plaque presence. Conclusions As women transition through menopause, increases in HDL-C levels are independently associated with greater cIMT progression. Thus, the quality of HDL may be altered over the MT rendering HDL dysfunctional and not providing the expected cardioprotective effect.
Aqua-chloridobis(diphenyl-glyoximato-κN,N')cobalt(III) dihydrate.

The asymmetric unit of the title complex, [Co(C14H11N2O2)2Cl(H2O)]·2H2O or [Co(dpgH)2Cl(H2O)]·2H2O, where dpgH− is diphenyl glyoximate, consists of one-half of a [Co(dpgH)2Cl(H2O)] complex and one solvent water mol­ecule. The complex is completed through inversion symmetry, with the CoIII atom situated at the centre of symmetry. The coordination geometry around the CoIII atom is distorted octa­hedral with the four N atoms of the two dpgH− ligands forming an approximate square plane with N—Co—N bite angles of 81.13 (14) and 98.87 (14)°. The Cl− ligand and the water mol­ecule are disordered in a 1:1 ratio and are in the axial positions, almost perpendicular to the plane of the glyoximate ligands [O—Co—Cl = 175.3 (10)°]. The two glyoximate ligands are linked by strong intra­molecular O—H⋯O hydrogen bonds. In addition, O—H⋯O inter­actions involving the solvent water mol­ecules and O—H⋯N hydrogen-bonding inter­actions are also observed. The solvent water mol­ecule is disordered over five positions with different occupancies.
Effect of day-night cycle on distribution of food intake and economic choice among imposed food opportunities in mice

We have shown previously that mice given access to four discrete feeding opportunities (FOs) per day show a characteristic sequence of sizes across ordinal FOs. The purpose of the present experiments was to determine the relative contributions of external and internal factors on the sequencing of FO size. The external factors were the light:dark Zeitgeber and the cost of food, imposed via different fixed unit prices (FUP) in a closed operant economy, and the internal factors were signals relating to energy status including time since last food and weight loss. In the first experiment, mice were given 4 FOs spaced 4-h apart, but with the timing of the FOs relative to the Zeitgeber altered by a 4-h Zeitgeber advance or delay of the cycle. Food intake, and associated body weight, declined as price increased, but the temporal order of FO size was invariant within a Zeitgeber condition. The Zeitgeber advanced group showed clear evidence of a shift in meal sequence relating to the light:dark cycle. Thus, external factors seem to be a more important determinant of total intake and sequencing than internal factors. In the second experiment, mice were given the choice between continuous costly (CC) and intermittent inexpensive (II) food. II food was available for four-15min intervals every 4-h, and the timing of the 15min intervals was varied relative to the Zeitgeber cycle. In spite of a 20-fold difference in price between CC and II food, mice took approximately equal amounts from each, and all food intake took place during the dark phase. Mice consumed II food only if it was available during the dark phase. Food intake was strongly linked to the light:dark cycle, largely independent of food cost.
GPs, mums, and the 'Twittersphere'.

The use of social media (SM) has exploded in popularity in recent years with 48% of adults and 87% of younger adults (16–24 years) in the UK using networking sites such as Facebook and Twitter.1 GPs will be most familiar with platforms that allow them to share aspects of their personal life with friends and family and to express opinion or support for their chosen social, charitable, or political cause. Far fewer GPs feel comfortable engaging on medical matters with the wider public in these same arenas, with some justification due to the attendant risks of personal criticism, professional complaint, and intrusion on their private life. There is general consensus as reflected by the RCGP Social Media Highway Code that SM is an inappropriate arena for giving personalised medical …
Plasminogen Activator Inhibitor 1 Deficiency Reduces the Progression of Atherosclerosis in a Murine Model of Human Familial Hypercholesterolemia.

Atherosclerosis has been described as a “self-perpetuating” inflammatory disease which progresses in discrete stages and involves a number of cell types and effector molecules. Lipid metabolic disorders are heavily involved in the genesis and progression of atherosclerosis in humans, and thrombotic complications substantially contribute to the coronary artery disease that frequently accompanies atherosclerosis. A relevant mouse model of human atherosclerosis with elevated LDL-cholesterol (C) is one in which both the Ldlr and Apobec1 genes are deleted ( Ldlr − / − /Apobec1 − / − ), since these mice lack the ability to convert apoB-100 to apoB-48 in liver and also are defective in LDL clearance. We have generated Ldlr − / − /Apobec1 − / − / PAI-1 − / − and characterized atherosclerosis progression in these mice. VLDL, LDL, HDL, and total C levels were identical between Ldlr − / − /Apobec1 − / − and Ldlr − / − /Apobec1 − / − / PAI-1 − / − mice (VLDL-C; 30.3±1.8 vs 26.0±1.7 (mg/dl), LDL-C; 268.7±6.3 vs 274.1±13.1 (mg/dl), HDL-C; Total-C; 353.8±8.1 vs 356.8±14.5 (mg/dl), respectively). However, both the plaque size in the aortic sinus and the extent of plaque area in aorta were significantly smaller in Ldlr − / − /Apobec1 − / − / PAI-1 − / − mice relative to Ldlr − / − /Apobec1 − / − mice (plaque in aortic sinus; 158792.9±11958.2 vs 227243.5±15291.1 (μm 2 ), plaque area in aorta; 3.90±0.34 vs 5.10±0.27 (%), respectively). To elucidate the cellular functions, especially macrophages, in the plaque, bone marrow-derived macrophages (BMMs) were isolated and utilized for Dil-oxidized (Ox) LDL uptake assays and migration assays using 8 μm pore culture inserts. There were no significant differences in Dil-OxLDL uptake by BMMs between the two genotypes. The kinetics of migration of BMMs was more rapid in Ldlr − / − /Apobec1 − / − / PAI-1 − / − cells than Ldlr − / − /Apobec1 − / − cells. Furthermore, thioglycollate-induced intraperitoneal migration of macrophages was increased in Ldlr − / − /Apobec1 − / − / PAI-1 − / − mice vs Ldlr − / − /Apobec1 − / − mice. Results from these studies indicate that cell migratory differences may contribute to attenuating atheroma formation in a PAI-1 deficient state.
Behavior Economics and Treatment Engagement

In Behavior Economics and Treatment Engagement authors Andrade and Petry provide an expert analysis of the application of contingency management (CM) programs to promotion of health behavior. First, the historical background of incentive-based interventions in the context of substance abuse treatment is reviewed. The reader will then learn to apply CM to engagement to quality health care initiatives, such as vaccinations, medical screenings, diabetes monitoring, physical activity, and weight loss programs. The fundamental concepts and elements of effective incentive-based interventions are explicated and dissemination of these programs is discussed.
Disulfide bonds and disorder in granulin‐3: An unusual handshake between structural stability and plasticity

Granulins (GRNs) are a family of small (∼6 kDa) proteins generated by the proteolytic processing of their precursor, progranulin (PGRN), in many cell types. Both PGRN and GRNs are implicated in a plethora of biological functions, often in opposing roles to each other. Lately, GRNs have generated significant attention due to their implicated roles in neurodegenerative disorders. Despite their physiological and pathological significance, the structure-function relationships of GRNs are poorly defined. GRNs contain 12 conserved cysteines forming six intramolecular disulfide bonds, making them rather exceptional, even among a few proteins with high disulfide bond density. Solution NMR investigations in the past have revealed a unique structure containing putative interdigitated disulfide bonds for several GRNs, but GRN-3 was unsolvable due to its heterogeneity and disorder. In our previous report, we showed that abrogation of disulfide bonds in GRN-3 renders the protein completely disordered (Ghag et al., Prot Eng Des Sel 2016). In this study, we report the cellular expression and biophysical analysis of fully oxidized, native GRN-3. Our results indicate that both E. coli and human embryonic kidney (HEK) cells do not exclusively make GRN-3 with homogenous disulfide bonds, likely due to the high cysteine density within the protein. Biophysical analysis suggests that GRN-3 structure is dominated by irregular loops held together only by disulfide bonds, which induced remarkable thermal stability to the protein despite the lack of regular secondary structure. This unusual handshake between disulfide bonds and disorder within GRN-3 could suggest a unique adaptation of intrinsically disordered proteins towards structural stability.
Atomic-Level Simulation Study of n-Hexane Pyrolysis on Silicon Carbide Surfaces.

Ethylene production plays a key role in the petrochemical industry. The severe operation conditions of ethylene thermal cracking, such as high-temperature and coke-formation, pose challenges for the development of new corrosion-resistant and coking-resistant materials for ethylene reactor radiant coils tubes (RCTs). We investigated the performance of ceramic materials such as silicon carbide (SiC) in severe pyrolysis conditions by using reactive force field molecular dynamics (ReaxFF MD) simulation method. Our results indicate that β-SiC surface remains fully stable at 1500 K, whereas increased temperature results in melted interface. At 2500 K, fully grown cross-linked-graphene-like polycyclic aromatic hydrocarbon coking structure on SiC surfaces was observed. Such coking was particularly severe in the carbon-side of the surface slab. The coking structures were mainly derived from surface atoms at the initial 3.0 ns, as a result of the loss of interfacial hydroxyl layer and further hydrothermal corrosion...
Determination of Mmax from Background Seismicity and Moment Conservation

We describe a simple method to determine the probability distribution function of the magnitude M_(max) and return period T_R of the maximum plausible earthquake on crustal faults. The method requires the background seismicity rate (estimated from instrumental data) and the rate of interseismic moment buildup. The method assumes that the moment released by the seismic slip is in balance with the moment deficit accumulated in between earthquakes. It also assumes that the seismicity obeys the Gutenberg–Richter (GR) law up to M_(max) . We took into account the aftershocks of large infrequent events that were not represented in the instrumental record, so that we could estimate the average seismicity rate over the entire fault history. We extrapolated the instrumental record, using the GR law to model the frequency of larger events and their aftershocks. This increased the frequencies of smaller events on average; when these smaller events were newly extrapolated, they predicted a higher frequency of larger events. We iterated this process until stability was reached, and then we assumed moment balance when we found the maximum magnitude; we have found this method to be appropriate in applications involving examples of fault with good historical catalogs. We then showed examples of applications to faults with no historical catalogs. We present results from nine cases. For the San Andreas fault system, we find M_(max)=8.1±0.3, with T_R380^(950)_(120)yrs ; for the North Anatolian fault, M_(max)=8.0±0.3, with T_R275^(650)_(135)yrs ; for the Main Himalayan thrust, M_(max)=9.0±0.2, with T_R1200^(2700)_(550)yrs; for the Japan trench, M_(max)=9.3±0.3, with T_R520^(1200)_(220)yrs; for the Sumatra–Andaman trench, M_(max)=9.0±0.3, with T_R200^(450)_(80)yrs ; for the Bocono fault, M_(max)=7.3±0.3, with T_R160^(360)_(70)yrs; for the Altyn Tagh fault, M_(max)=8.0±0.3, with T_R900^(2000)_(400)yrs; for the Dead Sea Transform, M_(max)=7.8±0.3, with T_R1000^(2400)_(450)yrs; and for the Kunlun fault, M_(max)=8.0±0.3, with T_R1000^(2000)_(450)yrs.
Instructional leadership and the charter school principal

ABSTRACTFew studies have investigated what occurs inside charter schools with respect to instructional leadership, teaching, and learning. To address this gap in the literature, this case study examines two major issues: how the principals at four charter schools enact instructional leadership in their respective schools, and what barriers the principals encounter when enacting instructional leadership at their school sites. The results highlight three main categories of instructional leadership practices: developing a school mission, managing curriculum and instruction, and promoting school climate and culture. In addition, the data reveal that while the principals attempted to engage in instructional leadership, they encountered barriers related to budgeting and staffing. The paper broadens the scholarly understanding of instructional leadership in schools with high levels of autonomy.
Predictors of Postoperative Rehabilitation Therapy Following Congenital Heart Surgery.

Background Patients with congenital heart disease are at risk of motor, cognitive, speech, and feeding difficulties after cardiac surgery. Rehabilitation therapy could improve functional outcomes in this population if applied in the acute postcardiac surgical in‐hospital stay. However, information on the types of acute postcardiac surgery therapy needs in children is scarce. Our goal was to describe rehabilitation therapy following congenital heart surgery and pre/intraoperative factors associated with need for therapy. Methods and Results This is a retrospective cohort study of patients Conclusions Nearly half of patients who underwent post–congenital heart surgery received rehabilitation therapy. Frequency of use and types of therapy vary according to patient characteristics; however, certain pre‐ and intraoperative factors are associated with need for rehabilitation therapy, and may aid decision‐making for appropriate resource allocation.
Home Oxygen Therapy for Bronchiolitis: An Evaluation of the Primary Care Providers’ Experience at Sea Level:

Despite 90% of primary care providers at altitude reporting experience with home oxygen therapy for hypoxemic, otherwise well infants, its use at sea level is not well described. Our objective was to understand experience with home oxygen at sea level and determine potential barriers and benefits of its use. We surveyed all pediatricians and family medicine providers within a 30-mile radius of our pediatric hospital from May 2016 to December 2016. Forty-three percent of providers responded. Few (8%) had any experience with home oxygen therapy for bronchiolitis. When all responders were asked about potential benefits and barriers, they reported less disruption of family routines and reduced cost as the largest potential benefits, and lack of parental comfort the largest barrier. Despite their concerns, 53% of providers felt that home oxygen use would not substantially affect their practice. Our results identify a need for education before using this alternative to admission in our center.
The Social Construction of Scientific Knowledge

In the closing pages of her remarkable study of Giordano Bruno, Frances Yates set forth the critical problem of modern science: The basic difference between the attitude of the magician to the world and the attitude of the scientist to the world is that the former wants to draw the world into himself, whilst the scientist does just the opposite, he externalizes and impersonalizes the world… Hence, may it not be supposed, when mechanics and mathematics took over from animism and magic, it was this internalisation, this intimate connection of the mens with the world, which had to be avoided at all costs. And, hence, it may be suggested, through the necessity for this strong reaction, the mistake arose of allowing the problem of mind to fall so completely out of step and so far behind the problem of matter in the external world and how it works… This bad start of the problem of knowledge has never quite been made up (1).
Challenges in Fossil Energy Chemistry

More fundamental knowledge of fossil fuels, particularly coal and shale in terms of structure and reactivity is essential for generating the new technologies necessary for their efficient use in the future. This paper is intended to review the present state of the art and to suggest specific basic research opportunities and challenges in the areas of coal characterization, gasification, and liquefaction. Many of the same opportunities apply to shale. Assessments of the impact such research programs could have are offered.
Exploring dedifferentiation across the adult lifespan.

One of the central concepts within the literature on cognitive aging is the notion of dedifferentiation-the idea that increasing age is associated with an increase in the interrelatedness of different cognitive abilities. Despite the centrality of this dedifferentiation hypothesis, there is a great deal of evidence that both supports and does not support dedifferentiation. We hypothesized that these inconsistent findings were due to (a) the use of different cognitive abilities (i.e., memory vs. speed of processing) that were correlated; and (b) the differing age groups that were used across studies. By using data from 11 well-validated cognitive test batteries (K = 2,355, range of the mean ages of correlations 18-85+), we found evidence for linear dedifferentiation when a test assessing speed of processing was included in the correlation with test of other cognitive abilities. We speculate that previous findings of nonlinear dedifferentiation are likely a result of undiagnosed or unrecognized pathology in a subsample of participants. (PsycINFO Database Record
Use of Objective Measures to Estimate Sedentary Time in Youth

The purpose of the study was to conduct a comprehensive evaluation of the ActiGraph GT3X+ (AG) and activPAL (AP) for assessing time spent in sedentary behaviors (SB) in youth using structured and free-living activities. Forty-four participants (mean±SD; age, 12.7±0.8 yrs) completed up to 8 structured activities and approximately 2-hrs of free-living activity while wearing an AG (right hip) and AP (right thigh). A Cosmed K4b2 was used for measured energy expenditure (METy; activity VO2 divided by resting VO2). Direct observation was used during the structured activities. SB time was estimated using the inclinometer function of the AP and AG, and count thresholds with AG ( 96% of the time. For the free-living measurement, the VA <25 counts/10-s has the lowest RMSE (20.6 min), while the VM <75 counts/10-s had the lowest MAPE (69.2%). The AG inclinometer was within 0.2 minutes of measured time, but had the highest MAPE (107.1%). The AP was within 1.6 minutes of measured time, but had the highest RMSE (28.5 minutes). Compared to measured SB time, the VA <25 counts/10-s and VM <75 counts/10-s provided the most precise estimates of SB during free-living activity. Further refinement is needed to improve the AP and AG posture estimates.
Comparison of analogue and electronic stethoscopes for pulmonary auscultation by internal medicine residents.

Background Electronic stethoscopes are becoming more common in clinical practice. They may improve the accuracy and efficiency of pulmonary auscultation, but the data to support their benefit are limited. Objective To determine how auscultation with an electronic stethoscope may affect clinical decision making. Methods An online module consisting of six fictional ambulatory cases was developed. Each case included a brief history and lung sounds recorded with an analogue and electronic stethoscope. Internal medicine resident participants were randomly selected to hear either the analogue or electronic lung sounds. Numbers of correct answers, time spent on each case and numbers of times the recordings were played were compared between the groups who heard each mode of auscultation, with a p value of less than 0.05 indicating statistical significance. Results 61 internal medicine residents completed at least one case, and 41 residents completed all six cases. There were no significant differences in overall scores between participants who heard analogue and electronic lung sounds (3.14±0.10 out of 6 correct for analogue, 3.20±0.10 out of 6 for electronic, p=0.74). There were no significant differences in performance for any of the six cases (p=0.78), time spent on the cases (p=0.67) or numbers of times the recordings were played (p=0.85). Conclusion When lung sounds were amplified with an electronic stethoscope, we did not detect an effect on performance, time spent on the cases or numbers of times participants listened to the recordings.
Rotating-Hinge Revision Total Knee Arthroplasty for Treatment of Severe Arthrofibrosis

Abstract Background Revision total knee arthroplasty (TKA) for arthrofibrosis is fraught with challenges. Because rotating-hinge (RH) prostheses do not rely on ligaments for stability, a more aggressive soft-tissue release is possible. The goal of this study was to report arc of motion, Knee Society scores, and implant survivorship in patients with arthrofibrosis revised with an RH. Methods Thirty-four patients revised with an RH for arthrofibrosis were matched to 68 patients revised without an RH. The mean age was 63 years, 62% were female, mean body mass index was 31 kg/m2, and mean follow-up was 6 years (range, 2-15 years). Results The mean arc of motion increased 20° (74°-94°) in the RH group versus 12° (87°-99°) in the non-RH group (P = .048). Two manipulations under anesthesia were performed in the RH group compared to 9 in the non-RH group (P = .2). Knee Society scores increased significantly in both groups (P = .01 and P Conclusion In this series, patients with arthrofibrosis revised to an RH TKA had a 20° improvement in arc of motion and manipulations under anesthesia were half as common. However, there was a higher risk of re-revision in the RH group. Level of Evidence III.
Students’ Reflections on Their Field Practicum: An Analysis of BSW Student Narratives

This qualitative study was undertaken to explore what undergraduate students reflect on during their learning to practice social work in the field. Reflection is essential in the social work field ...
Opioid Use and Outcomes in Hospitalized Older Patients With Heart Failure Receiving and Not Receiving Hospice Referrals.

Background The use of opioids is associated with poor outcomes. Less is known about this association in patients with heart failure (HF) and whether it varies by the receipt of hospice care. Methods Of the 7467 patients hospitalized for HF without previous opioid use, 124 received discharge opioids. We matched 123 of these patients with 123 not receiving opioids based on their propensity scores for opioid use, thus assembling a matched cohort of 246 patients balanced on 30 baseline characteristics (mean age, 76 years, 60% women, and 11% African American). We repeated the process in hospice (n = 155; 20 received opioids) and nonhospice (n = 7298; 104 received opioids) subgroups, thus assembling 2 matched cohorts of 22 and 208 patients, respectively. Hazard ratios (HRs) and 95% confidence intervals (CIs) associated with opioid use were estimated from matched cohorts. Results During 8.6 (median, 1.4) years of follow-up, all-cause mortality occurred in 80% and 68% of matched patients in the opioid and nonopioid groups, respectively (HR, 1.49; 95% CI, 1.11-1.99; P = 0.008). There was evidence of heterogeneity in this association between hospice and nonhospice patients (P for interaction, 0.027). Among matched hospice and nonhospice patients, HRs (95% CIs) for mortality were 6.37 (2.06-19.69; P = 0.001) and 1.42 (1.03-1.96; P = 0.035), respectively. HRs (95% CIs) for 30-day and 1-year mortality were 1.98 (1.06-3.70; P = 0.033) and 1.72 (1.18-2.49; P = 0.004), respectively. HRs (95% CIs) for all-cause, HF, and non-HF readmissions were 1.31 (0.97-1.76; P = 0.079), 1.03 (0.71-1.49; P = 0.866), and 1.75 (1.05-2.91; P = 0.031), respectively. Readmission associations were similar among matched nonhospice patients. There was no readmission among matched hospice patients receiving opioids. Conclusions In older patients with HF, opioid use is associated with a higher risk of mortality, which is greater in the hospice subgroup, and a higher risk of non-HF readmission in the nonhospice subgroup.
The return of the intolerant Hobbes

Thomas Hobbes in Leviathan presented a paradigm of the social contract that has proven foundational in Western political thought. A proper understanding of the philosopher’s thought is thus of para...
The New Bench for the Academic Surgeon: Precision Medicine

Precision medicine is a clinical discipline that was born from basic science in genetics, as well as engineering. This discipline finally represents an actual marriage of basic science with clinical science, a translational science “par excellence.” Also called personalized or individualized, precision medicine is a revolution in research, healthcare, and economics, for which its growth has been at an unprecedented speed. In the past few years, Precision Medicine has been changing the way diseases are diagnosed, treated, and cured. As it relates to cancer, precision medicine is potentially one of the most progressive approaches in individualized care that a patient may receive. By using human pancreatic cancer-derived material, the precision medicine research field is making significant contributions to our understanding of disease mechanisms. However, as pancreatic cancer surgeons and researchers, the time has come to more intensively immerse within this field. New concepts and methodologies of genomics, epigenomics, pharmacogenomics, and microbiome, high-level bioinformatics and data analytics, along with portable and wearable biosensors and printables, when combined with meticulously documented clinical data, have the ability to help advance any scientific endeavor and medical practice in this field. More than ever, surgeons are poised to leverage the power of precision medicine to develop a successful and rewarding academic career.
ED Stories: An Online Emergency Medicine Residency Community Building and Wellness Initiative.

The "ED Stories" project is a novel method for promoting individual wellness and interpersonal relationships on a virtual platform in an emergency medicine residency program. We engaged multiple individuals across all levels of medical training on a virtual platform to facilitate discussion regarding difficult situations, patient interactions, and tips on how to succeed in challenge circumstances in the future. The platform was outlined as a "safe space," free of judgment and criticism. We engaged 54 participants with a culmination of 131 interactions; there were 14 original posts with a total of 22 comments. We believe that this virtual platform allowed for safe discussion of difficult concepts related to our jobs and served as an outlet to promote physician wellness and reduce burnout in the future.
Supporting transgender students: School counselors’ preparedness, training efforts, and necessary support

Negative school climate and oppressive policies and laws significantly impact the psychological and academic well-being of transgender students in the United States. LGBTQ students consistently ide...
When the Learner Is the Expert: A Simulation-Based Curriculum for Emergency Medicine Faculty

Emergency physicians supervise residents performing rare clinical procedures, but they infrequently perform those procedures independently. Simulation offers a forum to practice procedural skills, but simulation labs often target resident learners, and barriers exist to faculty as learners in simulation-based training. Simulation-based curricula focused on improving emergency medicine (EM) faculty's rare procedure skills were not discovered on review of published literature. Our objective was to create a sustainable, simulation-based faculty education curriculum for rare procedural skills in EM. Between 2012 and 2019, most EM teaching faculty at a single, urban, Level 1 trauma center completed an annual two-hour simulation-based rare procedure lab with small-group learning and guided hands-on instruction, covering 30 different procedural education sessions for faculty learners. A questionnaire administered before and after each session assessed EM faculty physicians' self-perceived ability to perform these rare procedures. Participants' self-reported confidence in their performance improved for all procedures, regardless of prior procedural experience. Faculty participation was initially mandatory, but is now voluntary. Diverse strategies were used to address barriers in this learner group including eliciting learner feedback, offering continuing medical education credits, gradual roll-out of checklist assessments, and welcoming expertise of faculty leaders from EM and other specialties and professions. Participants perceived training to be most helpful for the most rarely-encountered clinical procedures. Similar curricula could be implemented with minimal risk at other institutions.
The rapid Bethesda assay is equivalent to the standard Bethesda assay for detection of factor IX inhibitors in patients with severe haemophilia B

INTRODUCTION The time-dependent nature of factor VIII (FVIII) inhibitors is well described, and the standard FVIII Bethesda assay used to measure inhibitors incorporates a 2-hour incubation. Despite case reports and reviews describing the immediate-acting nature of factor IX (FIX) inhibitors, many coagulation laboratories continue to use a traditional prolonged incubation for FIX Bethesda assays. To our knowledge, a comprehensive evaluation of the FIX Bethesda assay without incubation has not been reported. AIM The goal of this study was to evaluate the performance of a rapid FIX Bethesda (ie no incubation) compared with the standard Bethesda assay (2-hour incubation). METHODS The analysis used a Bethesda assay configured for either immediate testing or a 2-hour incubation. Samples from 14 haemophilia B patients with inhibitors and 9 non-human controls were tested. RESULTS The two assays yielded similar performance overall. The average per cent difference in inhibitor titre between the rapid and standard FIX Bethesda assay was -3% (range -15% to +13%; P = .175) for patient samples and -2% (range -17% to +14%; P = .376) for controls. CONCLUSION The rapid Bethesda assay showed good agreement with the standard Bethesda assay for determination of inhibitor levels in patients with severe haemophilia B. The rapid assay allows for faster assessment of inhibitors in patients with severe haemophilia B and has the potential to improve the ability of the coagulation laboratory to perform testing from a logistical viewpoint. Further studies involving larger numbers of patients would be important to confirm our findings.