cssi/SciSciGPT-SciSciNet huggingface dataset:
Tasimelteon for the treatment of non-24-hour sleep-wake disorder

Tasimelteon (Hetlioz®), a melatonin receptor agonist, is the first, and, at the time of the publication, the only drug to be approved by the U.S. Food and Drug Administration (FDA) for the treatment of non-24-hour sleep-wake disorder (non-24). This circadian rhythm disorder occurs most commonly in blind individuals without light perception, and it results from their inability to entrain to the 24-hour photoperiod, although the indication does not specify a particular patient population. Non-24 is characterized by a persistent cycle of nighttime insomnia and daytime sleepiness, alternating with asymptomatic periods depending on an individual's degree of circadian rhythm synchronization with the photoperiod at any particular time. Phase II clinical trials in healthy individuals confirmed the circadian phase-shifting potential of tasimelteon. Phase III trials in totally blind subjects diagnosed with non-24 demonstrated the efficacy of tasimelteon in reducing both nighttime wakefulness and daytime napping. Physiologic monitoring revealed that tasimelteon resulted in a higher proportion of individuals becoming entrained to the 24-hour cycle compared with placebo. Safety assessments indicated that tasimelteon is well tolerated, with the most common adverse events being headache, alanine aminotransferase elevation, nightmares or unusual dreams, and upper respiratory or urinary tract infections. Tasimelteon is available as a capsule in a single 20-mg dose and it must be obtained through Vanda Pharmaceutical's HetliozSolutions program with dispensing through a specialty pharmacy. Safety studies in blind individuals diagnosed with non-24 are ongoing and a future clinical trial with Smith-Magenis syndrome patients is planned.
A Rural Stroke Network without Telemedicine (P03.016)

Objective: Is a stroke network without video telemedicine feasible? Background Stroke networks typically have telemedecine at their core to extend stroke call coverage to needy hospitals. However, because telemedicine equipment is expensive it may widen stroke care disparities. An alternative is a network based on relationship-building, education of local providers, and quality improvement initiatives. Design/Methods: A stroke neurologist was assigned to create a network. Telemedicine was deemed too costly for most referring hospitals. With a core mission to serve disadvantaged populations, we focused on inexpensive educational lectures to local providers, nurse training, care protocols, community awareness campaigns, and local quality monitoring initiatives. Membership is at fair market value with a contract that details mutual responsibilities. Results: To date, several hospitals in Appalachian and Central Kentucky have joined, and several more are asking. Stroke referrals from affiliates have increased with network involvement. Because of network success, additional internal resources have been allocated and we are partnering with a large private health care provider to grow the network. Expanded network initiatives include a stroke registry that may capture 7000 subjects yearly. Conclusions: A stroke network without telemedicine is feasible. Community hospitals do not necessarily want or need telemedicine, and this technological advantage may widen stroke care disparities. Because we are indiscriminate in acquiring affiliates, we may be narrowing disparities in access to stroke care. This will be studied through the network registry. Our network may have spill-over effects to improve vascular health in general for our population. This also deserves further study. Our rate-limiting step for signing affiliates has been allocation of internal resources such as network personnel time. We are hiring additional personnel, allocating more neurologist director time to network activities, and partnering with a large private health care provider. Protected stroke neurology director time has been vital. We are poised for further network growth. Disclosure: Dr. Dobbs has nothing to disclose. Dr. Bellamy has nothing to disclose.
Solution Characteristics of Calcium Sulfite in Wet FGD

Deliquescence of calcium sulfite under various conditions including temperature,pH,dissolving time,stirring rate and initial quantity was investigated in experiment.The best deliquescence conditions of calcium sulfite and actual movement process was studied for the purpose of improving oxidation rate and generation rate of gypsum and preventing from blockade and encumbrance.
Reduction of Drug Abuse in Adolescents Previously Treated with Stimulants for ADHD

The effects of early stimulant medication on subsequent risk for cigarette smoking and substance use disorders (SUDs) were evaluated in a 5-year, case-controlled, follow-up study of adolescent girls with ADHD at the Pediatric Psychopharmacology Program, Masachusetts General Hospital, Boston, MA, and Department of Psychiatry, New York State University, Syracuse, NY.
In utero transfer of adult bone marrow cells into recipients with severe combined immunodeficiency disorder yields lymphoid progeny with T- and B-cell functional capabilities.

To determine if in utero transplantation could restore the immune system of mice with a severe combined immunodeficiency (SCID) disorder, C57BL/6Sz-scid/scid fetuses were injected on day 14/15 of gestation with adult congenic donor bone marrow (BM) cells. Congenic BM engrafted in one of eight (13%) recipients. Reconstitution of both lymphoid and nonlymphoid lineages was observed. In vitro and in vivo T-cell function was documented. Stem cells were shown to have engrafted by secondary transfer studies. When fully allogeneic C57BL/6 (H-2b) or B10.BR (H-2k) adult. BM cells were given to C.B-17-scid/scid (H-2d) fetal recipients, 15 of 54 (28%) recipients had evidence of engraftment, with up to 76% of peripheral blood (PB) being of in utero donor BM origin on day 131 postnatally. In all mice with persistent leukocyte engraftment, T- and B-lymphoid cells were entirely of donor origin. Donor T cells were tolerant to host but not third party alloantigens as measured in vitro. In vivo, T-cell function appeared intact. Although most mice had lower levels of B-cell engraftment than T-cell engraftment, mice with > or = 10% B cells were able to produce normal levels of IgM. Despite transplantation of fully allogeneic BM cells, stem cell engraftment could be demonstrated by secondary transfer of BM cells into lethally irradiated recipients that were congenic to the original in utero donor BM source. These data indicate that adult BM cells, even those fully allogeneic with the fetal recipient, can give rise to progeny with multilineage potential, which leads to restoration of T-cell and B-cell function.
Effect of time of day on aerobic power in exhaustive high-intensity exercise.

The purpose of this study was to determine if there is an effect of time of day on aerobic power elicited during exhaustive high-intensity constant-power cycle ergometer exercise. Twenty-four college students (12 women and 12 men) each performed three exhaustive exercise tests (against 3.5 W.kg -1 for women and 4.0 K.kg -1 for men). The first test served as a learning trial. The second and third tests were scheduled at about 08:00 hrs (AM) and 16:00 hrs (PM), with the order of testing randomly assigned. Results from these two tests were compared for evidence of a time of day effect using a two-way ANOVA with repeated measures over time of day and with subjects nested in sex. Time to exhaustion was 9% greater (p<0.01) in the PM (214±43 sec) than in the AM (196±38 sec). Peak VO 2 was 7% higher (p<0.01) in the PM (3.34±1.00 1.min -1 ) in the AM (3.11±0.98 1.min -1 ). The aerobic system responded 6% faster (p=0.04) in the PM than in the AM: the time constant describing VO 2 kinetics was 33.5±5.7 sec in the PM and 35.5±5.5 sec in the AM. However, there were no significant correlations (p≥0.20) between the AM-PM differences in time to exhaustion, time constant of the response, or peak VO 2 . The findings confirm previous reports of a time of day effect on time to exhaustion in high-intensity exercise. It was also concluded that there is a higher peak VO 2 in the PM than in the AM. In addition, there is a time of day effect on VO 2 kinetics, with the aerobic system responding faster in the PM than in the AM.
Measurement of Bacterioplankton Growth in the Sea and Its Regulation by Environmental Conditions

The last few years have witnessed something of a revolution in our view of the role of bacteria in the marine environment. It is now being recognized that bacteria play a quantitatively significant role in the flow of energy and matter in marine ecosystems. The central theme of this “new view” is based on two lines of evidence: (1) bacterial biomass is a significant part of the total biomass in the oceans (Hobbie et al. 1977), and (2) the bacterioplankton is, metabolically, a highly active component of marine biota (Pomeroy 1974; Williams 1981; Azam and Hodson 1977; Hagstrom et al. 1979; Fuhrman and Azam 1980, 1982). This thinking is diametrically opposed to the conventional wisdom which portrays bacterioplankton as quantitatively trivial and, even today, insists that dormancy due to insufficient nutrients is the dominant physiological state of most bacteria.
Low Body Mass Index, Serum Creatinine, and Cause of Death in Patients Undergoing Percutaneous Coronary Intervention

Background Low body mass index (BMI) and serum creatinine are surrogate markers of frailty and sarcopenia. Their relationship with cause‐specific mortality in elderly patients undergoing percutaneous coronary intervention is not well studied. Methods and Results We determined long‐term cardiovascular and noncardiovascular mortality in 9394 consecutive patients aged ≥65 years who underwent percutaneous coronary intervention from 2000 to 2011. BMI and serum creatinine were divided into 4 categories. During a median follow‐up of 4.2 years (interquartile range 1.8–7.3 years), 3243 patients (33.4%) died. In the multivariable model, compared with patients with normal BMI, patients with low BMI had significantly increased all‐cause mortality (hazard ratio [HR] 1.4, 95% CI 1.1–1.7), which was related to both cardiovascular causes (HR 1.4, 95% CI 1.0–1.8) and noncardiovascular causes (HR 1.4, 95% CI 1.06–1.9). Compared with normal BMI, significant reduction was noted in patients who were overweight and obese in terms of cardiovascular mortality (overweight: HR 0.77, 95% CI 0.67–0.88; obese: HR 0.80, 95% CI 0.70–0.93) and noncardiovascular mortality (overweight: HR 0.85, 95% CI 0.74–0.97; obese: HR 0.82, 95% CI 0.72–0.95). In a multivariable model, in patients with normal BMI, low creatinine (≤0.70 mg/dL) was significantly associated with increased all‐cause mortality (HR 1.8, 95% CI 1.3–2.5) and cardiovascular mortality (HR 2.3, 95% CI 1.4–3.8) compared with patients with normal creatinine (0.71–1.0 mg/dL); however, this was not observed in other BMI categories. Conclusions We identified a new subgroup of patients with low serum creatinine and normal BMI that was associated with increased all‐cause mortality and cardiovascular mortality in elderly patients undergoing percutaneous coronary intervention. Low BMI was associated with increased cardiovascular and noncardiovascular mortality. Nutritional support, resistance training, and weight‐gain strategies may have potential roles for these patients undergoing percutaneous coronary intervention.
Sensing Pulsed THz Waves with Ambient Air

We report the use of air to sense broadband THz waves. Ambient air, with about 79% nitrogen and 21% oxygen, exhibits remarkable performance for the generation and detection of pulsed THz waves with femtosecond laser beams.
A Cost Analysis of Alternative Fluid Milk Packaging Systems1

The fluid milk processing industry faces a problem arising from demands of consumers and environmentalists. Consumers want an inexpensive, high quality milk product in a convenient package, based on varying family needs. Environmental groups are concerned about the best container for packaging milk when the capacity of solid waste disposal systems, environmental quality, and natural resource utilization are considered. This study is intended to aid industry and government policy makers to evaluate the costs of five container systems: (a) paper, (b) returnable rigid plastic, (c) disposable blow-mold plastic, (d) plastic pouch, and (e) glass. The study is based on a non-random stratified sample of 28 firms in Washington, Oregon, and California. Costs were identified by departments or functions to reflect the various production or handling stages. The appropriate categories were combined for each type of fluid milk container to ascertain average unit costs. The average total dock cost for whole milk in all sizes of paper containers and gallon in-plant blow-mold plastic containers declines as the volume of fluid milk processed by a firm increases. Even with large variation in some cost categories by container type, there appears to be little difference in the average total dock cost among the returnable rigid plastic, paper, in-plant blow-mold plastic, and plastic pouch containers.
Transnational Networks for an International Education

This chapter presents a critical reflection upon an ongoing teaching experiment that began in 2012. The experiment has been a collaboration between Wagner College in the United States and Sandscribe Communications in Ethiopia, initiated by me, a professor of English at Wagner, and by Dhaba Wayessa, an immigrant from Ethiopia who works as a journalist for Voice of America in Washington DC and who is also the founder of Sandscribe.
Differential Diagnosis from Hemangioma

The term “vascular anomalies” represents a heterogeneous spectrum of vascular lesions. Although the etiology is unclear and most likely represents a multifactorial process, studies evaluating response to medical therapies, the identification of genomic and somatic mutations in some patients with vascular anomalies, and other research findings have contributed to our understanding of the pathogenesis of these disorders. Patients with vascular anomalies represent a unique population, in that they have focal aberrations of vascular development (vasculogenesis in vascular malformations) or vascular proliferation (angiogenesis in hemangiomas). Descriptive analyses of associated skeletal and developmental variations have led to the discovery of patterns of anatomic distribution of many vascular anomalies, as well as the identification of syndromic associations. In recent years, genomic and somatic mutations have been recognized as etiologic factors in the evolution of these lesions.
Differential physiological responses to central leptin overexpression in male and female rats

Brains of females are more sensitive to the acute catabolic actions of leptin. However, sex differences in the long-term physiological responses to central leptin receptor modulation are unknown. Accordingly, we centrally delivered a viral vector to overexpress leptin (Leptin), a neutral leptin receptor antagonist (Leptin-Antagonist) or a green fluorescence protein (GFP) (Control). We examined chronic changes in body weight and composition in male and female rats. Females displayed greater and sustained responses to Leptin, whereas males rapidly lost physiological effects and developed leptin resistance as confirmed by lower acute leptin-mediated phosphorylation of signal transducer and activator of transcription 3 (P-STAT3). Surprisingly, despite persistent physiological responses, Leptin-females also exhibited reduced acute leptin-mediated P-STAT3, suggesting an onset of leptin resistance near time of death. In line with this interpretation, Leptin-females and Control-females consumed the same amount of food on the last day of the experiment. Both Leptin-Antagonist groups gained similar percentages of their initial body weight and fat mass, whereas only Leptin-Antagonist-females gained lean body mass. Consequently, the lean/fat mass ratio with Leptin-Antagonist was preserved in females and decreased in males, suggesting a deterioration of body composition in males. In summary, the present study establishes that females are more responsive to long-term central leptin overexpression than males and that leptin antagonism has a greater physiological impact in males. The hormone environment may have played a role in these processes; however, future studies are needed to establish whether such physiological responses are mediated by female or male sex hormones.
Silicon Levels in Human Tissues

Silicon determinations were made in a variety of human tissues and body fluids. Both electron probe microanalyses of silicon were used, as were colorimetric assays, suitably modified to eliminate contamination by phosphorus. High silica levels were found in the central cores and in the rims of senile plaques found in Alzheimer’s dementia. The increased Si was substantially above that found in the background tissues and represented a striking focal increase in Si. Colorimetric assays of brain and other organs indicated that there was no generalized increase in silicon in the patients with Alzheimer’s disease. The increase in Si was not confined to Alzheimer’s plaques, but also occurred in corpora amylacea of the three patients with Alzheimer’s disease.
Development and validation of an LC-MS/MS method for quantitative determination of GS87, a novel antineoplastic agent, in mouse plasma.

Abstract GS87 is a novel, highly specific GSK3 inhibitor, which has shown to induce extensive differentiation of acute myeloid leukemia (AML) cells in early mouse studies and has great potential for therapeutic advancement. This work described the development and validation of an LC–MS/MS method for quantitative determination of GS87 in mouse plasma. In this method, GS87 and T6447952 (a structural analog used as internal standard) were extracted from plasma using hexane as extraction solvent, and separated isocratically on a Waters XTerra® MS C8 column (2.1 × 50 mm, 3.5 μm) using a mobile phase consisting of acetonitrile and 5.00 mM ammonium formate (35:65, v/v) pumped at a flow rate of 0.200 mL min−1. Quantitation of GS87 was done by positive electrospray ionization tandem mass spectrometry operated in multiple-reaction-monitoring (MRM) mode. The method has been validated in accordance with the US Food and drug administration guidelines for bioanalytical method validation. It has linear calibration range of 2.50–250 ng mL−1 with correlation coefficient of >0.999. The intra- and inter- assay accuracy and precision were ≤ ±5 and ≤6%, respectively. The IS normalized recovery of GS87 was 103–106%. The stability studies showed that GS87 was stable under all tested conditions. The method developed has been successfully applied to the measurement of GS87 concentrations in mouse plasma samples from an animal study, and may be useful for further preclinical investigation of GS87.
Using the Visual Arts to Form an Intervention Design Concept for Resettlement Support Among Refugee Women

This article offers findings from workshops researchers undertook with 60 Myanmar refugee women who convened in small groups of 10 to envision the properties and functioning of a resettlement commu...
Chemistry, Physical Properties, and Synthesis of Araneidae Orb Webs

It was the distinguished organic chemist, Emil Fischer (1907), who clearly demonstrated the protein nature of spider silk. Only much later (F.G. Fischer and Brander 1960) was it realized that the orb web contains low molecular weight, water soluble com­pounds as well.
Mitigating risk of preventable medical errors across a network through event sharing.

234Background: Medical errors are the 4th leading cause of death in the US. Oncology providers are not immune to preventable medical errors occurring in the treatment of their patients. As a nation...
Otopathology in Angiosarcoma of the Temporal Bone.

Objectives/hypothesis Investigate the otopathology of angiosarcoma of the temporal bone, which has not been previously described in the literature. Study design Postmortem evaluation and literature review. Methods Postmortem histological evaluation of the temporal bones and review of the literature for the treatment and prognosis of this rare disease were performed. Results A 50-year-old male with right chronic otitis media presented with progressive hearing loss, disequilibrium, otalgia, and acute facial paresis. Biopsy of the external auditory canal was unrevealing, but specimens from a canal wall down tympanomastoidectomy later showed high-grade angiosarcoma. Magnetic resonance imaging demonstrated an unresectable middle ear and mastoid mass extending superiorly into the temporal lobe. The patient received induction chemotherapy followed by proton beam radiation therapy and concurrent paclitaxel and bevacizumab. His course was complicated by a cerebrospinal fluid leak and cauda equina syndrome from leptomeningeal sarcomatosis. The patient died after developing meningitis and a temporal lobe abscess. Postmortem otopathology revealed persistent angiosarcoma in the internal auditory canal, although none was found in the middle ear or mastoid. There was inflammatory infiltrate throughout the mastoid, with direct extension of neutrophils and bacteria into the cochlea and through the tegmen into the middle cranial fossa. Conclusions Angiosarcoma of the temporal bone can arise in the setting of chronic otitis media. In this case, postmortem temporal bone sections demonstrated viable cancer despite chemoradiation. Inflammatory infiltrates crossing from the middle ear/mastoid into the labyrinth and central nervous system illustrate pathways for the development of otogenic meningitis. Level of evidence 4 Laryngoscope, 129:737-742, 2019.
Influenza A (H3N2) Induced Fulminant Myocarditis Requiring Mechanical Circulatory Support

Abstract The authors report a case of fulminant myocarditis from an influenza A (H3N2) infection in a healthy individual who experienced cardiac arrest requiring extracorporeal membrane oxygenation (ECMO). The case highlights the management of complications arising from the use of ECMO including differential hypoxia and left ventricular overload requiring left ventricular venting. (Level of Difficulty: Beginner.)
Decision Neuroscience and Organizational Ethics

Recent advances in decision neuroscience hold promise to address questions that have engaged organizational ethics scholars for decades. Following from this promise, two research questions emerge: (1) What are the most productive ways to enhance organizational ethics through scholarly communication and collaborative work among philosophers, social scientists, and neuroscientists? (2) What contributions have already been made, and how can we build on those contributions? Specifically, how can scholars in the field of organizational ethics, both normative and empirical scholars, shape future neuroscience research on topics germane to their research interests? Decision neuroscience confirms that people do not make ethical decisions in a strictly rational manner but that emotion and intuition play important roles. The challenge is to link neuroscience findings such as these to questions specific to empirical organizational ethics research, as well as to higher-order normative questions. Research on moral cognition is emphasized, including conceptualizations of moral cognition, brain structure and function, and dual process theory and the role of emotion. Future research suggestions are included.
Improving Information and Communications Technology (ICT) Knowledge and Skills to Develop Health Research Capacity in Kenya

ObjectivesInformation and communication technology (ICT) tools are increasingly important for clinical care, research, data management, international collaborations, and dissemination. Many technologies would be particularly useful for healthcare workers in resource-limited settings; however, these individuals are the least likely to utilize ICT tools, in part because they lack knowledge and skills necessary to use them. Our program aimed to train researchers in low-resource settings on using ICT tools.MethodsWe conducted a tiered, blended learning program for researchers in Kenya on three areas of ICT: geographic information systems, data management, and communication tools. Tiers included didactic online courses for 100-300 students for each topic, skills workshops for 30 students, and mentored projects for 10. Concurrently, a training of trainers course comprised of an online course and a skills workshop to ensure sustainable ongoing training.ResultsCourse ratings were high, particularly when participants engaged in hands-on skill building activities. Teaching that incorporated local examples was most valuable. Discussion boards were sometimes distracting, depending on multiple factors. Mentored projects were most useful when there were clear expectations, pre-existing projects or data, and clear timelines.DiscussionTraining in the use of ICT tools is essential to improve their use among researchers in low-income settings. However, very few training courses have been described. Our students demonstrated acquisition of new skills and felt these skills to be valuable in their workplaces.ConclusionsFurther and ongoing training in ICT skills should be considered in other low-resource settings, and could use our program as a foundational model.
Design and Performance Evaluation of an Implantable Ultrasonic Networking Platform for the Internet of Medical Things

Wireless networks of electronically controlled implantable medical sensors and actuators will be the basis of many innovative and potentially revolutionary therapies. The biggest obstacle in realizing this vision of networked implants is posed by the dielectric nature of the human body, which strongly attenuates radio-frequency (RF) electromagnetic waves. In this paper we present the first hardware and software architecture of an Internet of Medical Things (IoMT) platform with ultrasonic connectivity for intra-body communications. This platform can be used as a basis for building future IoT-ready medical implants and wearable devices. We demonstrate that ultrasonic waves can be efficiently generated and received with low-power mm-sized components, and that despite the conversion loss introduced by ultrasonic transducers, the attenuation of 2.4 GHz RF is substantially greater than ultrasound, e.g., ultrasound attenuates 70 dB less than RF at distances over 10 cm. We show that the proposed IoMT platform requires significantly less transmission power than 2.4 GHz RF with equal reliability, e.g., 35 dBm less at distances over 12 cm with 10−3 Bit Error Rate (BER) thus enabling a lower energy per bit and a longer device lifetime. Finally, we experimentally establish 2.4 GHz RF links do not function at distances greater than 12 cm, while ultrasonic links achieve a reliability of 10−6 BER up to a distance of 20 cm with less than 0 dBm transmission power.
Standard 6-mm Compared with Widefield 16.5-mm OCT for Staging of Posterior Vitreous Detachment.

Purpose To assess whether 6-mm OCT scans, which image the macula, can distinguish complete from partial posterior vitreous detachment (PVD) in comparison with 16.5-mm OCT scans, which image the macula, optic nerve, and mid periphery. Design Retrospective cross-sectional study. Participants We compared 6-mm and 16.5-mm scans in 157 eyes of 157 retina clinic patients (mean age, 50 years; range, 10–64 years) with diabetic retinopathy (36%), no retinal disease (19%), and various retinal conditions (45%). We also analyzed 16.5-mm scans in 35 healthy eyes (asymptomatic fellow eyes of patients with unilateral retinal conditions; mean age, 46 years; range, 9–63 years). Methods Each participant underwent Heidelberg Spectralis imaging with the standard lens (6-mm scan) and/or the 55° lens (16.5-mm scan). On 6-mm scans, we classified eyes as stage 3 partial PVD when the posterior vitreous cortex was visualized without visible attachment. On 16.5-mm scans, we classified eyes as stage 3 when the vitreous was attached at the optic nerve and separated from the macula. On both scan types, we classified eyes as stage 4 when neither the premacular bursa nor the posterior vitreous cortex were visualized. We assessed the accuracy of this system for detecting complete PVD on 6-mm scans by calculating test characteristics using 16.5-mm scans as a reference standard. Main Outcome Measure Posterior vitreous detachment stage (0–4). Results Posterior vitreous detachment stage was identical in 6-mm and 16.5-mm scans in 88% of eyes. Compared with 16.5-mm scans, 6-mm scans detected complete PVD (vs. earlier stages 0–3) with 91% sensitivity and 99% specificity. Seven eyes were classified as no PVD on 6-mm scans and were classified as partial PVD on 16.5-mm scans because vitreoretinal separation was localized to the mid periphery. All 16.5-mm scans showed some degree of PVD, including scans from 9 participants between 9 and 20 years of age. Conclusions Six-millimeter scans distinguished complete from partial PVD with good sensitivity and specificity but missed the earliest stages of PVD, which occur in the mid periphery. Posterior vitreous detachment may begin as early as the second decade of life.
What lies beneath: poking a hole in the diagnosis

A man aged 77 years was referred to the emergency department (ED) of our hospital by his primary physician for evaluation of dyspnoea and hypoxaemia. On presentation to the ED, he reported 2 months of progressively worsening dyspnoea and non-productive cough. He also endorsed weight loss and fatigue. He had been prescribed a recent course of clarithromycin after an episode of fever, but this did not ameliorate either the dyspnoea or the cough. On the day he was referred to the ED, his primary physician found him to be hypoxemic, which is what prompted the referral. The patient’s medical history was significant for hypertension and coronary artery disease with myocardial infarction and coronary stenting 4 years prior to admission. His usual home medications included aspirin, carvedilol, losartan, rosuvastatin, sertraline and zolpidem. He was a former smoker who quit 25 years earlier after accumulating 40 pack-years. He had no occupational or environmental exposures. On admission, his hypoxaemia was confirmed with an oxygen saturation by pulse oximetry on room air of 76%. The patient was visibly dyspnoeic and had diffuse bilateral crackles on auscultation. His jugular venous pulse was normal. There was no clubbing or oedema. Routine laboratory evaluation was remarkable for a brain natriuretic peptide level of 557 pg/mL (normal <100 pg/mL). There was no blood eosinophilia. Testing of a nasopharyngeal swab specimen for the most common respiratory viral pathogens and Bordetella pertussis by PCR was negative. Frontal chest radiograph (CXR) obtained in the ED demonstrated extensive bilateral airspace opacification (figure 1A), which was new compared with a CXR taken 18 months earlier. There were no pleural effusions. Intravenous furosemide was administered for a presumptive diagnosis of cardiogenic pulmonary oedema. However, the patient’s symptoms and oxygenation failed to improve. Transthoracic echocardiography showed focal left ventricular wall motion abnormalities. However, systolic function …
What is the clinical impact of positive cultures at the time of primary total shoulder arthroplasty

Background Cultures taken at the time of primary shoulder arthroplasty are commonly positive for Cutibacterium acnes. Despite our limited understanding of the clinical implication of deep tissue inoculation from dermal colonization, significant efforts have been made to decolonize the shoulder prior to surgery. The purpose of this study is to determine differences in clinical outcomes based on culture positivity at the time of primary shoulder arthroplasty. Methods A series of 134 patients who underwent primary anatomic or reverse total shoulder arthroplasty and had intraoperative cultures obtained via a standard protocol were included. In each case, 5 tissue samples were collected and processed in a single laboratory for culture on aerobic and anaerobic media for 13 days. Minimum 2-year functional outcomes scores (American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form [ASES] and Single Assessment Numeric Evaluation [SANE]) and reoperation data were analyzed. Results Forty-two (31.3%) patients had positive cultures (30 C acnes and 21 with at least 2 positive cultures) at the time of surgery. There was no statistically significant difference in postoperative functional outcome scores (ASES: 82.5 vs. 81.9; P = .89, SANE: 79.5 vs. 82.1; P = .54) between culture-positive and culture-negative cohorts. There were no cases of infection. Two patients (4.8%; 2/42) with positive cultures required reoperation compared with 4 patients (5.6%; 4/71) without positive cultures. Conclusion The apparent colonization by nonvirulent organisms in patients undergoing primary shoulder arthroplasty does not appear to have a clinically significant effect on functional outcomes or need for repeat surgery in the short term.
Government Financing for Clean Technology Development: Financial Risk and Social Benefits

Problem definition: We study implications of government financing to promote clean technology development, which provides loans for financially constrained firms that manufacture and sell clean-technology products. Methodology/results: We build an analytical model to explore the impact of such government financing in the presence of market uncertainty. Our analysis shows that government financing results in the firm's more aggressive technology investment and exposes the firm to a higher bankruptcy risk. We also provide empirical evidence based upon the clean-technology projects financed by loan programs under the U.S. Department of Energy to support this analytical result. To deal with the high bankruptcy risk under government financing, we propose a risk-mitigating mechanism where the government utilizes a more sophisticated loan contract that ties the firm's environment commitment and quantity commitment in such a way that discourages the firm's over-investment in technology. Managerial implications: Our work sheds light on the overlooked risk associated with government financing for clean technology development, and provides rationales for some of the high-profile bankruptcies of the financed firms.
A machine-learning modified CART algorithm informs Merkel cell carcinoma prognosis

Background Merkel cell carcinoma (MCC) is a rare neuroendocrine skin cancer with a high mortality rate. MCC staging is currently based on tumour primary size, clinical detectability of lymph node metastases, performance of a lymph node biopsy, and presence of distant metastases. Objective We aimed to use a modified classification and regression tree (CART) algorithm using available data points in the National Cancer Database (NCDB) to elucidate novel prognostic factors for MCC. Methods Retrospective cohort study of the NCDB and Surveillance, Epidemiology, and End Results (SEER) registries. Cases from the NCDB were randomly assigned to either the training or validation cohorts. A modified CART algorithm was created with data from the training cohort and used to identify prognostic groups that were validated in the NCDB validation and SEER cohorts. Results A modified CART algorithm using tumour variables available in the NCDB identified prognostic strata as follows: I: local disease, II: ≤3 positive nodes, III: ≥4 positive nodes, and IV: presence of distant metastases. Three-year survival for these groups in the NCDB validation cohort were 81.2% (SE: 1.7), 59.6% (SE: 3.0), 38.0% (SE: 6.0), and 20.2% (SE: 7.0), respectively. These strata were exhibited greater within-group homogeneity than AJCC groups and were more predictive of survival. Conclusions Risk-stratified grouping of MCC patients incorporating positive lymph node count were strongly predictive of survival and demonstrated a high degree of within-group homogeneity and survival prediction. Incorporation of positive lymph node count within overall staging or sub-staging may help to improve future MCC staging criteria.
Absorptive Weak Plume Detection on Gaussian and Non-Gaussian Background Clutter

For additive signals on Gaussian clutter, the optimal detector is a linear matched filter that is adapted to the known signal and the covariance of the background. This adaptive matched filter is widely used for gas-phase plume detection, even though the effect of the plume on the background is not strictly additive. Here, a derivation of the matched filter for a strictly absorptive plume produces, in the weak plume limit, a quadratic filter. This quadratic matched filter is extended in two ways: an elliptically-contoured multivariate $t$ distribution is used to generalize the Gaussian background clutter, and a generalized likelihood ratio test detector is derived to extend applicability to stronger plumes. In addition to detectors whose purpose is to identify presence versus absence of a plume, expressions are also derived for estimating plume strength. The performance of these various detectors is evaluated by implanting simulated plume into background images that are either real hyperspectral images or simulated images based on different (Gaussian, multivariate $t$ , and lognormal) clutter distributions.
Language Translation as a Socio-Technical System:Case-Studies of Mixed-Initiative Interactions

Seamless access to information in a rapidly globalizing world demands for availability of information across, ideally all but at the least a large number of, languages. Machine translation has been proposed as a technological solution to this complex problem. However, despite seven decades of research, and recently seen rapid progress in the field - thanks to deep learning and availability of large data-sets, perfect machine translation across a large number of the world’s languages still remains elusive. In fact, it is a distant and perhaps even an impossible goal. Erroneous translations, on the other hand, can be detrimental in critical situations such as talking to a law enforcement officer; or, they could potentially perpetuate social biases or stereotypes, for instance, by producing mis-gendered translations. In this work, we argue that language translation is inherently a socio-technical system, which has to be viewed, studied, and optimized for, as such. The need and context of translation, the socio-demographic factors behind the human translators as well as the consumers of the translated content affect the complexity of the translation system, as much as the accuracy of the technology and its interface. Through a series of case studies on mixed-initiative interaction based approach to translation, we bring out the various socio-technical factors and their complex interactions that one has to bear in mind while designing for the ideal human-machine translation systems. Through these observations, we make multiple recommendations which, at the core, suggest that ”solving” translation in the real sense would require more coordinated efforts between the technical (NLP) and social communities (HCI + CSCW + DEV).
Production and Inventory Control of a Single Product Assemble-to-Order Systems with Multiple Customer Classes

We consider the optimal production and inventory control of an assemble-to-order system with m components, one end-product, and n customer classes. A control policy specifies when to produce each component and, whenever an order is placed, whether or not to satisfy it from on-hand inventory. We formulate the problem as a Markov decision process and characterize the structure of an optimal policy. We show that a base-stock production policy is optimal, but the base-stock level for each component is dynamic and depends on the inventory level of all other components (more specifically, it is nondecreasing). We show that the optimal inventory allocation for each component is a rationing policy with different rationing levels for different demand classes. The rationing levels for each component are dynamic and also nondecreasing in the inventory level of all other components. We compare the performance of the optimal policy to heuristic policies, including the commonly used base-stock policy with fixed base-stock levels, and find them to perform surprisingly well, especially for systems with lost sales.
History and Physical Exam on the Thrower’s Elbow

Overhead athletes frequently sustain injuries to their dominant elbow secondary to the high valgus and extension forces inherent to the throwing motion. The relatively unnatural motion of throwing can produce a myriad of pathological stresses on the structures about the elbow, namely tensile stresses medially, compression stresses laterally, and shear stresses posteromedially. Accurate diagnosis and treatment of elbow pain in the throwing athlete depends upon a detailed history, methodical physical examination, and appropriate ancillary tests when needed, as any of the above mentioned stresses may produce varying types of lesions in the elbow joint. The clinician must possess a thorough understanding of the functional anatomy and biomechanical characteristics of the complex elbow articulation to efficiently evaluate and diagnosis such pathologies in the thrower’s elbow.
Clinical Ontologies for Discovery Applications

The recent achievements in the Human Genome Project have made possible a high-throughput “systems approach” for accelerating bioinformatics research. In addition, the NIH Whole Genome Association Studies will soon supply abundant clinical data annotated to clinical ontologies for mining. The elucidation of the molecular underpinnings of human diseases will require the use of genomic and ontology-anchored clinical databases. The objective of this chapter is to provide the background required to conduct biological discovery research with clinical ontologies. We first provide a description of the complexity of clinical information and the main characteristics of various clinical ontologies. The second section illustrates several methods used to integrate clinical ontologies and therefore databases annotated with heterogeneous standards. Finally the third section reviews a few genome-wide studies that leverage clinical ontologies. We conclude with the future opportunities and challenges offered by the Semantic Web and clinical ontologies for clinical data integration and mining. Discovery research faces the challenge of generating novel tools to help collect, access, integrate, organize and manage clinical information and enable genome wide analyses to associate phenotypic information with genomic data at different scales of biology. Collaborations between bioinformaticians and clinical informaticians are poised to leverage the Semantic Web.
The Effect of Nonlinear Critical Layers on Boundary Layer Transition

Asymptotic methods are used to describe the nonlinear self-interaction between pairs of oblique instability modes that eventually develops when initially linear and spatially growing instability waves evolve downstream in nominally two-dimensional and spanwise periodic laminar boundary layers. The first nonlinear reaction takes place locally within a so-called “critical layer” with the flow outside this layer consisting of a locally parallel mean flow plus an appropriate superposition of linear instability waves. The amplitudes of these waves are determined by either a single integro-differential equation or by a pair of integro-differential equations with quadratic to quartic-type nonlinearities.
EARTHQUAKE STABILITY OF SLOPES OF COHESIONLESS SOILS

Evaluation of the effects of ground accelerations on the stability of slopes of cohesionless materials involves the determination of the yield acceleration, i. e., the acceleration at which slippage will begin to occur and the magnitude of the deformations developed. For accelerations of short duration it is shown that there is a marked difference between the yield acceleration and the acceleration inducing noticeable movement. Experimental evidence is presented to show that for dense cohesionless soils there is a small shear strength developed at zero confining pressure, termed the shear strength intercept, which can have a profound effect on the yield accelerations of small embankments. It is pointed out that the uniformity of surface conditions of a slope is also extremely important in determining the yield acceleration for any given case. Analyses for determining the yield acceleration and the position of the sliding surface are presented and the results are shown in graphical form. The computed values are shown to be in good agreement with experimental data. The effects of acceleration direction and the initial factor of safety of the slope on the yield acceleration are also examined.
Epstein-Barr Virus and Cytomegalovirus Viral Load Monitoring by Quantitative Real-Time Polymerase Chain Reaction

Epstein-Barr virus (EBV) and cytomegalovirus (CMV) viral load testing using quantitative real-time polymerase chain reaction is commonly used for diagnosing and monitoring diseases associated with these viruses. In this chapter, we describe laboratory-developed test protocols for EBV based on published literature and for CMV based on commercially available analyte-specific reagents.
Superheated and Dissipative Ginzburg-Landau Superconductors

We study two superconducting systems using the Landau-Ginzburg equations. The first is a superconducting half-space with an applied magnetic field parallel to the surface. We calculate the maximum applied field that still supports superconductivity in the material by solving the Landau-Ginzburg equations analytically in asymptotic regimes of the Landau-Ginzburg parameter, kappa. These results are then checked against numerical studies. The other system is a thin, current-carrying strip. Here we do the first systematic study of nucleation of superconductivity in a normal strip and of the motion of a normal-superconducting interface in the presence of a current. This dissipative system requires solving the time-dependent Landau-Ginzburg equations analytically and numerically.
Movement of edge dislocations in KCl by large electric fields

Abstract Bands of etch pits resembling slip bands have been produced from an indentation made on the (001) surface of a KCl crystal containing nominally 88 p.p.m. Ca2+ by the sole action of a d.c. field up to 15 MV m−1 along [100]. Only edge dislocation bands appeared, extending from the indentation towards the anode and forming an asymmetric rosette pattern. From the minimum field needed to produce such edge bands and the yield stress of the crystal, a charge of – 7 × 10−11 Cm−1 was obtained for the edge dislocations.