cssi/SciSciGPT-SciSciNet huggingface dataset:
The Unaccounted Insurance Value of Medical Innovation

Traditional value of medical innovation models estimate the benefits of a new treatment to individuals who fall sick ex-post. However, economic theory suggests medical innovation has additional benefits ex-ante - before susceptible individuals know whether or not they will fall sick. This paper presents a model for estimating the ex-ante value of new medical innovation, where risk-averse individuals who are susceptible to contracting a disease in the future derive value from the existence of a treatment, because risk-averse individuals prefer to insure against uncertainty in future survival outcomes. A healthy, risk-averse individual should value a new treatment for a disease and be willing to pay a small premium for it, even if he never uses it because of his future risk of the disease. I demonstrate that when individuals are risk-averse, the total ex-ante value is always greater than the total ex-post value. The difference between ex-ante and ex-post value is the insurance value of medical innovation due to risk aversion. I show that insurance value is highest for rare diseases, where afflicted patient populations are small, but vulnerable patient populations are large. For very rare diseases, up to 64 percent of the value of a cure is ex-ante insurance value. Using population-level estimates of disease risk for cancer, I find that between 24 and 63 percent of the value of cancer-specific cures are comprised of ex-ante insurance value - estimates vary by the prevalence and mortality risk of each cancer type. These results suggest there will be under-provision of valuable innovation by the private biopharmaceutical market if only ex-post valuations are reimbursed by payers.
The Statistical Interpretation of Predictions

This chapter discusses the statistical interpretation of predictions. In order for discrete choice models to be really useful, it is necessary to find ways of assessing the accuracy of their predictions. Inaccuracies in the forecasts have three basic sources: (1) specification errors, (2) insufficient or poor data, and (3) poor or erroneous prediction of the distribution of the attribute vector. In the analysis of the statistical interpretation of predictions, the problems were assumed solved, which left two remaining sources of inaccuracies: (1) insufficient data and (2) uncertain distribution of the attribute vector. The chapter discusses errors in the estimation of θ 0 due to lack of data. It also describes the subject for very large groups of people and for both binary and multinomial models; the logic there parallels the development of confidence intervals for points on the regression line of the standard linear model. The chapter discusses prediction intervals for small groups of individual and gives a simple rule of thumb to select an adequate sample size prior to calibration, along with handling the uncertainty in the distribution of the attribute vector.
Loss of the SUMO protease Ulp2 triggers a specific multichromosome aneuploidy

Post-translational protein modification by the small ubiquitin-related modifier (SUMO) regulates numerous cellular pathways, including transcription, cell division, and genome maintenance. The SUMO protease Ulp2 modulates many of these SUMO-dependent processes in budding yeast. From whole-genome RNA sequencing (RNA-seq), we unexpectedly discovered that cells lacking Ulp2 display a twofold increase in transcript levels across two particular chromosomes: chromosome I (ChrI) and ChrXII. This is due to the two chromosomes being present at twice their normal copy number. An abnormal number of chromosomes, termed aneuploidy, is usually deleterious. However, development of specific aneuploidies allows rapid adaptation to cellular stresses, and aneuploidy characterizes most human tumors. Extra copies of ChrI and ChrXII appear quickly following loss of active Ulp2 and can be eliminated following reintroduction of ULP2, suggesting that aneuploidy is a reversible adaptive mechanism to counteract loss of the SUMO protease. Importantly, increased dosage of two genes on ChrI-CLN3 and CCR4, encoding a G1-phase cyclin and a subunit of the Ccr4-Not deadenylase complex, respectively-suppresses ulp2Δ aneuploidy, suggesting that increased levels of these genes underlie the aneuploidy induced by Ulp2 loss. Our results reveal a complex aneuploidy mechanism that adapts cells to loss of the SUMO protease Ulp2.
Microcytosis in Myelofibrosis with Myeloid Metaplasia: Prevalence and Clinical Correlates.

Background: Microcytosis is a characteristic laboratory feature for both iron deficiency anemia and thalassemia. Microcytosis is also infrequently seen with “anemia of chronic disease”. A partial list of the latter include rheumatoid arthritis, polymyalgia rheumatica, diabetes mellitus, connective tissue disease, chronic infection, Hodgkin’s lymphoma, Castleman’s disease, and renal cell carcinoma. In the current study, we show that microcytosis is a frequent laboratory feature in myelofibrosis with myeloid metaplasia (MMM) and investigate its clinical relevance in the particular setting. Methods: In order to minimize the confounding effects of nutritional deficiencies, red blood cell transfusion, and drug therapy on mean corpuscular volume (MCV), the current study was limited to young patients (age Results: The study population consisted of 102 consecutive patients with MMM (median age 51 years, range 18–60) including 60 males. At diagnosis, the median (range) values for hemoglobin, leukocyte count, and platelet count were 11 gm/dL (7.4–14.9), 8.3 x 109/L (1–40) and 357 x 109/L (14–1512), respectively. Spleen measurements were documented in 78 patients (median 6 cm below the left costal margin, range 0–24) and the incidence of hypercatabolic symptoms was 18% (12 of 67 evaluable patients). The Dupriez prognostic score distribution included low-risk (n=73), intermediate-risk (n=19), and high-risk (n=10) disease categories. The overall incidence of microcytosis (MCV Conclusion: Microcytosis with a normal or elevated serum ferritin level is a frequent laboratory feature in MMM but does not appear to influence survival. The observation regarding the low incidence of cytogenetic abnormalities in MMM patients with microcytosis is intriguing but requires validation by a prospective study. Whether or not MMM-associated microcytosis represents an acquired defect of globin synthesis, as might be the case in some patients with myelodysplastic syndrome, remains to be elucidated.
Comparison of Outcomes of Atrial Fibrillation in Patients With Reduced Versus Preserved Left Ventricular Ejection Fraction

Patients with newly diagnosed atrial fibrillation (AF) and a rapid ventricular response may present with a reduced left ventricular ejection fraction (LVEF). We compared long-term outcomes of these patients with those with preserved LVEF. This retrospective cohort study included 385 consecutive adults with newly diagnosed AF with rapid ventricular response, presenting to a single medical center from January 2006 to August 2014. Patients with a history of coronary artery disease or known cardiomyopathy were excluded. Patients were divided into 2 groups: those with an LVEF ≤55% (n = 147) (REF) and those with an LVEF >55% (n = 238) (PEF). Echocardiographic parameters, all-cause mortality, cardiovascular mortality, and stroke rates were compared between both groups at baseline and a minimum of 1-year follow-up. The mean age of patients was 68 ± 1.1 in REF versus 60 ± 7.4 in PEF (p = 0.39). There were no significant differences in baseline co-morbidities between both groups. The mean LVEF during the index admission was 47.7 ± 0.8% in REF versus 65.5 ± 0.3% in PEF. The average duration of follow-up was 2.8 years. Patients with REF had higher all-cause mortality (32.7% REF vs 20.6% PEF, odds ratio 2.17, p = 0.008). Patients with REF had higher rates of subsequent clinic or ER visits for AF with a rapid ventricular response (32% REF vs 22.7% PEF, p = 0.044). The incidence of stroke was similar between both groups (17% REF vs 18.9% PEF, p = 0.639). Of the patients with REF, 64% had subsequent EF recovery and had similar outcomes compared with patients with PEF. Baseline LV end-diastolic diameter predicted all-cause mortality (odds ratio 1.14, p = 0.003) in the REF group. None of the echocardiographic parameters predicted EF recovery. In conclusion, in patients with new AF with rapid ventricular response, REF was associated with higher long-term all-cause mortality. Those with subsequent LVEF recovery after medical therapy appear to have a similar prognosis compared with those with initial PEF.
Managing Periodontitis in Type 1 Diabetic Patients Improves Glycemic Control: A Case Report

This case report describes the long-term follow-up of a 22-year-old, female patient with type 1 diabetes managed by conservative oral care and glycemic control measures. She is on a twice a day insulin regimen. Tooth numbers 13 and 37 had pockets less than 6 mm while all remaining teeth had greater than 6 mm. Periodontal management consisted of root planing combined with instructions on diabetes self-management skills at home. Nine weeks after the first sextant was treated, Pocket depth measurements in 93 (81.6%) out of 114 sites and bleeding on probing (BOP) scores in 11 (57.9%) out of 19 teeth decreased. There was a 50% reduction in the C reactive Protein and a 46.7% decrease in the fructosamine assay levels. Initial glycohemoglobin level of 8.3% decreased substantially to 7.1%. The goal of the dentist is no longer just the improvement of oral health but ultimately the overall health of the patient and the physician’s goal is to include oral health in the promotion of overall health.
IP packet header compression and user grouping for LTE Multimedia Broadcast Multicast Services

Multimedia Broadcast Multicast Service (MBMS)1 is an efficiency cellular strategy for shared content delivery, widely popular in Long Term Evolution (LTE) networks. Typical multimedia IP packets possess redundantly large headers, relying on Robust Header Compression (ROHC) for efficiency boost. This work investigates the adaptation of ROHC schemes for MBMS. We formulate and solve the optimization problem of transmission efficiency maximization in point-to-multipoint (P-t-M) transmission mode. Based on this solution, we propose a new MBMS scheme, namely point-to-multigroup (P-t-MG) transmission in which MBMS aim user groups. We provide a grouping and parameter optimization algorithm for P-t-MG to achieve high efficiency under total radio resource constraints. Numerical results demonstrate the advantage of the optimized P-t-M and the P-t-MG schemes over conventional MBMS.
Using the Electronic Medical Record to Correlate Kawasaki Disease Phenotypes With Clinical Outcomes.

Background We sought to systematically standardize the documentation of clinical and laboratory features in Kawasaki disease (KD) on the day of initial treatment and correlate the presentation with clinical outcomes. Methods Kawasaki disease features and classification were documented by the attending physician using a standardized documentation tool on the day of treatment for KD, including confidence in the KD diagnosis on a 4-point scale. Incomplete KD was further classified using American Heart Association (AHA) criteria (sufficient or insufficient) and baseline echocardiogram data. We prospectively recorded intravenous immunoglobulin (IVIG) resistance, coronary artery abnormalities (CAAs), periungual peeling, and retrospectively identified subsequent diagnoses of autoimmune/inflammatory disease. Results From November 2012 to October, 2015, 162 patients were treated for KD: 105 with complete KD (Group 1), 7 with incomplete KD based on CAAs on day of KD diagnosis (Group 2), 23 with incomplete KD meeting AHA criteria (Group 3), and 27 with incomplete KD and insufficient AHA criteria (Group 4). Group 4 patients had lower baseline median C-reactive protein levels (Group 4 median 4.65 mg/dL [interquartile range {IQR}, 2.3-13.6] vs Group 1 median 8.0 mg/dL [IQR, 4.5-17], Group 2 median 13.9 mg/dL [IQR, 1.4-18.2], Group 3 median 13.3 mg/dL [IQR, 4.9-20.2]), and no coronary abnormalities developed, although 11% had IVIG resistance. Group 4 had higher rates of subsequent autoimmune/inflammatory conditions diagnosed (11.1% in Group 4 vs <5% for all others, P = .02). Conclusions Standardized documentation and classification of KD features may be useful to correlate with clinical outcomes, including subsequent diagnosis of autoimmune/autoinflammatory disease. Among patients with incomplete KD who did not meet AHA criteria and had a normal baseline echocardiogram, the IVIG resistance rate may have been related to a lower likelihood of an accurate diagnosis of KD.
Preoperative accuracy of gastric cancer staging in patient selection for preoperative therapy: race may affect accuracy of endoscopic ultrasonography

Background: Over the last 15 years, large randomized controlled studies have validated the benefit of preoperative therapy for patients with resectable gastric cancer. Computed tomography (CT) and endoscopic ultrasonography (EUS) are commonly used to select patients for preoperative treatment, but studies of preoperative staging accuracy that focus on patient selection for preoperative therapy are rare; therefore, whether CT or EUS can reliably identify patients eligible for preoperative therapy is still unclear. Our purpose was to determine the accuracy of EUS and CT for preoperative staging of gastric cancer and to identify factors that may affect their usefulness in selecting patients for preoperative therapy. Methods: We reviewed the medical records of 8,260 patients with gastric or gastroesophageal adenocarcinoma treated at our institution from 1995 to 2013, identifying those who underwent gastrectomy without preoperative treatment. We compared T stage and N status from preoperative EUS and CT reports with those drawn from surgical pathology reports. Clinicopathologic and demographic variables associated with incorrect preoperative staging were investigated using univariate and multivariate analyses. Results: We identified 187 patients who underwent preoperative staging by EUS (n=145) and/or CT (n=134) before gastrectomy. The accuracy, sensitivity, and specificity of EUS in distinguishing stage T1 from more advanced tumors were 82%, 78%, and 85%, respectively. Variables associated with underestimation of EUS T stage were lymphovascular invasion [odds ratio (OR), 7.51; 95% confidence interval (CI), 1.91– 29.50; P Conclusions: EUS is accurate in distinguishing T1 from T2–T4 lesions; both CT and EUS have low sensitivities and high specificities in determining N status. These accuracies and variables associated with inaccurate staging, including race, should be considered when selecting gastric cancer patients for preoperative therapy.
Imaging of endoscopic approaches to the anterior and central skull base

Sinonasal endoscopy for treatment of benign sinonasal diseases is a well-established procedure. Recent advances in endoscope technology have substantially expanded its application with many institutions now offering resection of skull base lesions and sinonasal malignancies via the endoscopic approach. Its minimally invasive nature leads to faster recovery time, better cosmetic results, and fewer complications. Unfortunately, not all lesions involving the sinonasal region and skull base are accessible to sinonasal endoscopy. In addition, many of these disease processes are not directly visible on clinical examination. Therefore, the surgeon relies upon imaging to (1) determine the extent and possible nature of the disease; (2) provide guidance for surgical planning purposes, in particular, if a lesion is accessible to endoscopic surgery or if an open surgical approach is indicated. The radiologist, on the other hand, needs to be familiar with the technical limitations and contraindications of sinonasal endoscopy to provide a meaningful radiology report to the surgeon. The relative and absolute contraindications to endoscopic surgery can be categorised into technical factors, extent of a lesion, tumour vascularity, and anatomical variations and are discussed in this review article.
An Approximate Method for Solving a Vibration Equation Involving Fractional Derivatives

The response of one-degree-of-freedom systems with fractional distributed-order damping is studied. The dynamics of such systems constitutes the problem of the fractional distributed-order oscillator. This paper presents a new numerical method for solving this fractional distributed order oscillator. The method is based on using fractional Taylor vector approximation. The operational matrix of the fractional integration for fractional Taylor vector is given and is utilized to reduce the solution of the fractional distributed order oscillator to a system of algebraic equations. An illustrative example is included to demonstrate the validity and applicability of this technique.
Healthcare Transition from the Family Perspective

The “magic age” of 18—legal adulthood—is a daunting transition under the best circumstances. High school graduation! College or vocational training! Employment! A first apartment or college dorm! The brave new world of adulthood!
Eyes of a Human, Eyes of a Program: Leveraging Different Views of the Web for Analysis and Detection

With JavaScript and images at their disposal, web authors can create content that is immediately understandable to a person, but is beyond the direct analysis capability of computer programs, including security tools. Conversely, information can be deceiving for humans even if unable to fool a program.
HCV adaptation to HIV coinfection.

Abstract Human immunodeficiency virus (HIV) infection is rising as a leading cause of morbidity and mortality among hepatitis C virus (HCV)-infected patients. Both viruses interact in co-infected hosts, which may affect their intra-host evolution, potentially leading to differing genetic composition of viral populations in co-infected (CIP) and mono-infected (MIP) patients. Here, we investigate genetic differences between intra-host variants of the HCV hypervariable region 1 (HVR1) sampled from CIP and MIP. Nucleotide (nt) sequences of intra-host HCV HVR1 variants (N = 28,622) obtained from CIP (N = 112) and MIP (n = 176) were represented using 148 physical-chemical (PhyChem) indexes of DNA nt dimers. Significant (p
The Bat’s Vertical Sweetness Gradient

Sweetness is defined as the probability of attaining a base hit. The sweetness of a specific bat–ball collision is found by determining the ball’s vertical launch characteristics, the range and hang time of the batted ball and finally, the probability of batter success. For MLB, the sweet spot of the bat is one-fifth of an inch high.
Design of finger gestures for locomotion in virtual reality

Abstract Background Within a virtual environment (VE) the control of locomotion (e.g., self-travel) is critical for creating a realistic and functional experience. Usually the direction of locomotion, while using a head-mounted display (HMD), is determined by the direction the head is pointing and the forward or backward motion is controlled with a hand held controllers. However, hand held devices can be difficult to use while the eyes are covered with a HMD. Free hand gestures, that are tracked with a camera or a hand data glove, have an advantage of eliminating the need to look at the hand controller but the design of hand or finger gestures for this purpose has not been well developed. Methods This study used a depth-sensing camera to track fingertip location (curling and straightening the fingers), which was converted to forward or backward self-travel in the VE. Fingertip position was converted to self-travel velocity using a mapping function with three parameters: a region of zero velocity (dead zone) around the relaxed hand position, a linear relationship of fingertip position to velocity (slope or/J) beginning at the edge of the dead zone, and an exponential relationship rather than a linear one mapping fingertip position to velocity (exponent). Using a HMD, participants moved forward along a virtual road and stopped at a target on the road by controlling self-travel velocity with finger flexion and extension. Each of the 3 mapping function parameters was tested at 3 levels. Outcomes measured included usability ratings, fatigue, nausea, and time to complete the tasks. Results Twenty subjects participated but five did not complete the study due to nausea. The size of the dead zone had little effect on performance or usability. Subjects preferred lower β values which were associated with better subjective ratings of control and reduced time to complete the task, especially for large targets. Exponent values of 1.0 or greater were preferred and reduced the time to complete the task, especially for small targets. Conclusions Small finger movements can be used to control velocity of self-travel in VE. The functions used for converting fingertip position to movement velocity influence usability and performance.
An inverse relationship between perceived social support and substance use frequency in socially stigmatized populations.

Abstract Introduction Social isolation and alcohol and substance use disorders (ASUD) have been identified as global health risks. Social support is protective against developing ASUD and is associated with beneficial addiction treatment outcomes. Socially stigmatized populations are at higher risk of both social isolation and ASUD, and the link between social support and substance use in these populations has been less researched than in general substance-using populations. We hypothesized that perceived social support, as measured by the Social Provisions Scale (SPS), would have an inverse relationship with frequency of substance use, from subsections of the Addiction Severity Index (ASI) that estimate use over the past 30 days and over an individual's lifetime. Methods Using a cross-sectional design, we conducted secondary correlational analyses with pre-existing data to test our hypothesis in two separate samples made up of socially marginalized populations entering ASUD treatment programs. Sample 1: substance-using male prison inmates (n = 72, average age = 30.79) and Sample 2: primary methamphetamine-using men who have sex with men (n = 86, average age = 43.41). Results Significant negative correlations were found between SPS and lifetime use of alcohol, tobacco, and cannabis (rs − 0.27, −0.39, −0.26; p-values 0.04, 0.001, 0.04, respectively) in Sample 1 and 30-day use of methamphetamine (rs − 0.28; p-value 0.008) in Sample 2. Discussion Differences in results between the samples (lifetime vs 30-day use) may reflect psychosocial and contextual differences impacting perceived social support. Our findings provide support for an important link between perceived social support and frequency of substance use in socially stigmatized populations.
Generating optimal overlapping subsystems for distributed statistical fault detection subject to constraints

Abstract Fast and accurate detection of faults is essential for the safe and cost-effective operation of chemical plants. Large scale process systems can potentially be affected by a wide variety of faults. An effective approach for detecting faults in such systems is to first divide or decompose the system's sensors into subsystems and to then implement a statistical monitoring method in each of the subsystems. The detection performance of such distributed multivariate statistical process monitoring methods depends strongly on the decomposition of the system's sensors into subsystems. In our previous work, we developed a simulation optimization method, called Performance Driven Agglomerative Clustering, which uses a greedy search strategy, based on clustering algorithms from graph theory, to find a decomposition of the system's sensors into subsystems for which the detection performance of a distributed monitoring method is near optimal. It is possible that the detection performance can be further improved by allowing a sensor to be part of multiple subsystems in the decomposition. User defined requirements may also place constraints on the decomposition of the sensors into subsystems. In this work, we propose the Extended Performance Driven Agglomerative Clustering method which allows to incorporate constraints and sensors to be allocated to multiple subsystems. To demonstrate its effectiveness, the proposed method is applied to the benchmark Tennessee Eastman Process.
Incorporation of high intensity ultrasound (HIU) to a scraped surface heat exchanger: Effect of HIU position

Abstract The objective of this work was to introduce high-intensity ultrasound (HIU) in different positions within a scraped surface heat exchanger (SSHE) and evaluate the crystallization behavior and physical properties of a low saturated, soybean-based fat. The SSHE in this study was composed of one pump (flow rate of 11 L/h), two crystallization barrels (32 °C, 344 rpm), and one pin worker (208 rpm). HIU was placed before the first crystallization step, or barrel 1 (HIU-0), between the two barrels (HIU-1), between barrels 2 and the pin worker (HIU-2) and after complete crystallization in the SSHE (HIU-3). HIU amplitudes of 20% or 50% using 5-s pulses were used. Physical properties of the crystallized material such as microstructure, solid fat content, oil binding capacity (OBC), viscoelasticity, hardness, and melting behavior were evaluated. HIU induced crystallization and improved all physical properties when positioned at HIU-2 and HIU-3 using 50% amplitude, but in HIU-3 the effect was more pronounced than in HIU-2. Samples sonicated using 50% amplitude at HIU-3 position showed the following improvements (p
A Visualization Framework for Multi-scale Coherent Structures in Taylor-Couette Turbulence

Taylor-Couette flow (TCF) is the turbulent fluid motion created between two concentric and independently rotating cylinders. It has been heavily researched in fluid mechanics thanks to the various nonlinear dynamical phenomena that are exhibited in the flow. As many dense coherent structures overlap each other in TCF, it is challenging to isolate and visualize them, especially when the cylinder rotation ratio is changing. Previous approaches rely on 2D cross sections to study TCF due to its simplicity, which cannot provide the complete information of TCF. In the meantime, standard visualization techniques, such as volume rendering / iso-surfacing of certain attributes and the placement of integral curves/surfaces, usually produce cluttered visualization. To address this challenge and to support domain experts in the analysis of TCF, we developed a visualization framework to separate large-scale structures from the dense, small-scale structures and provide an effective visual representation of these structures. Instead of using a single physical attribute as the standard approach which cannot efficiently separate structures in different scales for TCF, we adapt the feature level-set method to combine multiple attributes and use them as a filter to separate large- and small-scale structures. To visualize these structures, we apply the iso-surface extraction on the kernel density estimate of the distance field generated from the feature level-set. The proposed methods successfully reveal 3D large-scale coherent structures of TCF with different control parameter settings, which are difficult to achieve with the conventional methods.
Developing a Public Health Model for Regional Infection Prevention Collaboration Among Healthcare Facility Networks

Background: Antimicrobial resistance (AR), including Clostridioides difficile infection (CDI), can spread across the healthcare continuum when patients move between facilities. In 2015, the CDC recommended that healthcare facilities (HCFs) and local public health departments (LPH) coordinate their efforts to prevent the spread of AR and CDI. Accordingly, the California Department of Public Health (CDPH) Healthcare-Associated Infections (HAI) Program developed a model for implementing regionally based AR/CDI prevention collaboratives within HCF networks. Methods: The CDPH HAI Program began identifying regions in California with high AR/CDI incidence or risk for AR/CDI emergence using NHSN data. During 2015–2019, we organized AR/CDI prevention collaboratives in these regions. We recruited HCFs for participation by presenting at local professional organization meetings and engaging skilled nursing facility corporate leadership. HAI Program infection preventionists conducted onsite infection prevention assessments at each participating HCF. HAI Program and LPH staff convened quarterly in-person learning and discussion sessions focused on infection prevention and antimicrobial stewardship best practices. Participating HCFs committed to facility-tailored process improvement plans and conducted self-assessments to evaluate infection prevention practice changes at the conclusion of the collaborative. For CDI-focused collaboratives, we used data reported to CDPH via NHSN to assess changes in hospital- and community-onset CDI incidence among participating hospitals before and after the collaboratives. Results: Since 2015, 205 HCFs in 15 LPH jurisdictions have participated in 6 regional AR/CDI prevention collaboratives. Participating HCFs reported improved implementation of AR/CDI prevention strategies. For CDI-focused collaboratives, hospital-onset CDI incidence decreased by ~3% per month among participating hospitals. The collaboratives created forums for communication and relationship building, which previously did not exist among LPH and the HCF networks. We used our experience and feedback from partners to develop an HAI Program AR Prevention Collaborative Tool Kit to help LPHs and healthcare organizations develop and implement regional AR/CDI prevention collaboratives in other at-risk or high AR/CDI prevalence areas in California. The tool kit includes materials developed for each of our collaboratives, which may be adapted to meet local needs. Conclusions: Regionally coordinated AR/CDI prevention initiatives among LPHs and HCFs can contribute to increased AR awareness, improved AR prevention practices, and decreased AR/CDI incidence. The effectiveness of regional AR/CDI prevention collaboratives may be the result of concurrent efforts to improve AR prevention practices both within individual HCFs and across patient sharing networks. Funding: None Disclosures: None
Nocturnally swarming Caribbean polychaetes of St. John, U.S. Virgin Islands, USA

Nocturnally swarming polychaetes were sampled over a ten-year period (2007–2017) in shallow waters of the Virgin Islands National Park, St. John, United States Virgin Islands. While sampling was qualitative and conducted over different years, months and lunar phases, some patterns were noted in the emergence of swarming polychaetes. Three families (Nereididae, Opheliidae, and Syllidae) had members that swarmed on most nights, while reproductive epitokes from two families appeared only during specific lunar phases: Goniadidae around the full moon and Phyllodocidae around the new moon. Additional polychaete families represented included Amphinomidae, Dorvilleidae, and Scalibregmatidae, whose members swarmed during the waning or waxing lunar phases. This overview offers new information about the timing of reproductive swarming in Caribbean polychaetes and suggests some connections between lunar phases and the swarming of different families.
Choosing a Vasopressor for a Prehospital Emergency Medical System: Consideration for Agent Selection and Review of Pharmacologic Profiles, Efficacy, and Safety in Treatment of Shock

Introduction Prehospital medical teams encounter patients with varying states of shock that require the use of vasopressors for hemodynamic support during transport. Selection of a vasopressor is challenging due to the absent comparative literature in prehospital medicine, as well as practical limitation of use in an ambulance. Areas covered This article discusses specific challenges in the delivery of vasopressor support for hemodynamically compromised patients in the prehospital environment. Discussion includes the current state of vasopressor use in prehospital medicine, use of a patient-specific agent selection or "one-vasopressor-fits-all" modality, as well as considerations for each vasopressor based on practical, pharmacologic, and comparative evidence-based evaluations. Conclusions There are currently many limitations to assessment of shock etiology in the prehospital setting. A "one-vasopressor-fits-all" strategy may be most feasible for most prehospital emergency medical services (EMS) systems. No clear difference in extravasation exists amongst agents. Based on current evidence, norepinephrine may be more efficacious and have a better safety profile than other vasopressors in cardiogenic, distributive, and neurogenic shocks. Due to its suitability for most shocks, norepinephrine is a reasonable agent for EMS systems to employ as a "one-size-fits-all" vasopressor.
Management and Outcomes after Upper Versus Lower Extremity Vascular Trauma

Abstract Background While significant literature exists regarding peripheral vascular injury management, the vast majority focuses on lower extremity arterial injury. As a result, clinical management of arterial injury in the upper extremities is often guided by literature specific to lower extremity vessel injury. The purpose of this study is to use the largest series of patients reported in the literature to compare management and outcomes of upper and lower extremity traumatic vascular injuries. Methods Patients who underwent operative repair of traumatic vascular injuries of the extremities were identified from the trauma registry of a level I trauma center. A retrospective chart review (2011–2019) was conducted. Demographics, mechanism of injuries, operative techniques, and outcomes were compared between patients with upper versus lower extremity vascular injuries. Results Five hundred thirty-five patients were included with 234 (43.8%) patients undergoing repair of upper extremity vascular injuries. Patients with upper extremity vascular injuries were more likely to be female (16.7% vs. 9%, P = 0.007), have a pre-hospital tourniquet (21.8% vs. 12%,P = 0.002), have associated nerve injuries (40.2% vs. 4.7%, P Conclusions Upper extremity injuries are associated with a lower limb-loss rate but increased prevalence of neurological deficits after vascular trauma compared to lower extremities. A high level of suspicion is paramount to intraoperative identify associated nerve injuries to improve postoperative functional outcomes.
No, Face Masks Aren’t Dehumanizing

Wearing facial coverings has become a key element in the fight against COVID-19. However, deep partisan divisions have arisen over the adoption of face masks, with Democrats more supportive than Re...
Alcohol-associated intestinal dysbiosis alters mucosal-associated invariant T-cell phenotype and function.

Background Chronic alcohol consumption is associated with a compromised innate and adaptive immune response to infectious disease. Mucosa-associated invariant T (MAIT) cells play a critical role in antibacterial host defense. However, whether alcohol-associated deficits in innate and adaptive immune responses are mediated by alterations in MAIT cells remains unclear. Methods To investigate the impact of alcohol on MAIT cells, mice were treated with binge-on-chronic alcohol for 10 days and sacrificed at day 11. MAIT cells in the barrier organs (lung, liver and intestine) were characterized by flow cytometry. Two additional sets of animals were used to examine the involvement of gut microbiota on alcohol-induced MAIT cell changes. 1) Cecal microbiota from alcohol-fed (AF) mice were adoptive transferred into antibiotics-pretreated mice; 2) AF mice were treated with antibiotics during the experiment. MAIT cells in the barrier organs were measured via flow cytometry. Results Binge-on-chronic alcohol feeding led to a significant reduction in the abundance of MAIT cells in the barrier tissues. However, CD69 expression on tissue-associated MAIT cells was increased in AF mice compared to pair-fed (PF) mice. The expression of Th1 cytokines and the corresponding transcriptional factor was tissue specific with downregulation in the intestine, but increased in the lung and liver in alcohol-fed animals. Transplantation of fecal microbiota from AF mice resulted in a MAIT cell profile aligned to that of AF mice donor. Antibiotic treatment abolished the MAIT cell differences between AF and PF animals. Conclusion MAIT cells in the intestine, liver, and lung are perturbed by alcohol use, and these changes are, partially attributable to alcohol-associated dysbiosis. MAIT cell dysfunction may contribute to alcohol-induced, innate and adaptive immunity and consequently end-organ pathophysiology.
In Search of a Unifying Concept in Human Diseases.

Throughout the history of biological/medicine sciences, there has been opposing strategies to find solutions to complex human disease problems. Both empirical and deductive approaches have led to major insights and concepts that have led to practical preventive and therapeutic benefits for the human population. The classic definitions of “science” (to know) has been paired with the classic definition of technology (to do). One knew more as the technology developed, and that development was often based on science. In other words, one could do more if science could improve the technology. In turn, this made possible to know more science with improved technology. However, with the development of new technologies of today in biology and medicine, major advances have been made, such as the information from the Human Genome Project, genetic engineering techniques and the use of bioinformatic uses of sophisticated computer analyses. This has led to the renewed idea that Precision Medicine, while raising some serious ethical concerns, also raises the expectation of improved potential of risk predictions for prevention and treatment of various genetically and environmentally influenced human diseases. This new field Artificial Intelligence, as a major handmaiden to Precision Medicine, is significantly altering the fundamental means of biological discovery. However, can today’s fundamental premise of “Artificial Intelligence”, based on identifying DNA, as the primary nexus of human health and disease, provide the practical solutions to complex human diseases that involve the interaction of those genes with the broad spectrum of “environmental factors”? Will it be “precise” enough to provide practical solutions for prevention and treatments of diseases? In this “Commentary”, with the example of human carcinogenesis, it will be challenged that, without the integration of mechanistic and hypothesis-driven approaches with the “unbiased” empirical analyses of large numbers of data, the Artificial Intelligence approach with fall short.
Implementing Ethical and Legal Supported Decision Making: Some Unresolved Issues.

Discussion of supported decision making has been dominated by legal scholars, philosophers, and advocates for persons with disabilities. Peterson et al.’s (2021) primary contribution is introducing...
A preliminary study of fast fracture and arrest in the DCB test specimen

This paper describes measurements of unstable fracture and arrest in a 4340 steel, wedge-loaded DCB (double cantilever beam) test specimen with a blunted starting notch but which is well below the limiting speeds predicted by Broberg and Yoffe, specimen which accounts for transverse inertia forces. Preliminary results of crack speed and arrest measurements are described and compared with results of the dynamic analysis. These results reveal that: (a) the inclusion of inertia forces in the equation of motion leads to substantial improvement in the prediction of crack speeds over previous quasi-static analyses, (b) a crack in a wedge-loaded DCB specimen tends to propagate at a constant velocity which depends upon the bluntness of the starting notch but which is well below the limiting speed predicted by Broberg and Yoffe, and (c) the kinetic energy in the system tends to be recovered. It is concluded that the wedge-loaded DCB test specimen shows promise as a vehicle for characterizing the dynamic fracture toughness and crack arrest capabilities of structural materials.
An Adaptive Route-Guidance Algorithm for Intelligent Vehicle Highway Systems

This paper describes an algorithm used for the navigation of a vehicle in intelligent vehicle highway systems (IVHS). An internal map is constructed in the computer main memory to reflect a relevant road network which can be updated by the Traffic Management Center (TMC) or other resources on line. The network information is simply decomposed hierarchically into the map by nodes alone to avoid exhausting memory capacity, to limit time-consuming searching, and to meet the real-time constraints for on-line planning. The algorithm adaptively switches from heuristic search to real-time heuristic search to find a near-optimal route from a starting location to a final destination for the vehicle, provided that one exists. Furthermore, this algorithm can resume the planning process on line whenever the road-network database is updated by real-time traffic information from TMC and filtered into the internal map.
Loss of hyperbolicity in yield vertex plasticity models under nonproportional loading

Several authors [5,8,10,12] have shown that the dynamic partial differential equations arising from continuum models for granular flow may be linearly ill-posed. In a typical theory with shear-strain hardening, the equations are linearly well-posed for small deformations but become linearly ill-posed at some critical deformation which occurs before the maximum shear stress is achieved. Before this critical deformation the dynamic equations are hyperbolic, but after this point the equations are of no definite type; rather they resemble u tt = u xx - u yy , the wave equation with a rotated time axis, in that the possible uncontrolled growth of a plane wave depends on its direction of propagation.
CCR2 deficiency fails to protect mice with renal artery stenosis from chronic renal injury (278.7)

Recent studies have implicated CCR2 - CCL2 signaling in macrophage influx and development of chronic renal disease in human and experimental renal artery stenosis (RAS). We sought to test the hypothesis that development of chronic renal disease would be abrogated in CCR2 knockout (KO) mice. We established RAS in CCR2 KO and WT mice (n=10) through placement of a cuff on the right renal artery We have shown that the cuff reproducibly reduces blood flow by 65% to the kidney. Sham mice underwent manipulation of the right renal artery without cuff placement. Both CCR2 KO and WT mice developed hypertension, which persisted throughout the 4 week study. There was no difference in renal atrophy between CCR2 KO (53+//-14.6% cortical surface area) and WT (61.2%+/-14%) mice. Furthermore, there were no significant differences in F4/80+ macrophage infiltration (12.78+/-4.9% surface area for CCR2 KO mice and 13.13+/- 3.1% for WT mice) or CD3+ T cell infiltration. Infiltrating macrophages were predominantly iNOS+ M1 phen...
Collective Action and the Financing of Innovation: Evidencefrom Crowdfunding

The emergent phenomenon of crowdfunding, whereby large groups of individuals act collectively to support creative and entrepreneurial endeavors, suggests an alternate model for the financing of innovation. Drawing from extensive field interviews and unique hand-collected datasets of crowdfunding campaigns, this dissertation explored the following question: Under what conditions and through what mechanisms do voluntary contributors freely support private enterprise in the absence of conventional financial incentives? The results of this study revealed the significance of relational factors in the funding outcomes for crowdfunded projects, thereby advancing our understanding of social influence in the context of innovation and entrepreneurial finance.
A Mechanical Pulse Recorder for Pulse Rate Tests

(1940). A Mechanical Pulse Recorder for Pulse Rate Tests. Research Quarterly. American Association for Health, Physical Education and Recreation: Vol. 11, No. 1, pp. 3-8.
Constitutionally Inspired Approaches to Police Accountability for Violence against Women in the U.S. and South Africa: Conservations versus Transformation, The

In the summer of 2005, the United States Supreme Court in Castle Rock v. Gonzales and the South African Constitutional Court in N.K. v. Minister of Safety & Security overturned decisions from their appellate courts. N.K. drew on the Constitutional Court decision in Carmichele v. Minister of Safety & Security. All three were torts cases involving the duties of the police, their accountability to the public, and rights of women to be free from violence, and each depended on the respective court’s interpretation of its constitution for resolution. This article focuses on the comparison, or rather, the sharp contrast between, the values and spirit animating these decisions. The respective courts’ interpretations of the underlying values or spirit of their constitutions either help forge a special relationship between victims and the police, thereby altering the existing distribution of entitlement and duties, or they hinder those attempts. The contrast is between a Court that views its Constitution as a progressive covenant between the people and its government, which fosters a culture of justification and accountability, and a Court that views its Constitution as a charter of negative liberties, and which will go to great lengths to conserve the status quo distribution of rights and entitlements. One is intent on protecting the vulnerable members of its society and the other is skeptical of attempts by the legislature to do so through the creation of new rights and the imposition of new duties on the police. OUTLINE
Experimental implications of large CP violation and final state interactions in the search for D0 - D0 mixing

Abstract We discuss the implications of CP violation as well as final state interaction phases in the experimental search for D 0 - D 0 mixing. At the present level of sensitivity, these are not yet a significant systematic experimental limitation.
Fracture Toughness of High Strength Steel Predicted from Charpy Energy or Reduction in Area

Abstract : Analysis is presented of the results of an extensive mechanical and fracture test program. Ninety-six hollow cylinder forgings of A723 steel with five different manufacturing processes were tested at two locations with different outer diameters. Yield strength, plane-strain fracture toughness, Charpy impact energy, and tensile reduction-in-area were measured and analyzed for statistical variation and difference of mean value. Linear regression was used to fit lines to the data and to determine correlation coefficients. Conclusions were drawn as to the suitability of Charpy energy and reduction-in-area as predictors of plane-strain fracture toughness. (Author)