cssi/SciSciGPT-SciSciNet huggingface dataset:
Cardiac resynchronization therapy in low-flow low-gradient aortic stenosis

A 74-year-old male with New York Heart Association (NYHA) Class IV heart failure, low-flow low-gradient (LFLG) aortic stenosis, and severe functional mitral regurgitation (MR) was referred for transcatheter aortic valve implantation. Medical history included permanent atrial fibrillation and complete heart block requiring dual-chamber pacemaker implantation. Coronary angiography showed no flow-limiting lesions. Transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction (LVEF) of 27%, stroke volume index (SVI) of 26 cc/m2, aortic valve area (AVA) of 0.77 cm …
Classification and Evolution of the Family Gentianaceae

This chapter reviews research progress and resulting changes in classification in the Gentian family since the worldwide revision in 2002. Currently, the Gentianaceae includes 99 genera and approximately 1,736 species. The tribal classification still stands, but there have been some important changes of genus delimitations based on new evolutionary work. This includes reclassifications of poly- or paraphyletic genera (e.g., Canscora, Centaurium, Fagraea, Sebaea) that have led to the description of new or resurrected genera such as Cyrtophyllum, Duplipetala, Exochaenium, Gyrandra, Lagenias, Limahlania, Klackenbergia, Phyllocyclus, Picrophloeus, Schenkia, Utania, and Zeltnera. New genera have been discovered in South America, including Roraimaea and Yanomamua. Some genera were incorporated into others to preserve monophyly (Cotylanthera into Exacum, Wurdackanthus into Symbolanthus). Bisgoeppertia has been moved to the Potalieae. Unsolved generic delimitation problems remain in Gentianeae-Swertiinae and Helieae. The placement of the enigmatic mycoheterotroph Voyria is still uncertain, but it is likely an isolated, basally placed branch in the family. Recent biogeographic studies that address large-scale distribution patterns, vicariance events, and the significance of these new results are reviewed in this chapter, as are examples of evolutionary research progress within each tribe.
Abstract 567: A Successful Use of Tissue Plasminogen Activator and Argatroban for Acute Therapy of a Submassive Pulmonary Embolism Caused by Heparin-Induced Thrombocytopenia

The field of anticoagulation has become a highly relevant and expanding division of medicine. Clinicians must maintain an adequate knowledge of the indications, risks, and benefits of each particular anticoagulant before utilizing them in patient care. Despite great advancements in anticoagulate therapies, areas of uncertainty exist when applying combined use of anticoagulants. This vignette illustrates a unique circumstance of initial therapy combining argatroban with tissue plasminogen activator (tPA) and subsequent transition to warfarin in the management of submassive pulmonary embolism (PE) caused by heparin-induced thrombocytopenia (HIT). There are currently no other published cases or guidelines that have demonstrated this treatment strategy. We present the case of a 56-year-old African American female who was started on argatroban therapy for submassive bilateral PE secondary to HIT. She required tPA after becoming progressively unstable. The argatroban drip was continued without any hemorrhagic complications. This combination of therapy led to her stabilization, and she was ultimately safely transitioned to warfarin therapy for long term maintenance anticoagulation. Argatroban is effective in the prevention and treatment of life-threatening complications of HIT. Very little research has been conducted in patients receiving tPA followed by anticoagulation therapy. This case highlights the successful therapy with combined use of tPA and argatroban followed by warfarin transition in the treatment of submassive PE caused by HIT. We find that tPA was safe and effective when the initial argatroban failed to stabilize our patient. The continued use of argatroban infusion after tPA did not cause any hemorrhagic complications. Furthermore, the overlap use of warfarin with argatroban until an INR greater than 4 was achieved for maintenance therapy did not contribute to any hemorrhagic complications. We conclude that the combination of tPA and argatroban is effective in the acute management of hemodynamically unstable PE caused by HIT without significant hemorrhagic complications.
Abstract 3643: Intimal Hyperplasia Of Leptomeningeal Arteries In CADASIL

Objective: CADASIL is associated with abnormalities of penetrating white matter arteries; but recent studies showing pathology in the gray matter and the increased incidence of migraine with aura suggest that leptomeningeal vessels may be affected in the disease. The pathology of leptomeningeal vessels has not been extensively characterized. This study tests the hypothesis that the intima and media of leptomeningeal small vessels are abnormal in CADASIL compared to age matched controls and the very old. Methods: Samples analyzed included four genetically proven CADASIL brains (average age 61), four controls without symptoms of cerebrovascular disease (average age 68), and five very aged brains (average age 90). Temporal lobe brain sections (approximately 5-10 cm 2 ) from autopsy material were stained with Movat’s pentachrome and immunohistochemistry (for smooth muscle actin, NOTCH3, and collagen). All leptomeningeal arteries Results: We first confirmed that pentachrome staining precisely delineates the intima, media, and adventitia of leptomeningeal arteries by comparing serial vessels stained using immunohistochemical markers. Pentachrome stained was then used to delineate three layers of each vessel. The intima of CADASIL arteries was significantly thickened compared to controls and the very aged (7.5+/-3.2; 1.3+/- 0.5; 1.85+/-0.69 um; p p p p p Conclusion: The leptomeningeal arteries in CADASIL undergo significant remodeling. The most obvious change is a dramatic increase in intimal thickness and vessel diameter. The significant loss of media in CADASIL was also seen in very aged brains. These pathological findings may underlie migraine with aura, which is seen at a higher frequency in CADASIL patients. In addition, leptomeningeal pathology could contribute to impairment of cerebral blood flow regulation in the white matter.
Transient distraction and attentional control during a sustained selective attention task

Distracting stimuli in the environment can pull our attention away from our goal-directed tasks. fMRI studies have implicated regions in right frontal cortex as being particularly important for processing distractors [e.g., de Fockert, J. W., & Theeuwes, J. Role of frontal cortex in attentional capture by singleton distractors. Brain and Cognition, 80, 367-373, 2012; Demeter, E., Hernandez-Garcia, L., Sarter, M., & Lustig, C. Challenges to attention: A continuous arterial spin labeling ASL study of the effects of distraction on sustained attention. Neuroimage, 54, 1518-1529, 2011]. Less is known, however, about the timing and sequence of how right frontal or other brain regions respond selectively to distractors and how distractors impinge upon the cascade of processes related to detecting and processing behaviorally relevant target stimuli. Here we used EEG and ERPs to investigate the neural consequences of a perceptually salient but task-irrelevant distractor on the detection of rare target stimuli embedded in a rapid, serial visual presentation RSVP stream. We found that distractors that occur during the presentation of a target interfere behaviorally with detection of those targets, reflected by reduced detection rates, and that these missed targets show a reduced amplitude of the long-latency, detection-related P3 component. We also found that distractors elicited a right-lateralized frontal negativity beginning at 100 msec, whose amplitude negatively correlated across participants with their distraction-related behavioral impairment. Finally, we also quantified the instantaneous amplitude of the steady-state visual evoked potentials elicited by the RSVP stream and found that the occurrence of a distractor resulted in a transient amplitude decrement of the steady-state visual evoked potential, presumably reflecting the pull of attention away from the RSVP stream when distracting stimuli occur in the environment.
The Largest Unit Ball in Any Euclidean Space

(1986). The Largest Unit Ball in Any Euclidean Space. Mathematics Magazine: Vol. 59, No. 3, pp. 170-171.
Tobacco may mask poorer episodic memory among young adult cannabis users.

Objective Co-occurring cannabis and tobacco use has become increasingly prevalent among young adults, but it is not clear how tobacco use may alter the neurocognitive profile typically observed among cannabis users. Although there is substantial evidence citing cannabis and tobacco's individual effect on episodic memory and related brain structures, few studies have examined the effect of combined cannabis and tobacco use on memory. Method This investigation examined relationships between amount of past year cannabis and tobacco use on 4 different indices of episodic memory among a sample of young adults who identified cannabis as their drug of choice. Results Results indicated that more cannabis use was linked with poorer initial acquisition, total learning, and delayed recall on the Hopkins Verbal Learning Test-Revised, but only among cannabis users who sporadically smoked cigarettes in the past year. Conversely, the amount of past year cannabis use was not associated with episodic memory performance among individuals who more consistently smoked cigarettes in the past year. These differences could not be explained by several relevant potential confounds. Conclusions These findings provide important insight into a potential mechanism (i.e., attenuation of cognitive decrements) that might reinforce use of both substances and hamper cessation attempts among cannabis users who also smoke cigarettes. Ongoing and future research will help to better understand how co-use of cannabis and tobacco affects memory during acute intoxication and abstinence and the stability of these associations over time.
Sensitivity of Texas strains of Ceratocystis fagacearum to triazole fungicides

Ten geographically diverse Texas strains of the oak wilt fungus Ceratocystis fagacearum were tested in vitro for their sensitivity to five triazole fungicides based on accumulated linear growth, li...
New substrates for the radioassay of angiotensin converting enzyme of endothelial cells in culture.

ABSTRACT To develop means of measuring angiotensin converting enzyme of endothelial cells in culture, we have synthesized benzoyl-Phe-Ala-Pro-OH (I), benzoyl-Pro-Phe-Arg-OH (II) and benzoyl-Gly-His-Leu-OH (III), each bearing a 3 H-atom on the para-position of its benzoyl moiety. All three of the acylated tripeptides are substrates for the enzyme. Substrate I exhibits the lowest Km (12·5 µ M) and yields the most sensitive assay: the enzyme of 10 6 cells can be measured in a 30 min incubation at 37°C. Radiolabelled reaction product is separated from substrate by extraction of acidified reaction mixture with an organic solvent, and the rate of formation of product can be quantified by liquid scintillation counting of the organic phase. Substrate III can also be used to measure angiotensin converting enzyme of cells but requires longer incubations (180-240 min) and high salt concentrations (0·75 M Na 2 SO 4 ). Substrate II is not specific: it is hydrolyzed by more than one enzyme of endothelial cells.
Advanced endometrial maturation after ovulation induction with human menopausal gonadotropin/human chorionic gonadotropin for in vitro fertilization

Endometrial biopsy was performed between the first and third luteal phase day in 22 normally cycling patients following human menopausal gonadotropin and human chorionic gonadotropin ovulation induction for in vitro fertilization but in whom embryo transfer was not accomplished. Eleven patients showed an "advanced" pattern and 10 an "in-phase" endometrium according to the Noyes criteria. A significant difference in serum progesterone levels on days 16 and 18 was found in these two groups. Serum progesterone levels were significantly higher by day 18 if pregnancy was established. In in vitro fertilization and embryo transfer the embryo arrives 24 to 48 hours earlier than in natural conception in the endometrial cavity. Therefore, the "advanced" endometrium may have some benefit for embryo implantation.
Prediction of lung cancer incidence on the low-dose computed tomography arm of the National Lung Screening Trial

HighlightsDynamic Bayesian Network (DBN) built using a lung cancer staging state-space model.Use of resampling techniques to address data imbalance.Results are comparable to experts' decisions.Similar structure and performance between learned and expert-derived DBNs. IntroductionIdentifying high-risk lung cancer individuals at an early disease stage is the most effective way of improving survival. The landmark National Lung Screening Trial (NLST) demonstrated the utility of low-dose computed tomography (LDCT) imaging to reduce mortality (relative to X-ray screening). As a result of the NLST and other studies, imaging-based lung cancer screening programs are now being implemented. However, LDCT interpretation results in a high number of false positives. A set of dynamic Bayesian networks (DBN) were designed and evaluated to provide insight into how longitudinal data can be used to help inform lung cancer screening decisions. MethodsThe LDCT arm of the NLST dataset was used to build and explore five DBNs for high-risk individuals. Three of these DBNs were built using a backward construction process, and two using structure learning methods. All models employ demographics, smoking status, cancer history, family lung cancer history, exposure risk factors, comorbidities related to lung cancer, and LDCT screening outcome information. Given the uncertainty arising from lung cancer screening, a cancer state-space model based on lung cancer staging was utilized to characterize the cancer status of an individual over time. The models were evaluated on balanced training and test sets of cancer and non-cancer cases to deal with data imbalance and overfitting. ResultsResults were comparable to expert decisions. The average area under the curve (AUC) of the receiver operating characteristic (ROC) for the three intervention points of the NLST trial was higher than 0.75 for all models. Evaluation of the models on the complete LDCT arm of the NLST dataset (N=25,486) demonstrated satisfactory generalization. Consensus of predictions over similar cases is reported in concordance statistics between the models' and the physicians' predictions. The models' predictive ability with respect to missing data was also evaluated with the sample of cases that missed the second screening exam of the trial (N=417). The DBNs outperformed comparison models such as logistic regression and naive Bayes. ConclusionThe lung cancer screening DBNs demonstrated high discrimination and predictive power with the majority of cancer and non-cancer cases.
Flowing water affects fish fast-starts: escape performance of the Hawaiian stream goby, Sicyopterus stimpsoni

Experimental measurements of escape performance in fishes have typically been conducted in still water; however, many fishes inhabit environments with flow that could impact escape behavior. We examined the influences of flow and predator attack direction on the escape behavior of fish, using juveniles of the amphidromous Hawaiian goby Sicyopterus stimpsoni In nature, these fish must escape ambush predation while moving through streams with high-velocity flow. We measured the escape performance of juvenile gobies while exposing them to a range of water velocities encountered in natural streams and stimulating fish from three different directions. Frequency of response across treatments indicated strong effects of flow conditions and attack direction. Juvenile S. stimpsoni had uniformly high response rates for attacks from a caudal direction (opposite flow); however, response rates for attacks from a cranial direction (matching flow) decreased dramatically as flow speed increased. Mechanical stimuli produced by predators attacking in the same direction as flow might be masked by the flow environment, impairing the ability of prey to detect attacks. Thus, the likelihood of successful escape performance in fishes can depend critically on environmental context.
Acute Hemiplegia with Chickenpox

A case of an 18-month-old girl who developed a right hemiplegia 10 days after onset of varicella infection is reported from the Division of Pediatric Neurology, Istanbul University, Turkey.
Counseling At-Risk Parkinson’s Disease Cohorts: Integrating Emerging Evidence

This article evaluates the current state of testing and counseling viewpoints for Parkinson’s disease (PD) risk gene carriers and their families. Recent discoveries of mutations in genes associated with increased risk for PD not only portend novel possibilities for targeted clinical research but also present salient challenges for genetic counseling. A patient-centered and transparent approach to counseling that assesses preferences and communication styles is described to aid in facilitating the use of evolving evidence regarding strategies to attenuate PD phenoconversion in non-manifesting carriers.
Xenoconformities and the stratigraphic record of paleoenvironmental change

Most interpretations of the stratigraphic record are founded on the premise that the depositional environments that produced it either have not changed appreciably through time, or else have changed very slowly. Paradoxically, some of the most important transitions in the sedimentary archive are those interpreted to reflect relatively rapid, comprehensive paleoenvironmental change. Recognition of the anomalous nature of such transitions is vital to accurately understanding their significance but is not systematically incorporated in current stratigraphic models. The new term “xenoconformity” is therefore proposed, and defined as a stratigraphic surface or gradational interval that records a fundamental, abrupt, and persistent change in sedimentary facies across basinal to global scales. Xenoconformities may mark major paleoenvironmental tipping points and signal transformations in how paleoenvironmental signals were transferred into the stratigraphic record.
I Told Steve Bannon: “We Are Not At War With Islam.” He Disagreed

I was the target of Islamist ire for publishing cartoons of the Prophet Muhammad in a Danish newspaper. But a war against all Muslims is not the solution.
Gravitational Two-Body Problem

In Chap. 3 we assumed the source of gravity is stationary and only one object moves. Now we are ready to study what happens when both objects are free to move. As we will see, there is a deep connection between the one-body and two-body problems that provides a powerful opportunity to understand binary star systems and extrasolar planets.
Learning Through Victorian Garbage: Disgust and Desire in an Interdisciplinary Capstone Course

This chapter discusses my experience teaching an interdisciplinary capstone course on ideas of filth, disease, and contamination in urban nineteenth-century Britain. As “matter out of place,” garbage is an ideal topic for exploring ways of knowing and seeing still central both to the Victorians and to us today. What did it mean to be dirty in a culture riven by changing notions of urban life and industrial labor, of gender and sexuality, of colony and metropolis, and of social class and economic value? Along with the nineteenth-century novel, this class addressed materials from a wide variety of fields (anthropology, sociology, psychoanalysis, the visual arts, public health). It culminated with a substantial final capstone project, designed for students from a variety of skill levels and perspectives.
Alcoholics Anonymous: Membership Characteristics and Effectiveness as Treatment

Reports published since 1976 were reviewed with respect to the characteristics of alcohol-dependent individuals who affiliate with Alcoholics Anonymous (AA). No “AA personality” was identified inasmuch as systematic differences have not been observed between affiliates and nonaffiliates. Evaluation studies were reviewed with regard to data on AA’s effectiveness as treatment, leading to several observations. When “alcoholics” participate in AA in addition to professional treatment, their outcome on drinking and other indices is no worse, and may be better, than that of patients who do not involve themselves in AA. AA involvement tends to be associated with relatively high abstinence rates but with only fairly typical total improvement rates. The effectiveness of AA as compared to other treatments for “alcoholism” has yet to be demonstrated. Reliable guidelines have not been established for predicting who among AA members will be successful. An alcohol-involved person’s chances of participating in AA are related to the type of drinking outcome achieved. Caution was raised against rigidly referring every alcohol-troubled person to AA.
Imaging the Hydrogen Absorption Dynamics of Individual Grains in Polycrystalline Palladium Thin Films in 3D

Defects such as dislocations and grain boundaries often control the properties of polycrystalline materials. In nanocrystalline materials, investigating this structure–function relationship while preserving the sample remains challenging because of the short length scales and buried interfaces involved. Here we use Bragg coherent diffractive imaging to investigate the role of structural inhomogeneity on the hydriding phase transformation dynamics of individual Pd grains in polycrystalline films in three-dimensional detail. In contrast to previous reports on single- and polycrystalline nanoparticles, we observe no evidence of a hydrogen-rich surface layer and consequently no size dependence in the hydriding phase transformation pressure over a 125–325 nm size range. We do observe interesting grain boundary dynamics, including reversible rotations of grain lattices while the material remains in the hydrogen-poor phase. The mobility of the grain boundaries, combined with the lack of a hydrogen-rich surface l...
Early prediction of cognitive deficits in very preterm infants using functional connectome data in an artificial neural network framework.

Abstract Investigation of the brain's functional connectome can improve our understanding of how an individual brain's organizational changes influence cognitive function and could result in improved individual risk stratification. Brain connectome studies in adults and older children have shown that abnormal network properties may be useful as discriminative features and have exploited machine learning models for early diagnosis in a variety of neurological conditions. However, analogous studies in neonates are rare and with limited significant findings. In this paper, we propose an artificial neural network (ANN) framework for early prediction of cognitive deficits in very preterm infants based on functional connectome data from resting state fMRI. Specifically, we conducted feature selection via stacked sparse autoencoder and outcome prediction via support vector machine (SVM). The proposed ANN model was unsupervised learned using brain connectome data from 884 subjects in autism brain imaging data exchange database and SVM was cross-validated on 28 very preterm infants (born at 23–31 weeks of gestation and without brain injury; scanned at term-equivalent postmenstrual age). Using 90 regions of interests, we found that the ANN model applied to functional connectome data from very premature infants can predict cognitive outcome at 2 years of corrected age with an accuracy of 70.6% and area under receiver operating characteristic curve of 0.76. We also noted that several frontal lobe and somatosensory regions, significantly contributed to prediction of cognitive deficits 2 years later. Our work can be considered as a proof of concept for utilizing ANN models on functional connectome data to capture the individual variability inherent in the developing brains of preterm infants. The full potential of ANN will be realized and more robust conclusions drawn when applied to much larger neuroimaging datasets, as we plan to do.
Reformation Humanism: Reading the Classics in the New Theology

Scholarly discussions on what constitutes Christian humanism in the Renaissance and Reformation periods have typically concentrated on its manifestations before 1536, when Erasmus died. In this per...
Spatiotemporal Labeling of Melanocytes in Mice

Melanocytes are pigment producing cells in the skin that give rise to cutaneous malignant melanoma, which is a highly aggressive and the deadliest form of skin cancer. Studying melanocytes in vivo is often difficult due to their small proportion in the skin and the lack of specific cell surface markers. Several genetically-engineered mouse models (GEMMs) have been created to specifically label the melanocyte compartment. These models give both spatial and temporal control over the expression of a cellular ‘beacon’ that has an added benefit of inducible expression that can be activated on demand. Two powerful models that are discussed in this review include the melanocyte-specific, tetracycline-inducible green fluorescent protein expression system (iDct-GFP), and the fluorescent ubiquitination-based cell cycle indicator (FUCCI) model that allows for the monitoring of the cell-cycle. These two systems are powerful tools in studying melanocyte and melanoma biology. We discuss their current uses and how they could be employed to help answer unresolved questions in the fields of melanocyte and melanoma biology.
Software engineering industry experience: the key to success

Computer science graduates of most university programs are knowledgeable of computer science concepts and theories. Most graduates experience a variety of languages and associated programming techniques. Few graduates are exposed to software engineering industrial strength analysis and design tools. The growth of outsourcing is primarily prompted by financial criteria, but there are some indicators that U.S. software professionals don't have sufficient experience with tools that support the first half of the software engineering life cycle. In order to counteract this situation, universities need access to software engineering tools that can be incorporated into the computer science curriculum. This is necessary to ensure the successful employment of computer science graduates.
A High Achieving Inner-City School: An Ecological Analysis.

Holy Angels, a high achieving, African American, urban, elementary school in Chicago, Illinois offers a model for successful education of ethnic minority children. Despite coming from predominantly...
Comparison of the Photodegradation of Imazethapyr in Aqueous Solution, on Epicuticular Waxes, and on Intact Corn (Zea Mays) and Soybean (Glycine Max) Leaves

AbstractA direct, controlled comparison of the photodegradation of imazethapyr has been made between imazethapyr in aqueous solutions, imazethapyr on the surface of epicuticular waxes of corn and s...
Intraoperative biophotonic imaging systems for image-guided interventions

Biophotonic imaging has revolutionized the operation room by providing surgeons intraoperative image-guidance to diagnose tumors more efficiently and to resect tumors with real-time image navigation. Among many medical imaging modalities, near-infrared (NIR) light is ideal for image-guided surgery because it penetrates relatively deeply into living tissue, while nuclear imaging provides quantitative and unlimited depth information. It is therefore ideal to develop an integrated imaging system by combining NIR fluorescence and gamma-positron imaging to provide surgeons with highly sensitive and quantitative detection of diseases, such as cancer, in real-time without changing the look of the surgical field. The focus of this review is to provide recent progress in intraoperative biophotonic imaging systems, NIR fluorescence imaging and intraoperative nuclear imaging devices, and their future perspectives for image-guided interventions.
Understanding stress reports in daily life: a coordinated analysis of factors associated with the frequency of reporting stress.

Although stress is a common experience in everyday life, a clear understanding of how often an individual experiences and reports stress is lacking. Notably, there is little information regarding factors that may influence how frequently stress is reported, including which stress dimension is measured (i.e., stressors—did an event happen, subjective stress—how stressed do you feel, conditional stress—how stressful a stressor was) and the temporal features of that assessment (i.e., time of day, day of study, weekday vs. weekend day). The purpose of the present study was to conduct a coordinated analysis of five independent ecological momentary assessment studies utilizing varied stress reporting dimensions and temporal features. Results indicated that, within days, stress was reported at different frequencies depending on the stress dimension. Stressors were reported on 15–32% of momentary reports made within a day; across days, the frequency ranged from 42 to 76% of days. Depending on the cutoff, subjective stress was reported more frequently ranging about 8–56% of all moments within days, and 40–90% of days. Likewise, conditional stress ranged from just 3% of moments to 22%, and 11–69% of days. For the temporal features, stress was reported more frequently on weekdays (compared to weekend days) and on days earlier in the study (relative to days later in the study); time of day was inconsistently related to stress reports. In sum, stress report frequency depends in part on how stress is assessed. As such, researchers may wish to measure stress in multiple ways and, in the case of subjective and conditional stress with multiple operational definitions, to thoroughly characterize the frequency of stress reporting.
Procalcitonin-Guided Antibiotic Discontinuation and Mortality in Critically Ill Adults: A Systematic Review and Meta-analysis

Background Procalcitonin (PCT)-guided antibiotic discontinuation appears to decrease antibiotic use in critically ill patients, but its impact on survival remains less certain. Methods We searched PubMed, Embase, Scopus, Web of Science, and CENTRAL for randomized controlled trials (RCTs) of PCT-guided antibiotic discontinuation in critically ill adults reporting survival or antibiotic duration. Searches were conducted without language restrictions from inception to July 23, 2018. Two reviewers independently conducted all review stages; another adjudicated differences. Data were pooled using random-effects meta-analysis. Study quality was assessed with the Cochrane risk of bias tool, and evidence was graded using GRADEpro. Results Among critically ill adults (5,158 randomized; 5,000 analyzed), PCT-guided antibiotic discontinuation was associated with decreased mortality (16 RCTs; risk ratio [RR], 0.89; 95% CI, 0.83-0.97; I2 = 0%; low certainty). Death was the primary outcome in only one study and a survival benefit was not observed in the subset specified as sepsis (10 RCTs; RR, 0.94; 95% CI, 0.85-1.03; I2 = 0%), those without industry sponsorship (nine RCTs; RR, 0.98; 95% CI, 0.87-1.10; I2 = 0%), high PCT-guided algorithm adherence (five RCTs; RR, 0.93; 95% CI, 0.71-1.22; I2 = 0%), and PCT-guided algorithms without C-reactive protein (eight RCTs; RR, 0.96; 95% CI, 0.87-1.06; I2 = 0%). PCT-guided antibiotic discontinuation decreased antibiotic duration (mean difference, 1.31 days; 95% CI, –2.27 to –0.35; I2 = 93%) (low certainty). Conclusions Our findings of increased survival and decreased antibiotic utilization associated with PCT-guided antibiotic discontinuation represent low-certainty evidence with a high risk of bias. This relationship was primarily observed in studies without high protocol adherence and in studies with algorithms combining PCT and C-reactive protein. Properly designed studies with mortality as the primary outcome are needed to address this question. Trial Registry International Prospective Register of Systematic Reviews (PROSPERO); No.: CRD42016049715; URL: http://www.crd.york.ac.uk/PROSPERO_REBRANDING/display_record.asp?ID=CRD42016049715
Book Review: 'Shakespeare and Gender in Practice' by Terri Power

Shakespeare and Gender in Practice, the third volume in the Shakespeare {in} Practice series, is a theoretical and practical exploration of gender performance through Shakespeare’s works on stage. This volume implements intersectional feminist and queer theories, historical documentation, interviews, and workshop exercises to demonstrate the depth of Shakespearean gender performance. Power’s goal for this volume is to offer new ideas of gender performance using an intersectional feminist framework while simultaneously deconstructing preconceived notions of traditional Shakespearean performance. Power also sheds new light on possibilities of casting Shakespearean work and provides inspiration for feminist scholars, directors, students, and working actors who wish to explore gender in practice.
Simulation of Fast-Rise Transients in a Large-Power Transformer Winding

A high-altitude electromagnetic pulse (HEMP) may pose a significant threat to the electrical power grid. In this context, the present study considers the potential impact of the HEMP early-time component (E1) on the winding of a typical transmission power line transformer. A time-domain, fully electromagnetic, three-dimensional, finite-element model was used to simulate the propagation of an E1-induced voltage surge into the transformer winding. The analysis is focused on the first few turns of the winding, the ones that are impacted by the largest electric field resulting from the applied pulse. The model follows the transient dynamics, while the pulse is traveling along the conductor, and the electric field is established across the insulation gaps through capacitive coupling. The simulations also considered the effect of an electrically floating, “shield” winding conductor. This is used as a countermeasure to improve the voltage uniformity across the winding during fast-rise transients. In this case, the propagation of the E1-induced pulse is compared with that from a slower rising, lightning standard waveform. The simulation results show that the presence of the shield conductor can effectively reduce the peak electric field between winding turns, in the presence of either E1 or lightning waveforms.
The Milan System at Memorial Sloan Kettering: Utility of the categorization system for in-house salivary gland fine-needle aspiration cytology at a comprehensive cancer center.

Background The Milan System for Reporting Salivary Gland Cytopathology (MSRSGC) provides a standardized reporting system for salivary gland fine-needle aspiration (SGFNA). We review the clinical utility of the MSRSGC at a tertiary care cancer center by assessing the rates of malignancy (ROM) among different categories. Methods A retrospective search was performed to retrieve all SGFNA cases performed at our institution between 1/1/07 and 12/31/18. The initial primary diagnoses were recorded and cases were then assigned to appropriate MSRSGC categories. ROM was then calculated for all categories. Results A total of 976 cases were identified, and 373 with follow-up. The ROM was 19.7% (192/976) for all-comers and 51.3% (192/374) among cases with follow-up. Using MSRSGC, SGFNA showed a sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of 65.6%, 87.4%, 100%, and 72.6%, respectively. ROM for MSRSGC categories I, II, III, IVa, IVb, V, and VI were 20.7%, 30.0%, 45.8%, 3.3%, 50.7%, 100%, and 100%, respectively. Utilizing MSRSGC resulted in a nondiagnostic rate of 14.4%. The nondiagnostic rate was lower when the procedure was performed by pathologists vs nonpathologists (12.9% vs 15.8%) but was comparable when rapid on site evaluation (ROSE) was performed (12.9% vs 11.6%). Conclusion In our patient population, MSRSGC resulted in a perfect PPV and moderate NPV. Utilizing MSRSGC results in a higher nondiagnostic rate due to the inclusion of cases with benign elements or cyst contents only in this category. Performing ROSE is more important in attaining an adequate sample than the specialty of the person performing SGFNA.
Global Excision of Severe Heterotopic Ossification of the Shoulder: A Case Report.

CASE A 21-year-old man sustained a closed glenohumeral fracture/dislocation as a pedestrian struck by a motor vehicle. He was treated nonoperatively and developed severe post-traumatic heterotopic ossification (HO) with near-complete shoulder ankylosis. We present our technique for safe surgical excision. CONCLUSIONS Excision led to improvements in motion and quality of life at 1 year postoperatively. Recommendations for successful HO excision around the shoulder include excision after at least 180 days, appropriate preoperative imaging to include cross-sectional imaging and a 3D model, intraoperative fluoroscopy, well-serviced instruments, preparation for iatrogenic fracture and/or neurovascular injury, meticulous hemostasis, postoperative HO prophylaxis, immediate postoperative therapy, and involvement of a multidisciplinary team.
Original ArticlesSensory recovery in melolabial flaps used for oral cavity reconstruction

Current literature advocates the use of complex reinnervated free flaps to re-establish oral sensation after resection of oral cavity cancers. It has been demonstrated that noninnervated flaps can also re-establish sensation. We assessed the return of sensation in local melolabial flaps used in oral reconstruction. Seven patients underwent sensory testing at intervals from 12 to 18 months after surgery. The ability to distinguish differences in temperature was present in all patients. Spontaneous return of sensitivity to touch was documented by clinical testing in 71% of the patients. Less return of sensation was seen in flaps used for defects of the buccal mucosa relative to the floor of mouth. We conclude that spontaneous return of flap sensation does occur with local melolabial flaps. Given the simplicity of these procedures, melolabial flaps represent a reasonable alternative in floor-of-mouth reconstruction for selected patients. (Otolaryngol Head Neck Surg 2000;122:509-13.)
Economic Growth Since 1973: A Closer Look at the American Experience

Advocates of orthodox (i.e. neoliberal) economic policy have often pointed to the economic performance of the U.S. as indicative of those policies' superior results. This paper critically examines such claims by comparing U.S. economic performance in the neoliberal era with its prior performance (since 1870, and particularly since 1947); its performance relative to other major industrialized states since 1973, namely Japan, Germany, Britain and France; and considering the changing makeup of its economic activity with an eye to the claims regarding "hollow growth" (e.g. the hypertrophy of the FIRE sector). The analysis points to the decay of U.S. growth rates as compared with the pre-1973 period, especially after the turn of the century. It also concludes that the image of the U.S. outperforming other advanced nations, especially when this is considered in more nuanced terms, principally held good for the "tech boom" years of the late 1990s (1995-2000), and that the composition of U.S. economic activity--as well as the falling trend of U.S. growth, especially since 2007--calls any argument on the basis of superior U.S. growth into question.
Development of an algebraic nonuniformity correction algorithm for hexagonally-sampled infrared imagery

Previously, Ratliff et al. and Sakoglu et al. developed algebraic nonuniformity correction (NUC) algorithms (the latter developed a matrix-based version with regularization capabilities) which mitigate fixed-pattern nonuniformity (noise) that is notoriously present in infrared image sequences/videos, by utilizing global translational motion of the scene or the imaging camera system. Infrared imagery, like almost any other two-dimensional (2-D) imagery, have been traditionally sampled and acquired using a rectangular grid, therefore the developed NUC algorithms work on this traditional rectangular grid mitigating the most dominant, bias/offset portion of the nonuniformity. On the other hand, it is well-known that hexagonal sampling grid captures more information in sampled data/imagery when compared to traditional rectangular sampling, and a hexagonal addressing scheme for hexagonally-sampled imagery, namely array set addressing scheme, was recently developed by Rummelt et al. in order to be able to convert imagery between the two different coordinate systems and to perform various mathematical and image processing operations. In this work, we derive the bilinear interpolation equations between two image frames for hexagonally-sampled infrared imagery with bias/offset nonuniformity under the 2-D global motion of the scene or the camera, and apply the 2-D algebraic NUC algorithm to hexagonally-sampled imagery. We present a simulation of MWIR infrared imagery with hexagonally-sampled pixel array, with global motion of the scene and with bias/offset nonuniformity, and we test the efficiency of the NUC algorithm on the simulated infrared imagery (based on real MWIR infrared imagery) and compare the performance of the hexagonally-sampled pixel array imagery NUC results to those of the traditional rectangularly-sampled pixel array imagery.
Ionic Versus Nonionic Contrast Material

Currently, there are two major categories of iodinated contrast agents—high and low osmolar. With high-osmolar (“ionic”) contrast there is a small, but well-recognized, risk of adverse reactions, some of which are life threatening. However, the vast majority of patients receiving highosmolar contrast do not experience any significant side effects. Lowosmolar (“non-ionic”) contrast has a substantially lower rate of serious reactions (though not fatalities), but is considerably more expensive even in view of a significant decrease in price over the past few years.1
Patient Safety/Quality Improvement Primer, Part III: The Role of Simulation:

Simulation training has taken a prominent role in otolaryngology–head and neck surgery (OTO-HNS) as a means to ensure patient safety and quality improvement (PS/QI). While it is often equated to re...
Factors that Influence School Choice: A Look at Parents’ and School Leaders’ Perceptions

School choice is a growing movement, and public school districts are faced with the challenge of preventing declines in student enrollment. In response, school districts must work to retain enrolled students and at the same time, attract new students. This qualitative study focused on developing an understanding of the factors that influence parents’ decisions to enroll their child(ren) in a chosen school, that is, a school which differs from that assigned to the student, also known as school choice. This case study examined data from the perspectives and experiences of parents and public school district leaders. Results suggest that school leaders need to ensure they build good relationships with parents and keep a positive school culture where customer service is valued and held to the highest standards. In essence, school leaders must maintain strong partnerships with their families to attract and retain student enrollment. The results from this study equip school leaders with valuable information for strategic planning to address declines in student enrollment.
Improved Motor Proficiency and Quality of Life in Youth With Prader-Willi Syndrome and Obesity 6 Months After Completing a Parent-Led, Game-Based Intervention.

Purpose To determine changes and potential differences in physical activity (PA), gross motor proficiency (MP), and health parameters after a 6-month follow-up (FU) period following participation in a parent-led PA intervention in youth with or without Prader-Willi syndrome (PWS). Methods About 42 youth with PWS and 65 youth without PWS but with obesity (body fat percentage >95th percentile for age and sex), aged 8-16 years, participated. The intervention included preplanned PA sessions containing playground and console-based video games scheduled 4 days per week for 24 weeks. Families received training and curriculum materials. PA (accelerometry), MP (Bruininks-Oseretsky Test of MP), and health-related quality of life were obtained before (PRE), after completing the intervention (POST), and at FU. Results There were no significant changes in PA at any time point. At FU and POST, participants showed higher bilateral coordination (PRE = 9.3 [0.4], POST = 11.7 [0.5], and FU = 11.1 [0.6]); speed and agility (PRE = 9.2 [0.4], POST = 10.8 [0.4], and FU = 11.5 [0.5]); and strength (PRE = 8.0 [0.3], POST = 9.2 [0.3], and FU = 9.2 [0.3]) than at PRE. At FU (80.3 [2.1]) and POST (79.8 [1.7]), youth without PWS showed higher health-related quality of life than PRE (75.0 [1.8]). Conclusion The improvements in MP and health-related quality of life at FU suggest long-term durability of intervention outcomes.
Brown midrib corn shredlage in diets for high-producing dairy cows

Abstract A novel method of harvesting whole-plant corn silage, shredlage, may increase kernel processing and physically effective fiber. Improved fiber effectiveness may be especially advantageous when feeding brown midrib (BMR) corn hybrids, which have reduced lignin content. The objective of this study was to determine the effect of feeding TMR containing BMR corn shredlage (SHRD) compared with BMR conventionally processed corn silage (KP) or KP plus chopped alfalfa hay (KPH) on intake, lactation performance, and total-tract nutrient digestibility in dairy cows. The KP was harvested using conventional rolls (2-mm gap) and the self-propelled forage harvester set at 19mm of theoretical length of cut, whereas SHRD was harvested using novel cross-grooved rolls (2-mm gap) and the self-propelled forage harvester set at 26mm of theoretical length of cut. Holstein cows (n=120; 81±8 d in milk at trial initiation), stratified by parity, days in milk, and milk yield, were randomly assigned to 15 pens of 8 cows each. Pens were randomly assigned to 1 of 3 treatment diets, SHRD, KP, or KPH, in a completely randomized design using a 2-wk covariate period with cows fed a common diet followed by a 14-wk treatment period with cows fed their assigned treatment diet. The TMR contained (dry matter basis) KP or SHRD forages (45%), alfalfa silage (10%), and a concentrate mixture (45%). Hay replaced 10% of KP silage in the KPH treatment TMR (dry matter basis). Milk, protein, and lactose yields were 3.4, 0.08, and 0.16kg/d greater, respectively, for cows fed KP and SHRD than KPH. A week by treatment interaction was detected for milk yield, such that cows fed SHRD produced or tended to produce 1.5kg/d per cow more milk, on average, than cows fed KP during 6 of the 14 treatment weeks. Component-corrected milk yields were similar among treatments. Cows fed KPH had greater milk fat concentration than cows fed KP and SHRD (3.67 vs. 3.30% on average). Consumption of dry matter, rumination activity, and sorting behavior were similar among treatments. Ruminal in situ starch digestibility was greater for SHRD than KP forages, and total-tract dietary starch digestibility was greater for SHRD than KP. Milk yield and starch digestibility were greater for SHRD than KP. Lack of improvement in milk fat content and rumination activity for SHRD compared with KP and reduced milk fat content for SHRD compared with KPH, however, suggest no improvement in physically effective fiber from the longer theoretical length of cut used with SHRD in a BMR hybrid.