cssi/SciSciGPT-SciSciNet huggingface dataset:
Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations

Objective: The aim of this study was to assess the significance of malperfusion syndromes in patients with acute type A aortic dissection following a contemporary surgical management algorithm and the effects on morbidity, hospital mortality, and long-term survival. We believe that obliteration of the primary tear site with restoration of flow in the true aortic lumen results in decreased need for revascularization of malperfused organ systems. Methods: Our operative approach aims at replacing the entire ascending aorta, resuspension of the aortic valve with repair or replacement of the sinus segment, and routine open replacement of the arch under hypothermic circulatory arrest with retrograde cerebral perfusion with obliteration of false lumen at the distal arch/proximal descending thoracic aorta, thus reestablishing normal flow in the descending thoracic true lumen. From January 1993 to December 2004, 221 consecutive patients underwent repair of acute type A aortic dissection at our institution. Data were collected retrospectively and prospectively. Various types of malperfusion syndromes were present in 26.7% of patients. The organ systems with malperfusion were as follows: cardiac, 7.2%; cerebral, 7.2%; iliofemoral, 12.7%; renal, 4.1%; mesenteric, 1.4%; innominate, 5.4%; and spine, 2.2%. Results: Coronary malperfusion required coronary revascularization in 62.5% of cases. Distal revascularization was needed in 42.9% of patients with iliofemoral malperfusion. Patients with malperfusion were more likely to suffer perioperative myocardial infarction (p < 0.001), postoperative coma (p = 0.012), delirium (p = 0.011), sepsis (p = 0.006), acute renal failure (p = 0.017), dialysis (p = 0.018), and acute limb ischemia (p < 0.001). The in-hospital mortality was 30.5% in patients presenting with any malperfusion syndrome while only 6.2% in patients without malperfusion syndrome (p < 0.001). Both cardiac (p = 0.020) and cerebral malperfusions (p < 0.001) were risk factors for in-hospital mortality. The actuarial long-term survival in patients with malperfusion syndrome was estimated by Kaplan—Meier methods to be 67.8% 6.1% at 1 year, 54.0% 7.0% at 5 years, and 43.1% 8.0% at 10 years and for patient without malperfusion 82.7% 3.0% at 1 year, 66.3% 3.9% at 5 years, and 46.1% 6.7% at 10 years (log rank 2.55, p = 0.110). Cerebral malperfusion was a significant risk factor for decreased long-term survival (p = 0.0002). Conclusions: The occurrence of malperfusion in patients with acute type A dissectionis associatedwith significant increasedrisk of in-hospital mortality and complications. Additional revascularization is generally needed in patients with coronary malperfusion and iliofemoral malperfusion. Patients presenting with cardiac and cerebral malperfusions have a high hospital mortality and preoperative cerebral malperfusion is associated with dismal long-term survival. # 2007 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.
Sets of Commuting Derivations and Simplicity

A ring R is simple under a set D of derivations if no nontrivial ideal of R is preserved by all derivations in D. Continuing previous joint work with C. J. Maxson, the author provides a computational test for the simplicity of k[x 1,…,x n ]/〈 x 1 p ,…, x n p 〉 (k a field of characteristic p > 0) under a set of commuting k-derivations. Specific rings are then examined for sets of commuting derivations, especially those under which the ring is simple. The possible sizes and minimality of such sets are also determined in particular cases.
The Importance of Eating Behavior in Eating Disorders

A disturbance in eating behavior is the defining characteristic of the clinical eating disorders, Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. Surprisingly little research has been devoted to assessing objectively the nature of the eating disturbances in these disorders, to elucidating what factors contribute to the development and persistence of these disturbances, or to describing how they change with treatment. This review, which is based on a Mars lecture delivered at the 2010 meeting of the Society for the Study of Ingestive Behavior, reviews objective information about the nature of the disturbances of eating behavior in eating disorders. These data suggest that more detailed knowledge of eating behavior is an essential component of a full understanding of eating disorders and may provide a foundation for studies of pathophysiology and for the development of new treatment methods.
A single nucleotide change in the mumps virus F gene affects virus fusogenicity in vitro and virulence in vivo

Mumps virus is highly neurotropic, with evidence of infection of the central nervous system in more than half of clinical cases. In the prevaccine era, mumps was a major cause of viral meningitis in most developed countries. Despite efforts to attenuate the virus, some mumps vaccines have retained virulence properties and have caused aseptic meningitis in vaccinees, resulting in public resistance to vaccination in some countries. Ensuring the safety of mumps vaccines is an important public health objective, as the need for robust immunization programs has been made clear by the recent resurgence of mumps outbreaks worldwide, including the United States, which in 2006 experienced its largest mumps outbreak in 20 years. To better understand the molecular basis of mumps virus attenuation, the authors developed two infectious full-length cDNA clones for a highly neurovirulent strain of mumps virus. The clones differed at only one site, possessing either an A or G at nucleotide position 271 in the F gene, to represent the heterogeneity identified in the original virulent clinical isolate. In comparison to the clinical isolate, virus rescued from the A-variant cDNA clone grew to higher cumulative titers in vitro but exhibited similar cytopathic effects in vitro and virulence in vivo. In contrast, virus rescued from the G-variant cDNA clone, in comparison to the clinical isolate and the A-variant, was more fusogenic in vitro but replicated to lower cumulative titers and was less neurovirulent in vivo. These data suggest that nucleotide position 271 in the F gene plays a significant role in virus pathogenesis. This infectious clone system will serve as a key tool for further examination of the molecular basis for mumps virus neurovirulence and neuroattenuation.
Effect of High Fiber Energy Supplements on Nutrient Digestibility and Milk Production of Lactating Dairy Cows

Abstract Sixteen multiparous Holstein cows past peak lactation were used in a 4 × 4 Latin square design replicated four times to determine the production response and digestibility of diets containing high fiber energy supplements. Corn gluten feed, soybean hulls, or wheat middlings were substituted for a portion of corn, soybean meal, and corn silage in the control diet to provide 22% of the total dietary DM. Intake of DM was decreased when cows consumed wheat middlings compared with control and soybean hulls. Actual milk and SCM yields and milk fat percentage were not different among treatments. Milk protein percentage was greater when cows consumed corn gluten feed compared with soybean hulls. Apparent digestibility of DM was greater when cows consumed soybean hulls compared with wheat middlings. Intake and apparent digestibility of ADF and NDF were greatest when cows consumed soybean hulls. Cows consuming wheat middlings had intermediate intake and decreased apparent digestibility of NDF compared with controls. Intake and apparent digestibility of NDF were not different when cows received corn gluten feed compared with control or wheat middlings. High fiber energy supplements supported milk production equally; however, differences in DM and nutrient intake, milk composition, and nutrient apparent digestibility were significant.
Clustering overhead for hierarchical routing in mobile ad hoc networks

Numerous clustering algorithms have been proposed that can support routing in mobile ad hoc networks (MANET). However, there is very little formal analysis that considers the communication overhead incurred by these procedures. Further, there is no published investigation of the overhead associated with the recursive application of clustering algorithms to support hierarchical routing. This paper provides a theoretical upper bound on the communication overhead incurred by a particular clustering algorithm for hierarchical routing in MANET. It is demonstrated that, given reasonable assumptions, the average clustering overhead generated per node per second is only polylogarithmic in the node count. To derive this result, novel techniques to assess cluster maintenance overhead are employed.
On Completely Recursively Enumerable Classes and Their Key Arrays

The two results of this paper (a theorem and an example) are applications of a device described in section 1. Our notation is that of [4], with which we assume familiarity. It may be worth while to mention in particular the function Φ(n, x) which recursively enumerates the partial recursive functions of one variable, the Cantor enumerating functions J(x, y), K(x), L(x), and the classes F and Q of r.e. (recursively enumerable) and finite sets respectively.It is possible to “give” a finite set in a way which conveys the maximum amount of information; this may be called “giving explicitly”, and it requires that in addition to an effective enumeration or decision procedure for the set we give its cardinal number. It is sometimes desired to enumerate effectively an infinite class of finite sets, each given explicitly (e.g., [4] p. 360, or Dekker [1] p. 497), and we suggest here a device for doing this.We set up an effective one-to-one correspondence between the finite sets of non-negative integers and these integers themselves: the integer , corresponds to the set αi, = {a1, a2, …, an} and inversely. α0 is the empty set. Clearly i can be effectively computed from the elements of αi and its cardinal number.
EBV and human microRNAs co-target oncogenic and apoptotic viral and human genes during latency

Epstein–Barr virus (EBV) controls gene expression to transform human B cells and maintain viral latency. High-throughput sequencing and crosslinking immunoprecipitation (HITS-CLIP) identified mRNA targets of 44 EBV and 310 human microRNAs (miRNAs) in Jijoye (Latency III) EBV-transformed B cells. While 25% of total cellular miRNAs are viral, only three viral mRNAs, all latent transcripts, are targeted. Thus, miRNAs do not control the latent/lytic switch by targeting EBV lytic genes. Unexpectedly, 90% of the 1664 human 3′-untranslated regions targeted by the 12 most abundant EBV miRNAs are also targeted by human miRNAs via distinct binding sites. Half of these are targets of the oncogenic miR-17∼92 miRNA cluster and associated families, including mRNAs that regulate transcription, apoptosis, Wnt signalling, and the cell cycle. Reporter assays confirmed the functionality of several EBV and miR-17 family miRNA-binding sites in EBV latent membrane protein 1 (LMP1), EBV BHRF1, and host CAPRIN2 mRNAs. Our extensive list of EBV and human miRNA targets implicates miRNAs in the control of EBV latency and illuminates viral miRNA function in general.
Red blood cell sodium-proton exchange in hypertensive blacks with insulin-resistant glucose disposal.

To define the potential pathogenic role of hyperinsulinemia as a mediator of alterations in sodium transport, we have examined red blood cell Na(+)-H+ and Na(+)-Li+ exchanges in a young adult black population characterized for blood pressure and insulin-mediated glucose disposal. Normotensive and mildly hypertensive blacks (blood pressure, 120 +/- 2/76 +/- 2 and 139 +/- 3/94 +/- 2 mm Hg, respectively) with a mean age of 26.1 years were studied for insulin sensitivity with the euglycemic hyperinsulinemic clamp (molar index of insulin sensitivity, M/I = moles glucose metabolized/insulin in milliliters of plasma). Na(+)-H+ exchange (U = mmol/L cell.h) was measured before and after the insulin clamp as a function of cell pH to determine the maximum transport rate. In the normotensive subjects, 18 were insulin sensitive (M/I = 9.37 +/- 0.6 x 10(4)) and 4 were insulin resistant (M/I = 3.64 +/- 0.6 x 10(4)). In the hypertensive subjects, 4 were insulin sensitive (M/I = 9.15 +/- 1.1 x 10(4)) and 16 were insulin resistant (M/I = 3.02 +/- 0.3 x 10(4)). The maximum rate of Na(+)-H+ exchange was significantly higher in all hypertensive vs normotensive individuals (35 +/- 3 vs 23 +/- 3 U, P < .005). Na(+)-H+ exchange activity was higher in insulin-resistant vs insulin-sensitive hypertensive subjects (40 +/- 3 vs 20 +/- 2 U, P < .001) but not in insulin-resistant normotensive subjects. Na(+)-Li+ exchange was not different in hypertensive and normotensive individuals but was higher in all insulin-resistant compared with all insulin-sensitive subjects (0.26 +/- 0.03 vs 0.16 +/- 0.02 U, P < .01). Na(+)-Li+ exchange also was higher in insulin-resistant vs insulin-sensitive normotensive subjects (0.35 +/- 0.03 vs 0.15 +/- 0.02 U, P < .001) and in insulin-resistant hypertensive subjects vs insulin-sensitive normotensive subjects (0.24 +/- 0.03 vs 0.15 +/- 0.02 U, P < .001). A stepwise multiple regression analysis for all variables revealed that with Na(+)-H+ exchange as a dependent variable the main determinant was blood pressure, which in turn had insulin sensitivity as the main determinant. In conclusion, these results indicate that in hypertensive blacks, insulin-resistant glucose disposal is strongly associated with elevated red blood cell Na(+)-H+ exchange activity. Thus, despite impaired insulin-mediated glucose disposal, cellular Na+ gain via enhanced activity of Na(+)-H+ exchange is not blunted in hypertensive blacks.
Characterization of Trial-to-Trial Fluctuations in Local Field Potentials Recorded in Cerebral Cortex of Awake Behaving Macaque

In analyzing neurophysiologic data, individual experimental trials are usually assumed to be statistically independent. However, many studies employing functional imaging and electrophysiology have shown that brain activity during behavioral tasks includes temporally correlated trial-to-trial fluctuations. This could lead to spurious results in statistical significance tests used to compare data from different interleaved behavioral conditions presented throughout an experiment. We characterize trial-to-trial fluctuations in local field potentials recorded from the frontal cortex of a macaque monkey performing an oculomotor delayed response task. Our analysis identifies slow fluctuations (<0.1 Hz) of spectral power in 22/27 recording sessions. These trial-to-trial fluctuations are non-Gaussian, and call into question the statistical utility of standard trial shuffling. We compare our results with evidence for slow fluctuations in human functional imaging studies and other electrophysiologic studies in nonhuman primates.
From Serve-on-Demand to Serve-on-Need: A Game Theoretic Approach

Everyone is familiar with the scenario, people demand or assign tasks to robots, and robots execute the tasks to serve people. We call such a model Serve-on-Demand. With the advancement of pervasive computing, machine learning and artificial intelligence, the robot service of the next generation will inevitably turn to actively and exactly meet people’s needs, even without explicit demand. We call it Serve-on-Need. It requires the robots to comprehend the intentions and preferences of people exactly. In this paper, we model the human-computer interaction for Serve-on-Need as a repeated stochastic Bayesian game. We solve the stochastic Bayesian game by an equilibrium analysis and rational learning. We present the service of a coffee robot to illustrate such an approach.
Computer modeling for enhancing instruction of electric machinery

This paper discusses the use of computers for modeling of electric machinery at the undergraduate level to enhance the lecture as well as the laboratory part of a course on electric machinery with introduction to power systems. It explains how computer simulation helps students not only get a better understanding of the advantages and limitations of computer simulation, but also get a better feel for the physical concepts they study in the lecture and laboratory part of the course. Sample computational projects assigned to the students are described and simulation results obtained from the computer models are presented. >
Using full information when computing modes of post-Newtonian waveforms from inspiralling compact binaries in circular orbit

The increasing sophistication and accuracy of numerical simulations of compact binaries (especially binary black holes) presents the opportunity to test the regime in which post-Newtonian (PN) predictions for the emitted gravitational waves are accurate. In order to confront numerical results with those of post-Newtonian theory, it is convenient to compare multipolar decompositions of the two waveforms. It is pointed out here that the individual modes can be computed to higher post-Newtonian order by examining the radiative multipole moments of the system, rather than by decomposing the 2.5PN polarization waveforms. In particular, the dominant (l=2, m={+-}2) mode can be computed to 3PN order. Individual modes are computed to as high a post-Newtonian order as possible given previous post-Newtonian results.
Built-in Self Testing of a DRP-Based GSM Transmitter

We present a novel approach for built-in self-testing (BIST) of an RF wireless transmitter. This approach, based on fully-digital hardware and on software algorithms, allows the testing of the transmitter's analog/RF circuitry while providing low-cost replacements for the costly traditional RF tests. The testing approach is structural in nature and substitutes for the commonly employed RF performance testing of high-cost test equipment and extended test times. The test coverage achieved for the analog circuitry is maximized to approach 100% and the test-time and associated test costs are minimized. The presented techniques have been successfully verified in a commercial 90 nm CMOS single-chip GSM radio based on the Digital RF Processor (DRPtrade) technology.
Sansalvamide Induces Pancreatic Cancer Growth Arrest through Changes in the Cell Cycle

Survival of patients with pancreatic cancer remains poor due to inadequate chemotherapeutic options. Sansalvamide A, a cyclic depsipeptide produced by a marine fungus, has demonstrated significant anticancer activity. We previously observed antiproliferative effects in a series of sansalvamide A analogs in pancreatic cancer cells, one of which was further evaluated in this study. Two human pancreatic cancer cell lines (AsPC-1 and CD18) were incubated with increasing concentrations (10-50 muM) of the sansalvamide analog. Cell proliferation was then measured by thymidine incorporation and cell counting, and cell cycle analysis was determined by flow cytometry. Western blot analysis was used to evaluate expression of cyclin D1, cdk4, cdk6, cyclin E, cyclin A, cdk2, and p21. Sansalvamide caused G(1) phase cell cycle arrest in both cell lines, and Western blot analyses demonstrated up-regulation of p21, down-regulation of cyclins D1, E, and A, and cdk4, consistent with G(0)/G(1) cell cycle arrest. Cumulatively the results show that Sansalvamide A attenuates pancreatic cancer cell growth and represents a potential anticancer therapy.
Software engineering for real-time high reliability applications

More and more frequently computer/software systems are finding their way into applications wherein both real-time requirements and public or user safety requirements are explicit. The design and development of real-time systems/software requires unique system and software engineering. The development and delivery of software products whose continued successful performance is essential to operational safety and whose failure can lead to loss of life or a significant financial impact also requires a unique software engineering approach. The confluence of these requirements in a single software application is one of the most challenging software development problems. The purpose of this paper is to provide a general discussion of the unique system/software engineering concerns associated with development of software products for real-time applications involving public or user safety or the potential for significant financial loss.
Chemical transformations of the condensation products of structurally different aminoacids with pyridoxal as a function of Ph, solvent, and temperature

The kinetics and mechanism of chemical transformations of condensation products of structurally different aminoacids with pyridoxal as a function of pH of the medium, the solvent, and temperature were studied. The Schiff bases were found to be the most stable at pH close to neutral values. In acidic media the condensation products of α-aminoacids with pyridoxal decompose to the starting components. In alkaline media the elimination of the α-hydrogen atom from the aminoacid fragment and rearrangement of the Schiff base into the quinoid form occurs, the subsequent hydrolysis leading to the formation of pyridoxamine and ketoacids. The condensation products of the β- and e-aminoacids with pyridoxal decompose to the starting components in acidic media but are stable in alkaline media.
Seasonal and annual occurrence of Mediterranean fruit flies (Diptera: Tephritidae) in Makaha and Waianae Valleys, Oahu, Hawaii

A long-term study of trap catches and fruit sampling showed definitive habitat-related patterns of occurrence of populations of the Mediterranean fruit fly (medfly), Ceratitis capitata (Wiedemann), in the Hawaiian valleys of Makaha and Waianae. In general, seasonal and annual fluctuations in patterns of occurrence were influenced by seasonal and annual differences in abundance of coffee berries and distribution of other fruits. Three distinct areas of activity were observed. The most ecologically significant occurred in coffee in the upper part of Makaha and Waianae valleys with a mean catch of 0.78 and 0.32 flies, respectively, per trap per day. The other, dependent upon dispersing flies, occurred in the common residential area in the lower part of each valley, with a mean catch of 0.12 flies per trap per day in Makaha and 0.06 in Waianae. The most important host fruits were coffee, false kamani, common guava, mango, and mock orange. The stabilizing influence of coffee on the medfly population and the fly's propensity to disperse are discussed. Although several small populations exist in Hawaii, previous investigators have studied only the large populations, especially those in Kona, and in Kula, Maui. This is the first ecological study of a small population.
The Ascocarps in Species of Penicillium

SUMMARYA morphologic study of the reproductive structures involved in the ascomycetous phase of 12 species (17 strains) of Penicillium and of one related species has revealed a surprising diversity...
An EOQ Model for Items with Weibull Distribution Deterioration

Abstract An inventory model is considered for deteriorating items with a variable rate of deterioration, where deterioration means decay, damage or spoilage such that the item cannot be used for its original purpose. Specifically, the Weibull distribution is used to represent the distribution of the time to deterioration. The EOQ formula is derived under conditions of constant demand, instantaneous delivery and no shortages, and it is shown that the results can be related to previously developed simpler models. A computer program is developed to provide the numerical solution and a numerical example is used to show the solution form and verify that the solution gives minimum total cost per unit time. An economic lot size model has been developed for situation in which the deterioration follows a Weibull distribution. The theoretical derivation was shown to reduce to the previous model found by Ghare and Schrader when the deterioration was exponential in nature and to a non deteriorating EOQ model when det...
Renal lesions of familial juvenile nephronophthisis examined by microdissection.

Renal lesions from four individuals afflicted with familial juvenile nephronophthisis were examined by light microscopy and microdissection. By microdissection: (1) tubules were altered by multiple diverticula; (2) the nephrons were strikingly heterogeneous in size; (3) cysts were confined to collecting and distal convoluted tubules. The only change in Henle’s loops was the presence of multiple diverticula. Changes in paraffin sections were: (1) diffuse rather than focal interstitial fibrosis; (2) focal interstitial infiltration, predominately of lymphocytes and plasma cells; (3) widely disseminated atrophy of glomeruli, often with pericapsular fibrosis and without glomerular cellular infiltration or extraglomerular vascular change; (4) mixed atrophy and hyperplasia of tubules, with irregular outlines and macula densa-like lesions; (5) focally thickened basement membranes; and (6) cysts in the medeulla or at the corticomedullary junction.
Timing of Ecdysis and Spermatogenesis in the Winter Tick, Dermacentor albipictus (Packard)

After exposure to the host as unfed larvae, most Dermacentor albipictus (Packard) larvae engorge and ecdyse to nymphs in 9–10 days. Nymphs engorge and ecdyse to adults 15–20 days after infestation, with most males ecdysing before females. When nymphs start to feed, spermatogenesis begins with increased mitotic activity and testicular growth. In adult ticks fed 3 days, testes contain spermatogonia, early spermatocytes, growth-stage spermatocytes, meiotic figures, early spermatids, and partially and fully elongated spermatids. The latter are also present in the vasa deferentia. Spermatogenesis in D. albipictus resembles that found in other 1-host ticks.
The Diagnosis and Treatment of Pseudomonas Sepsis in Major Burns

Sepsis due to Pseudomonas in burn wounds is diagnosed by the clinical changes produced by absorbed bacterial exotoxins [1]. A sudden and severe anemia, focal necrosis of granulations, and marginal pyoderma gangrenosa are suggestive. However, the demonstration of verdoglobin in the patient's urine is the most reliable sign that a significant toxemia has developed and indicates a probable progression to fatal septicemia [2]. With severe Pseudomonas exotoxemia, the urinary concentration of verdoglobin may be sufficient to give the urine a deep green color in daylight. Verdoglobinuria of a lesser degree is seldom as obvious and requires fluorescence with an ultraviolent light to detect it. The test is merely qualitative, but it will differentiate verdoglobin from other pigments in the patient's urine [2]. The diagnosis of an associated septicemia can be made only by the presence of a positive blood culture. Approximately one third of the patients with Pseudomonas toxemia have a blood culture
Making Friends: Building Social Robots through Interdisciplinary Collaboration.

This paper discusses social robotics as a hybrid knowledge space that encourages interaction and collaboration among many different disciplines: engineering, computer science, the social sciences and humanities, design, the arts, etc. Such collaboration in the design of socio-culturally situated artifacts poses many challenges, occassioned by differences in conceptual frameworks, methods for conducting research, and even daily work practices. By approaching these challenges in a spirit of friendship across the sciences, it is possible to achieve transdisciplinary understanding and reap the benefits of applying different, yet complementary, forms of expertise to social robot design. In this paper, we use insights and lessons learned from our own collaborative experiences to discuss how social as well as technical and design issues are addressed in the construction and evaluation of social robots and how the boundaries between the social, natural, and applied sciences are challenged, redefined, and traversed.
Mechanical Characterization of Nanowires Using a Customized Atomic Force Microscope

A new experimental method is introduced in order to characterize the mechanical properties of mettalic nanowires. An accurate mechanical characterization of nanowires requires the imaging with scanning electron microscope (SEM) and the bending of nanowires with an atomic force microscope (AFM). In this study, an AFM is located inside an SEM in order to establish the visibility of the nanowires. The tip of the AFM cantilever is utilized to bend and break the nanowires. Nanowire specimens are prepared by electroplating of metal ions into the nanoscale pores of the alumina memberanes. The mechanical properties are extracted by using analytical formulation along with the experimental force versus bending displacement response. Preliminary results revealed that copper nanowires have unique mechanical properties such as high flexibility in addition to high strength compared to their bulk counterparts.
Working Both Sides

Accepting the importance of Jim Greeno’s work, not just in this volume but throughout his career, I offer this commentary from the position of a researcher who first worked “from the inside out” and who now works “from the outside in.” My identity is that of a mathematics educator with a theoretical commitment to design research. To clarify, for almost seven years I collaborated with Paul Cobb, Koeno Gravemeijer and others in the execution of classroom design experiments in which I acted as the teacher. In these settings, I was working from the inside out to first, in action, make sense of students’ understandings so that I could planfully orchestrate classroom discussions. Later, I would conduct retrospective analyses of my interactions by analyzing from the “outside” what I had previously participated in on the “inside.” In these instances, I worked to understand both the students’ and my learning through normative patterns of engagement. The theoretical lens that I adopted for most of my analyses of the classroom is that of a social constructivist with a strong emphasis on tools. I find Greeno’s levels of accounts of cognition in interaction strengthen my previous orientation by more clearly articulating levels of a progression of conceptual understanding. However, I am left wondering what the means of support are for shifts between the levels. Clearly, having a way to analyze the students’ current abilities or ways of reasoning is crucial. However, I view it as necessary but insufficient for supporting learning. It is this stance that I take in my commentary.
I Feel More Like a Sort of Chemist

A few days after Galsworthy’s father’s funeral, in December 1904, he and Ada went to Wings tone, a farmhouse in the village of Manaton on the edge of Dartmoor between Moretonhampstead and Bovey Tracey. Galsworthy had earlier, when on a walking tour, discovered the farmhouse: In these rare spots, which are always in the remote country, untouched by the advantages of civilization, one is conscious of an enwrapping web or mist of spirit — is it, perhaps, the glamorous and wistful wraith of all the vanished shapes once dwelling there in such close comradeship? It was a Sunday of an early June when I first came upon one such, far down in the West Country. I had walked with my knapsack twenty miles, and there being no room at the tiny inn of the very little village, they directed me to a wicket gate, through which, by a path leading down a field, I would come to a farmhouse, where I might find lodging. The moment I got into that field I felt within me a special contentment, and sat down on a rock to let the feeling grow …. Leaving the rock at last, I went towards the house. It was long and low and rather sad, standing in a garden all mossy grass and buttercups, with a few rhododendrons and flowery shrubs below a row of fine old Irish yews. On the stone verandah a grey sheep-dog and a very small golden-haired child were sitting close together, absorbed in each other. A woman came in answer to my knock, and told me, in a pleasant, soft, slurring voice, that I might stay the night.1
Stresses near a Crack in a Rubber Sheet

Crack tip stresses in rubber sheet determined by measuring strain field with imprinted grid work
Protein adsorption on nanoparticles: model development using computer simulation.

The adsorption of proteins on nanoparticles results in the formation of the protein corona, the composition of which determines how nanoparticles influence their biological surroundings. We seek to better understand corona formation by developing models that describe protein adsorption on nanoparticles using computer simulation results as data. Using a coarse-grained protein model, discontinuous molecular dynamics simulations are conducted to investigate the adsorption of two small proteins (Trp-cage and WW domain) on a model nanoparticle of diameter 10.0 nm at protein concentrations ranging from 0.5 to 5 mM. The resulting adsorption isotherms are well described by the Langmuir, Freundlich, Temkin and Kiselev models, but not by the Elovich, Fowler–Guggenheim and Hill–de Boer models. We also try to develop a generalized model that can describe protein adsorption equilibrium on nanoparticles of different diameters in terms of dimensionless size parameters. The simulation results for three proteins (Trp-cage, WW domain, and GB3) on four nanoparticles (diameter = 5.0, 10.0, 15.0, and 20.0 nm) illustrate both the promise and the challenge associated with developing generalized models of protein adsorption on nanoparticles.
High-efficiency UV superconducting nanowire single-photon detectors from amorphous MoSi

We demonstrate high-efficiency detection of 370 nm photons using superconducting nanowire single-photon detectors. The detectors employ amorphous MoSi (bulk T c = 6.8 K) to enable operation on a compact cryocooler system.
Myasthenia Gravis Exacerbation after Discontinuing Mycophenolate: A Case-Control Study. (P7.070)

OBJECTIVE: To describe the rate of myasthenia gravis (MG) exacerbations after the discontinuation of mycophenolate mofetil (MMF) in a retrospective single clinic case-control series in patients on otherwise stable medication therapy. BACKGROUND: MMF is commonly used to treat MG despite two RCT’s failing to prove its effectiveness. DESIGN/METHODS: We identified all (103) MG patients who were prescribed MMF during the five-year period 2007-2011 at our MG clinic. We then performed detailed chart reviews and recorded all MG exacerbations and their relationship to MMF and other treatment changes. We also recorded demographic data and disease characteristics (including antibody status and MGFA status). RESULTS: Of the 18 patients in whom MMF was discontinued or rapidly and markedly reduced during this period, 13 experienced an exacerbation. Of the 85 patients in whom the MMF was not discontinued, 2 experienced an exacerbation. This results in a relative risk of exacerbation after MMF discontinuation of 31.4 (95 [percnt] CI 7.8 to 127.3), P < 0.0001. Of the five patients who discontinued MMF without an exacerbation, two restarted MMF within 2 months, one was placed on Imuran, one only took mycophenolate for 10 days and one was lost to follow-up. In the group of 85 patients in which no or little change in MMF was made, 2 underwent an exacerbation, one following a reduction in prednisone dose, and one following a small (500 mg) reduction in MMF dose. Six of 103 were lost to follow-up. CONCLUSIONS: This case-control study suggests that stopping MMF may increase the risk of a MG exacerbation many fold. Our data support the hypothesis that MMF plays a role in the maintenance of MG remission/minimal manifestation status, because the discontinuation/reduction was associated with an increased risk of MG flair in the absence of change in any other component of the immunosuppressive regimen. Disclosure: Dr. Oskarsson has received personal compensation for activities with Avanir Pharmaceuticals as a speaker. Dr. Richman has nothing to disclose. Dr. Rocke has nothing to disclose.
Opinion: On being an advisor to today's junior scientists.

Scientist advisors should take pains to guide their proteges, ensuring they have every opportunity to succeed in this increasingly challenging profession. Image courtesy of Dave Cutler (artist).
Note: Smooth torsional potentials for degenerate dihedral angles

A general method is proposed for smoothing torsional potentials when the dihedral angle becomes undefined.
Privileged Access and Merleau-Ponty

The Cartesian notion that a conscious subject has “privileged access” to her inner mental states — that she is an authority on their nature because they are hers — has been out of favor for some time in Western philosophy of the mind. In part because Phenomenology claims something like privileged access, it was considered by some computationalist philosophers to be irrelevant to the real business of constructing a scientifically respectable theory of consciousness and cognition. This paper argues that while it is true that we, qua conscious subjects, lack full experiential understanding of all the causal mechanisms, seams and faultlines of our conscious states, we do have a certain privileged access. The basis for this argument was supplied by Merleau-Ponty as early as The Structure of Behavior and is made very clear in The Phenomenology of Perception. His work establishes two vital facts: that we necessarily understand the basic structure of our consciousness, and that this structure is entailed and elucidated by the physical structures of the brain and body, not by mysterious powers of a Cartesian cogito. Merleau-Ponty brings together the phenomenological and the scientific in a way that cognitive scientists are only now beginning to appreciate.
The autonomic nervous system, molder and integrator of function. Review of a concept

This paper treats a number of topics relative to functions of the autonomic nervous system: its role in the sympathies and emotional inter-reactions essential to society and common endeavor; the history and evolution of our knowledge of the structure, composition and function of this system; the recent concurrent genesis of concepts of the roles this system plays. Among the most recently developed ideas of autonomic system function is that of its integrating role and that of its molding role in determining the color and intensities of behavioral responses. These latter concepts are supported by recent discoveries of the role played in sensory reception, in several disease states, in control of the neuroendocrine and endocrine systems, in modulation of cardiovascular function, in regulation of energy release and use, and, finally, in conditioned behavior. It appears that there is considerable plasticity and possibility of drastically modifying cell of this system which normally would have functioned in a quite different way. Modern methods of anatomical analysis have shown that the central representation of the autonomic outflow is not as simplistically and independently organized as often visualized. Furthermore the same centers which control somatic responses also affect autonomic system activity. There is only one nervous system and the autonomic complex is an integral part thereof, participating in all behavior. It is, however, specially concerned with the emotional component, reactions to real or anticipated emergencies, control of the viscera and maintenance of homeostasis. In addition to integrating the activity of body parts it has a modulatory effect on all functions.
Procedural competency training during diagnostic radiology residency: Time to go beyond “See one, do one, teach one”!

Objectives: Achieving procedural competency during diagnostic radiology residency can impact the radiologist's future independent practice after graduation, especially in a private practice setting. However, standardized procedure competency training within most radiology residency programs is lacking, and overall procedural skills are still mainly acquired by the traditional “see one, do one, teach one” methodology. We report the development of a simple standardized procedural training protocol that can easily be adopted by residency programs currently lacking any form of structured procedural training. Materials and Methods: An ad hoc resident procedural competency committee was created in our radiology residency program. A procedural certification protocol was developed by the committee which was composed of attending radiologists from the involved divisions and two chief residents. A road map to achieve procedural competency certification status was finalized. The protocol was then implemented through online commercial software. Results: Our procedural certification protocol took effect in September 2014. We reviewed all resident records from September 2014 to December 2016. Eighteen residents of various levels of training participated in our training protocol. About 72% became certified in paracentesis, 11% in thoracentesis, 83% in feeding tube placement, 55% in lumbar puncture/myelogram, and 77% in tunneled catheter removal. Conclusions: Our single-center experience demonstrates that a simple to adopt structured approach to procedural competency training is feasible and effective. Our “certified” radiology residents were deemed capable of performing those procedures under indirect supervision. The following core competencies are addressed in this article: Patient care, Medical knowledge, and Systems-based practice.
A Survey of Technologies Utilized in the Treatment and Diagnosis of Attention Deficit Hyperactivity Disorder

Imaging and signal processing technologies play a critical role in many medical diagnoses. However, these tools have not yet been utilized to aid in the clinical diagnosis or treatment of neurocognitive disorders such as Attention Deficit Hyperactivity Disorder (ADHD). This paper reviews research literature investigating the potential ADHD diagnosis and treatment efficacy of various imaging and signal processing modalities. The benefits and drawbacks of each modality are then summarized and compared by a decision matrix wherein the viability of a computer vision modality is highlighted. Finally, the paper suggests a general system design for a modality that uses computer vision and that can be used along with neuropsychological assessments for the diagnosis and treatment of ADHD.
Cannabis & ENT: State certification-An expanding yet unregulated system.

Abstract Objectives 1) Ascertain the status of cannabis legalization by state, 2) Explore the process required to obtain cannabis credentials for both the patient and the physician, 3) Determine the level of interest of otolaryngologists in the medicinal cannabis, and 4) Explore possible research directions into efficacy and potential complications. Study design Descriptive study. Methods Internet searches were conducted to identify each state's Medical Cannabis Program website. The qualifying conditions, list of approved-practitioners, process required for both practitioners and patients for approval were noted. Lists of approved practitioners were analyzed to determine the prevalence of board-certified otolaryngologists. Results Of the 33 states that authorize medicinal cannabis, eight provide lists of approved-practitioners, six of which provide specialty information. A total of 24 Otolaryngologists can be found of the 5944 physicians on these six lists. All otolaryngologists were located in highly-populated metropolitan areas with a mean number of 29.9 years in practice. Significant variations exist between each state including legal definitions and qualifying conditions. Conclusions Lack of consistent regulation across the country drives uncertainty regarding the adoption of medicinal cannabis. Very few otolaryngologists in the country are registered to certify patients for medical cannabis. While the medicinal use of cannabis may currently have limited applications within otolaryngology, many areas that have yet to be explored.
Integrated assessment of ecosystem integrity of large northern rivers: the Northern Rivers Basins Study example

The Northern River Basins Study (NRBS) assessed the ecologicalstate of three complex northern river basins for which we had a limitedunderstanding of the physical, chemical and biological environment. Amajor challenge of this study was the choice of ecosystem components tomonitor. This process was guided by determining the indicators thatwould best assess environmental state relative to ecosystem objectivesarticulated by people living within the basin. This charge lead the NRBSto use a cumulative effects assessment framework that measured stressorexposure and their effects along with the development of plausiblecause-effect mechanisms. Thus, the NRBS developed and applied anintegrated assessment framework that included public stakeholders,various levels of government and scientists. A key feature of thisframework was the ability to allow feedback among these groups toproduce the syntheses of science results, and the resultant managementresponses that ultimately modified environmental regulations. Papers inthis series present the results of the NRBS and emphasize theinterdisciplinary nature of this project. Investigations evaluated theroles of flow regulation, nutrients, contaminants, and their interactiveeffects, on the integrity of the Athabasca, Peace and Slave rivers,Canada. Novel contributions of the NRBS model included the cooperationamong governments, aboriginal peoples, non-government organizations,industry and other stakeholders, and the two-way communications flowamong the scientific community and these groups.
Bariatric Enhanced Recovery Protocol: a Community Quality Perspective

Bariatric enhanced recovery protocols can decrease length of stay (LOS) and hospital costs without compromising patient safety. Increased data is needed to compare patient outcomes before and after application of enhanced recovery pathways. We present a bariatric enhanced recovery protocol (BERP) at a community hospital. The objectives were to decrease hospital LOS and reduce schedule II substance use (medications with a high potential for abuse, potentially resulting in psychological or physical dependence), without compromising patient safety. This was a combined retrospective and prospective analysis of all patients undergoing bariatric surgery by two surgeons from September 2016 to April 2018. Mann-Whitney U, Pearson chi-square, and Fisher’s exact tests were used to compare demographics, comorbidities, and outcomes. Two hundred patients were evaluated. Overall median (interquartile range) age was 43.0 (36.0–54.0) years and body mass index (BMI) was 45.0 (40.6–50.3) kg/m2. Pre-protocol mean hospital LOS was 2.3 days while enhanced recovery protocol patients mean LOS was 1.4 days (p < 0.001). Sixty-five percent of BERP patients were discharged on hospital day 1, while no patients prior to the protocol were discharged before hospital day 2. Only 9% of BERP patients were discharged with schedule II medications, compared to 100% of the pre-protocol patients (p < 0.001). Intraoperative, in-hospital, and 30-day complication rates were not statistically significant between the two groups. Community hospitals can reduce length of stay and narcotic prescribing without compromising safety-related outcomes. Significant reductions in the amount of schedule II medications can be achieved when using multimodal enhanced recovery protocol approaches.