cssi/SciSciGPT-SciSciNet huggingface dataset:
905Screening and Isolation/Contact Precautions for Multi-Drug Resistant Organisms (MDRO) in Acute Care Hospitals: Results from a National Survey

Background. Infections caused by MDRO lead to significant morbidity and mortality. Consequently, several states have mandated reporting of MDRO and C. difficile. Objectives of this study were: 1) to describe policies to screen and isolate for MDRO in U.S. hospitals; and 2) examine the relationship between state mandates for reporting of MDRO and implementation of screening and isolation/contact precaution policies. Methods. A cross-sectional survey of hospitals enrolled in the National Healthcare Safety Network was conducted in the Fall of 2011. Descriptive statistics were computed. Differences in policies between hospitals located in states with and without MDRO reporting mandates at the time of the survey were examined using chi-square tests. Results. 1,015 hospitals provided data (30% response rate). The majority (68%) reported targeted screening upon admission for methicillin-resistant Staphylococcus aureus (MRSA); screening for vancomycin-resistant Enterococci (VRE) and C. difficile were infrequently reported, 13% and 5%, respectively. Of hospitals with targeted MRSA screening, populations screened were ICU patients (73%) and transfers from skilled nursing facilities (57%) or other hospitals (43%). Contact precautions (CP) for patients with the following organisms were commonly reported: MRSA (95%), VRE (93%), and C. difficile (86%). While presumptive isolation/CP were common for C. difficile (78%), they were less common for MRSA (39%) and VRE (24%). Few hospitals routinely screened for other organisms, including methicillin-susceptible Staphylococcus aureus (12%), Acinetobacter spp (9%), Klebsiella pneumoniae (8%) and Pseudomonas spp (7%). Hospitals located in states with mandatory reporting of MRSA were more likely to have a policy for targeted MRSA screening (p < 0.001), and less likely to have a policy for presumptive isolation/CP pending a screen (p = 0.024). Conclusion. This study found variation in the adoption of MDRO screening and isolation/contact precautions. Further research is needed to provide additional insight on effective strategies and to examine the impact of mandatory reporting of infections on implementation of policies and infection rates. Disclosures. All authors: No reported disclosures.
The Predictive Value of Clinical Laboratory Test Results

Bayes’ formula is being used with increasing frequency to calculate predictive values for positive and negative clinical laboratory test results. Because of its nonlinear form, however, it is difficult to visualize how changes in the test characteristics or disease prevalence will effect predictive values. This paper shows that Bayes’ formula is transformed to a linear function through the use of odds, rather than probabilities, thus facilitating conceptualization, understanding, and memory.
Venous ulcer care: which dressings are cost effective?:

Healed or open venous ulcers may be present in up to 1% of Western populations and consume a large amount of healthcare resources. These ulcers are characterized by a chronic inflammatory environment with impaired healing and often require months for closure. The average monthly cost of care for an open ulcer has been estimated to be $4095. The fundamental tenets of ulcer care include adequate compression and maintaining a moist wound environment with an appropriate primary dressing. A number of specialized products including semi-occlusive/occlusive, antimicrobial, and advanced wound matrix dressings are now available. However, there is little data from appropriate clinical studies to suggest significantly improved outcomes with any of these dressings. Data regarding their cost-effectiveness is also limited, often conflicting, and subject to bias. At present, there is little solid evidence to guide the choice of primary dressings and a patient-centered approach focusing on characteristics of both the patient and their ulcer, while paying attention to costs, may be most appropriate.
Turbidity produced by hexamminecobaltic chloride in serum of rabbits injected intravenously with papain.

Summary1. Serum of rabbits following injection of chondroitin sulfate, crude papain, or several modifications of papain, became turbid following addition of hexamminecobaltic trivalent cation. Turbidity was directly related to amount of chondroitin sulfate-like material present in the serum. 2. The precipitate produced by this cation contained most of the non-dialysable S35 activity present in the circulation following injection of crude papain, was metachromatic when redissolved, and did not form after incubation of serum with testicular hyaluronidase. 3. Addition of hexamminecobaltic chloride to dilute, dialysed serum is a useful way of demonstrating sulfated mucopolysaccharides in serum at levels exceeding 250 μg/ml.
Low-dose trazodone for symptomatic patients with esophageal contraction abnormalities. A double-blind, placebo-controlled trial.

Twenty-nine patients with esophageal symptoms and contraction abnormalities of the esophageal body completed a 6-wk, double-blind, placebocontrolled trial of trazodone (100–150 mg1day). Measures of esophageal and psychologic symptoms were completed at entry and at each follow-up visit. Esophageal manometry was repeated at the termination of the trial. Upon completion of the treatment, patients receiving trazodone (n = 15) reported a significantly greater global improvement than those receiving placebo (n =14; p=0.02). Although a variable clinical response was observed, the trazodone group had less residual distress over esophageal symptoms compared with the placebo group (59% ± 9% vs. 108% ± 19%, p=0.03). Manometric changes observed during the course of the trial were not influenced by treatment nor by clinical response. Remarkable reductions in ratings of chest pain were reported by both treatment groups, emphasizing the importace of controlled trials when studying this patient population. We conclude that low-dose trazodone therapy can be of benefit in the management of symptomatic patients with esophageal contraction abnormalities. In addition, our findings support recent observations that manometric abnormalities characterizing this patient group may not be solely responsible for symptoms.
The effects of chemical treatment of whole canola seed on lipid and protein digestion by steers.

Five Angus x Simmental steers (average BW 259 kg) cannulated in the rumen, proximal duodenum, and terminal ileum were fed five diets in a 5 x 5 Latin square design. Experimental periods were 14 d in length, with 10 d of diet adaptation and 4 d of sample collection. The basal diet contained (percentage of diet DM) ammoniated corn cobs (50%), alfalfa hay (22%), cornstarch grits (13%), corn (6.7%), cane molasses (5%), and urea (1.25%). Three canola seed-containing diets and a diet containing Ca salts of longchain fatty acids (Ca-LCFA) were formulated by replacing cornstarch grits from the basal diet with the test feedstuffs. Whole canola seed untreated, crushed, or treated with a caustic alkaline solution and an oxidant were included at 10% of diet DM. The Ca-LCFA diet contained (percentage of diet DM) canola meal (5%) and Megalac® (5%). Diets containing untreated, crushed, and treated canola seed and Ca-LCFA contained, on average, 5.6% more total fatty acids than the basal diet. Steers were fed 5.3 kg DM/d (2.05% of initial BW) in 12 equal portions (every 2 h). Ruminal fermentation characteristics and digestibilities of OM, GE, N, NDF, and ADF were unaffected (P >.05) by diet. Biohydrogenation of total 18-carbon unsaturated fatty acids was greater (P < .05) for steers fed the crushed canola seed-containing diet (72.0%) than for steers fed the untreated (27.9%) and treated (38.6%) canola seed-containing diets. Digestibility of total 18-carbon fatty acids in the small intestine was greater for steers fed the crushed canola seed (58.9% of duodenal flow) rather than the untreated canola seed (28.4% of duodenal flow) and intermediate for steers fed the treated canola seed (47.0% of duodenal flow). Chemical treatment of whole canola seed may be a viable method for the postruminal delivery of intestinally available unsaturated fatty acids to ruminants.
Chemical defense in pelagic octopus paralarvae: Tetrodotoxin alone does not protect individual paralarvae of the greater blue-ringed octopus (Hapalochlaena lunulata) from common reef predators

Some pelagic marine larvae possess anti-predator chemical defenses. Occasionally, toxic adults imbue their young with their own defensive cocktails. We examined paralarvae of the greater blue-ringed octopus (Hapalochlaena lunulata) for the deadly neurotoxin tetrodotoxin (TTX), and if present, whether TTX conferred protection to individual paralarvae. Paralarvae of H. lunulata possessed 150 ± 17 ng TTX each. These paralarvae appeared distasteful to a variety of fish and stomatopod predators, yet food items spiked with 200 ng TTX were readily consumed by predators. We conclude that TTX alone does not confer individual protection to paralarvae of H. lunulata, and that they possess an alternative defense. In larger doses, tetrodotoxin is a deterrent to the predatory stomatopod Haptosquilla trispinosa (mean dose = 3.97 μg/g). This corresponds to 12–13 paralarvae per predator based on the TTX levels of the clutch we examined. Thus, the basic assumption that individual paralarvae of H. lunulata are defended by TTX alone was disproved. Instead, functionality of TTX levels in paralarvae may arise through alternative selective pathways, such as deterrence to parasites, through kin selection, or against predator species not tested here.
The Free Grace Controversy and Redefining the Role of Lay Believers

Edward Johnson, one of the first settlers of Woburn, had come over with Winthrop in 1630. A few years later he went to England to get his family and bring them to Massachusetts. On his return to Massachusetts he was approached by a group which he categorized as a faction of “ignorant and unlettered men and women, in a posture of preaching to a multitude.” “Come along with me,” one told him, and “I’ll bring you to a woman that preached better gospel than any of your black-coats who have been at the Ninniversity, a woman of another kind of spirit who hath many revelations of things to come.” “For my part,” the man who accosted him continued, “I had rather hear such a one that speaks from the merest motion of the Spirit, without any study at all, than one of your learned scholars, although they may be fuller of Scripture.” Shortly thereafter he met a “a little nimble tongued woman who said she could bring me acquainted with one of her own sex that would show me a way, if I could attain it, even Revelations, full of such ravishing joy that I should never have cause to worry for sin so long as I live.”1
Memory and Learning in Intellectual Disability

Abstract Within cognitive domains, memory is one of the most investigated processes in people with intellectual disability (ID), and studies have documented severe deficits in its functioning. Data indicate that memory impairment is not homogeneous across all individuals with ID, but it is related to the specific etiology of ID. The chapter reviewed literature on memory and learning in individuals with ID considering memory as multicomponential, enlisting multiple cognitive functions, and changing over developmental time. The profiles of memory and learning exhibited by well-defined etiological groups of neurodevelopmental disorders, as Williams syndrome (WS) and Down syndrome (DS), were analyzed. In studies on DS, a widespread deficit in the explicit domain of long-term memory (LTM) compared to the implicit one was demonstrated, while studies on WS have showed more mixed results. Regarding the implicit LTM domain, there is evidence of an opposite implicit LTM profiles in individuals with DS (relatively preserved) and with WS (relatively impaired), indicating that the assumed proficient implicit LTM abilities cannot be confirmed in all individuals with ID. Results on short-term memory (STM) and working memory (WM) also showed peaks and valleys in profiles related to specific etiologies of ID and even the relationship between STM and WM, and academic achievement differs according to the different etiologies of ID. In conclusion, differential patterns of memory abilities are documented across different etiological groups of individuals with ID, and the irregularities in the memory profile may reflect discrepancies in the maturation of different cerebral networks linked to a specific genotype.
Extrema of a Function of Two or More Variables (without Constraint)

Let f(x 1, x 2) be a function of two real variables x 1 and x 2 with continuous partial derivatives $$ {f_1} = \frac{{\partial f\left( {{x_1},{x_2}} \right)}}{{\partial {x_1}}}\,and\,{f_2} = \frac{{\partial ({x_1},{x_2})}}{{\partial {x_2}}} $$ (2.1.1) Suppose that f(x 1, x 2) attains a local extremum at the point (a,b). Then intuitively it is clear that the function of a single variable f(x 1,b) must attain an extremum at x 1 = a. From Section 1.4 it is necessary that f 1 = 0 at x 1 = a. Similarly, since the function f(a,x 2) must also attain an extremum at x 2 = b, it is also necessary that f 2 = 0 at x 2 = b.
Analysis of 2015 Meteorological Data from the Bettis Atomic Power Laboratory

The Bettis Atomic Power Laboratory (Bettis) in West Miffin, PA is required to estimate the effects of hypothetical emissions of radiological material from its facility by the U.S. Environmental Protection Agency (EPA). An atmospheric dispersion model known as CAP88, which was developed and approved by the EPA for such purposes, is used by Bettis to meet this requirement. CAP88 calculations over a given time period are based on statistical data on the meteorological conditions for that period. The Bettis facility has an on-site meteorological tower which takes atmospheric measurements at a frequency ideal for EPA regulatory model input. However, an independent analysis and processing of the meteorological data from the site tower is required to derive a data set appropriate for use in the CAP88 model. The National Atmospheric Release Advisory Center (NARAC) was contracted by the Bettis Atomic Power Laboratory to process the on-site meteorological data for the calendar year 2015.
Continuity of medication management in Medicaid patients with chronic comorbid conditions: An examination by mental health status

Abstract Objective Patients with serious mental illness (SMI) often have comorbid cardiometabolic conditions (CMCs) that may increase the number of prescribers involved in treatment. This study examined whether patients with SMI (depression and schizophrenia) and comorbid CMCs experience greater discontinuity of prescribing than patients with CMCs alone. Methods 2009 Medicaid data were used to compare number and types of prescribers (primary care, cardiometabolic, psychiatric, other) in individuals with 1–3 CMCs (diabetes, hypertension, dyslipidemia) alone (n=76.451); with CMC and schizophrenia (n=6507); and with CMC and depression (n=23.510) and the degree of prescribing within a provider's area of specialty. Results 44%, 61%, and 71% of individuals with CMCs only, with CMCs and schizophrenia, and with CMCs and depression had medications from these classes prescribed by 5 or more providers respectively. >35% of patients with CMCs alone or CMCs and schizophrenia had prescriptions provided by 3 or more PCP providers, which increased to 49.1% for patients with CMCs and depression. In the schizophrenia cohort, 29% of antipsychotics were PCP-prescribed while psychiatrists prescribed 10%, 9%, and 9% of antihypertensive, antihyperlipidemic, and antidiabetic medications respectively. Conclusions The presence of SMI increases the number of prescribers treating individuals with CMCs. The impact of this fragmentation in medication management on health outcomes is unknown.
HMGA1 expression levels are elevated in pancreatic intraepithelial neoplasia cells in the Ptf1a-Cre; LSL-KrasG12D transgenic mouse model of pancreatic cancer

Pancreatic cancer is currently the third leading cause of cancer deaths in the United States and it is predicted to become the second by the year 2030. High-mobility group A1 protein (HMGA1) is an oncogenic transcription factor, localised and active in cell nuclei, that is linked to tumour progression in many human cancers, including pancreatic cancer. Overexpression of HMGA1 renders cancer cells resistant to chemotherapy. Although the Ptf1a-Cre; LSL-KrasG12D transgenic mouse is perhaps the most widely utilised animal model for human pancreatic cancer, expression levels of HMGA1 in pancreata from this mouse model have not been characterised. Quantitative immunohistochemical analysis was used to determine nuclear HMGA1 levels in pancreatic tissue sections from Ptf1a-Cre; LSL-KrasG12D mice aged 5, 11, and 15 months. The H Score method was used for quantitative analysis. The HMGA1 levels were significantly elevated in pancreatic intraepithelial neoplasia (PanIN) epithelia compared with untransformed acinar tissues or fibroinflammatory stroma. The PanINs have long been regarded as precancerous precursors to pancreatic adenocarcinoma. Significantly elevated HMGA1 levels observed in the nuclei of PanINs in Ptf1a-Cre; LSL-KrasG12D mice validate this animal model for investigating the role that HMGA1 plays in cancer progression and testing therapeutic approaches targeting HMGA1 in human cancers.
Association between single nucleotide polymorphisms of tumor necrosis factor gene and grade II–IV acute GvHD: a systematic review and meta-analysis

Acute GvHD (aGvHD) complicates up to 50% of allogeneic hematopoietic cell transplants and pre-transplant estimation of its risk can guide prophylaxis, monitoring and early intervention strategies. Inspired by the role of tumor necrosis factor alpha (TNFα) in the pathogenesis of aGvHD and the inconsistency of the association studies exploring single nucleotide polymorphisms (SNPs) of the TNF gene, we conducted a systematic review and meta-analysis of the available reports using PubMed and EMBASE. Original human studies reporting on the association between recipient TNF SNPs and grade II–IV aGvHD in a format convertible to effect size and confidence interval were included. One of the two most widely investigated SNPs (rs361525G>A) was marginally associated with increased risk of grade II–IV aGvHD in random-effects meta-analysis of six studies (627 patients in total, risk ratio=1.29, 95% confidence interval=0.99–1.69, P=0.06). If this result is validated in a large cohort with uniform conditioning and GvHD prophylaxis, TNF rs361525G>A may become a useful tool for aGvHD risk estimation before the transplant.
Increased X-ray Visualization of Shape Memory Polymer Foams by Chemical Incorporation of Iodine Motifs

Shape memory polymers can be programmed into a secondary geometry and recovered to their primary geometry with the application of a controlled stimulus. Porous shape memory polymer foam scaffolds that respond to body temperature show particular promise for embolic medical applications. A limitation for the minimally invasive delivery of these materials is an inherent lack of X-ray contrast. In this work, a triiodobenzene containing a monomer was incorporated into a shape memory polymer foam material system to chemically impart X-ray visibility and increase material toughness. Composition and process changes enabled further control over material density and thermomechanical properties. The proposed material system demonstrates a wide range of tailorable functional properties for the design of embolic medical devices, including X-ray visibility, expansion rate, and porosity. Enhanced visualization of these materials can improve the acute performance of medical devices used to treat vascular malformations, and the material porosity provides a healing scaffold for durable occlusion.
Effects of expiratory muscle activation via high-frequency spinal cord stimulation.

The findings in the present study suggest that lower thoracic high-frequency spinal cord stimulation with low stimulus currents results in sufficient activation of the expiratory muscles via spinal...
Hands‐off Ultrasound Technique: Utilizing Simultaneous Modeling to Enhance Ultrasound Training

Image acquisition can be a challenging component of obtaining ultrasound proficiency. To assist with obtaining the correct image, instructors may take the transducer away or guide the learner's hand. However, this passive form of learning has been suggested to be much less valuable, as it removes learner autonomy and somatosensory cueing. This paper describes the hands-off ultrasound technique, a simultaneous modeling teaching strategy using multimodal feedback to improve ultrasound image acquisition.
Variational generalized Kohn-Sham approach combining the random-phase-approximation and Green's-function methods

Author(s): Voora, Vamsee K; Balasubramani, Sree Ganesh; Furche, Filipp | Abstract: A generalized Kohn–Sham (GKS) scheme which variationally minimizes the random phase approximation (RPA) ground state energy with respect to the GKS one-particle density matrix is introduced. We introduce the notion of functional-selfconsistent (FSC) schemes, which vary the one- particle Kohn–Sham (KS) potential entering an explicitly potential-dependent exchange-correlation (XC) energy functional for a given density, and distinguish them from orbital-selfconsistent (OSC) schemes, which vary the density, or the orbitals, density matrix, or KS potential generating the density. It is shown that, for explicitly potential-dependent XC functionals, existing OSC schemes such as the optimized effective potential method violate the Hellmann-Feynman theorem for the density, producing a spurious discrepancy between the KS density and the correct Hellmann-Feynman density for approximate functionals. A functional selfconsistency condition is derived which resolves this discrepancy by requiring the XC energy to be stationary with respect to the KS potential at fixed density. We approximately impose functional selfconsistency by by semicanonical projection (sp) of the PBE KS Hamiltonian. Variational OSC minimization of the resulting GKS-spRPA energy functional leads to a nonlocal correlation potential whose off-diagonal blocks correspond to orbital rotation gradients, while its diagonal blocks are related to the RPA self-energy at real frequency. Quasiparticle GW energies are a first-order perturbative limit of the GKS-spRPA orbital energies; the lowest-order change of the total energy captures the renormalized singles excitation correction to RPA. GKS-spRPA orbital energies are found to approximate ionization potentials and fundamental gaps of atoms and molecules more accurately than semilocal density functional approximations (SL DFAs) or G0W0 and correct the spurious behavior of SL DFAs for negative ions. GKS-spRPA energy differences are uniformly more accurate than the SL-RPA ones; improvements are modest for covalent bonds but substantial for weakly bound systems. GKS-spRPA energy minimization also removes the spurious maximum in the SL-RPA potential energy curve of Be 2 , and produces a single Coulson-Fischer point at ∼ 2.7 times the equilibrium bond length in H 2 . GKS-spRPA thus corrects most density-driven errors of SL-RPA, enhances the accuracy of RPA energy differences for electron-pair conserving processes, and provides an intuitive one-electron GKS picture yielding ionization potentials energies and gaps of GW quality.
Conversations in Male Genderlect in Young Adult Fiction: Their Effect on Reading Motivation

A study was conducted to test the hypothesis that eighth grade young adults would indicate greater motivation to read books with accurate representation of conversations in male genderlect, with genderlect being defined as “a set of linguistic features that characterizes language production of a socially defined gender category (typically woman/girl and man/boy)” (Johnson, 2009). Fifty-six eighth grade volunteers--29 female and 27 male--were presented with five excerpts from young adult novels that contained conversations in male genderlect. These excerpts were paired with the same conversation re-written in Standard English. Subjects were asked to indicate which seemed more like a book they would like to read--the male genderlect version or the Standard English version. The hypothesis was not supported.
Leveraging employer practices in global regulatory frameworks to improve employment outcomes for people with disabilities

Work is an important part of life, providing both economic security and a forum to contribute one’s talents and skills to society, thereby anchoring the individual in a social role. However, access to work is not equally available to people with disabilities globally. Regulatory environments that prohibit discrimination and support vocational training and educational opportunities constitute a critical first step toward economic independence. However, they have not proven sufficient in themselves. In this article, we aim to infuse deeper consideration of employer practice and demand-side policy reforms into global policy discussions of the right to work for people with disabilities. We begin by documenting the employment and economic disparities existing for people with disabilities globally, followed by a description of the international, regional, and local regulatory contexts aiming to improve labor market outcomes for people with disabilities. Next, we examine how policies can leverage employer interests to further address inequalities. We discuss employer policies and practices demonstrated in the research to facilitate recruitment, hiring, career development, retention, and meaningful workplace inclusion. The goal of the article is to synthesize existing international literature on employment rights for people with disabilities with the employer perspective.
Parameters of motion vision in low light in the hawkmoth Manduca sexta

ABSTRACT The hawkmoth Manduca sexta is nocturnally active, beginning its flight activity at sunset, and executing rapid controlled maneuvers to search for food and mates in dim light conditions. The visual system of this moth has been shown to trade off spatial and temporal resolution for increased sensitivity in these conditions. The study presented here uses tethered flying moths to characterize the flight performance envelope of the wide-field-motion-triggered steering response of M. sexta in low light conditions by measuring attempted turning in response to wide-field visual motion. Moths were challenged with a horizontally oscillating sinusoidal grating at a range of luminance, from daylight to starlight conditions. The impact of luminance on response to a range of temporal frequencies and spatial wavelengths was assessed across a range of pattern contrasts. The optomotor response decreased as a function of decreasing luminance, and the lower limit of the moth9s contrast sensitivity was found to be between 1 and 5%. The preferred spatial frequency for M. sexta increased from 0.06 to 0.3 cycles deg−1 as the luminance decreased, but the preferred temporal frequency remained stable at 4.5 Hz across all conditions. The relationship between the optomotor response time to the temporal frequency of the pattern movement did not vary significantly with luminance levels. Taken together, these results suggest that the behavioral response to wide-field visual input in M. sexta is adapted to operate during crepuscular to nocturnal luminance levels, and the decreasing light levels experienced during that period changes visual acuity and does not affect their response time significantly.
Introduction Psychiatry and Law—General Issues

The practice of psychiatry is in large part regulated by law, but this is a relatively recent development. Up until the mid-1960s the law made few demands on us. Our day-to-day practice was not heavily monitored by government agencies, nor did negative outcomes in treating patients put us in jeopardy of being sued for malpractice. Before legal regulation of psychiatry expanded so rapidly, psychiatrists viewed their relationship to the law as one in which they provided valuable assistance. The law allowed psychiatrists to assist society in the social control function of restraining and treating deviant and disorderly people. We were given considerable power to define our own role in managing the behavior of the mentally ill, and for the most part society appreciated our efforts. The courts also asked psychiatrists for assistance in resolving conflicts which were influenced by the mental status of one or both parties in litigation. Here the psychiatrist was expected to be an expert witness. Few psychiatrists volunteered to be expert witnesses, but when they did their services were usually welcomed.
Episiotomy practice in a community hospital setting.

OBJECTIVE: Episiotomy practice in the United States has changed dramatically over the past 20 years, and recent studies have questioned the utility of routine episiotomy. Our objective was to evaluate current episiotomy practice in a community hospital. STUDY DESIGN: We reviewed vaginal deliveries at a community hospital from January 1, 2004, to December 31, 2005. Maternal, fetal, labor and provider data were collected Data were analyzed collected. Data were analyzed with t test, Χ 2 and logistic regression. RESULTS: A total of 2,959 deliveries by 17 practitioners were evaluated. The episiotomy rate increased for younger patients, with estimated fetal weight > 4,000 g, when presentation was not occiput anterior and with decreasing parity. Provider characteristics, such as a greater number of years in practice or when the delivering physician was not the outpatient physician, increased episiotomy rates. The overall episiotomy rate declined from 20.6% to 17.7% during the study; however, this did not reach statistical significance, and some practitioners had unchanged or increased rates. CONCLUSION: Practitioner characteristics were the strongest predictors of episiotomy. Overall, the rate at this community hospital was within published recommendations, but wide variations in practice (range, 2-43%) suggest that education needs to target community physicians remote from training to ensure that all women receive optimal, evidence-based delivery care.
Chemical Reactivity of Copolymers

Chemical reactions of polymers, whether or not they yield copolymers as final products involve copolymers as intermediates. An understanding of the factors that influence copolymer reactivity is therefore basic to a general understanding of polymer reactivity. Since it is relatively easy to calculate various aspects of copolymer structure from information about variables involved in its preparation, it is of interest to evaluate the influence that neighboring substituents can have on the chemical reactivity of a monomer unit in a copolymer.
Treatment patterns and survival outcomes in patients with cervical cancer complicated by complete uterine prolapse: a systematic review of literature.

Cervical cancer complicated by complete uterine prolapse is a rare clinical entity and uniform management recommendations have yet to be determined. The aim of the current review was to examine the effects of management patterns on survival outcomes in cervical cancer patients with complete uterine prolapse. A systematic review of the literature was conducted using three public search engines. This included case reports with detailed descriptions of tumor characteristics, cancer management, and survival outcomes. Treatment patterns and tumor characteristics were correlated to survival outcomes. There were 78 patients with cervical cancer with complete uterine prolapse. Their mean age was 63.7 years. The median duration of prolapse was 147.9 months and 22.2 % of the patients experienced persistent/recurrent prolapse after cancer treatment. The mean tumor size was 8.9 cm and squamous cell carcinoma (83.9 %) was the most common histologic type. The majority of patients (56.2 %) had stage I cancer. Tumor characteristics were similar across the treatment patterns. Survival outcomes were more favorable with surgery-based treatment (48 patients) than with radiation-based treatment (30 patients): 5-year recurrence-free survival rate 72.0 % vs. 62.9 % (p = 0.057), and 5-year disease-specific overall survival rate 77.0 % vs. 68.2 % (p = 0.017). After controlling for age and stage, surgery-based therapy remained an independent prognostic factor for better disease-specific overall survival outcome (hazard ratio 0.32, 95 % confidence interval 0.11 – 0.94, adjusted p = 0.039). Although limited in study size, our results at least suggest that surgery-based treatment may have a positive effect on survival outcome in cervical cancer patients with complete uterine prolapse.
Monitoring Online Discussions About Suicide Among Twitter Users With Schizophrenia: Exploratory Study.

Background: People with schizophrenia experience elevated risk of suicide. Mental health symptoms, including depression and anxiety, contribute to increased risk of suicide. Digital technology could support efforts to detect suicide risk and inform suicide prevention efforts. Objective: This exploratory study examined the feasibility of monitoring online discussions about suicide among Twitter users who self-identify as having schizophrenia. Methods: Posts containing the terms suicide or suicidal were collected from a sample of Twitter users who self-identify as having schizophrenia (N=203) and a random sample of control users (N=173) over a 200-day period. Frequency and timing of posts about suicide were compared between groups. The associations between posting about suicide and common mental health symptoms were examined. Results: Twitter users who self-identify as having schizophrenia posted more tweets about suicide (mean 7.10, SD 15.98) compared to control users (mean 1.89, SD 4.79; t374=-4.13, P<.001). Twitter users who self-identify as having schizophrenia showed greater odds of tweeting about suicide compared to control users (odds ratio 2.15, 95% CI 1.42-3.28). Among all users, tweets about suicide were associated with tweets about depression (r=0.62, P<.001) and anxiety (r=0.45, P<.001). Conclusions: Twitter users who self-identify as having schizophrenia appear to commonly discuss suicide on social media, which is associated with greater discussion about other mental health symptoms. These findings should be interpreted cautiously, as it is not possible to determine whether online discussions about suicide correlate with suicide risk. However, these patterns of online discussion may be indicative of elevated risk of suicide observed in this patient group. There may be opportunities to leverage social media for supporting suicide prevention among individuals with schizophrenia.
Female breast cancer mortality in relation to puberty on Staten Island, New York

Pursuant to a Congressional act in 2008, the Department of Health and Human Services established the Interagency Breast Cancer and Environmental Research Coordinating Committee to address the burden of breast cancer in the United States. Subsequently, the Committee recommended researchers study the timing of exposure to breast cancer risk factors. Given the high breast cancer mortality rate on Staten Island, this paper presents a case-control study investigating breast cancer risk associated with puberty while living on Staten Island. The dataset combined New York City Department of Health and Mental Hygiene female death certificate information between 1985 and 2006, with life history information from newspaper obituaries. Data analyzed included: age, length of residence on Staten Island, birth on Staten Island, and residence on Staten Island during puberty. Cases were individuals who died of breast cancer and controls were individuals who died of non-malignant causes. Analysis included multivariate logistic regression on the full dataset and multiple replicates of randomized one case to two controls simulations. Results indicated that living on Staten Island during puberty (ages 9-19) was associated with an elevated risk of dying from breast cancer (odds ratio 1.35, p < 0.001, 95% CI = 1.18, 1.55). This paper suggests the importance of studying puberty as a window of susceptibility for breast cancer risk.
IGT/LAZY family genes are differentially influenced by light signals and collectively required for light-induced changes to branch angle

Abstract Plants adjust their growth orientations in response to environmental signals such as light and gravity in order to optimize photosynthesis and access to nutrients. However, given the fixed nature of gravity, understanding how light and gravity signals are integrated is challenging. Branch orientation, or gravitropic set point angle, is a key aspect of plant architecture, set with respect to gravity and shown to be altered by changes in light conditions. The IGT gene family, also known as the LAZY family, contains important components for branch angle and gravity responses, including three gene clades: LAZY, DEEPER ROOTING (DRO), and TILLER ANGLE CONTROL (TAC). LAZY and DRO genes promote upward branch orientations downstream of amyloplast sedimentation, and upstream of auxin redistribution in response to gravity. In contrast, TAC1 promotes downward branch angles in response to photosynthetic signals. Here, we investigated the influence of different light signaling pathways on LAZY and DRO gene expression, and their role in light regulation of branch angle responses. We found differential effects of continuous light and dark, circadian clock, photoreceptor-mediated signaling, and photosynthetic signals on LAZY and DRO gene expression. Phenotypic analysis revealed that LAZY and DRO genes are collectively required for branch angle responses to light. Highlight LAZY and DRO gene expression responds differentially to changes in light regime and signaling. Loss of multiple LAZY and DRO genes leads to loss of branch angle response to light.
Firing patterns of gonadotropin-releasing hormone neurons are sculpted by their biologic state

Gonadotropin-releasing hormone (GnRH) neurons form the final pathway for the central neuronal control of fertility. GnRH is released in pulses that vary in frequency in females, helping drive hormonal changes of the reproductive cycle. In the common fertility disorder polycystic ovary syndrome (PCOS), persistent high-frequency hormone release is associated with disrupted cycles. We investigated long- and short-term action potential patterns of GnRH neurons in brain slices before and after puberty in female control and prenatally androgenized (PNA) mice, which mimic aspects of PCOS. A Monte Carlo (MC) approach was used to randomize action potential interval order. Dataset distributions were analysed to assess (i) if organization persists in GnRH neuron activity in vitro, and (ii) to determine if any organization changes with development and/or PNA treatment. GnRH neurons in adult control, but not PNA, mice produce long-term patterns different from MC distributions. Short-term patterns differ from MC distributions before puberty but become absorbed into the distributions with maturation, and the distributions narrow. These maturational changes are blunted by PNA treatment. Firing patterns of GnRH neurons in brain slices thus maintain organization dictated at least in part by the biologic status of the source and are disrupted in models of disease.
Standard module hydraulic technology: A novel geometrical design methodology and analysis for a low-head hydraulic turbine system, part II: Turbine stator-blade and runner-blade geometry, and off-design considerations

Abstract Low-head hydropower has the potential to generate a significant amount of electricity from rivers that traditionally were unsuitable for developing hydraulic power plants. To effectively and eco-friendly utilizing those renewable energy resources, a Standard Modular Hydropower Technology was proposed by the U.S. Department of Energy (DOE) in 2017. This new concept offers a new paradigm for small hydropower technology development based on the premise of standardization, modularity, and preservation of stream functionality. This technology has three primary modules: Generation Module, Passage Modules, Foundation Modules , and this series of papers presents a general design methodology for the generation module. The first part of this series of papers covered the basic development of the design methodology and some fundamental geometrical considerations. This second part of the papers presents additional numerical simulation contents on several blade configurations, including stator blade inlet angle, runner blade solidity, and runner blade thickness considerations, and how those geometrical configurations affect the overall performance and fluid behaviors. Additionally, how those geometrical configurations influence the overall off-design performance is also investigated with comprehensive performance maps analysis. With improved blade geometrical configurations, the test models have a vast off-design potential with 23%-1220% operating range and over 75% hydraulic efficiency.
Spatiotemporal Nonrecurring Traffic Spillback Pattern Prediction for Freeway Merging Bottleneck Using Conditional Generative Adversarial Nets with Simulation Accelerated Training

Forecasting short-term, nonrecurring traffic dynamics caused by incidents is an essential capability in the Intelligent Transportation Systems. This research proposes a prediction framework in which Conditional Deep Convolutional Generative Adversarial Nets (C-DCGAN) is trained to predict the traffic spillbacks patterns associated with freeway incidents at merging bottleneck. Speed tensors, which depict the spatiotemporal incident-induced impacts for multiple neighboring routes, is a suitable object for the GAN model to understand and predict. Further, we demonstrated how to use the mesoscopic Dynamic Traffic Assignment (DTA) model DynusT to generate a large number of training data, thus speeding up the model training. The developed model achieves both statistical and spatial similarities between predicted speed tensors and actual tensors, to 83.84%. To the best of our knowledge, this line of work is one of the first attempts in the literature to train the Machine Learning model to predict speed tensor representation of multi-location incident-induced spatiotemporal impact at merging bottleneck and speeding up the training via simulation.
A Polynomial Chaos-based Approach to Quantify Uncertainties of Correlated Renewable Energy Sources on Voltage Regulation

Assessing the impacts of uncertainties on various power system operations has become a key factor for modern power grids. Renewable energy sources (RESs) have introduced significant uncertainties especially in electric power distribution systems. Although several probabilistic methods have been used for quantifying uncertainties such as Monte Carlo simulation and perturbation techniques, they usually have high computational time. In addition, the existence of more than one source of randomization requires deep understanding of the correlation between them via intensive statistical approaches. This paper proposes a Generalized Polynomial Chaos (gPC)-based approach to quantify the impacts of uncertainties resulting from RESs on voltage magnitudes of distribution systems. The gPC has been used to propagate uncertainties in the transmission system. In the gPC, the behavior of each random variable is transformed into a series of orthogonal polynomials that can be easily evaluated. A correlation matrix is calculated and used to estimate the proper values of each RES. The proposed method is implemented on the IEEE-13 and IEEE-123 distribution systems integrated with solar energy and wind energy at various locations. The results show that the proposed algorithm provides high efficiency and significant reduction in computation time in comparison with Monte Carlo simulation.
Using Dynamic Virtual Microscopy to Train Pathology Residents During the Pandemic: Perspectives on Pathology Education in the Age of COVID-19

The COVID-19 pandemic has forced educational programs, including pathology residency, to move to a physically distanced learning environment. Tandem microscopic review (also known as "double-scoping") of pathology slides is a traditional cornerstone of pathology education. However, this requires the use of a double- or multi-headed optical light microscope which is unfortunately not amenable to physical distancing. The loss of double-scoping has forced educational innovation in order to continue teaching microscopy. Digital pathology options such as whole slide imaging could be considered; however, financial constraints felt by many departments often render this option cost-prohibitive. Alternatively, a shift toward teaching via dynamic virtual microscopy offers a readily available, physically distanced, and cost-conscious alternative for pathology education. Required elements include a standard light microscope, a mounted digital camera, computers, and videoconferencing software to share a slide image with the learner(s). Through survey data, we show immediate benefits include maintaining the essence of the traditional light microscope teaching experience, and additional gains were discovered such as the ability for educators and learners to annotate images in real time, among others. Existing technology may not be initially optimized for a dynamic virtual experience, resulting in lag time with image movement, problems focusing, image quality issues, and a narrower field of view; however, these technological barriers can be overcome through hardware and software optimization. Herein, we share the experience of establishing a dynamic virtual microscopy educational system in response to the COVID-19 pandemic, utilizing readily available technology in the pathology department of a major academic medical center.
Institutional Ownership and Share Prices: Theory and Evidence

We develop and test a theory to explain the variation in institutional ownership and share price levels across firms. In our model, institutional owners provide an alternative channel through which firms can disseminate information and create value by monitoring, thus substituting for costly information generation by analysts. We show that both institutional ownership and share price level increase with the extent to which institutional investors are able to positively affect a firm, in contrast to the causal relation between price and institutional ownership that is widely asserted in the literature. We find that the positive association between share prices and institutional ownership persists even after controlling for liquidity and size differences. Our study resolves the apparent conflict between existing rationales for lowering stock prices through splits and the argument in previous studies that institutions prefer higher priced stocks.
Discovering Newton’s Second Law of Motion in the Classroom

Richard Feynman, in one of the Messenger Lectures he delivered at Cornell University in 1964, explained that one looks for a new law of nature by the following process: