cssi/SciSciGPT-SciSciNet huggingface dataset:
Effect of follow-up provider source on outcomes of patients with hematologic malignancies receiving hematopoietic stem cell transplantation

6112 Background: Studies have shown that involvement of trained physicians is associated with favorable outcomes of patients receiving hematopoietic stem cell transplantation (HSCT). At the Univers...
Lattice flexures: Geometries for stiffness reduction of blade flexures

Abstract Reducing the motion-direction stiffness of compliant mechanisms reduces their actuation effort and simplifies associated static balancing mechanisms. This work introduces a flexure type called lattice flexures and evaluates some of their fundamental properties. Lattice flexures have a reduced bending stiffness when compared to traditional rectangular-section blade flexures of similar size. The motion-direction bending stiffness of two lattice flexure types, called X-type and V-type, are analytically derived, corroborated with finite element analysis, and validated with measurements of physical prototypes. The lattice flexure has the potential to reduce the bending stiffness of some compliant mechanisms by 60–80%, as demonstrated in devices manufactured using 3D printing technologies. It is shown that some lattice flexures exhibit a torsional/bending stiffness ratio as much as 1.7 times higher than an equal aspect-ratio blade flexure, and a transverse bending/motion-direction bending stiffness ratio up to 6.5 times higher than an equal aspect-ratio blade flexure.
The Twin-Arginine Subunit C in Oscarella: Origin, Evolution, and Potential Functional Significance

The twin-arginine translocation (Tat) pathway is a protein transport system that moves completely folded proteins across lipid membranes. Genes encoding components of the pathway have been found in the genomes of many Bacteria, Archaea, and eukaryotic organelles including chloroplasts, plant mitochondria, and the mitochondria of many protists. However, with a single exception, Tat genes are absent from the mitochondrial genomes of all animals. The only exception comes from the homoscleromorph sponges in the family Oscarellidae, whose mitochondrial genomes encode a gene for tatC, the largest subunit of the complex. Here, we explore the origin and evolution of the mitochondrial tatC gene in Oscarellidae, and use bioinformatic approaches to evaluate its functional significance. We conclude that tatC in Homoscleromorpha sponges was likely inherited from the ancestral proto-mitochondrial genome, implying multiple independent losses of the mitochondrial Tat pathway during the evolution of opisthokonts. In addition, bioinformatic evidence suggests that tatC comprises the entire Tat pathway in Oscarellidae, and that the Rieske Fe/S protein of mitochondrial complex III is its likely substrate.
Technology-Assisted Virtual Consultation for Medical Imaging

Abstract Purpose The aim of this study was to report the investigators' preliminary experience in the implementation of a "virtual consult" (VC) system enabling consultations between radiologists and referring physicians in physically remote locations throughout their enterprise. Methods Referrers and radiologists directly access the VC through the electronic medical record and PACS, respectively. Referrers may click a VC link associated with any examination report to instant message the appropriate subspecialist radiologist, who receives an alert allowing automatic loading of the examination. The radiologist and referrer may then discuss the examination via instant messaging as well as launch a real-time screen-share of the radiologist's PACS display, with the option for either participant to control the display. Radiologists' and referrers' feedback was evaluated after the institution's first 110 VC sessions. Results Referrers' most common specialties were emergency medicine (27.3%) and internal medicine (13.6%); radiologists' most common subspecialties were abdominal (33.6%) and thoracic (16.4%) imaging. Screen-shares lasted on average 12 ± 16 minutes. From 80% to 90% of referrers agreed that the VC was easy to use, improved their understanding of the radiology report, affected patient management, and enhanced radiologists' role. Referrers found the VC to be particularly useful when traditional consultation was difficult because of location or time constraints or when seeking a quick response to a targeted question. Radiologists recognized referrers' positive response to the VC, although they tended to view the VC as disruptive to normal workflow. Conclusions The VC addresses a key challenge in the current era of digital radiology practice and provides added value to referrers, though continued radiologists' workflow optimization is warranted.
Formation and Redox Interconversion of Niobium Methylidene and Methylidyne Complexes

The niobium methylidene [{(Ar'O)2 Nb}2 (μ2 -Cl)2 (μ2 -CH2 )] (2) can be cleanly prepared via thermolysis or photolysis of [(Ar'O)2 Nb(CH3 )2 Cl] (1) (OAr'=2,6-bis(diphenylmethyl)-4-tert-butylphenoxide). Reduction of 2 with two equivalents of KC8 results in formation of the first niobium methylidyne [K][{(Ar'O)2 Nb}2 (μ2 -CH)(μ2 -H)(μ2 -Cl)] (3) via a binuclear α-hydrogen elimination. Oxidation of 3 with two equiv of ClCPh3 reforms 2. In addition to solid state X-ray analysis, all these complexes were elucidated via multinuclear NMR experiments and isotopic labelling studies, including a crossover experiment, support the notion for a radical mechanism as well as a binuclear α-hydrogen abstraction pathway being operative in the formation of 2 from 1.
Abstract #5257: ADP-Glo: An Ideal approach to monitor the activity of protein kinases and beyond

Because of its versatility (all types of substrates), robustness (Z\#8217;>0.8), rapid performance, and its ease of use, the luminescence based Kinase GloTM assay platform have gained wide acceptance in many drug screening programs for protein kinase inhibitors. The new ADP Glo assay maintains all the positive features of kinase Glo. It is universal, applicable to all kinds of kinase substrates regardless of their nature with no prior modification (peptides, protein, polymer, lipids, and sugars). In stead of measuring ATP depletion, ADP-Glo monitors ADP production. It detects ADP at early stages of enzyme reactions with very high signal to background (SB) ratio. It can be run at wide range of ATP concentrations (low micromolar to millimolar), is sensitive to low ADP concentrations, and it can be carried out in high density plate formats. The assay is robust as is indicated by the high Z\#8217; values (over 0.8), homogenous, does not require antibodies or custom synthesized substrates, and is ideal to search for optimal substrates in a collection of peptides, proteins, lipids in one assay format and to screen for ATP competitive and Non competitive inhibitors. Because of the high dynamic range and more importantly, the high SB values at low % ATP to ADP conversion, the assay allows the use of low amount of enzyme during high-throughput screenings. ADP-Glo assay is applicable to all types of kinases, ATPases and many other ADP producing enzyme reactions. Citation Information: In: Proc Am Assoc Cancer Res; 2009 Apr 18-22; Denver, CO. Philadelphia (PA): AACR; 2009. Abstract nr 5257.
The AMPK-SKP2-CARM1 axis links nutrient sensing to transcriptional and epigenetic regulation of autophagy.

Macroautophagy/autophagy is a highly conserved catabolic process that targets bulk cytoplasm, and damaged organelles or other harmful intracellular content to the lysosome/vacuole for degradation. Autophagy is essential for maintaining proper cellular homeostasis and for survival under adverse conditions. When this cytoprotective process becomes dysfunctional, it is often associated with a spectrum of human ailments including cancer and neurodegenerative diseases. Intensive studies have been carried out in the past two decades to understand the mechanism and regulation of autophagy; so far, more than thirty autophagy-related ( ATG ) genes have been identified in human that orchestrate the complex membrane dynamics involved in autophagic sequestration. In order to further our understanding of this crucial cellular activity, and to gain the knowledge necessary to modulate autophagy for therapeutic purposes, it is imperative that we continue to explore the mechanisms involved in its regulation.
The Fountain of the Dragon: water, allegory, and burlesque in the gardens of Versailles

Versailles in the 1660s, the decade of Louis XIV’s earliest involvements, is often called the ‘Premier Versailles’. The designation applies as much to the festive spirit of the place as to an inter...
Overview of the Measurement

Being a momentum transfer squared, Q2 naturally has dimensions of momentum squared or (length × mass/time)2. W, being an invariant mass, has dimensions of mass. In natural units, these quantities have units of GeV2 and GeV, respectively.The DIS analysis presented in this thesis contains many studies of backgrounds in different Q2 and W regions than the canonical Q2 > 1. 0 (GeV/c)2 and W > 2. 0 (GeV/c2). In order to ease confusion, the remainder of this document uses SI units to clearly distinguish if a value is a momentum transfer squared or invariant mass. This means momentum squared now has units of (GeV/c)2 and mass has units of (GeV/c2). This convention is persisted in the document’s appendix as well.
Impact of Obstructive Sleep Apnea on Outcomes of Catheter Ablation of Atrial Fibrillation.

Obstructive sleep apnea (OSA) is a growing epidemic in the United States and significantly contributes to the increasing prevalence of atrial fibrillation (AF) in the U.S. POPULATION Although a strong correlation between OSA and AF has been demonstrated, a causal relationship between these two conditions has not been definitively established. Evidence of OSA is an important consideration of AF management and impacts the success rate of catheter ablation. The presence of OSA tends to predict a lower success rate and higher complication rate for catheter ablation of AF. However, recent studies evaluating OSA as an independent risk predictor of AF recurrence following an ablation procedure have yielded conflicting results. A greater understanding of these conditions would allow for a more specific therapy targeting the type of AF associated with OSA. The following review provides a brief summary of obstructive sleep apnea etiology, focuses on the relationship between OSA and AF, and discusses the impact of OSA on the outcomes of catheter ablation of AF.
Trauma morning report is the ideal environment to teach and evaluate resident communication and sign-outs in the 80 hour work week.

Abstract Background The 80 h work week has raised concerns that complications may increase due to multiple sign-outs or poor communication. Trauma Surgery manages complex trauma and acute care surgical patients with rapidly changing physiology, clinical demands and a large volume of data that must be communicated to render safe, effective patient care. Trauma Morning Report format may offer the ideal situation to study and teach sign-outs and resident communication. Materials and methods Surgery Residents were assessed on a 1–5 scale for their ability to communicate to their fellow residents. This consisted of 10 critical points of the presentation, treatment and workup from the previous night’s trauma admissions. Scores were grouped into three areas. Each area was scored out of 15. Area 1 consisted of Initial patient presentation. Area 2 consisted of events in the trauma bay. Area 3 assessed clarity of language and ability to communicate to their fellow residents. The residents were assessed for inclusion of pertinent positive and negative findings, as well as overall clarity of communication. In phase 1, residents were unaware of the evaluation process. Phase 2 followed a series of resident education session about effective communication, sign-out techniques and delineation of evaluation criteria. Phase 3 was a resident-blinded phase which evaluated the sustainability of the improvements in resident communication. Results 50 patient presentations in phase 1, 200 in phase 2, and 50 presentations in phase 3 were evaluated. Comparisons were made between the Phase 1 and Phase 2 evaluations. Area 1 (initial events) improved from 6.18 to 12.4 out of 15 (p Conclusions Trauma Surgery manages complex surgical patients, with rapidly changing physiologic and clinical demands. Trauma Morning Report, with diverse attendance including surgical attendings and residents in various training years, is the ideal venue for real-time teaching and evaluation of sign-outs and reinforcing good communication skills in residents.
Abstract 248: Baseline Cognitive Impairment a Predictor of Mortality in Cardiovascular Disease

Objective: Few longitudinal studies have examined outcomes of patients with cardiovascular disease (CVD) in relation to earlier, baseline cognitive function, or examined the relationship between specific cognitive domains and mortality. This study attempted to clarify the relationship between cognitive function and long-term outcomes, particularly mortality, in patients with cardiovascular disease. Methods: One hundred seventy seven participants between 55 and 85 years of age with an established history CVD were recruited from healthcare institutions. A comprehensive neurophysiological test battery was administered to all patients at baseline assessing 4 cognitive domains: language, visual-spatial, memory, and attention-executive function. Composite scores were calculated by averaging z-scores of all component measures. At 6-year the follow-up, of the 136 patients who were still enrolled, the 116 who were still alive were contacted by phone for assessment of level of independent living, and subjective assessment of cognitive function, and quality of life.Results were corrected for age. Results: At follow-up, participants who were deceased had significantly lower baseline attention-executive function (M=-0.51, SD=0.78 vs. M=0.06, SD=0.54 in survivors, p Conclusion: Impaired executive function was predictive of poorer outcomes, specifically, 6-year mortality. This finding reinforces the frontal nature of vascular cognitive impairments, especially in regard to the long term sequelae of cognitive dysfunction in patients with CVD. The higher mortality observed in patients with baseline executive domain impairment may be due to behaviors such as impaired self-care, treatment adherence and rehab participation or functional impairments that exacerbate health problems, resulting in death. Patients with cardiovascular disease and executive function impairment should be identified and measures taken to address these potential problems.
Real-time signal control accounting for urban freight deliveries

Freight vehicles often block lanes of traffic on signalized arterials when double-parking to make deliveries in urban areas. When delivery vehicles block lanes of traffic near signalized intersections, the capacity of the intersection is affected. Current practice is for traffic signals to be timed assuming that each approach can serve vehicles at the unobstructed saturation flow. This paper presents a model for adapting the traffic signal timing in real time for signal cycles during which a delivery blocks a link upstream of the intersection. The model requires real-time information about the location of the double-parked delivery vehicle, which is assumed to be available from connected vehicle data from urban freight vehicles or from another detection system. The results show that for low levels of traffic demand, the signal control method reduces intersection delay compared to a signal that is timed for unblocked traffic. The algorithm also keeps the intersection approach undersaturated for higher levels of demand, which is important because deliveries can last for many signal cycles.
Proposed method of producing large optical mirrors Single-point diamond crushing followed by polishing with a small-area tool

Faster production of large optical mirrors may result from combining single-point diamond crushing of the glass with polishing using a small area tool to smooth the surface and remove the damaged layer. Diamond crushing allows a surface contour accurate to 0.5 microns to be generated, and the small area computer-controlled polishing tool allows the surface roughness to be removed without destroying the initial contour. Final contours with an accuracy of 0.04 microns have been achieved.
Algorithms for Design and Interrogation of Functionally Gradient Material Objects

Solid Freeform Fabrication (SFF) processes have demonstrated the ability to produce parts with locally controlled composition. In the limit, processes such as Three-Dimensional Printing(3DP) can create parts with composition to the length scale of 100 µm. To exploit this potential, new methods for automatic design of Functionally Gradient Material (FGM) parts need to be developed. This paper presents an efficient method for design and composition interrogation of FGM solids. The design tool based on the distance function from the surface of the part requires enhanced efficiency, and so does the interrogation of the part. The approach for improving efficiency includes preprocessing the model with bucket sorting and 3D digital distance transform, and an efficient point classification algorithm. Based on these tools, an efficient algorithm for distance function computation is developed for the design of FGM through distance to the surface of the part or distance to an .STL surface boundary. An efficient algorithm to evaluate composition at a point, along a ray or on a plane is also presented.
[18F]Fluoromethylallylcholine (FMAC): Synthesis and evaluation of a new PET tracer for cancer imaging

1833 Objectives:18F-labeled choline analogs are currently under development as oncologic probes for PET. In this study, [18F]fluoromethylallylcholine (FMAC) was synthesized and preliminarily evaluated as a new PET imaging tracer for cancer imaging. Methods: FMAC was synthesized using an automated system (Tracera LLC, Zionsville, IN) via the alkylation of N-allyl-N-methyl-N-hydroxyethylamine (10 mg) with [18F]fluoromethyl triflate in acetone (0.4 mL). The product was held up on a cation-exchange cartridge, isolated from the precursor using rinses with ethanol and water, and eluted form the cartridge with sterile isotonic saline. Radiochemical purity was determined by cation-exchange HPLC. Biodistribution and metabolism studies were performed in Fisher rats bearing subcutaneous 9L-glioma tumors in comparison with [14C]choline and [18F]fluorocholine (FCH). Results: Radiochemical yields of FMAC were found to depend on temperature, reaction time and concentration of amine precursor. Optimal [18F]fluoromethylation yields of up to 90% were obtained at reaction temperatures of 30-40 °C. At higher temperatures decomposition of the product was observed. High radiochemical purity (99%) of FMAC was achieved. In 9L-glioma-bearing rats, highest uptake was seen in kidneys and liver. In comparison with FCH and [14C]choline, FMAC showed slower oxidation to the corresponding betaine analog in lung, liver and kidney which lead to a prolonged plasma clearance of nonmetabolized FMAC. Tumor:blood and tumor:muscle ratios for FMAC were 10 and 2 fold higher, respectively, than seen with FCH. Uptake of FMAC in kidney was lower than for [14C]choline and FCH, while urinary clearance was increased. Conclusions: The fluoromethylallylcholine is an 18F-labeled choline analog with slower oxidation, more prolonged plasma clearance, and higher tumor:background ratios than fluorocholine. These results encourage further evaluation of the FMAC as a cancer imaging probe for PET.
Remarks on the Comparative Experiments of Miele, Sandgren, and Schittkowski

I will in this brief discussion offer critical remarks on the recent comparative experiments of Miele [1], Sandgren [2] and Schittkowski [3]. Because of my closeness to the work of my former doctoral student, Eric Sandgren, it is difficult for me to be completely objective in evaluating his work. I will comment on his work in spite of this obvious bias.
B-Cell Precursors in Normal Pediatric Bone Marrow

A number of studies have been published pertaining to "normal" lymphocyte subsets in bone marrow. However, these studies are based on normal adult marrow or marrows of children with leukemia in remission or other systemic illness. Data on hematologically normal children are lacking. This study demonstrates that, compared with that of adults, bone marrow of hematologically normal children has an increased percentage of B cells and B-cell precursors. Dual-parameter flow cytometric methods demonstrated subpopulations of B cells at various stages of differentiation; the percentage of cells in these subsets is highest in the very young and decreases with increasing age. Caution must be exercised when searching for early leukemic relapse in pediatric marrows because these normal immature B-cell precursors immunophenotypically resemble leukemic blasts.
Study-abroad students’ identity and social integration

Abstract Students’ experiences abroad can vary a great deal and their identity plays a critical role in shaping their experiences. This study employed sociocultural theory, Critical Race Theory and Bourdieu’s notions of habitus and capital to explore the experiences of four groups of US undergraduates enrolled in four study abroad programs in Spain sponsored by a large US university located in the South East. Findings showed how students’ identity intersected and shaped their journey and impacted their social integration. The examples of Albert, Theresa, and Rebecca, three focal students, allowed for the analysis of how differently students’ identity, notably gender, race, ethnicity, age, social class, and nationality, affected their interactions with locals and perceptions of the target language, culture, and society. Important implications are discussed, including the importance of training study abroad participants before, during and after the trip, and selecting activities that facilitate greater and more sustained social integration.
Improvements in an Organization's Culture of Health Reduces Workers' Health Risk Profile and Health Care Utilization

Objective:To examine changes in internal and external cultures of health scores and relate those changes to employees’ health risks, health care utilization, and costs for 21 large employers (N = 641,901).Methods:We measured the relationship between changes in internal and external culture of health
Artificial Intelligence: Opportunities and Challenges for the Public Sector

Artificial Intelligence (AI) refers to a set of technologies through which "intelligent machines are gaining the ability to learn, improve and make calculated decisions in ways that enable them to perform tasks previously thought to rely solely on human experience, creativity, and ingenuity" [2]. As stated in the 2018 the UN E-Government Survey, major technological developments in software and hardware have enhanced the advancement of AI and its potential impact on society. Increased data collection and usage are magnifying the learning process of computers and improving the quality of AI systems which are heavily data-dependent. On the one hand, AI holds the promise to be a catalyst in accelerating development and allowing developing countries to leapfrog over some traditional obstacles. On the other hand, it brings along challenges such as its impact on the workforce, the ethical implications of some of its applications, and the need for capacity-building which would essentially overhaul the kind of education required for the next generation. This working paper analyzes the above issues from a public sector angle and raises questions which should be considered by public administrators and those working on digital government development in particular. Moreover, the analyses are built on the 2018 United Nations E-Government Survey findings and the working paper is expected to be discussed in detail in the preparatory meetings leading to the next edition of the United Nations E-Government Survey.
Ultramarathon Comprehensive Injury Prevention

This paper aims to review injury prevention for ultramarathon runners during training, race day, and recovery. Injury prevention starts with a training plan that emphasizes a gradual increase in distance interspersed with speed work, long runs, strength training, and active recovery. Pre-race training environment that mirrors race day terrain and climate is preferred. Customized nutrition and hydration strategies are recommended. Further research is needed regarding various carbohydrate/fat nutrition strategies. There are numerous reviews of ultramarathon running-related injuries, which often include discussion on symptoms, treatment options, and how to improve race day performance. This review rather focuses on recent findings in ultramarathon injury prevention including pre-participation screening, training recommendations, shoe selection, foot strike patterns, blisters, and environmental issues. Pre-race and race day nutrition is highlighted with a discussion on high-carbohydrate low-fat diet vs. low-carbohydrate high-fat diets. Prevention of gastrointestinal distress and exercise-associated hyponatremia are also reviewed.
Acute Cardiovascular Toxicity of Procaine, Chloroprocaine, and Tetracaine in Anesthetized Ventilated Dogs

The acute intravenous cardiovascular toxicity of three amino-ester local anesthetic agents was studied in the pentobarbitalized, ventilated dog. Significant depression of mean arterial blood pressure, heart rate, cardiac output and stroke volume was observed at 10 mg/kg of tetracaine, while insignificant changes were seen after the same dose of procaine and chloroprocaine. At 30 mg/kg there was minimal depression of cardiovascular parameters with procaine, whereas this same dose of chloroprocaine proved to be lethal. Myocardial depression appeared to be primarily responsible for the profound cardiovascular depression since minimal changes in peripheral vascular resistance occurred until a lethal dose was administered. Increases in mean pulmonary artery pressures and pulmonary vascular resistance were observed prior to the development of myocardial depression which suggests a direct pulmonary vasoconstrictor effect. The cumulative lethal dose was approximately 30 mg/kg for tetracaine, 60 mg/kg for chloroprocaine, and 230 mg/kg for procaine. The cardiovascular toxicity of these agents appears to be proportional to their anesthetic potency rather than their rate of hydrolysis when administered as an intravenous bolus which mimics the clinical situation of an inadvertent intravascular injection.
Mechanistic basis of neonatal heart regeneration revealed by transcriptome and histone modification profiling

The adult mammalian heart has limited capacity for regeneration following injury, whereas the neonatal heart can readily regenerate within a short period after birth. To uncover the molecular mechanisms underlying neonatal heart regeneration, we compared the transcriptomes and epigenomes of regenerative and nonregenerative mouse hearts over a 7-d time period following myocardial infarction injury. By integrating gene expression profiles with histone marks associated with active or repressed chromatin, we identified transcriptional programs underlying neonatal heart regeneration, and the blockade to regeneration in later life. Our results reveal a unique immune response in regenerative hearts and a retained embryonic cardiogenic gene program that is active during neonatal heart regeneration. Among the unique immune factors and embryonic genes associated with cardiac regeneration, we identified Ccl24, which encodes a cytokine, and Igf2bp3, which encodes an RNA-binding protein, as previously unrecognized regulators of cardiomyocyte proliferation. Our data provide insights into the molecular basis of neonatal heart regeneration and identify genes that can be modulated to promote heart regeneration.
Do Indigenous American Peoples’ Stories Inform the Study of Dog Domestication?

I discuss the article “Relationships Between Indigenous American Peoples and Wolves 1: Wolves as Teachers and Guides” (Fogg et al. 2015) and the book “The First Domestication: How Wolves and Humans Coevolved” (Pierotti and Fogg 2017). The article proposed that published stories about interactions between indigenous American peoples and wolves (Canis lupus) provide insight into wolf-human relationships as humans began domesticating wolves. In the book, the authors offer a theory of how wolves and humans coevolved by building on the information in the article and the authors’ long experience with captive and pet wolves, wolf-dog hybrids, and dogs. I (1) present arguments and evidence that question the value of indigenous American stories for drawing conclusions about the relationship between early humans and wolves 14,000 yrs BP; (2) demonstrate how indigenous American stories contradict documented information about wolf biology, behavior, and known interactions with humans; and (3) point out important information not considered by the authors about wolf attacks on humans and the importance of rabies in the wolf-human relationship.
High-Volume Arthroplasty Centers Demonstrate Higher Composite Quality Scores and Enhanced Value: Perspective on Higher-Volume Hospitals Performing Arthroplasty from 2001 to 2011.

BACKGROUND In recent years, there has been a move toward value-based health care. Value is generally defined as outcome divided by cost; however, it is not clear exactly how to define and measure outcomes. In this study, we utilized the Nationwide Inpatient Sample (NIS) to determine how hospital volume and other factors affect quality for patients undergoing total hip and knee arthroplasty. METHODS Using the NIS of the Healthcare Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ), we conducted a retrospective study of all total hip and total knee arthroplasties performed from 2001 to 2011. We identified all procedure and outcome variables using the International Classification of Diseases, Ninth Revision (ICD-9) billing codes. Patients were grouped into quartiles based on the corresponding hospital's procedure volume. The quality measurement for each hospitalization was binary, with perfect inpatient care reflecting a favorable result for all of the following outcomes of interest: death, sepsis, postoperative infection, thromboembolic events, venous thrombosis, hematoma, blood transfusion, and length of stay below average. The Perfect Inpatient Care Index (PICI) was then calculated for each hospital. The PICI was defined as the number of hospitalizations with no unfavorable outcomes divided by total volume of arthroplasty. Value was measured as the PICI divided by the mean total charges. Multivariable nested regression was used to determine variables that predict perfect inpatient care. RESULTS From 2001 to 2011, the NIS database reported 1,651,354 total hip or total knee arthroplasties. Hospital arthroplasty volume ranged from 0 to 11,758 procedures. Overall, hospital PICI scores increased as arthroplasty volume increased. In multivariable nested regression analysis, procedure volume (odds ratio [OR] for the highest quartile compared with the lowest quartile, 2.116 [95% confidence interval (CI), 1.883 to 2.378]) and lower patient acuity (OR, 2.450 [95% CI, 2.429 to 2.472]) were independently associated with better PICI scores. Value increased as hospital procedure volume increased. CONCLUSIONS Hospital procedure volume varied widely. Although small differences were seen in individual outcome measures, composite scores (PICI) and value were substantially better at hospitals that had higher procedure volume and in lower-acuity patients. LEVEL OF EVIDENCE Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Trends in National Use of Anterior Cervical Discectomy and Fusion from 2006 to 2016.

Objective Anterior cervical discectomy and fusion (ACDF) is the most common procedure for the treatment of degenerative cervical conditions. The objective of this study is to determine time-dependent trends in patient outcomes following ACDF for degenerative disease from 2006 to 2016. Methods We used the National Surgical Quality Improvement Program (NSQIP) database to retrospectively review all patients who underwent elective ACDF between 2006 and 2016. A descriptive statistical analysis followed by time trend analysis was performed on demographics, comorbidities, perioperative, and outcome variables. Primary outcomes were reoperation and readmission rates. Secondary outcomes were medical and surgical complications reported within 30 days of operation. Results A total of 36,854 patients underwent elective ACDF from the 2006 to 2016 NSQIP database. Mean age increased from 48.19 years [standard error: 1.49] in 2006 to 54.08 years [standard error: 0.12] in 2016 (P Conclusions Since the establishment of the NSQIP database, there have been no considerable improvements in reoperation or postoperative complication rates based on available data, however, there have been increased rates of readmission. Changes in data collection and an aging patient population with greater burden of comorbidities could confound these trends.
Remembering John Tate

In this article, I reminisce about my fond interactions with John Torrence Tate (13 March, 1925-16 October, 2019), my teacher, mentor and PhD advisor. It is hard to trace the influence of Tate’s work on other works accurately, as the basic objects, ideas and theorems that he introduced have permeated (and have been generalized by others into widely used theories) throughout mathematics. I briefly describe his many fundamental contributions to number theory and arithmetic geometry, and end with some personal anecdotes.
Update on in-vivo preclinical research models in adrenocortical carcinoma.

Purpose of review The aim of this review is to summarize recent advances on development of in vivo preclinical models of adrenocortical carcinoma (ACC). Recent findings Significant progress has been achieved in the underlying molecular mechanisms of adrenocortical tumorigenesis over the last decade, and recent comprehensive profiling analysis of ACC tumors identified several genetic and molecular drivers of this disease. Therapeutic breakthroughs, however, have been limited because of the lack of preclinical models recapitulating the molecular features and heterogeneity of the tumors. Recent publications on genetically engineered mouse models and development of patient-derived ACC xenografts in both nude mice and humanized mice now provide researchers with novel tools to explore therapeutic targets in the context of heterogeneity and tumor microenvironment in human ACC. Summary We review current in-vivo models of ACC and discuss potential therapeutic opportunities that have emerged from these studies.
Inconsistency’s Many Forms in Investor-State Dispute Settlement and Implications for Reform

UNCITRAL has a vital role to play in exploring problems with and potential reform of ISDS, and in considering how to ensure its work better promotes, and does not undermine, rule of law, other domestic and international commitments and policies, and the globally agreed Agenda 2030. As the process moves forward, it is essential for the work to take a broad approach to defining the problem of “inconsistency” and designing reform solutions, as explored in this briefing note. Reform proposals regarding limiting shareholder claims, increasing states’ interpretive power, and avoiding inappropriate adjudicator incentives are undoubtedly positive signs that reflect earnest desire for change. But it is unclear that anything short of a reversion to state-to-state dispute settlement will minimize the risk of inconsistency across law and policy spheres.
Validation of the Hospital Asthma Severity Score (HASS) in children ages 2-18 years old.

INTRODUCTION The Hospital Asthma Severity Score (HASS) was developed to communicate inpatient asthma severity between providers. The purpose of this prospective study was to validate the HASS against the Pediatric Respiratory Assessment Measure (PRAM) and spirometry for assessment of inpatient asthma exacerbation severity in patients 2-18 years old, at a single point-in-time. METHODS This study was registered with clinicaltrials.gov (NCT02782065). Children admitted to a tertiary care, free-standing children's hospital were assessed for asthma severity using the HASS, PRAM, and pulmonary function by spirometry. Inter-rater agreement of HASS and PRAM scores was assessed between two blinded clinician raters. Spirometry results were obtained by a certified pulmonary laboratory technician and correlated with HASS and PRAM scores. RESULTS The sample included 58 subjects. Allowing for a one-point difference in continuous HASS and PRAM scores, inter-rater agreement was 79% for the HASS and 60% for the PRAM. When the scores were categorized as mild, moderate, and severe, inter-rater agreement was 62% for the HASS and 93% for the PRAM (p < .0001). Additionally, intra-rater agreement between HASS and PRAM severity categories was 71% for Rater 1 and 64% for Rater 2. A weak correlation was noted between both the HASS and FEV1 (r = -0.31; p = 0.11), and PRAM and FEV1 (r = -0.30; p = 0.11) for the 29 subjects with acceptable spirometry results. CONCLUSIONS The HASS and PRAM have acceptable inter-rater and intra-rater agreement. These results support validation of the HASS for managing hospitalized patients during asthma exacerbations.
Improving Staff Morale in the Respiratory Care Department

Background: In the past year low staff morale has had a profound effect on our department. Low morale is causing low productivity, increased turnover, un-engaging peer to peer encounters and an overall decline in leadership approval. Low morale makes our employees not want to be their best! Cincinnati Children’s Hospital Medical Center is ranked #2 by US News World Report. In our ideal staffing model our respiratory therapist should be boasting with pride in regards to their employment at Children’s. However, recently at Children’s we were having a difficult time retaining and recruiting new employees. Everyone knew that morale was low and needed to change in order for our culture to change. Leadership and shared governance believes that employees with high morale levels are more productive, engaging, works as a team and have a sense of self-worth. We want our employees to invest in themselves and be the best they can be! Methods: Based off our survey results we are focusing on recognition from peers, patients and families. Team building and serving others was also a request from our RTs. We believe that if we increase morale we will increase staff retention. In order to get a baseline of staff morale a survey was sent to staff prior to research being done. Results: Since the results of the survey were unsatisfactory, stating the obvious that staff morale is lower than anticipated. We decided that we will use this as an opportunity for a QI project for our division. Multiple things will be implemented throughout the year by the shared governance team and the leadership team will increase recognition of employees. We will re-survey and trend the data to see if it worked. We will then need to determine which programs facilitated the increase in employee satisfaction. The following programs will be implemented: Grab and Go Cards, Code Lavender Bags, Serving Others, Sunflower Award, RT Outings, Liberty Branch of the Sunshine Club, Monthly Raffles, Leadership sponsored one a month drawing for RTs that pick up extra shifts, we appreciate the way you ventilate bags and setting up a core planning committee for Respiratory Care Week. Conclusions: The results of the study showed us the single most important factor was staff wanted recognition. Our next resurvey will be in July 2019.
Anesthetic Management of the Substance Abuse Patient

Summary When taking a preanesthetic history, one must assume a nonjudgmental, compassionate, and confidential yet assertive position. Addiction, abuse, and dependency are based on the consequence of drug use as opposed to the quantity and frequency of use. The most commonly abused drugs that influence anesthesia administration are alcohol, cocaine, and heroin. Chemical dependency on alcohol, prescription drugs, and illegal drugs is common but frequently overlooked in medical and surgical patients. Detection in the elderly population is difficult because presenting signs and symptoms of substance abuse are often associated with aging itself. It is common to attribute too many problems to alcoholism (known alcoholics) and too few problems to alcoholism in the undiagnosed or “less typical” patient. The provision of reasonable relief from acute, self-limiting pain is a justifiable expectation for all patients regardless of their chemical dependency status. Patients who have misused mood-altering drugs in the past may have higher medication tolerance and may require higher doses of medication. Anesthesia in all of its variations may be used safely provided perioperative planning has been complete.
Lithotrophic (“Stone-Eating”) Microbes Provide the Foundation for Deep Subsurface Ecosystems

Those of us who are microbiologists have no trouble thinking of microbes as the most important and indeed the most fascinating of all organisms. They’re the center of our world. They’re more numerous (~1030 individuals) than any other organisms on Earth ([Whitman WB, Coleman DC, Wiebe WJ, Proc Natl Acad Sci USA 95:6578-6583, 1998]; [Kallmeyer J, Pockalny R, Adhikari RR, Smith DC, D’ Hondt, Proc Natl Acad Sci USA 109:16213-16216, 2012]), and they’re vastly more diverse than the (some say) more charismatic macroorganisms (Locey KJ, Lennon JT, Proc Natl Acad Sci USA 113:5970-5975, 2016). Anthropocentric types may be surprised to learn that a human adult holobiome (a holistic view of a person as a consortium) is comprised of a trillion or more human cells and that an even greater number of microbes are living in and on each of us, providing myriad biochemical and protective advantages. They outnumber us on almost any scale and in every environment, whether we’re looking at a gram of soil, a ml of seawater, our own bodies, or the entire biosphere. However, among all the possible environments for considering the supremacy of microbes, my own favorite and my choice for demonstrating that microbes are indeed the “foundation stone” is the deep terrestrial subsurface, i.e., very deep groundwater, the deepest, least investigated, and largest biome on Earth.
Acting on Information: Representing Actions That Manipulate Information

Information manipulation is the creation of new information based on existing information sources. This paper discusses problems that arise when planning for information manipulation, and proposes a novel action representation, called ADLIM, that addresses these problems, including: How to represent information in a way sufficient to express the effects of actions that modify the information. I present a simple, yet expressive, representation of information goals and effects that generalizes earlier work on representing sensing actions; How to concisely represent actions that copy information, or produce new information that is based on existing information sources. I show how this is a generalization of the frame problem, and present a solution based on generalized frame effects; and How to generate a pipeline of information-processing commands that will produce an output containing exactly the desired information. I present a new approach to goal regression.
On Restricted Bases for Finite Fields

Publisher Summary This chapter describes restricted bases for finite fields. Some theorems and problems with its solution are discussed in the chapter.
Interface-Driven Plasticity in Metal–Ceramic Nanolayered Composites: Direct Validation of Multiscale Deformation Modeling via In Situ Indentation in TEM

We present in situ indentation in a transmission electron microscope on Al-TiN multilayers with individual layer thicknesses of 50 nm and 2.7 nm to explore the effect of length scales on the plastic co-deformability of a metal and a ceramic. At 50 nm, plasticity was confined to the Al layers with brittle fracture in the TiN layers. At 5 nm and below, cracking in TiN was suppressed with co-deformation evident in both layers. The in situ transmission electron microscopy (TEM) straining results demonstrate a profound size effect in enhancing plastic co-deformability in nanoscale metal-ceramic multilayers, as well as direct validation of ex situ and 3-D elastic–plastic deformation models.
Playing by the Rules in Both Home and Away Games - U.S. Interests in the Arctic and the South China Sea

No single nation of the world has a sovereignty claim in both the South China Sea and the Arctic, and not every nation of the world has asserted an interest in both regions. Some nations, including the United States of America and the People’s Republic of China, have indicated or suggested they have interests in both regions or interests indirectly affected by disputes in both regions. Therefore, a preliminary question of fact worth considering is: what are the specific interests of those nations? A deeper, analytical question to also consider is: are those national interests consistent, and truly universal in nature? If an observer were to view the two regional situations of the Arctic and the South China Sea through a sports lens, they would see the United States playing a 'home game' in one of its geographic regions of the world (i.e., the Arctic), while playing an 'away game' in another geographic region of the world (i.e., the South China Sea). Meanwhile, a nation like China would be playing a home game in its region and an away game outside of its region, but in the opposite locations. Logically, the national interests for home-region and away-region situations cannot be exactly the same. What, then, should be the relationship between national interests asserted by a nation in two different geographic locations? This paper will also consider that question. The discussion in this paper will be divided into two parts. First, it will identify the interests that the United States holds in the South China Sea and the Arctic. Second, it will provide some personal insights and opinions of the author about two of those interests. This second part will also highlight and examine actions and inactions by other nations in the two regions that, in the author’s opinion, might be putting those U.S. interests at risk.
Going global, locally: the socio-technical influences on performance in distributed collaborative learning teams

With the increasing use of distributed knowledge work in a range of industrial, scientific, and organizational environments, understanding how to support such work has become increasingly important. From previous field and laboratory studies, we know that a range of socio-technical factors influence performance and satisfaction in distributed teams. Among the most important of these factors are trust, leadership and the level of media richness in the computer-mediated communications environment. We also know that specific socio-technical interventions can help to build trust in CMC environments. However, many of these studies have not taken into consideration sufficiently the impact of cross-national cultural factors on distributed teams. This paper reports the preliminary analysis of a thirteen week qualitative and quantitative quasi-experimental field study of distributed collaborative learning teams, consisting of 35 post-graduate students from four research universities, two in the United States and two in South Africa. These teams completed a series of unstructured strategy and decision-making tasks, using a suite of rich-media CMC tools. Data are reported from participant surveys, narrative evaluation essays, and observations.