cssi/SciSciGPT-SciSciNet huggingface dataset:
Association of Primary Care Practice Location and Ownership With the Provision of Low-Value Care in the United States

Importance Hospital-employed physicians provide primary care within the hospital or within community-based office practices. Yet, little is understood regarding the influence of hospital location and ownership on the delivery of low-value care. Objective To assess the association of hospital location and hospital ownership with the provision of low-value health services. Design, Setting, and Participants This study compared low-value service use after primary care visits at hospital-based outpatient practices from January 1, 1997, to December 31, 2011, vs community-based office practices and at hospital-owned vs physician-owned community-based office practices from January 1, 1997, to December 31, 2013. Logistic regression models adjusted for patient and health care professional characteristics and year, and weighted results were used to reflect population estimates. Results were also stratified by symptom acuity and whether a generalist physician (eg, general internist or family practitioner) was the patient’s primary care provider. This study used nationally representative data from the National Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2013) and the National Hospital Ambulatory Medical Care Survey (January 1, 1997, to December 31, 2011) on outpatient visits to generalist physicians. Participants were patients seen with 3 common primary care conditions, namely, upper respiratory tract infection, back pain, and headache. Main Outcomes and Measures The use of antibiotics (for upper respiratory tract infection), computed tomography or magnetic resonance imaging (for back pain and headache), radiographs (for upper respiratory tract infection and back pain), and specialty referrals (for all 3 conditions). Results This study identified 31 162 visits for upper respiratory tract infection, back pain, and headache, representing an estimated 739 million US primary care visits from 1997 to 2013. Compared with visits with community-based physicians, patients in visits to hospital-based physicians were younger (mean age, 44.5 vs 49.1 years; P P P = .01), radiographs (12.8% vs 9.9%, P P Conclusions and Relevance Visits to US hospital-based practices are associated with greater use of low-value computed tomography and magnetic resonance imaging, radiographs, and specialty referrals than visits to community-based practices, and visits to hospital-owned community-based practices had more specialty referrals than visits to physician-owned community-based practices. These findings raise concerns about the provision of low-value care at hospital-associated primary care practices.
Fluxional Behavior of cis-Fe(DMeOPrPE)2(H)2 (DMeOPrPE = 1,2-[bis(dimethoxypropyl)phosphino]ethane); Implications for the Pressure Swing Purification of Natural Gas

Materials such as trans-Fe(DMeOPrPE)2(X)(H2O)+ (DMeOPrPE = 1,2-[bis(dimethoxypropyl)phosphino]ethane; X = Cl or H) show considerable promise as sorbents for the removal of N2 from natural gas in a pressure swing process. One problem, however, is that in long-term tests these sorbents slowly degrade over a period of many weeks. This study probed the degradation mechanism for the purpose of finding ways to stabilize the sorbents. To investigate the likelihood of degradation initiated by Fe–P bond dissociation, the fluxional behavior of the related cis-Fe(DMeOPrPE)2(H)2 complex was investigated by variable temperature 1P{1H} NMR spectroscopy. Analysis of the spectra gave the following activation parameters for the fluxional process: ΔH‡ = 11.6 kcal/mol and ΔS‡ = −9.2 cal/mol K. These results suggest that Fe–P bond dissociation (20–45 kcal/mol) is not occurring in the fluxional process and by implication that Fe–P bond dissociation is not initiating the decomposition of the trans-Fe(DMeOPrPE)2(X)(H2O)+ sorbents. Consequently, macrocycle ligands may not be the best approach for stabilizing the sorbents, as we have previously proposed. A “tetrahedral jump” mechanism is proposed for the fluxional process in cis-Fe(DMeOPrPE)2(H)2.
The propensity for epithelial-mesenchymal transitions is dictated by chromatin states in the cancer cell of origin.

At its core, epithelial-mesenchymal transition (EMT) programs are well-established physiological processes that transpire during embryogenesis to facilitate the development of the mesoderm and neural crest, and during adulthood to oversee the repair of wounded tissues (1-3). Epithelial cells undergoing EMT programs downregulate epithelial markers (e.g., E-cadherin) and upregulate mesenchymal markers (e.g., vimentin), leading to stark changes in cell morphology and behavior. For instance, epithelial cells are typically arranged as a single layer of polarized cells that exhibit strong cell-cell contacts, a phenotype that gives way during EMT programs to the generation of apolar mesenchymal-like cells that exhibit elongated spindle morphologies (1-3). Importantly, the phenomenon of EMT can be hijacked by pathological processes, including fibrosis, inflammatory conditions, and the progression and metastasis of solid tumors (1).
Low Side Gan Fet Driver for Space Applications

This paper reports the results of preliminary single event effects (SEE) testing of the Intersil ISL70040SEH, a single low side driver specifically designed to drive enhancement mode power GaN FETs.
Growth and Survival of Listeria monocytogenes in Market Cheeses Stored at 4 to 30°C.

Forty-nine market cheeses representing 24 types and 28 brands were purchased from local supermarkets. Pieces of cheeses of approximately 1.5 × 0.5 cm were surface inoculated with log10 3.95 to 4.36 cells of a Listeria monocytogenes pool made up of five strains (Scott A, V7, RM-1, VPH1, VPH2) and placed in petri dishes. After wrapping with cellophane, the dishes were stored at 4, 8, and 30°C for up to 36 d. Of the cheeses, 36.7% supported growth equivalent to a mean inoculum increase of 1.4 log10 (range 0.21 to 3.58) in at least one storage temperature. They included soft Hispanic type (Queso Fresco, Panela Ranchero, pH 6.2-6.6), Ricotta (pH 5.9-6.1), Teleme (pH 5.9), Brie (pH 7.2-7.7), Camembert (pH 7.3), and cottage (pH 4.9-5.1) cheeses. Ricotta was the best and cottage the worst substrate for growth. Cheeses not supporting Listeria growth but causing gradual death at all temperatures include: Cotija (Hispanic hard cheese), cream, blue, Tillamook, Cracker Barrel, Monterey Jack, Swiss, Cheddar, Colby, string, Provolone, Muenster, Feta, and Kasseri with values of pH 4.3-5.6, process (American, Monterey Jack, Piedmont, pH 5.7-6.4), and Limburger (pH 7.2) cheeses. A highly significant (P 5.5 and absence of starter cultures during the cheese manufacturing was observed. Overall, the study demonstrated that cross-contamination of certain cheeses with L. monocytogenes originating from raw foods (meat, poultry, fish, vegetables), after opening of packages, may lead to significant growth of the pathogen during refrigerated storage.
Phonological Development of Monolingual Haitian Creole–Speaking Preschool Children:

This study provides preliminary data on the phonological development of Haitian Creole–Speaking children. The purpose of this study is to determine phonological acquisition in the speech of normall...
IKZF1 Enhances Immune Infiltrate Recruitment in Solid Tumors and Susceptibility to Immunotherapy

Immunotherapies are some of the most promising emergent treatments for several cancers, yet there remains a majority of patients who do not benefit from them due to immune-resistant tumors. One avenue for enhancing treatment for these patients is by converting these tumors to an immunoreactive state, thereby restoring treatment efficacy. By leveraging regulatory networks we previously characterized in autoimmunity, here we show that overexpression of the master regulator IKZF1 leads to enhanced immune infiltrate recruitment and tumor sensitivity to PD1 and CTLA4 inhibitors in several tumors that normally lack IKZF1 expression. This work provides proof of concept that tumors can be rendered susceptible by hijacking immune cell recruitment signals through molecular master regulators. On a broader scale, this work also demonstrates the feasibility of using computational approaches to drive the discovery of novel molecular mechanisms toward treatment.
Construction, gene delivery, and expression of DNA tethered nanoparticles

Purpose: Layered nanoparticles have the potential to deliver any number of substances to cells both in vitro and in vivo. The purpose of this study was to develop and test a relatively simple alternative to custom synthesized nanoparticles for use in multiple biological systems, with special focus on the eye. Methods: The biotin-labeled transcriptionally active PCR products (TAP) were conjugated to gold, semiconductor nanocrystals, and magnetic nanoparticles (MNP) coated with streptavidin. The process of nanoparticle construction was monitored with gel electrophoresis. Fluorescence microscopy followed by image analysis was used to examine gene expression levels from DNA alone and tethered MNP in human hepatoma derived Huh-7 cells. Adult retinal endothelial cells from both dog (ADREC) and human (HREC) sources were transfected with nanoparticles and reporter gene expression evaluated with confocal and fluorescent microscopy. Transmission electron microscopy was used to quantify the concentration of nanoparticles in a stock solution. Nanoparticles were evaluated for transfection efficiency, determined by fluorescence microscopy cell counts. Cells treated with MNP were evaluated for increased reactive oxygen species (ROS) and necrosis with flow cytometry. Results: Both 5' and 3' biotin-labeled TAP bound equally to MNP and there were no differences in functionality between the two tethering orientations. Free DNA was easily removed by the use of magnetic columns. These particles were also able to deliver genes to a human hepatoma cell line, Huh-7, but transfection efficiency was greater than TAP. The semiconductor nanocrystals and MNP had the highest transfection efficiencies. The MNP did not induce ROS formation or necrosis after 48 h of incubation. Conclusions: Once transfected, the MNP had reporter gene expression levels equivalent to TAP. The nanoparticles, however, had better transfection efficiencies than TAP. The magnetic nanoparticles were the most easily purified of all the nanoparticles tested. This strategy for bioconjugating TAP to nanoparticles is valuable because nanoparticle composition can be changed and the system optimized quickly. Since endothelial cells take up MNP, this strategy could be used to target neovascularization as occurs in proliferative retinopathies. Multiple cell types were used to test this technology and in each the nanoparticles were capable of transfection. In adult endothelial cells the MNP appeared innocuous, even at the highest doses tested with respect to ROS and necrosis. This technology has the potential to be used as more than just a vector for gene transfer, because each layer has the potential to perform its own unique function and then degrade to expose the next functional layer.
An Equation of Volterra

Consider the system $${\rm{A\:x}}\left( {\rm{t}} \right) + {\rm{Bx}}\left( {\rm{t}} \right) = \int_0^{\rm{r}} {{\rm{F}}\left( \theta \right){\rm{x}}\left( {{\rm{t}} - \theta } \right)} {\rm{d}}\theta $$ (15.1) where A,B,F are symmetric n × n matrices and F is continuously differentiable. Let $${\rm{M}} = {\rm{B}} - \int_0^{\rm{r}} {{\rm{F}}\left( \theta \right){\rm{d}}\theta }$$ and write (15.1) as $$\begin{array}{*{20}c} {{\rm{\dot x}}\left( {\rm{t}} \right)} & = & {{\rm{y}}\left( {\rm{t}} \right),} \\ {{\rm{A\dot y}}\left( {\rm{t}} \right)} & = & { - {\rm{Mx}}\left( {\rm{t}} \right) + \int_0^{\rm{r}} {{\rm{F}}\left( \theta \right)\left[ {{\rm{x}}\left( {{\rm{t - }}\theta } \right) - {\rm{x}}\left( {\rm{t}} \right)} \right]{\rm{d}}\theta} } \\ \end{array}$$ (15.2) .
Population Structure of Leishmania using POPSICLE reveals extensive dichotomy in zygosity and discloses the role of sex in diversity of the parasite

Mosaic aneuploidy prevalent in organisms such as Leishmania and Fungi and in genomes of some neurological disorders and cancers manifest as non-integer haplotypes due to heterogeneity in somy across a population of cells. Thus, the tools designed for strictly haploid or diploid genomes are insufficient to study them. We addressed this issue by upgrading our population genetics tool POPSICLE for aneuploid genomes and studied the population structure of 50 strains of Leishmania to understand genetic diversity and the sexual strategies that predispose to that diversity. Leishmania showed enormous diversity but a dichotomic nature of extreme zygosities. To understand this dichotomy, we specifically studied two species, L. tropica that contained strains with both hetero and homozygosities and L. major that were mainly homozygous. The homozygosity in L. tropica was a consequence of extreme inbreeding while heterozygosity was due to recent hybridizations involving two different genotypes. In contrast, L. major also contained two different genotypes and products of extreme inbreeding but no recent hybridizations. The heterozygous strains of L. tropica that were geographically isolated from the homozygous strains were F1 hybrids that appeared sterile to each other while those in proximity to the homozygous strains were outcrosses involving multiple cycles of hybridization indicating their mating preference with homozygous strains. Development of POPSICLE for aneuploid genomes offers a unique tool for determining the shared ancestries and in reinforcing sex as one of the driving mechanisms for speciation as demonstrated for Leishmania. POPSICLE is a Java based utility available for free download at https://popsicle-admixture.sourceforge.io/
A higher-order slender-body theory for axisymmetric flow past a particle at moderate Reynolds number

Slender-body theory is utilized to derive an asymptotic approximation to the hydrodynamic drag on an axisymmetric particle that is held fixed in an otherwise uniform stream of an incompressible Newtonian fluid at moderate Reynolds number. The Reynolds number, , is based on the length of the particle. The axis of rotational symmetry of the particle is collinear with the uniform stream. The drag is expressed as a series in powers of , where is the small ratio of the characteristic width to length of the particle; the series is asymptotic for . The drag is calculated through terms of , thereby extending the work of Khayat & Cox (J. Fluid Mech., vol. 209, 1989, pp. 435–462) who determined the drag through . The calculation of the term is accomplished via the generalized reciprocal theorem (Lovalenti & Brady, J. Fluid Mech., vol. 256, 1993, pp. 561–605). The first dependence of the inertial contribution to the drag on the cross-sectional profile of the particle is at . Notably, the drag is insensitive to the direction of travel at this order. The asymptotic results are compared to a numerical solution of the Navier–Stokes equations for the case of a prolate spheroid. Good agreement between the two is observed at moderately small values of , which is surprising given the logarithmic error associated with the asymptotic expansion.
Toward Epistemological Ethics: Centering Communities and Social Justice in Qualitative Research

Als qualitative Sozialforscher/innen in den Vereinigten Staaten theoretisieren und verorten wir die ethischen Fragen unserer Arbeit in einem Kontinuum von Methodologien, Epistemologien und Forschungsbeziehungen. Dem Ansatz einer kollektiven und transgressiven Reflexivitat folgend, schreiben wir als Mitglieder der Ethik-Task-Force der Society of Qualitative Research on Psychology (SQIP) den Ethikkodex der American Psychological Association (APA) um. Wir imaginieren den Kodex neu, sodass er qualitative Forschung mit einschliest und eine Hilfestellung fur die evidenzbasierten Dilemmata geben kann, die in unserer Forschung auftauchen. In diesem Artikel benennen wir Leerstellen innerhalb des Kodex, die unvereinbar sind mit einer kritischen qualitativen Sozialforschung, die nach sozialer Gerechtigkeit strebt. Wir rutteln quasi von unten an den erkenntnistheoretischen Grundlagen des Kodex. Dabei entwerfen wir unsere Vision/en fur einen neuen Ethikkodex, der die intersubjektive und reflexive Natur der Wissensproduktion in den Vordergrund stellt, die Wurde der Beteiligten wahrt, Machtbeziehungen innerhalb und auserhalb des Forschungsvorhabens beachtet, relationale und epistemische Distanz kritisiert und den inneren Zusammenhang zwischen Epistemologie, Validitat und Ethik expliziert. In unserem Text weisen wir auf einen Bruch zwischen den normativen Formen von Erkenntnis und Sein in der Universitat und der qualitativen Forschung hin.
An Interesting Case of Atherosclerotic Occlusion of the First Septal Perforator in a Physically Young and Fit Individual Causing Complete Heart Block

Complete heart block (CHB) is an unfortunate complication of an anterior and inferior myocardial infarction (MI). We present a case of an atherosclerotic occlusion of the first septal perforator leading to CHB requiring permanent pacemaker placement in a young patient. A 33-year-old healthy white male presented to the emergency department with an episode of syncope. His vitals were stable, and his physical exam was unremarkable. His electrocardiogram (EKG) showed CHB and ST elevations in V1, V2, and V3 suggestive of septal MI. He underwent emergent left heart catheterization which revealed significant stenosis of the proximal left anterior descending (LAD) artery, proximal diagonal artery, and the first septal perforator. An intervention was done with stent placement in the LAD and insertion of a temporary pacemaker. After removal of the temporary pacemaker two days later, the patient developed asystole with alternating bundle branch block which prompted immediate reinsertion of the temporary pacemaker which was replaced later with a permanent pacemaker. The patient was stable afterward and discharged. The persistent atherosclerotic occlusion of the first septal perforator prevented adequate perfusion of the conduction system, even after revascularization of the proximal LAD. In conclusion, it is essential to acknowledge that difficulty to revascularize an occluded septal perforator raises the need for a permanent pacemaker to prevent a CHB.
Report of the Committee on Glaciers, 1934-35

The members of the Committee on Glaciers for 1935 are as given in the report of the Committee for 1933–34 in the Transactions of the Fifteenth Annual Meeting with the addition of Kenneth N. Phillips (The Mazamas, Pacific Building, Portland, Oregon). The year 1934 witnessed a further expansion of the program of systematic annual observations on the variations of American glaciers which was inaugurated by the Committee in 1931. Several of the collaborators in the field-work of their own initiative enlarged the scope of their activities, and a new group joined the movement in the Pacific Northwest, These are the Mountaineers, of Seattle, Washington, who began observations on the glaciers of Mount Baker, which are the largest in the continental United States next to those on Mount Rainier. Under the leadership of H. V. Strandberg a base-line was laid out by the Mountaineers for measurement of the recession of the Easton Glacier, on the south side of the peak.
MRP2, Multiple Drug Resistance Protein 2

MRP2 also known as canalicular Multispecific Organic Anion Transporter (cMOAT) is an ABC protein that belongs to the ABCC subfamily of …
Komplexe Dynamik in Natur, Wirtschaft und Internet: Qualitätssicherung am Rande des Chaos

Im Zeitalter der Globalisierung werden die Lebensbedingungen der Menschen immer komplexer und unubersichtlicher. Taglich erleben wir die labilen Gleichgewichte in Politik, Wirtschaft und Gesellschaft. Einige furchten den Verlust gewohnter Besitzstande und den Absturz ins Chaos. Andere sehen die Chance kreativer Innovationen und den Aufbruch zu neuen Markten. Internet und World Wide Web eroffnen komplexe Netzwelten, die mit virtuellen Markten locken, aber auch zum Absturz im Informationschaos fuhren konnen. In der Evolution, so zeigen uns jedenfalls die Naturwissenschaften, entsteht Leben nur am Rande des Chaos, fern der Erstarrung im thermischen Gleichgewicht. Gesundheit, so zeigt uns die Medizin, bedeutet keine starre Regularitat und Chaos nicht notwendig Krankheit und Tod. Was konnen wir vom Komplexitatmanagement der Natur lernen? Wie ist Qualitatssicherung fern von wettbewerbsfeindlicher Regulation, aber am Rande chaotischen Wildwuchs moglich?
Exploring Use and Influence in Culturally Responsive Approaches to Evaluation: A Review of the Empirical Literature:

Culturally responsive approaches to evaluation are emerging across diverse program and community contexts to address increasingly intractable social, economic, political, and environmental concerns...
Preoperative Risk Factors Associated With PACU Pediatric Respiratory Complications: An Integrative Review.

Abstract Purpose This article reviews state of the science of preoperative risk factors associated with postanesthesia care unit (PACU) pediatric respiratory complications. Design An integrative review. Methods A search of PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), MEDLINE, Scopus, Cochrane, and Joanna Briggs Institute databases was performed. Thirty-one articles, published between 2006 and 2018, were appraised for quality and the level of evidence using the Johns Hopkins Nursing Evidence-Based Practice Model. Findings These articles were grouped into the following categories: age, American Society of Anesthesiologists status, gender, airway comorbidities, syndromes, anomalies, pulmonary comorbidities, ethnicity, obesity, neurologic comorbidities, and cardiac comorbidities. Conclusions Evidence identified significant preoperative and anesthesia risk factors that are associated with PACU pediatric respiratory complications. This article reveals the importance for the perioperative team to identify, assess for, communicate, and develop a management plan for pediatric respiratory complications.
Influence of distillers grains with solubles on bull growth and reproductive traits.

This study evaluated the effects of offering growing bulls a diet with 40% modified wet distillers grains plus solubles (MWDGS; dry matter [DM] basis) on growth, composition, hoof scores, and reproductive performance. Simmental × Angus bulls (n = 28) were stratified by body weight (BW; 316 ± 29 kg), sire, and day 0 semen production (Y/N) and assigned into one of six pens. Pens were randomly assigned to one of two dietary treatments (n = 3 pens/treatment): 1) offered free-choice access to a corn-based diet with no MWDGS (CON) or 2) offered free-choice access to a diet with 40% MWDGS (DST; DM basis). Bulls were offered treatments for 140 d and, then, switched to a free-choice, common, low-energy diet for an additional 70 d. Bull BW, body condition score (BCS), hip height (HH), ultrasound (rump fat depth [RF], 12th rib fat thickness [BF], marbling score [MS], and longissimus muscle depth [MD]), hoof evaluations, breeding soundness examination (BSE), and semen evaluations were performed on days 0, 28, 56, 84, 112, 140, 175, and 210. There was a tendency (P < 0.09) for a treatment × time effect for BW. Bulls fed DST tended (P ≤ 0.10) to be heavier on days 28 and 56 than CON bulls. A treatment × time effect was detected (P < 0.01) for RF. Bulls fed DST had greater (P = 0.02) RF on day 84 than CON bulls. Treatment × time and treatment effects were detected (P ≤ 0.05) for BF, in which DST bulls had greater (P ≤ 0.05) BF on days 84, 112, and 175 and tended (P ≤ 0.10) to be greater on days 56 and 210 than CON bulls. A treatment × time effect was detected (P < 0.02) for percentage of major sperm defects. Bulls fed DST had a greater (P < 0.01) percentage of major sperm defects on day 140 than control bulls. There was a tendency (P = 0.09) for a treatment × time effect for percentage of sperm with proximal droplets. Bulls fed DST had a greater (P = 0.01) percentage of sperm with proximal droplets on day 140 than CON bulls. In conclusion, offering growing bulls a diet with 40% MWDGS (DM basis) resulted in heavier BW at days 28 and 56, increased RF at day 84, and increased BF and increases in both major sperm defects and sperm with proximal droplets at day 140. However, after 70 d on the common low-energy diet, there were no carryover effects for any growth, composition, hoof, or reproductive measures except for a tendency for BF.
Interdisciplinary approach in research on the role of local government units in environmental protection

: Environmental protection was placed by the legislator as one of the public tasks performed by local government. Due to the fact that the local government performs decentralized tasks, which are mainly intended to meet the needs of local communities in a given territory, tasks related to the fi eld of environmental protection also serve the needs of residents of communes, poviats andvoivodships in terms of the use of the environment. Therefore, the type and nature of these tasks will be adapted to the role and specialization of individual local government units. Local government units perform tasks stipulated in the existing legislation. They are also obliged to use instruments related to planning and strategic documents that take account of statutory environmental protection assumptions. In order to achieve higher effectiveness in the scope of environmental protection, local government units may take actions that facilitate the use of techniques and methods for environmental management and use quality management tools.
Standardization of Specific Contact Resistivity Measurements using Transmission Line Model (TLM)

The transmission line model (TLM) method is most commonly used to determine the specific contact resistivity of metal -semiconductor contacts. Inconsistencies have been observed in the literature in reported values of specific contact resistivities in devices ranging in their dimensions, e.g between those in nm-μm scaled integrated circuit devices and mm-cm scaled photovoltaic devices indicating that the contact resistivity extraction may depend on dimensions. Therefore, TLM test geometries need to be specified. This paper discusses the effect of the TLM width on extracted transfer length. The effect of pad length is investigated using the Exact Field Solution model. Linear and circular TLM test structures were created and tested on Al, NiSi/Al on p+n and n+p substrates. Specific contact resistivitiy values agree in both wide linear and circular TLM methods. However, sheet resistance values differ.
Rare transmission of commensal and pathogenic bacteria in the gut microbiome of hospitalized adults

Abstract Bacterial bloodstream infections are a major cause of morbidity and mortality among patients undergoing hematopoietic cell transplantation (HCT). Although previous research has demonstrated that pathogenic organisms may translocate from the gut microbiome into the bloodstream to cause infections, the mechanisms by which HCT patients acquire pathogens in their microbiome have not yet been described. We hypothesized that patient-patient transmission may be responsible for pathogens colonizing the microbiome of HCT patients, and that patients who share time and space in the hospital are more likely to share bacterial strains. Here, we used linked-read and short-read metagenomic sequencing to analyze 401 stool samples collected from 149 adults undergoing HCT and hospitalized in the same unit over five years. We used metagenomic assembly and strain-specific comparison methods to investigate transmission of gut microbiota between individuals. While patients who shared time and space in the hospital did not converge in overall microbiome composition, we did observe four pairs of patients who harbor identical or nearly identical E. faecium strains in their microbiome. These strains may be the result of transmission between patients who shared a room and bathroom, acquisition from a common source in the hospital or transmission from an unsampled source. We also observed identical Akkermansia muciniphila and Hungatella hathewayi strains in two pairs of patients. In both cases, the patients were roommates for at least one day, the strain was absent in the putative recipient’s microbiome prior to the period of roommate overlap and the putative recipient had a microbiome perturbed by antibiotic treatment for a bloodstream infection. Finally, we identified multiple patients who harbored identical strains of several species commonly found in commercial probiotics and dairy products, including Lactobacillus rhamnosus, Lactobacillus gasseri and Streptococcus thermophilus. Overall, our findings indicate that pathogenic organisms from a single source are not frequently colonizing the gut microbiome of multiple patients. However, the potential transmission of commensal microbes with immunomodulatory properties raises questions about the recovery of microbiome diversity after HCT, and indicates that patients in this setting may acquire new microbes by sharing space with others.
My Two Boys

A father writes of his two sons, Alex and Mateo, both of different temperaments and talents, and once thought to be of different sexualities—one gay, the other straight—until it became clear the boys were gay. Both artistically inclined, Alex becomes an actor and playwright, Mateo a dancer and musician. They collaborate in artistic ventures. The boys grow apart as adolescents and come together as men.
Severe ovarian hyperstimulation syndrome associated with long-acting GnRH agonist in oncofertility patients.

To report three cases of severe ovarian hyperstimulation syndrome (OHSS) among oncofertility patients receiving a long-acting GnRH agonist for ovarian suppression after controlled ovarian hyperstimulation (COH) with a GnRH antagonist protocol Chart abstraction was completed for three patients at a single academic medical center. Patients included were undergoing fertility preservation prior to gonadotoxic chemotherapy. All patients underwent COH with GnRH antagonist protocol and embryo cryopreservation immediately followed by ovarian suppression with long-acting GnRH agonist. Main outcome measure was development of OHSS. Despite using GnRH agonist trigger and freezing all embryos, patients developed ascites, intermittent hyponatremia and hemoconcentration consistent with severe early-onset OHSS after receiving long-acting GnRH agonist immediately following oocyte retrieval for ovarian preservation. Risk of severe OHSS may be increased when a long-acting GnRH agonist is used for ovarian suppression immediately following oocyte retrieval. A delay in initiating long-acting GnRH agonist after oocyte retrieval in patients at high risk for developing OHSS should be considered.
Urine Cytology in the Clinical Management of Bladder Cancer

Urinary tract cytology, which involves microscopic examination of exfoliated cells within a patient’s urine, continues to play an important role in the diagnosis and surveillance of urothelial malignancies. Advances in cytopathological technique as well as the advent of robust classification systems such as the Paris System have led to improvements in the diagnostic accuracy and reliability of urinary tract cytology to identify clinically significant urothelial carcinoma. Overall, urinary tract cytology has a low sensitivity and high specificity for the detection of any urothelial carcinoma of the bladder. However, when stratified by pathologic grade, urinary tract cytology has significantly higher sensitivity and specificity for high-grade disease. As such, guidelines currently support the use of urinary tract cytology in the surveillance of intermediate and high-risk urothelial carcinoma of the bladder, but not in low-risk disease. Likewise, urinary tract cytology is not recommended in the evaluation of patients with microscopic hematuria but may be considered in patients with gross hematuria. Although cystoscopy continues to be the gold standard for diagnosis and surveillance of patients with bladder cancer, urinary tract cytology can serve as a valuable and cost-effective adjunctive test, particularly in high-risk patients.
A case for standardized communications for point of distribution operations.

Objective: Propose standardized communication formats and procedures at the point of distribution (POD) sites to facilitate the effective management and alleviate friction points that may occur while responding to a widespread medical incident within the National Incident Management System (NIMS). Design: Through observation of POD operations and interviews with key personnel in Indiana and county emergency management agencies (EMA), identify current communication practices and propose a structured command and control (C2) framework that would streamline management requirements during a widespread activation. Setting: The State of Indiana, various counties throughout Indiana. Conclusions: Current C2 practices are adequate for small-scale events. However, a standardized approach to the C2 and reporting framework may provide more responsive situational awareness and incident management of larger-scale medical incidents within Indiana.
Modeling and Testing Differential Item Functioning in Unidimensional Binary Item Response Models with a Single Continuous Covariate: A Functional Data Analysis Approach.

Differential item functioning (DIF), referring to between-group variation in item characteristics above and beyond the group-level disparity in the latent variable of interest, has long been regarded as an important item-level diagnostic. The presence of DIF impairs the fit of the single-group item response model being used, and calls for either model modification or item deletion in practice, depending on the mode of analysis. Methods for testing DIF with continuous covariates, rather than categorical grouping variables, have been developed; however, they are restrictive in parametric forms, and thus are not sufficiently flexible to describe complex interaction among latent variables and covariates. In the current study, we formulate the probability of endorsing each test item as a general bivariate function of a unidimensional latent trait and a single covariate, which is then approximated by a two-dimensional smoothing spline. The accuracy and precision of the proposed procedure is evaluated via Monte Carlo simulations. If anchor items are available, we proposed an extended model that simultaneously estimates item characteristic functions (ICFs) for anchor items, ICFs conditional on the covariate for non-anchor items, and the latent variable density conditional on the covariate—all using regression splines. A permutation DIF test is developed, and its performance is compared to the conventional parametric approach in a simulation study. We also illustrate the proposed semiparametric DIF testing procedure with an empirical example.
An iterative approach to measuring two-dimensional gradient-index profiles based on external measurements of laser beam deflection

We present a numerical method for retrieving the refractive index distribution in two-dimensional gradient-index media from external measurements of laser beam deflection. Using an iterative approach to ascertain the boundary positions and angles of probe beams that transit the optical medium and constructing approximate beam trajectories that satisfy these boundary values, we show that the inverse problem can be reduced to the inversion of a sparse linear algebraic system. The beam trajectories are subsequently corrected using an iterative ray trace procedure that continually refines the computed solution and the associated boundary values. We demonstrate our method in simulation by calculating the refractive index distribution of a hypothetical 2-D gradient-index element from computer-generated external beam deflection data, where RMS index errors below 1% of the index range (n max − n min ) are achieved.
An Outbreak of Toxoplasmosis Linked to Cats

Clinical, serologic, and epidermiologic evidence documents an outbreak of toxoplasmosis involving ten of 30 members of an extended family. The index patient had unusual clinical manifestations including brain abscesses, progressive chorioretinitis, seizures, neurologic deficits, hepatosplenomegaly, pneumonitis, and eosinophilia. Toxoplasmosis was confirmed by demonstrating the organism in brain tissue and cerebrospinal fluids; clinical and serologic evidence also indicated infection with Toxocara (viscd children. Of the 11 such children, seven (68%) were seropositive, six of whom had high acute-phase titers (greater than or equal to 1024) to Toxoplasma and a disease consistent with acute toxoplasmosis. All six of the latter group required specific chemotherapy. Geophagia was associated statistically with acute toxoplasmosis among the children; it also increased the risk of infection with Toxocara and enteroparasites. Two school-aged children and two adults had serologic evidence of acute toxoplasmosis, but only one of the group was symptomatic. Epidemiologic evidence indicates that this outbreak was probably caused by ingesting oocysts from cat feces. We suggest that the severe and unusual clinical manifestations of the index patient resulted from simultaneous infection with Toxoplasma and Toxocara.
Effect of type of dietary fat, cholesterol and chenodeoxycholic acid on gallstone formation, bile acid kinetics and plasma lipids in squirrel monkeys

To explore the effect of type of dietary fat, cholesterol and chenodeoxycholic acid on gallstone formation, bile formation, bile composition, bile acid kinetics and plasma lipids in squirrel monkeys, 39 monkeys were studied using seven different diets. Safflower oil, a highly unsaturated fat, added to a diet with cholesterol resulted in at least as high an incidence of cholesterol gallstones as butter added to the same diet. On the other hand, diets with high levels of saturated or unsaturated fat without cholesterol did not result in gallstone formation. Dietary chenodeoxycholic acid (0.1%) did not reduce the incidence of cholesterol gallstones, although the proportion of bile acids as chenodeoxycholic acid increased. Gallbladder biles from monkeys fed semipurified diets with cholesterol had a significantly higher lithogenic index than the comparable groups without cholesterol. Pool sizes of bile acids in all semipurified diet groups were reduced and the lithogenic indices were increased compared with the group fed a commercial feed. Dietary chenodeoxycholic acid caused a decrease in plasma cholesterol in butter groups and an increase in triglyceride concentrations in safflower groups. Diet infuences bile composition and bile acid kinetics, as well as the incidence of gallstones, in squirrel monkeys.
Factors Underlying the Adoption and Adaption of a University Physics Reform over Three Generations of Implementation.

SCALE-UP (Student-Centered Active Learning Environment with Upside-Down Pedagogies) (Beichner et al., 2007) is a reformed pedagogy and classroom design originally developed for large enrollment university physics courses at North Carolina State University. It is currently being used at over 250 institutions worldwide and has since expanded into other content areas. This exploratory case study examines how classroom, departmental, institutional and cultural factors have caused the reform to evolve over three generations of implementation from its development site to a well-known American implementation and a site in Singapore. A mixed methods study using interviews and class observations reveal the implementation process follows an iterative version of Rogers’ (2003) “Innovation in Organizations” model, as institutions re-invent and refine the reform to adapt to their institution. The findings suggest some changes ensure the survival of the reform, for example, adjusting instruction to fit available resources or student learning styles. However, many modifications shift pedagogy toward traditional instruction, potentially decreasing the reform’s intended benefits. Awareness of this tendency could help researchers, curriculum and professional development developers and future implementers better support sustainable and effective use of research-based pedagogies.
Abstract B03: Molecular profiling of immune activation associated with melanoma regression induced by diphencyprone

Topical diphencyprone (DPCP), a hapten that causes delayed-type hypersensitivity reactions, has been used to treat cutaneous metastases in melanoma patients, with an 84% regression rate and minimal side effects observed in a 50-patient case series. However, the immunological mechanisms underlying these cases of regression are not well understood. Here we report the case of a 91-year-old female with a history of primary melanoma treated by excision, followed by several recurrences initially responsive to imiquimod, presenting to us with two unresponsive, unresectable cutaneous melanoma metastases on her left lower leg. After 14 weeks of topical DPCP application twice weekly, the patient9s melanoma lesions first became very inflamed and then were no longer clinically visible, and we confirmed the absence of melanoma by analysis of biopsy tissue. Immunohistochemistry for Melan-A as well as qRT-PCR analysis of various melanocyte/melanoma markers both demonstrated high levels in the pre-treatment melanoma biopsy, which returned to peri-lesional (non-melanoma) skin levels following DPCP treatment. The patient remains well five months after finishing her DPCP treatment regimen with no cutaneous metastases visible. To better ascertain the mechanisms involved in immune-mediated tumor regression, we studied biopsy tissues at various time points. Previous work from our group has demonstrated that gene expression markers of all major T cell subsets (Th1, Th2, Th9, Th17, Th22, and regulatory T cells) increase at 3 days after a single application of DPCP in healthy volunteers. However, this previous report did not examine the effects of repeated applications of DPCP, as is traditionally required when DPCP is used as a treatment (for clinical conditions that include alopecia areata and warts in addition to melanoma). In our current study, we noted that DPCP led to extensive immune cell infiltrates (by HE Sep 20-23, 2014; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(14 Suppl):Abstract nr B03.
MicroRNA miR-150 Is Involved in Vα14 Invariant NKT Cell Development and Function

CD1d-restricted Vα14 invariant NKT (iNKT) cells play an important role in the regulation of diverse immune responses. MicroRNA-mediated RNA interference is emerging as a crucial regulatory mechanism in the control of iNKT cell differentiation and function. Yet, roles of specific microRNAs in the development and function of iNKT cells remain to be further addressed. In this study, we identified the gradually increased expression of microRNA-150 (miR-150) during the maturation of iNKT cells in thymus. Using miR-150 knockout (KO) mice, we found that miR-150 deletion resulted in an interruption of iNKT cell final maturation in both thymus and periphery. Upon activation, iNKT cells from miR-150KO mice showed significantly increased IFN-γ production compared with wild-type iNKT cells. Bone marrow-transferring experiments demonstrated the cell-intrinsic characteristics of iNKT cell maturation and functional defects in mice lacking miR-150. Furthermore, miR-150 target c-Myb was significantly upregulated in miR-150KO iNKT cells, which potentially contribute to iNKT cell defects in miR-150KO mice. Our data define a specific role of miR-150 in the development and function of iNKT cells.
FROM GABII AND GORDION TO ERETRIA AND METHONE: THE RISE OF THE GREEK ALPHABET†

The three longest inscriptions from Methone, which all seem to be in Eretrian script, are an important testimony to the diffusion of literacy across the Mediterranean world. They help us to reconstruct the prehistory of the Greek alphabet, which according to internal evidence went through three phases, from the simplest ‘Cretan’ script to Euboean, Roman and ultimately Ionian. Yet the earliest alphabetic inscriptions seem to come from Gabii in Latium and Gordion in Phrygia, a fact which contradicts the internal evidence that Greeks adapted the Phoenician script. Consistency returns only if one accepts a recent proposal to raise the chronology of the Middle and Late Geometric periods. The finds from Methone confirm that Euboean script was already well adapted to the recording of complex texts such as epic poetry.
A multiple-site perineal applicator (MUPIT) for treatment of prostatic, anorectal, and gynecologic malignancies

Recently, transperineal interstitial-intracavitary applicators have been used to treat locally limited and advanced perineal and gynecologic malignancies. We have developed a single afterloading applicator, referred to as the "MUPIT" (Martinez Universal Perineal Interstitial Template), which with its prototypes has been utilized to treat 78 patients with malignancies of the cervix, vagina, female urethra, perineum, prostate, and anorectal region. The device basically consists of two acrylic cylinders, an acrylic template with a predrilled array of holes that serve as guides for trocars, and a cover plate. Some of the guide holes on the template are angled outward to permit a wide lateral coverage without danger of striking the ischium. The cylinders have an axial hole large enough to pass a central tandem or a suction tube for the drainage of secretions. Thus, the device allows for the interstitial placement of 192Ir ribbons as well as the intracavitary placement of either 137Cs tubes or 192Ir ribbons. In use, the cylinders are placed in the vagina and rectum and then fastened to the template, so that a fixed geometric relationship among the tumor volume, normal structures, and source placement is preserved throughout the course of the implantation. Hollow, closed-end, stainless steel trocars are then inserted through the guide holes that produce optimal coverage of the treatment volume. Appropriate computer programs also have been developed on a minicomputer for the corresponding dose-rate computations. These programs run with sufficient speed that they may be used for both the planning of the source placement beforehand and the computation of the actual dose-rate distribution obtained. The advantages of the system are (1) greater control of the placement of sources relative to the tumor volume and critical structures owing to the fixed geometry provided by the template and cylinders, and (2) improved dose-rate distributions obtained by means of computer-assisted optimization of the source placement and strength during the planning phase.
Note: efficient generation of optical sidebands at GHz with a high-power tapered amplifier.

Two methods using a laser-diode tapered amplifier to produce high-power, high-efficiency optical frequency sidebands over a wide tunable frequency range are studied and compared. For a total output of 500 mW at 811 nm, 20% of the power can be placed in each of the first-order sidebands. Functionality and characterization are presented within the sideband frequency region of 0.8–2.3 GHz, and it is shown that both methods can be applied beyond this frequency range. These methods provide a versatile and effective tool for atomic physics experiments.