cssi/SciSciGPT-SciSciNet huggingface dataset:
Evaluating the quality, clinical relevance, and resident perception of the radiation oncology in-training examination: A national survey.

Abstract Purpose The yearly radiation oncology in-training examination (ITE) by the American College of Radiology is a widely used, norm-referenced educational assessment, with high test reliability and psychometric performance. We distributed a national survey to evaluate the academic radiation oncology community's perception of the ITE. Methods and Materials In June 2014, a 7-question online survey was distributed via e-mail to current radiation oncology residents, program directors, and attending physicians who had completed residency in the past 5 years or junior attendings. Survey questions were designed on a 5-point Likert scale. Sign test was performed with P ≤ .05 considered statistically different from neutral. Results Thirty-one program directors (33.3%), 114 junior attendings (35.4%), and 225 residents (41.2%) responded. Junior attendings and program directors reported that the ITE directly contributed to their preparation for the American Board of Radiology written certification ( P = .050 and .004, respectively). Residents did not perceive the examination as an accurate assessment of relevant clinical and scientific knowledge ( P P P Conclusions Despite high examination reliability and psychometric performance, resident and attending physicians report a need for improved quality assurance and clinical relevance in the ITE. Although the current examination allows limited feedback, establishing a venue for individualized feedback may allow continual and timely improvement of the ITE. Adopting a criterion-referenced examination may further increase resident investment in and utilization of this valuable learning tool.
Report of the ALCTS Catalog Form and Function Interest Group Meeting. American Library Association Midwinter Meeting, Chicago, January 2015

Many libraries wrestle with how to best provide access to the wealth of information available to their users. Today it is common for academic libraries to have a variety of different systems that p...
Targeting An Ancient Retrovirus In Tumor Using Engineered T Cells

Human endogenous retroviruses (HERVs) are ancient viruses forming 8% of human genome. One subset of HERVs, the HERV-K has recently been found to be expressed on tumor cells including melanoma, breast cancer and lymphoma but not on normal body cells. Thus, targeting HERV-K protein as a tumor associated antigen (TAA) may be a potential treatment strategy for tumors that are resistant to conventional therapies. One approach to improve therapeutic outcome is by infusing T cells rendered specific for such TAAs preferentially expressed on tumor cells. Recognition of cell-surface TAAs independent of major histocompatibility complex can be achieved by introducing a chimeric antigen receptor (CAR) on T cells using gene therapy. This approach is currently being used in our clinical trials adoptively transferring CD19-specific CAR+ T cells into patients with B-lineage malignancies. Preliminary analysis of HERV-K env protein expression in 268 melanoma samples and 139 normal organ donor tissues using immunohistochemistry demonstrated antigen expression in tumor cells and absence of expression in normal organ tissues. The scFv region from a mouse monoclonal antibody to target HERV-K env was used to generate a CAR and cloned into Sleeping Beauty (SB) plasmid for stable expression in T cells. HERV-K-specific CAR+T cells were selectively propagated ex vivo on artificial antigen presenting cells (aAPC) using an approach already in our clinical trials. Indeed, after genetic modification of T cells and selection on HERV-K+ aAPC, over 95% of propagated T cells stably expressed the introduced HERV-K-specific CAR and exhibited redirected specificity for HERV-K+ melanoma (Figure 1). Further, the adoptive transfer of HERV-K-specific CAR+T cells killed metastatic melanoma in a mouse xenograph model. While we have chosen melanoma as our tumor model, this study has the potential to be applied to other malignancies, including lymphoma and myeloma due to restricted expression of HERV-K envelope (env) protein on these tumor cells. These data demonstrate that it is feasible to generate T cells expressing a HERV-K-specific CAR using a clinically-appealing approach as a treatment strategy for HERV-K env+ tumors. ![Figure][1] Disclosures: No relevant conflicts of interest to declare. [1]: pending:yes
Phase Transformation of Smooth Diamond Films Grown by hot Filament Chemical Vapor Deposition on Positively Biased Silicon Substrates.

Smooth diamond films have been grown by hot filament chemical vapor deposition under d.c. bias on mirror-polished Si substrates. Films a few micrometers thick were obtained in 30 minutes. Raman spectra showed very broad diamond peaks. X-ray diffraction showed the presence of diamond and also other carbon phase with a line 2.11 A. With time, the films apparently underwent a phase transformation.
Studies of antiretroviral therapy in the multicenter AIDS cohort study

The Food and Drug Administration has been increasingly reliant on surrogate end points to fast-track the licensing of antiretroviral agents. As a result, critical information, such as long-term adverse events, clinical progression rates, survival, and development of resistance, are not available before licensure. Therefore, phase IV studies conducted in large community- and/or clinic-based cohorts will become essential to fill in the gaps in the clinical knowledge base for many of these drugs, and observational cohort studies of HIV-infected patients have been used to address many of these questions. In addition to studies of antiretroviral impact on adverse events and outcomes, such cohorts can provide valuable data on utilization patterns, physician prescribing patterns, and the important issue of patient compliance with increasingly complicated drug regimens.
Calcium, Strontium, and Protein Dynamics during the S2 to S3 Transition in the Photosynthetic Oxygen-Evolving Cycle

Photosystem II (PSII) catalyzes the oxidation of water at a Mn4CaO5 cluster. The mechanism of water oxidation requires four sequential photooxidation events and cycles the OEC through the S0–4 states. Oxygen is released during a thermal transition from S4 to S0, and S1 is the dark stable state. Calcium is required for activity, and, of substituted cations, only strontium supports activity but at a lower steady-state rate. The S1 to S2 transition corresponds to a Mn oxidation reaction. Previously, we used divalent ion substitution to provide evidence that calcium activates water and that an internal water cluster (W5+) is protonated during the S1 to S2 transition. For the next transition, S2 to S3, either a Mn or a ligand oxidation event has been proposed. Here, we use strontium reconstitution and reaction-induced FT-IR spectroscopy to study this transition. We show that strontium substitution has a dramatic effect on the infrared spectrum of the S2 to S3 transition, reducing the intensity of all spectral ...
The Clinical Simulation Service at NIH: Our Journey

The National Institutes of Health Clinical Center, Bethesda, Maryland, USA, is a 250-bed hospital that is unique in that its primary mission is research. It has select training fellowships but no residency programs and no affiliation with a medical or nursing school. A believer in simulation-based education, the chairman of the Critical Care Medicine Department started the simulation program with the purchase of a Laerdal SimMan and audiovisual package in 2003. So far, all of the funding for the program has come from this single department. The program was started with the simple, focused goal of teaching critical care medicine fellows, and planned eventually to expand it to postgraduate nursing education as well. This chapter shares the perspective gained by the authors on how to make an effective program with a small budget and a small space work. They relate, “Our very first scenarios were Advanced Cardiac Life Support types written by several cardiologists and a clinical nurse specialist for the intensive care unit. A major obstacle was that these staff were struggling to program scenarios with the ‘flowchart’ type approach in the Laerdal SimMan software, with minimal instruction on how to do so. This led to a great deal of frustration as it was time consuming and complex to try to anticipate all trainee moves and plan a response to them in a preprogrammed way. Eventually, these volunteer educators gave up and refused to continue to do it this way, thinking they would just have to change vital signs ‘on the fly.’ Since simulation was not a major emphasis of their careers, these individuals had little motivation to struggle with the simulator and for several months, it was not used at all.”
Protein kinases: aspects of their regulation and diversity.

Publisher Summary This chapter discusses the protein kinases, aspects of their regulation, and their diversity. Studies of protein kinases have become intimately associated with an understanding of the function of cyclic AMP. In the past few years, it has been observed that hormones, interacting with specific receptors on the cell surface, modulate adenyl cyclase activity. The resultant changes in intracellular cyclic AMP concentrations evoke the physiological responses distinctive of each hormone-target cell interaction. The cyclic nucleotide binds to a specific receptor protein that interacts at the promoter region of the operon and, in consequence, modulates the rate of synthesis of specific species of messenger RNA. Moreover, glycogenolysis is a common feature of most mammalian tissues and, therefore, caution must be used in expanding the interpretation of the enzyme distribution data to account for the hormonal regulation of other metabolic processes. Recently, no correlation was found in the developmental patterns in skeletal muscle, liver, and heart, between cyclic AMP-dependent protein kinase and the glycogenolytic enzymes phosphorylase and phosphorylase kinase.
Design and fabrication of printed optical phantoms for deep tissue imaging

We demonstrate optical imaging in physiologically realistic phantoms with controlled optical properties fabricated using 3D printing. Our method is adaptable to many optical imaging methods, and can be used for calibration of live animal data.
Primum Non Nocere: Healthcare In The Digital Age

Internet search has become the first stop in many users' health journeys. Today, about 1 in 20 Google searches are related to healthcare. These queries span a broad range of information needs as people are looking for possible conditions related to their symptoms and are seeking to understand their diagnoses and prescribed treatments, decipher their test results, find pathways of self-care as well as connect to people with similar experiences. This talk will cover the approaches that we at Google have used to meet these diverse user needs. We will also discuss how we constructed and curated the Health Knowledge Graph, a large scale resource of highly accurate medical knowledge that powers many of our health applications. In the second part of the talk, we will show how the confluence of advances in technology enables us to revolutionize health data collection and perform it at unprecedented scale and granularity. Combined with contextual signals, anonymous aggregated user activity can be used to quantify public health phenomena and provide concerned authorities with actionable information about seasonal or situational health issues. We will conclude the talk with an outline of research directions that could enable people and organizations in personal and public health settings obtain actionable information in a timely manner. The work presented here was the product of collaboration of multiple teams at Google.
miRNAs in synapse development and synaptic plasticity.

Synapses are functional units of the nervous system, through which information is transferred between neurons. The development and activity-dependent modification of synapses require temporally and spatially controlled modulation of gene expression. microRNAs (miRNAs) have emerged as essential regulators of gene expression. They are small non-coding RNAs that regulate mRNA stability and translation by interacting with the 3′ untranslated region (3′ UTR) of mRNAs. miRNAs are located to neuronal processes to regulate protein synthesis locally and their expression is regulated by synaptic activity. This article reviews recent findings on the role of miRNAs in synapse development and synaptic plasticity.
Anatomic segmentectomy versus lobectomy for clinical stage I non-small cell lung cancer: A propensity-matched analysis.

7071 Background: Although anatomic segmentectomy is considered a “compromised” procedure by many surgeons, new information from several retrospective, single-institution series has countered negati...
Purex Processing of 10-Year Light Water Reactor Fuel: Flow Sheet

A flow sheet for simplified reprocessing of long-cooled light water reactor (LWR) fuel is presented. The standard Purex process is modified so that after the first solvent extraction cascade (co-decontamination), plutonium is was-hed out of the organic phase without reduction. This step also washes out enough uranium that the U-Pu product can be directly used as LWR fuel. A finish partitioning step, with plutonium reduction, decontaminates the remaining uranium product. Neither the U-Pu product nor the uranium product requires further purification, process yields are excellent, and plant equipment can be simplified
Aerogel microspheres based on cellulose nanofibrils as potential cell culture scaffolds

Crosslinked poly(vinyl alcohol) (PVA)/cellulose nanofibril (CNF) hybrid aerogel micro-spheres with two different particle sizes were fabricated via a combination of the water-in-oil (W/O) emulsification process and the freeze-drying process. The aerogel micro-spheres were highly porous with a bulk density as low as 0.0047 g/cm3 for the large microspheres. The pore size of the microspheres ranged from nano- to micro-meters. Preliminary biocompatibility assays of the aerogel microspheres were investigated with NIH 3T3 cells to explore their potential application as cell culture scaffolds. The highly crosslinked aerogel microspheres were robust and were able to maintain their shape during the cell culture process. The live/dead assay showed that the cells could be seeded, attached, and proliferated on the surface of PVA/CNF aerogel microspheres. The fluorescence images showed that some of the cells migrated into the inner pores of the microspheres. Moreover, the large microspheres with larger average pore sizes had a higher cell count than that of the small microspheres. This study confirms that the PVA/CNF aerogel microspheres fabricated in this work are nontoxic and biocompatible. Furthermore, the interconnected, highly porous nanofibrous structure of the microspheres can successfully facilitate cell attachment, differentiation, and proliferation.
New Therapies for Hepatitis C Virus Infection

Approximately 350 million people worldwide are infected with hepatitis C virus (HCV), which is associated with morbidity and mortality related to cirrhosis, hepatocellular carcinoma, or liver failure. Recently, vast improvements have been made with the development of direct-acting antiviral (DAA) agents, which are all-oral, are better tolerated than interferon-based treatment, and provide a sustained virologic response in more than 90% of treated patients. This article reviews the new therapies available for HCV infection, with a focus on patients who have chronic HCV with and without compensated cirrhosis. As DAA development continues, more attention will need to be given to special patient populations, specifically to patients who fail treatment due to emerging resistant strains. Considerable challenges yet to be overcome are incremental diagnosis of unidentified patients and linkage to care that is affordable and available to all patients.
Sexually Dimorphic Effects of Early-Life Exposures to Endocrine Disruptors: Sex-Specific Epigenetic Reprogramming as a Potential Mechanism.

The genetic material of every organism exists within the context of regulatory networks that govern gene expression—collectively called the epigenome. Animal models and human birth cohort studies have revealed key developmental periods that are important for epigenetic programming and vulnerable to environmental insults. Thus, epigenetics represent a potential mechanism through which sexually dimorphic effects of early-life exposures such as endocrine-disrupting chemicals (EDCs) manifest. Several animal studies, and to a lesser extent human studies, have evaluated life-course sexually dimorphic health effects following developmental toxicant exposures; many fewer studies, however, have evaluated epigenetics as a mechanism mediating developmental exposures and later outcomes. To evaluate epigenetic reprogramming as a mechanistic link of sexually dimorphic early-life EDCs exposures, the following criteria should be met: (1) well-characterized exposure paradigm that includes relevant windows for developmental epigenetic reprogramming; (2) evaluation of sex-specific exposure-related epigenetic change; and (3) observation of a sexually dimorphic phenotype in either childhood, adolescence, or adulthood.
Multimodal Instruction, the New Hybrid: A Student-Centered Approach to Blended Learning

Innovative approaches and modalities of instruction in online teaching and learning have had major implications in higher education including nonprofit education. This article proposes a new form of blended learning not yet described in the literature called multimodal instruction. Multimodal instruction provides students with the autonomy to dictate their own terms of a blended course. Students in a multimodal course choose on a weekly basis whether to participate in learning activities synchronously online, asynchronously online, or face-to-face. The article identifies how multi-modal instruction aligns with current trends in higher education that are also affecting nonprofit education. The article presents a case study illustration of how multimodal instruction can be applied. The article concludes with a discussion on the implications of multimodal instruction for students, faculty, and institutions. Subscribe to JNEL
Descriptors of Pain Quality Associate with Pulpal and Periapical Diagnostic Tests in Patients Experiencing Acute Tooth Pain

Objective: Endodontic diagnosis collectively relies on interpretation of chair-side clinical testing and pain history to assess the presence of inflammation in the pulp and periapical tissues. Whether clinical findings relate to a patient subjective pain description is largely unknown. We tested for an association between mechanical and thermal sensory responses of affected teeth, with pain quality descriptors and pain intensity at rest and in function. Identification of such associations will clarify whether pain descriptors are useful in discriminating the underlying biological processes contributing to dental pain. Methods: Participants (n= 228) were recruited from among those presenting with toothache at a dental emergency clinic. Clinical testing (cold, EPT, percussion, palpation, and bite) was completed by calibrated examiners and participants verbally rated their pain intensity with reference to 22 pain qualities (0-10 VAS). Two-way ANOVA determined the relationship between groups defined by pulp vitality and percussion sensitivity and the intensity rating of each pain descriptor. Results: Patients with percussion hypersensitivity reported significantly higher levels of current pain, worst pain, pain at rest and pain in function. Patients with positive cold detection reported higher levels of pain at rest. There was a significant interaction between the cold responsiveness and percussion hypersensitivity on the intensity of pain evoked by cold. Patients with a positive cold detection and percussion hypersensitivity experienced more intense evoked pain with eating or drinking cold things. Patients with positive cold detection reported higher intensity shooting pain. Finally, patients with percussion hypersensitivity reported higher levels of radiating, throbbing pain and pain evoked by chewing/biting (all p<0.05). Conclusion: Shooting pain is more salient in odontalgia patients with a vital pulp diagnosis with positive cold detection results, and may be a unique feature of pulp mediated pain. Radiating, throbbing, and evoked pain are associated with percussion sensitivity and could reflect central sensitization or more advanced inflammatory processes. As pain is an individual and multidimensional experience, a detailed pain history including pain descriptors may help improve endodontic diagnosis and distinguish the underlying biological mechanisms in different stages of the disease.
Critically Examining the Agency and Professional Identity Development of Novice Dual Language Teachers through Figured Worlds.

Drawing on the concept of figured worlds, we examined how four preservice teachers in a monoglossically oriented teacher preparation program developed their professional identities and sense of age...
Autonomic Ganglia and Their Biochemistry

The systemic involuntary control of animal visceral function is supported and controlled by the autonomic nervous system. The biochemical subtlety and the pathologies of this system are not often appreciated (re: pineal, iris, spleen T-cells, heart, and gastrointestinal tract, to mention a few). An understanding, then, of this system’s biology, particularly its ontogeny, developmental control, and biochemical functions, allows not only an understanding of this system but also of the more complex systems of the CNS.
After the Case

At the end of the case, you will usually have to give up your hard-fought vascular access. The most common means of achieving hemostasis in pediatric patients is still manual compression. There is actually a technique to pulling catheters and holding the groin. Groin hematomas are usually the result of poor holding technique in establishing and maintaining hemostasis, and occur relatively commonly, especially during a fellow’s first month in the lab.
The Relationship Between Population Attributable Fraction and Heritability in Genetic Studies

Population attributable fraction (PAF) has been widely used to quantify the proportion of disease risk in a population that can be attributed to risk factors in epidemiological studies. However, the use of PAF has been limited in assessing the contribution of genetic variants. Most notably, the PAF estimate is typically much larger than other commonly used measures, such as heritability, thereby raising the concern that PAF may overestimate the genetic contribution. In this paper, we show that PAF is a one-to-one function of heritability, and explain why PAF is larger than heritability. Further, we present an estimation procedure based on the summary statistics from genome-wide association studies (GWAS) to estimate the PAF of multiple correlated genetic variants for a binary outcome. Currently available estimation procedures only apply to a single variant or to multiple genetic variants that are independent from each other. Our simulation studies verified the relationship between PAF and heritability, and showed that the proposed estimation procedure for these two measures performed well. Finally, we applied the proposed method to the published data of two lung cancer GWAS to estimate the PAF and heritability of several newly identified variants. Our results demonstrate that the PAF estimate is a useful measure of the genetic contribution to the development of the disease. We hope this paper serves as an advocate for a wider use of PAF in genetic studies.
The Mississippi Charter School Act: Will it Produce Effective and Equitable Charter Schools?

The Mississippi Charter School Act (CSA) is under constitutional and political attack. On the first front, litigation is underway challenging the funding provisions of the CSA under the Mississippi Constitution. The second front is a broader political attack against charter schools generally, which questions their effectiveness, viability and impact on traditional public schools. These critical issues have diverted attention from a third, and equally important, consideration: whether the CSA is an effective charter enabling statute. This article addresses this overlooked issue and analyzes the CSA to determine if it constructs a landscape that ensures the creation, governance and oversight of effective and equitable charter schools. The current constitutional and political attacks seek to prevent charter schools from existing at-all in Mississippi. But if charter schools are deemed constitutionally permissible (almost all similar attacks have failed) and if they continue to grow in Mississippi (as is occurring nationwide), the CSA and the policies of the Charter School Authorizer Board of Mississippi (CSAB) stand as the primary mechanisms ensuring charter schools are effective and provide equitable access. This article provides a critique of the CSA and CSAB’s policies and suggests changes to ensure that Mississippi provides equitable access to high performing charter schools.
Possible new phase of thermal QCD

Using lattice simulations, we show that there is a phase of thermal QCD, where the spectral density $\rho(\lambda)$ of Dirac operator changes as $1/\lambda$ for the infrared eigenvalues $\lambda<T$. This behavior persists over the entire low energy band we can resolve accurately, over three orders of magnitude on our largest volumes. We propose that in this "IR phase", the well-known non-interacting scale invariance at very short distances (UV, $\lambda \rightarrow \infty$, asymptotic freedom), coexists with very different interacting type of scale invariance at long distances (IR, $\lambda<T$). Such dynamics may be responsible for the unusual fluidity properties of the medium observed at RHIC and LHC. We point out its connection to the physics of Banks-Zaks fixed point, leading to the possibility of massless glueballs in the fluid. Our results lead to the classification of thermal QCD phases in terms of IR scale invariance. The ensuing picture naturally subsumes the standard chiral crossover feature at $"\!T_c\!" \,\approx 155$ MeV. Its crucial new aspect is the existence of temperature $T_{IR}$ (200 MeV $< T_{IR} < $ 250 MeV) marking the onset of IR phase and possibly a true phase transition.
Advance Care Planning in Healthy Older Adults

This article reports the secondary analysis of a qualitative study that examined the beliefs, values, lifestyles and health status of adults at least 75 years old (N=18). An unanticipated finding was that all participants who self-identified as healthy (N=14) had in place advance directives which dictated their end-of-life wishes. In contrast, participants who self-identified as fair or poor health (N=4) did not have advance directives (N=4). These "healthy" older adults also differed substantially from their counterparts in the degree in which they were socially engaged in their community and family, but varied little related to their actual medical diagnoses or health problems. The self-described healthy group approached advanced care planning as part of health promotion; they simultaneously planned for end-of-life while engaging in activities to maintain optimum health. In contrast, those who evaluated their health as fair or poor perceived advanced care planning as something to be avoided. Planning for end-of-life may be a form of ongoing engagement as it requires dialogue with health care providers, and thoughtful consideration of experiences and wishes. It may also be a manifestation of successful aging in that death is recognized as the culmination of a good life rather than something to be feared.
Intensive Care Management of Acute Liver Failure: Considerations While Awaiting Liver Transplantation

Acute liver failure is a unique clinical phenomenon characterized by abrupt deterioration in liver function and altered mentation. The development of high-grade encephalopathy and multisystem organ dysfunction herald poor prognosis. Etiologic-specific treatments and supportive measures are routinely employed; however, liver transplantation remains the only chance for cure in those who do not spontaneously recover. The utility of artificial and bioartificial assist therapies as supportive care—to allow time for hepatic recovery or as a bridge to liver transplantation—has been examined but studies have been small, with mixed results. Given the severity of derangements, intensive critical care is needed to successfully bridge patients to transplant, and evaluation of candidates occurs rapidly in parallel with serial reassessments of operative fitness. Psychosocial assessment is often suboptimal and relative contraindications to transplant, such as ventilator-dependence may be overlooked. While often employed to guide evaluation, no single prognostic model discriminates those who will spontaneously recover and those who will require transplant. The purpose of this review will be to summarize approaches in critical care, prognostic modeling, and medical evaluation of the acute liver failure transplant candidate.
1980 Evolution of philopatry

Abstract Paul Greenwood (1980) reviewed a large body of empirical evidence and showed that birds and mammals show a sex-biased dispersal from their natal habitats. In birds, males are more likely to leave and in mammals females are more likely to leave. Greenwood suggested these patterns were due to evolution and the fitness consequences of dispersal.
NCBP3: A Multifaceted Adaptive Regulator of Gene Expression.

Eukaryotic cells have divided the steps of gene expression between their nucleus and cytoplasm. Protein-encoding genes generate mRNAs in the nucleus and mRNAs undergo transport to the cytoplasm for the purpose of producing proteins. Cap-binding protein (CBP)20 and its binding partner CBP80 have been thought to constitute the cap-binding complex (CBC) that is acquired co-transcriptionally by the precursors of all mRNAs. However, this principle has recently been challenged by studies of nuclear cap-binding protein 3 (NCBP3). Here we submit how NCBP3, as an alternative to CBP20, an accessory to the canonical CBP20−CBP80 CBC, and/or an RNA-binding protein – possibly in association with the exon-junction complex (EJC) – expands the capacity of cells to regulate gene expression.
Structure- and Sampling-Adaptive Gait Balance Symmetry Estimation Using Footstep-Induced Structural Floor Vibrations

AbstractThis paper presents a structure- and sampling-adaptive approach for analyzing human footstep-induced structural floor vibrations to estimate footstep ground reaction forces (GRFs) and gait ...
Design of High-Voltage Stable Hybrid Electrolyte with an Ultrahigh Li Transference Number

Considering the high energy consumption during processing, and the low compliance and adhesion of ceramic electrolytes, the integration of polymer into ceramic electrolytes provides a way to mitiga...
Post-partum rectus sheath hematoma complication: case report

Pregnancy, surgery, and trauma are known risk factors for the development of rectus sheath hematomas (RSHs). The exact incidence of RSH during pregnancy is unknown, however this disease carries a risk of complication and even mortality. The role of infection in this condition is less known with only a few reported case studies in medical literature. In our case a 26-year-old G4P2113 1-month status post cesarean section presented with 2 weeks of progressive lower abdominal pain after her 50-pound daughter jumped on her. Upon further work up a computed tomography (CT) scan found a 15-cm RSH. Expectant management is the recommended first line of treatment, however, this failed after the patient presented with signs and symptoms of infection. An exploratory laparotomy was performed that had evidence of necrotizing fasciitis of the rectus muscle and subcutaneous tissue. This is a very atypical presentation of a RSH complicated with myonecrosis after a cesarean delivery. Review of the medical literature shows appropriate work up and diagnosis of RSH in pregnant patients is critical for early intervention. Furthermore, while conservative treatment is typically appropriate for non-pregnant patients it may not be sufficient for pregnant and post-partum patients. Improved understanding of this condition will result in heightened clinical suspicion, faster intervention, and more appropriate treatment. This is critical to reducing the maternal and perinatal morbidity/mortality associated with this disease.
Deep-learning Based Approach to Identify Covid-19

COVID-19 is a large-scale contagious respiratory disease that has spread across the world in 2020. Therefore, a low-cost, fast, and easily available solution is needed to provide a COVID-19 diagnosis to curb the outbreak. According to recent studies, one of the main symptoms of COVID-19 is coughing. The goal of this research effort is to develop a method for the automatic diagnosis of COVID-19 by detecting cough during recorded conversations. The method is composed of five main modules: sound extraction, sound feature extraction, cough detection, cough classification, and COVID-19 diagnosis. The method extracts relevant features from the audio signal and then uses machine learning and deep learning models, like SVM, KNN, and RNN, to classify them, which can successfully diagnose COVID-19 from audio recordings. Our method has relatively high accuracy when dealing with completely unfamiliar cough samples. When the training set and the test set are from two different databases, it still achieves an accuracy of 81.25% (AUC of 0.79). As more data sets are collected, the model can be further developed and improved to create a machine learning solution based on cough analysis for COVID-19 detection, which may be promoted as a non-clinical self-inspection solution.
Otolaryngology Residency Program Rankings and Social Media Usage: A Longitudinal Analysis.

OBJECTIVE: Social media is a powerful networking tool among health care organizations. This study determines correlations between program reputation and social media activity and popularity, specifically among otolaryngology residency programs. METHODS: Accredited programs, excluding military and osteopathic, in the United States were included. Activity and popularity on Facebook, Twitter, and Instagram were assessed during the same 7-month period from 2016 to 2020. Doximity Residency reputation scores (dividing programs into quartiles) and US News & World Report (comparing programs affiliated with top hospitals versus those with unranked hospitals) were utilized to compare differences based on reputation. RESULTS: Of 104 programs, 91 (88%) had social media accounts. Instagram and Twitter were more commonly used than Facebook, with 78 (75%), 49 (47%), and 42 (40%) accounts, respectively. The cumulative use of all three platforms grew yearly, while Twitter (R2 = 0.9863) and Instagram (R2 = 0.9955) presence increased exponentially. Doximity's top quartile programs had more Facebook (P = .020), Twitter (P < .001), and Instagram (P = .102) accounts. First-quartile programs also adopted each platform months before fourth-quartile programs. Stratified by US News & World Report, ranked programs had more social media accounts, with 24 (53%) on Facebook (P = .028), 32 (71%) on Twitter (P < .001), and 37 (82%) on Instagram (P = .155). Programs with higher reputations were more active and exhibited increased likes and followers over time. CONCLUSION: Social media use among otolaryngology programs has grown exponentially, with Instagram and Twitter becoming the dominant platforms. Higher ranked programs are more active on social media, have more followers, and adopt social media earlier. LEVEL OF EVIDENCE: Level 4 Laryngoscope, 2021.
Trends in cannabis-related attitudes and behaviors among cannabis-using adolescent and young adult outpatients following medical cannabis legalization in Massachusetts

BACKGROUND Among youth already using cannabis, legalization of medical cannabis may influence cannabis-related attitudes and behaviors, including increasing access through use of someone else's medical cannabis (diversion). Objective: To examine cannabis-related attitudes and behaviors (including diverted cannabis use) in cannabis-using youth in the four years following medical cannabis legalization. Additionally, we investigated characteristics of youth who used vs. did not use diverted medical cannabis. Methods: Data were collected in Boston from 2013 (when medical cannabis legislation took effect in Massachusetts) through 2016 (when recreational cannabis use became legal in Massachusetts). Cannabis-using youth (age 13-24) presenting to an outpatient adolescent substance use treatment program (ASUTP) or recruited for an adolescent medicine clinic study (AMCS) completed a confidential survey on demographic characteristics and cannabis use behaviors and attitudes. We used multiple logistic regression to analyze changes in attitudes and behaviors over three years versus the reference year (2013), controlling for demographics. We used chi-square to compare characteristics of youth reporting use of diverted medical cannabis versus those not. Results: The sample included 273 cannabis-using youth (ASUTP n = 203, AMCS n = 70; 2013 n = 67, 2014 n = 67, 2015 n = 77, 2016 n = 62). Mean ± SD age was 18.2 ± 2.5 years, 32% were female, 58% were White non-Hispanic, and 70% had college-graduate parents. In 2013, most youth reported that cannabis was easy to obtain (97.9%), and that occasional cannabis use had "no" or "slight" risk of harm (89.4%), with little change across years. In 2016, 44% of youth reported using someone else's medical cannabis, versus 15% in 2013 (aOR 4.66, 95% CI 1.81, 11.95). Youth using diverted medical cannabis had higher likelihood of reporting riding with a driver, or driving themselves, after cannabis use (both p < .01). Conclusion: Among at-risk youth in Massachusetts, use of diverted medical cannabis increased after medical cannabis legalization, and those using diverted medical cannabis reported higher risk for cannabis-related traffic injury.
Striving for Normalcy after Lower Extremity Reconstruction with Free Tissue: The Role of Secondary Esthetic Refinements.

Background Many patients with successful lower extremity salvage have postoperative functional and esthetic concerns. Such concerns range from contour irregularity preventing proper shoe-fitting to esthetic concerns involving color, contour, and texture match. The purpose of this study is to determine the overall incidence as well as factors associated with an increased likelihood of undergoing secondary, esthetic refinements of lower extremity free flaps and to review current revision techniques. Methods All patients undergoing lower extremity soft tissue coverage for limb salvage procedures between January 2007 and June 2013 at a single institution were included in the analysis. Patients who underwent secondary refinements for lower extremity free flaps were compared with patients not undergoing secondary procedures. Results During the study period, 152 patients underwent reconstruction and were eligible for inclusion. Of these, 32 (21.1%) patients underwent secondary, esthetic revisions. Few differences in patient or case characteristics were noted, although revision patients trended toward being younger, having lower body mass index, with defects secondary to acute trauma located below the ankle. The most common revision was complex soft tissue rearrangement or surgical flap debulking/direct excision (87.5% of patients), followed by scar revision (12.5%), suction-assisted lipectomy (3.1%), laser scar revision (3.1%), and tissue expansion with local tissue rearrangement (3.1%). Conclusion A significant portion of patients desire secondary revisions following the initial procedure. This is especially true of younger patients with below ankle reconstruction. In many patients, an esthetic consideration should not be of secondary concern, but should be part of the ultimate reconstructive algorithm for lower extremity limb salvage.
“Spontaneous” ping-pong fracture in newborns: case report and review of the literature

“Ping-pong” fractures (PPF) are depressed skull fractures typical of newborns. PPF usually result from head injury and, rarely, may cause severe long-term neurological sequelae. The management of PPF is still controversial. The goal of this paper is to present a case of “spontaneous” ping-pong fracture and to review the pertinent literature of the last 20 years. We report on a newborn who presented with a “spontaneous” parietal depressed skull fracture at birth. Preoperative computed tomography (CT) scan confirmed the PPF and excluded brain injuries. Neurosurgical intervention was performed on day 3 with immediate lifting of the fracture; the postoperative course was uneventful.During the last 20 years, 22 cases of “spontaneous ping-pong” fractures in newborn have been reported, with different clinical pictures and management but, generally, with a good outcome.“Ping-pong” fractures can occur in uneventful pregnancies and after uncomplicated vaginal or cesarean deliveries. CT scan, with low-dose protocol for infants, is the gold standard examination to evaluate the fracture and any associated brain lesions. Treatment is selected according to fracture characteristics.
SKELETAL EVIDENCE FOR CHILD ABUSE : A PHYSICAL ANTHROPOLOGICAL PERSPECTIVE

Analysis of the skeletal remains of abused children can prove challenging for forensic pathologists and radiographers who are inexperienced in the direct examination of bones. In such cases, radiographically invisible skeletal lesions that document a history of trauma can often be identified by a physical anthropologist with appropriate osteological experience. This is illustrated by cases in which skeletal remains of four murdered children and a mentally handicapped adult produced evidence of antemortem trauma and perimortem injuries that was critical in developing murder cases against the assailants. In these cases, well-healed areas of subperiosteal new bone formation were identified that were below the threshold of radiographic detection. Such injuries provide strong evidence for a history of physical abuse.
Gender and Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are some of the most prevalent sources of illness globally. These diseases have great health, economic, and social impacts. STDs disproportionately affect the health and well-being of women, especially those who live in economically disadvantaged areas. Keywords: gender; inequality; sex; sociology of sex and gender
Management of Biliary Complications in the Liver Transplant Patient

Biliary complications after liver transplantation remain common. Resources for livers are limited, and these individuals are often ill, making nonoperative treatment and management attractive options. The endoscopic route for evaluation (endoscopic retrograde cholangiopancreatography) remains preferable, due to its safety profile, as opposed to the percutaneous route (percutaneous transhepatic cholangiography with percutaneous transhepatic biliary drainage), though the endoscopic route may not be possible in patients with a Roux-en-Y reconstruction. The two most common early complications include leaks from the anastomosis or cystic duct stump (of the donor or native duct) and obstruction at the surgical anastomosis. Nonoperative treatment is often successful in early complications. Late complications presenting with leaks and obstruction are often more difficult to treat nonoperatively and frequently require surgical treatment or retransplantation, though both endoscopic and percutaneous methods can be useful in the management of these complications or as a bridge to definitive surgical therapy.
Sporulation of Yeast Harvested During Logarithmic Growth

Rapid and abundant sporulation of yeast can be obtained, with cells harvested during logarithmic growth, by employing potassium acetate rather than glucose as a carbon source.
The Lord Giveth: Christian 'Health Insurance', the Role of State Insurance Regulation, and the Aftermath of Kentucky v. Reinhold

This article seeks to examine the nexus between what is traditionally considered 'insurance' and what is traditionally exempted from government regulation as a religious donation, the holding and repercussions of the Kentucky high court's decision in Kentucky v. Reinhold, and the expected ripple effect on other state and federal regulations.
The American College Novel, An Annotated Bibliography

1 Introduction 2 Student-Centered Annotations 3 Staff-Centered Annotations 4 Appendix: Starter List of College Novels
Determination of the pulse wave velocity by a filtered cross-correlation technique

Abstract A cross-correlation technique is presented to determine the average time lag between simultaneous pulse wave tracings at two points by considering the similarity of the complete wave series. It is shown that a true average phase velocity can be meaningfully defined for a natural pulse wave by the correlation technique. The cross-correlation technique is also performed on the pulse wave series of a particular frequency component isolated from the original series with a specially designed digital band pass filter. It is shown that well defined dispersion curve of pulse wave velocity can be determined from the filtered cross-correlation technique. The conventional method to determine pulse wave velocity from a single characteristic point is discussed in the light of the findings of the present study.
Breakpoint detection using covariance propagation

Presents a statistical approach for detecting breakpoints from chain encoded digital arcs. An arc point is declared as a breakpoint if the estimated orientations of the two fitted lines of the two arc segments immediately to the right and left of the arc point are significantly statistically different. The major contributions of this research include developing a method for analytically estimating the covariance matrix of the fitted line parameters and proposing a perturbation model to characterize the perturbation associated with each arc point.
Inertia, environments and strategic choice: a quasi-experimental design for comparative-longitudinal research

This paper develops a research design for examining the relative influence of managers and environments on organizational activity over time. We outline three basic models of organization evolution: 1 an inertial model, which emphasizes constraints on evolution imposed by early patterns of exchange; 2 an external control model, which posits change in organizational activities that is guided by changes in environmental conditions over time; and 3 a strategic management model, which emphasizes the role of senior executives in choosing patterns and domains of competitive activity. Using the general logic of experimental design, we outline methods for comparing longitudinal patterns in change and persistence that will distinguish between these alternative perspectives. Specifically, we describe procedures for operationalizing two basic parameters of research design: 1 the organization population cohort, which imposes systematic restrictions on sampling; and 2 a generalized version of the product class life cycle, which helps isolate changes in environmental conditions for comparing organizational activity patterns over time. Data from an ongoing study of firms in the minicomputer product class are presented to illustrate these concepts.
On fighting in mice: Situational determinants O intragroup dyadic stimulation

Two experiments are reported in which it was shown that small groups of C57BL/10 mice intensively investigate animals that are introduced into their living compartments. The effects were obtained regardless of whether the animal was a member of the group or was unfamiliar to it. Whether or not the investigatory activity escalates into fighting seemed dependent upon the reactivity of the animal being stimulated, with previously isolated mice being most reactive.