cssi/SciSciGPT-SciSciNet huggingface dataset:
Keeping a consulting system on course

All to often, User Services staff view the absence of complaints as a primary source of evaluation and feedback of services. As a frontline emergency service, the consulting effort is one of the most visible and critical elements of effective user support. It is difficult to collect data about the effectiveness and quality of frontline consulting services, but many techniques provide enlightening information for user services staff.At Brown University collecting data and feedback about the consulting process is a priority for Academic and User Services. A Consulting Task Group was formed to collect feedback from a variety of sources and to prepare a plan and implement a new structure (where necessary) for our computer consulting system. We quickly identified areas where immediate improvement resulted and committed to the longer term project of collecting data. By keeping data from “support log forms” at the point of consulting contact we have gained the following insights: the profiles of the computing user community — who & when & how are questions being askedwhat the typical and atypical questions are and how frequently they are askedthe percentage of questions referred to expert sourcesthe management issues of allocation of resources, revision of training curriculum, and restructuring of consulting to meet Brown's needs.Computer consulting takes on many forms and can be a complex and time consuming task. Knowing the key elements of the consulting environment, such as the volume of questions, frequency of questions, types of questions, and referral path of questions, can have a positive impact on the management and effectiveness of services. But data collection through log forms is not the only technique we have used for collecting information on the health of the consulting system at Brown.Additional techniques of gathering information about the consulting effort have also proved to be important, such as conducting “key user information sessions”. We have also emphasized taking the time to gather street smarts and conduct more housecalls; an aspect of consultant savvy that tends to be neglected because of the frantic pace of consulting.The results of Brown's first phase of support log data and key user information sessions will be reviewed in this paper. The presentation will include statistics, graphs, and anecdotal reviews of the data collection effort. Handouts will be available. Techniques for gathering information will be offered, as well as how such information can be used to improve the quality of consulting services.
New wine in old bottles: Increasing the coherence of early childhood care and education policy

Early childhood care and education (ECCE) policy is inadequately funded, fragmented, and internally inconsistent. The roots of these problems lie in historic social transformations that have fundamentally altered the public interests in ECCE and antiquated the programmatic structures which shape ECCE policy. The public interests in ECCE are analyzed and federal policy from the mid-1960s to the early 1990s is chronicled, with particular attention to changes in the amount of funding and its allocation. Policy changes beginning around 1988 may have signaled an important shift in federal policy, but problems of incoherence appear to have intensified. Alternative proposals for systemic reform of ECCE policy are evaluated and specific recommendations are made for radical restructuring of federal policy.
The taste reactivity test. I. Mimetic responses to gustatory stimuli in neurologically normal rats

Abstract One or two bottle preference tests, i.e., relative fluid consumption, constitute the primary methodology for determining acceptance or rejection of tastes in animals other than humans. These tests require organisms to initiate and maintain drinking behavior and, therefore, can not be applied to preparations which do not eat or drink spontaneously. The taste reactivity test, a new method for assessing responses to gustatory stimuli, circumvents this shortcoming. A 50 μl taste stimulus is injected directly into the oral cavity of a freely moving rat and the immediate response videotaped for frame by frame analysis. Each of the sapid stimuli used (4 concentrations of sucrose, NaCl, HCl, and quinine HCl) generated a stereotyped response derived from 3 lexicon of 4 mimetic (movements of lingual, masticatory, and facial musculature) and 5 body response components. Responses to taste stimuli were highly consistent within and between rats. For example, sapid sucrose, NaCl and HCl stimuli elicited a response sequence beginning with low amplitude, rhythmic mouth movements, followed by rhythmic tongue protrusions, and then lateral tongue movements. No body movements accompanied these mimetic responses. In contrast, quinine in concentrations at and above 3 × 10 −5 M ( 1 2 log step above the absolute behabioral threshold for quinine) elicited a response pattern beginning with gaping and proceeding through as many as 5 body responses. These normative data for the intact rat can be directly compared to the taste reactivity of neurally ablated preparations which do not spontaneously feed or drink. Such comparisons can be utilized in determining the neural substrates necessary for the execution and regulation of ingestive behavior.
The Open Abdomen

Temporary closure of the abdomen following a laparotomy for trauma or emergency surgery (open abdomen) is an invaluable tool that improves patient outcomes. It allows the surgeon to control bleeding or sepsis with as little physiologic stress to the patient as possible. Ongoing resuscitation in the intensive care unit (ICU) in the patient with an open abdomen followed by the definitive procedure can, in select patients, improve outcomes. Unfortunately, the open abdomen also has many potential, associated complications. This chapter discusses the history of the open abdomen, indications for temporary closure of the abdomen, the evolution of the care of the laparotomy wound, abdominal closure techniques following the open abdomen, and complications of the open abdomen.
Effect of Cation on the Mössbauer Spectra of Tetrahaloferrate Anions

The tetrahaloferrates are high-spin, tetrahedral Fe (III) complexes and as such, they should have spherical electric field symmetry. Thus expects to observe only a small (or zero) quadrupole splitting derived from lattice effects for these anions. However, if chemical effects, such as hydrogen bonding, are present to destroy or distort the tetrahedral symmetry one can expect to see larger quadrupole splittings due to the distortion of the electric field symmetry. This paper describes the Mossbaure spectra at liquid-nitrogen temperature for a series compounds of the form (R)4−nNHnFeC14, where R is a straight-chain alkane. In the methyl series where R is -CH3, a single narrow line was observed for (CH3)4NFeCl4 and (CH3)NH3FeCl4. A quadrupole splitting of approximately 0.33 mm/sec was observed for (CH3)2NH2-FeCl4, and a single, broadened peak (Г = 0.54 mm/sec) was found for (CH3)3NHFeC14. For the corresponding butyl series, where R is -(CH2)3CH3, a splitting of approximately 0.33 mm/sec was observed in all cases except tetrabutyl, [CH3(CH2)3]4NFeCl4, where a narrow singlet was again obtained. To rule out the Possibility that the splittings were arising from lattice effects, the butyl compounds were dissolved in benzene and the spectra repeated at liquid-nitro temperatures. The Mossbauer spectrum of each compound in solution was identical with that obtained for the crystalline solid. Thus it appears that the quadrupole interactions are not of lattice origin but are caused by cation diatortion of the spherical symmetry. The most reasonable explanation appears to be hydrogen bonding, which exists both in the solid state and in solution. Correlations of the observed Mossbaure spectra with far-infrared data (where metal-halide stretching and bending vibration can be seen) are presented. Also other cations and their effects are discussed,as well as effects observed for other tetrahaloferrates such as FeBr4 -.
PRODUCT DEVELOPMENT DECISION SUPPORT SYSTEM CUSTOMER-BASED

Quality Function Deployment (QFD) has been traditionally used as a planning tool primarily for product development and quality improvement. In this context, many people have used QFD for making decisions on how to prioritize critical product areas from a customer perspective. However, it is the position of the author that the QFD process can be viewed as a decision support system that would encompass multiple facets of information to enhance the quality and output of the decision making process in the course of product development. In this paper, the author submits the QFD process in combination with other engineering decision making tools such as the Pugh concept selection and the Kepner-Tregoe analysis technique as a decision making and modeling process that is as old as management science itself. Specifically, the attempt is made to illustrate how QFD provides an iterative sequence of steps involved in decision making, from the initial problem identification to a proposal for the actual implementation plan. To make this position more applicable to the reader, the subject has been approached from an actual business environment.
A comparative life cycle assessment (LCA) of lighting technologies for greenhouse crop production

Abstract Greenhouse, indoor or vertical horticulture using supplemental lighting have become an important part of specialty crop cultivation. This study reports a comparative life cycle assessment of different lighting systems applied in greenhouse crop production. Two typical cases are considered: (1) 1000 W HPS lighting system vs. 650 W LED lighting system with functional unit defined as 653 kg tomatoes from 8 sq. ft. floor area over 15 year; (2) 150 W incandescent lighting vs. 18 W LED lighting with functional unit defined as 1640 sq. ft. of bedding plants from 8 sq. ft. floor area over 15 year. Impact assessment is done using TRACI methodology and cumulative energy demand (CED) is also considered. The results show that 650 W LED lighting system has smaller environmental impact than the HPS lighting system (38%–47% reduction). The use phase dominates the total environmental impacts (approximately 74%–97% for HPS lighting system, and 78%–100% for LEDs). Benefits of substituting LEDs for incandescent lighting for greenhouse applications are even larger leading to a significant reduction (67%–90%) on most environmental impact categories considered (except carcinogenics where LED is 12% higher)). For this case, the use phase remains the largest contributor, accounting for 28%–100% for incandescent and 47%–100% for LEDs.
A Fused Floating-Point Four-Term Dot Product Unit

This paper presents a novel design for a fused floating-point four-term dot product unit. The dot product is one of the most frequently used operations for a wide variety of graphics, digital signal processing (DSP) and statistical applications. The proposed design computes the four-term dot product in a single unit to achieve better performance and accuracy compared to a network of traditional floating-point multipliers and adders, which is referred to as a discrete design. In order to further improve the performance of the fused floating-point four-term dot product unit, a new exponent compare and significand alignment scheme, dual-reduction, early normalization, four-input Leading Zero Anticipation (LZA), and compound addition and rounding are applied. The proposed design is implemented for both single and double precision and synthesized with a 45 nm CMOS standard-cell library. In order to evaluate the improvement of the proposed design, the area, latency, and power consumption are investigated. The proposed design reduces the area, power consumption and latency by about 40% compared to the discrete design.
Enhanced delamination of ultrathin free-standing polymer films via self-limiting surface modification.

Free-standing polymer thin films are typically fabricated using a sacrificial underlayer (between the film and its deposition substrate) or overlayer (on top of the film to assist peeling) in order to facilitate removal of the thin film from its deposition substrate. We show the direct delamination of extraordinarily thin (as thin as 8 nm) films of poly(vinyl formal) (PVF), polystyrene, and poly(methyl methacrylate). Large (up to 13 cm diameter) films of PVF could be captured on wire supports to produce free-standing films. By modifying the substrate to lower the interfacial energy resisting film–substrate separation, the conditions for spontaneous delamination are satisfied even for very thin films. The substrate modification is based on the electrostatic adsorption of a cationic polyelectrolyte. Eliminating the use of sacrificial materials and instead relying on naturally self-limiting adsorption makes this method suitable for large areas. We have observed delamination of films with aspect ratios (ratio...
Abstract P6-09-08: Patient Preference for Intra-Operative (TARGIT) or External Beam Radiotherapy Following Breast Conservation

Background: Recently published data for the TARGIT Trial (a randomized trial comparing Intraoperative Radiotherapy [IORT] for equivalence to External Beam Radiotherapy [EBRT] following lumpectomy for invasive breast cancer for selected low risk patients) shows equivalence for the IORT and EBRT arms at 4 years follow-up[1]. The TARGIT steering committee originally used a 2.5% non-inferiority margin for statistical considerations at trial initiation. We hypothesized that patients would indeed choose IORT even with the possible 2.5% inferior local recurrence rate and can now compare recently published data to patient preference. Methods: We used a validated tradeoff technique to quantify any additional risk patients would accept to receive either treatment. Subjects who were candidates for breast conserving radiation were presented with a slideshow comparing EBRT with IORT, and then asked their preference given hypothetical recurrence risks. Two initial Tradeoff Slides were used to assess whether the initial risk comparison had an effect on patients’ switch points. The first stated both forms of radiotherapy lead to a 10% 10 year risk of local recurrence, while the second stated EBRT leads to a 10% risk versus an IORT risk of 20%. Subsequent tradeoff slides incrementally increased or decreased the rate of recurrence associated with IORT until the subject preference changed. Results: Data from 81 patients were analyzed. The median additional accepted risk to have IORT was 2% (-9% to 39%). There were two outliers who accepted 34% and 39% additional risk with IORT. Only 7 patients chose to accept additional risk for EBRT; 22 accepted IORT at no additional risk, and the remaining 52 chose IORT with some additional risk. Patients who were grade 2 or 3 (versus 1) were more likely to accept a higher additional risk for IORT. No other factors studied correlated with a higher additional tolerated risk for IORT. Conclusions: Some patients chose to consider IORT even if experimental and with a higher risk for 10 year local recurrence compared to EBRT. The recetly published results from the TARGIT Trial at 4 years reported a 1.2% (95%CI 0.53-2.71) local recurrence rate for TARGIT and a 0.95% (95%CI 0.39-2.3) local recurrence for EBRT, clearly within the projected margin of 2.5% inferiority. Thus, it may be appropriate to consider offering TARGIT as an informed option on registry trial to selected low-risk patients. 1. Vaidya, J et al. Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial), Lancet available online June 4, 2010 Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-09-08.
Effect evaluation of HIV /AIDS-related knowledge education for school teenagers in Fuzhou City

[Objective]To understand the awareness rate of HIV /AIDS-related knowledge among school teenagers,to evaluate the effect of the HIV / AIDS-related education,and provide scientific evidence for carrying out it in school.[Methods]By using stratified cluster sampling method,the students from 2 senior schools and 2 vocational high schools were recruited to listen to seminars.The effect of HIV / AIDS-related knowledge education was evaluated via questionnaire survey.[Results]Before training,the awareness rates of main routes of transmission such as blood transmission,perinatal transmission,sexual contact,sharing needles were relatively high( all above 87. 8%) among students; but the awareness rates of non-transmission routes were between 54. 2%-71. 4%.After training,the awareness rates were significantly increased. The awareness rate of AIDS-related knowledge about the main routes of transmission was more than 92. 0% and the rate of non-transmission routes was more than 85. 9%. Also the knowledge level of prevention and control was significantly increased. Most students wanted to obtain knowledge via television. was restudents knew more about than non-transmission routes. Before education,the awareness rate of AIDS-related knowledge about the main routes of transmission is more than 87. 8% and the rate of non-transmission routes is 54. 2% ～ 71. 4%. After education,students' knowledge level is significantly increased. The awareness rate of AIDS-related knowledge about the main routes of transmission is more than 92. 0% and the rate of non-transmission routes is more than 85%. Also the knowledge of prevention and control is significantly increased. The most popular way to obtain knowledge is television. [Conclusion]Through the AIDS seminar,students' knowledge level of HIV / AIDS is significantly increased. And the attitude to the people with HIV / AIDS tends to be positive. But the education related to AIDS prevention still needs to be enforced to promote the awareness of AIDS knowledge
The floating cardiac fat pad—sign of occult pneumothorax

Pneumothoraces are a possible sequela of chest trauma with potential morbidity and mortality if not recognized and treated promptly. A portable supine chest radiograph is frequently the first radiologic study performed in the setting of trauma. While large pneumothoraces can be readily recognized on these radiographs, smaller pneumothoraces are missed in up to 15 % of trauma patients. There are many radiographic signs of occult pneumothoraces, and we are presenting a new radiographic sign of occult pneumothorax. The floating cardiac fat pad sign occurs when pleural air collects anteriorly and superiorly in the most non-dependent portion of the chest lifting the pericardial fat pad off the diaphragm. Lung markings are still seen surrounding the pericardial fat pad due to the inflated lower lobe of the lung resting dependently. Rapid and accurate identification of pneumothoraces is critical but often difficult on chest radiographs. Although there are many existing radiographic signs for identification of pneumothorax, prospective identification of small pneumothoraces is still relatively poor. Here, we describe an additional sign which aides in the detection of pneumothoraces, the floating cardiac fat pad. When present, this should prompt further evaluation with chest CT or upright chest radiograph.
What to Do When There's No 'I Do': A Model for Awarding Damages Under Promissory Estoppel

Since its inception in the seventeenth century, the common-law action for breach of promise to marry has been the subject of recurrent legal debates. Beginning in the 1930s, some states began passing statutes that abolished the action altogether. Even so, today about half of American jurisdictions retain the breach-of-promise action in some form. This Article advocates a compromise that is not currently the law in any American jurisdiction: parties who breach promises to marry should be liable for damages, but only to the extent they have induced reliance by those to whom they were formerly engaged. Under this proposed model, courts would employ promissory estoppel to define both the nature and scope of damages available to those aggrieved by broken nuptial promises. Through the prism of promissory estoppel, this Article re-examines the broad range of damages courts traditionally awarded breach-of-promise plaintiffs at common law and explains why, given modem social conditions, reliance damages are the only appropriate elements of recovery. In this context, reliance damages would include provision both for expenditures made and economic opportunities foregone in anticipation of marriage. The reliance-based approach advocated in this Article would encourage responsibility, honesty, and forthrightness in romantic relationships, but avoid the abuses associated with the historical breach-of-promise action.
Acetaminophen: Acute Overdose Toxicity in Children:

The use of acetaminophen in young children has increased, in part due to concerns over the association of Reye's syndrome with aspirin. Accidental ingestion of acetaminophen in this age group has also increased, and treatment of overdose in children has been controversial. Recommendations for treatment of adolescents and young children are presented, based on the acetaminophen nomogram. It is recommended that children in the highest risk group (above the upper nomogram line) be treated with N-acetylcysteine, even though treatment may be unnecessary in many.
Laboratory Evaluation of Hyper- and Hypoglycemic States

Appropriate use of test strategies requires not only an appreciation of analytic considerations and the ability of the tests to confirm or exclude the hypotheses, but also an understanding of the underlying pathophysiology and clinical features of the problems to be addressed. This discussion covers disease definition, pathophysiology, analytic considerations, and strategies for diagnosis and management.
A randomized controlled trial of brief interventions for problem gambling in substance abuse treatment patients

Objective This study evaluated the efficacy of brief gambling treatments in patients attending substance abuse treatment clinics. Method Substance abuse treatment patients with gambling problems (N = 217) were randomly assigned to a 10- to 15-min brief psychoeducation gambling intervention; a 10- to 15-min brief advice intervention addressing gambling norms, risk factors, and methods to prevent additional problems; or 4 50-min sessions of motivational enhancement therapy plus cognitive behavior therapy for reducing gambling (MET + CBT). Gambling and related problems were assessed at baseline and throughout 24 months. Results In the sample as a whole, days and dollars wagered and gambling problems decreased markedly from baseline through Month 5; thereafter, reductions in dollars wagered and gambling problems continued to decrease modestly but significantly, and days gambled remained constant. Brief advice significantly reduced days gambled between baseline and Month 5 relative to brief psychoeducation. The MET + CBT condition engendered no benefit beyond brief advice in terms of days gambled but did lead to more precipitous reductions in dollars gambled and problems experienced in the initial 5 months, and greater clinically significant improvements in gambling in both the short and long term. MET + CBT also resulted in initial decreases in self-reported alcohol use and problems but did not differentially impact self-reported illicit drug use or submission of positive samples. Conclusions Gambling problems tend to dissipate over time regardless of the intervention applied, but offering MET + CBT was more efficacious in decreasing gambling than providing a brief single session intervention. (PsycINFO Database Record
Prostate Carcinoma Surveillance Counterpoint: USA

Surveillance strategies following curative therapy for prostate cancer have been debated in the literature. Many institutions have developed their own algorithms. In this counterpoint, we discuss our experience at the University of North Carolina-Chapel Hill. Predictors of prostate cancer recurrence along with surveillance strategies are outlined for various treatment modalities, including radical prostatectomy, radiation therapy, ablative therapies, and active surveillance.
The Salafi Mystique: The Rise of Gender Segregation in 1970s Egypt

In this article, I trace the emergence of gender segregation within contemporary Salafism, focusing on Egypt as a case study to examine the interaction between textual hermeneutics, ideological cross-pollination and political competition. Drawing on two Egyptian Salafi magazines, alongside a variety of pamphlets and lay-oriented works by Salafi and non-Salafi authors alike, I challenge a majority view that claims gender segregation as a long-established religious principle and practice, while historically contextualizing a minority view that gender segregation arose out of contemporary political calculations. Specifically, although the core anxieties of women’s presence in public were not new, the attempt to comprehensively regulate women’s presence in state institutions and on mass transportation was a response to contemporary intellectual trends, particularly the project of State Feminism and leading Muslim Brotherhood thinkers during the Nasser period (1952–1970), and to political competition with the Brotherhood during the 1970s.
Chapter One: Persian Empire?

At the current volatile geopolitics of the region, the ruling regime in Iran has survived against all odds—under severe pressure, both internal and external to its borders. The politics of crisis management is definitive to this state. A postnational account of the nation, as I propose to do, does not abandon the national frame of reference, or its entanglement with the state that claims it, but embraces the nation within a larger transnational frame of reference that contrapuntally makes the national scene more meaningful. In this chapter, I begin with a panoramic view of the region at large, where the role of Iran has become consistently more dominant, to the point that some observers in the Arab and the larger Muslim world are speaking of a resurrection of “the Persian Empire.” This is a false analogy, I will argue, and a red herring. There is only one flagellant empire in our world, the US Empire, and it is not particularly a potent or competent empire. Instead of fishing for flawed metaphors, we need to reconfigure the geopolitics of the region, in which the ruling regime in Iran has amassed considerable soft power, waging a successful asymmetrical warfare to protect its domestic and regional interests. What we see as a result is not an “empire” but a new geostrategic reality in which Iran is dominantly mapped out not by virtue of any inherent hard power or a particularly powerful political leadership but mostly by virtue of the follies of the USA and its European and regional allies and their misbegotten imperial vagaries. Beginning with the geopolitics of the region will enable us to frame the Iranian national scene in a far better frame of reference.
THE EFFECT OF COPPER ON DISTILLED WATER QUALITY FOR USE IN MILK AND WATER LABORATORIES

Summary Levels of copper toxicity have been established in distilled water using the distilled water suitability test. It is shown that levels of copper, toxic by the distilled water suitability test, are not toxic to the test organism, Aerobacter aerogenes, in sterile milk or to the normal bacterial flora of a raw milk sample. It is the contention of this paper that the distilled water suitability test is an unrealistically severe yardstick of distilled water quality for use in routine milk and water laboratories.
In-Line and Roller Skating

At the height of their popularity, roller skating and in-line skating were a major public health concern. Roughly $4 billion dollars were spent in 1997 treating injuries related to these recreational activities. While most of these sports-specific injuries tend to be of the upper extremity, ankle injuries tend to be more severe that require operative treatment.
Unrelated Donor Hematopoietic Stem Cell Transplantation for the Treatment of Advanced Multiple Myeloma: The John Theurer Cancer Center Experience,

Abstract 4162 Allogeneic hematopoietic stem cell transplantation has been associated with a graft-versus-myeloma effect and may be the only potentially curative option for patients with advanced multiple myeloma. Unfortunately, the majority of patients (pts) do not have an HLA-identical sibling. Unrelated donor transplantation is an alternative option for these patients. We conducted a retrospective analysis of patients with advanced multiple myeloma who received an unrelated donor (URD) hematopoietic stem cell transplant at our institution between 11/1997 and 11/2010. Analyses were done using Kaplan Meier survival and Cox regression on the SAS version 9.2 software. Between 11/1997 and 11/2010, 27 pts with multiple myeloma received an URD transplant. One patient was lost to follow-up and 26 pts are evaluable. Patient characteristics included: median age 52 years (range 37–64), male 58%, all patients had prior autologous transplant (23% of pts had 2 or more prior transplants), and 43% of pts had refractory or progressive disease at the time of transplantation. Transplant regimens were ablative (defined as melphalan dose > 140mg/m2) in 73% of pts. GVHD prophylaxis was tacrolimus-based in all. Hematopoietic cell source was peripheral blood for 92% of pts, 46% of pts received a 10/10 HLA matched URD and 54% had a least one allele mismatch. Results: With a median follow up of 3.4 years, 54% of patients are alive and 47% of patients are progression-free. The treatment-related mortality at day 100 was 15%. The incidence of acute graft-versus-host disease (GVHD) was 44% and chronic GVHD 25%. Univariate analysis of risk of progression or relapse and overall survival failed to show any significance for disease status at the time of transplantation, degree of donor match, transplant regimen, refractoriness to bortezomib or lenalidomide, acute or chronic GVHD. Conclusion: In this analysis, URD transplantation has an acceptable treatment related mortality, and leads to durable remissions even in patients with relapsed and/or refractory disease. The 3.4 year PFS is similar to the BMT CTN 0102 sibling data and compares favorably to related donor transplantation for relapsed disease. In comparison to the BMT CTN study, the preparative regimen in this current analysis was overall more intense and regimen intensity has been previously shown to be significant. Allogeneic transplantation is an effective treatment strategy in multiple myeloma. Unrelated donor transplantation should be offered to patients with advanced multiple myeloma who do not have an HLA-identical sibling. Disclosures: No relevant conflicts of interest to declare.
Local anesthetics systemic toxicity association with exparel (bupivacaine liposome)- a pharmacovigilance evaluation.

ABSTRACTBackground: Local anesthetic systemic toxicity (last) is a rare life threatening complication usually from intra-arterial or intravenous injection leading to systemic absorption of regional anesthesia drug. the objective of this research was to statistically quantify the association between exparel (bupivacaine liposome) injectable suspension and last.Methods: Adverse Event Reporting System database of FDA, which houses public and industry submitted adverse event case reports, was queried and analyzed to quantify the passive pharmacovigilance signal for Local Anesthetic Systemic Toxicity as associated with use of bupivacaine Liposome.Results: A dis-proportionality analysis of the signals yielded a significant association between Local Anesthetic Systemic Toxicity and Exparel. The Chi-Squared with Yates’ correction was 596.66 and Proportional Reporting Ratio was 6.23 [95% CI: 5.41–7.18]).Conclusion: The health care provider, including anesthetists, should be made aware that as with bupivacaine HCl,...
Abstract 2326: Timing of Clinical Grade Assessment and Poor Outcome in Patients with Aneurysmal Subarachnoid Hemorrhage

Introduction: Timing of clinical grading has not been fully studied in patients with aneurysmal subarachnoid hemorrhage (aSAH). Our primary objective was to identify at which time point the clinical assessment using the World Federation of Neurological Surgeons Scale (WFNS) and the Glasgow Coma Scale (GCS) is most predictive of poor functional outcome. Methods: Retrospective cohort study on the association of clinical grading determined at presentation, nadir and post-resuscitation, and poor outcome. Poor functional outcome was defined as Glasgow Outcome Scale score of 1-3 at 6 months. The study was approved by our Institutional Review Board. Results: We identified 186 consecutive patients admitted to a teaching hospital between January 2002 and June 2008. Patients’ mean age was 56.9±13.7 years and 63% of the patients were women. Twenty-four percent had poor functional outcome (mortality was 17%). On univariable logistic regression analyses, GCS determined at presentation (OR=0.80; p Conclusions: Timing of WFNS assessment affects its prognostic value. Outcome after aSAH is best predicted by rating WFNS after neurological resuscitation.
Treatments for giant cell arteritis: Meta-analysis and assessment of estimates reliability using the fragility index.

Abstract Background To better communicate the results of randomized controlled trials (RCTs) of giant cell arteritis (GCA), we propose the use of the fragility index (FI), which is an intuitive measure defined as the minimum number of subjects whose status would have to change (e.g., from having the outcome to not) to render a statistically significant result nonsignificant, or vice-versa. Methods We conducted a systematic review and random-effects meta-analysis of RCTs of glucocorticoid (GC) sparing strategies for relapse-free maintenance in GCA, and used the FI to simplify the presentation of results. Results Ten RCTs (nine phase II and one phase III enrolling 645 subjects) were included. Tocilizumab, IV GC and methotrexate significantly improved the likelihood of being relapse free with relative risks and 95% confidence intervals of 3.54 (2.28, 5.51), 5.11 (1.39, 18.81) and 1.54 (1.02, 2.30); respectively. The median FI was 4.5 (range, 1–28), and was generally higher for negative RCTs (n = 6; median FI 4.5) than for positive RCTs (n = 4; median FI 3.5). The range of FI per treatment was (1–8) for methotrexate, (2–6) for anti-TNF agents, 4 for abatacept, 3 for IV GC pulses and (4–28) for tocilizumab. Conclusion Tocilizumab, IV GC and methotrexate improve the likelihood of being relapse-free in subjects with GCA. Assessment of GC sparing strategies in GCA has long depended on imprecise trials that would change significance if outcomes were reversed for a handful of subjects. FI may be used in rheumatology to simplify communication of statistical significance and overcome limitations of p-value.
Clinical-Community Collaboration: A Strategy to Improve Retention and Outcomes in Low-Income Minority Youth in Family-Based Obesity Treatment.

Abstract Background: Clinical-community collaboration is a promising strategy for pediatric obesity treatment, but current research is limited. This study examined the effect of a family-based treatment program embedded in a primary care clinic on retention and changes in child weight status at 1 year. Methods: Children (2–16 years, BMI ≥85th percentile, 87.0% Hispanic) and their parents were recruited from a single pediatric clinic for Healthy Hawks Primary Plus (HHP+). Children were referred by physicians and enrolled by a bilingual clinic-based recruitment coordinator. Participants received 12 weekly 2-hour sessions focused on lifestyle modification and health behavior change and then received bimonthly follow-up visits with their clinic-based physician through 1-year follow-up. Child body mass index (BMI) percentage of the 95th percentile (%BMIp95) was measured as the primary outcome at baseline, postintervention, and 1-year follow-up. Random effect multilevel models assessed changes in child weight s...
Expressing Intrinsic Motivation Through Acts of Exploration and Facial Displays of Interest

Intrinsically-motivated behavior has been defined through participants' task persistence, during a free-choice interval. While fruitful, this operational definition assesses only the person's postperformance reaction to an activity. Presumably, people experience and express intrinsic motivation during task engagement as well. The need therefore exists for a supplemental in-performance behavioral measure of intrinsic motivation. To test the viability of constructing such a measure, we recorded the extent to which five acts of exploration and four facial displays of interest corresponded to self-reports of interest, self-determination, and competence for 60 undergraduates as they solved SOMA puzzles. Correlational and LISREL analyses confirmed the validity of three acts of exploration and two facial displays of interest We concluded that just as task persistence is a valid postperformance indicator of intrinsic motivation, acts of exploration and facial displays of interest are valid in-performance indicators.
In Search of the Active Sites in Endotoxins

The history of fever, studies of its effects and search for its origin, go back as far as the history of medicine. The beneficial effects of fever were praised by famous healers in Egypt, Greece, and in the Roman and Persian empires several millenia ago. This appreciation continued through the Middle Ages into our modern times, when “fever therapy” was applied to diseases as diverse as rheumatoid arthritis (Barsi, 1947), manic depression (Terry, 1939), headaches (Sutherland and Wolf, 1940), neurosyphilis (Favorite and Morgan, 1946), herpes zoster (Bernstein and Klotz, 1947), various eye and skin diseases (Tucker, 1946), and many others.
Privacy-Preserving Average Consensus on Directed Graphs Using Push-Sum

Average consensus is key for distributed networks, with applications ranging from load balancing for parallel processors, network synchronization, distributed information fusion, to decentralized control. To reach agreement, existing average consensus algorithms require each node to exchange explicit state values with its neighbors, which results in the undesirable disclosure of sensitive state information. In this paper, we propose a novel average consensus approach for directed graphs which can protect the state privacy of participating nodes without the assistance of any trusted third party or aggregator. By leveraging the inherent robustness of consensus dynamics to embed privacy in random coupling weights between interacting nodes, our proposed algorithm can guarantee consensus to the exact value without any error. This is in distinct difference from differential-privacy based average consensus approaches which enable privacy through compromising accuracy in the consensus value. By using two different weight matrices, our proposed algorithm is able to prevent disclosing a node’s initial value to honest-but-curious nodes. What’s more, by encrypting exchanged information, the proposed algorithm can also provide privacy protection against inference by external eavesdroppers wiretapping communication links. Numerical simulations and hardware experiments on Raspberry Pi boards confirm that the algorithm is lightweight in computation and communication.
The Maryland Health Enterprise Zone Initiative Reduced Hospital Cost And Utilization In Underserved Communities

The State of Maryland implemented the Health Enterprise Zone Initiative in 2013 to improve access to health care and health outcomes in underserved communities and reduce health care costs and avoi...
A risk-stratified approach to neoadjuvant chemotherapy in muscle-invasive bladder cancer: implications for patients classified with low-risk disease

To validate published risk criteria for informing use of neoadjuvant chemotherapy (NAC) in patients with muscle-invasive bladder cancer (MIBC), and to examine outcomes of low-risk (LR) patients treated with immediate radical cystectomy (RC). We identified 1931 patients who underwent RC for MIBC from 1980 to 2016. Patients were considered high risk (HR) with hydronephrosis, lymphovascular invasion, variant histology and/or cT3/4 disease. Kaplan–Meier survival estimates were compared to patients classified as LR, and logistic regression was used to examine factors associated with pathologic downstaging. A total of 1025 LR and 906 HR patients were identified. Median follow-up was 6.3 years (IQR 2.6–12), during which time 1321 (68%) patients died, 753 (39%) from bladder cancer. HR patients had significantly lower 5-year CSS than LR patients (50% vs. 68%, p = 0.001). Of 561 cisplatin-eligible LR patients treated with RC without NAC, 293 (52%) had pathologic non-organ confined disease; of these, 81 (14%) received adjuvant chemotherapy; 78 (14%) did not due to a perioperative event, while 134 (24%) did not due to patient/provider choice. NAC in LR patients was associated with greater odds of pT0 (OR 3.05; p < 0.001) and < pT2 (OR 2.53; p < 0.001) disease, but was not significantly associated with CSS (p = 0.31). Our results validate the proposed risk groups. Among LR patients treated without NAC, 52% experienced pathologic upstaging, and 14% were unable to receive adjuvant chemotherapy due to a perioperative event. These data support offering NAC to both HR and LR MIBC patients, and may be useful for patient counseling.
Renal cell carcinoma: the oncological outcome is not the only endpoint.

The primary focus for patients diagnosed with cancer is the prognosis in terms of survival. Equally, surgeons are generally concerned about the treatment approach of the tumor, the recurrence-free survival and cancer-specific survival. However, there is a balance between surgical cure of the renal mass and renal functional preservation.
Treatment of Type 1 Diabetes with Anti-CD3 Monoclonal Antibody

Anti-CD3 monoclonal antibodies (MAbs) were developed as a way of inducing immune suppression of T cells. More recent studies have indicated that anti-CD3 MAbs can affect immune responses by inducing immune regulation. We recently reported that a single course of treatment with a non-FcR binding anti-CD3 MAb, hOKT3γ1 (Ala-Ala), can lead to preservation of insulin production in patients with new-onset Type 1 diabetes for even beyond 1 yr after treatment. The sustained insulin production was accompanied by improvement in glucose control and reduced use of insulin. Our studies of the mechanism of the non-FcR binding anti-CD3 MAb indicate that the MAb delivers an activation signal to T cells resulting in disproportionate production of interleukin-10 (IL-10) relative to interferon-γ(IFN-γ) in vitro compared with FcR binding anti-CD3 MAb, and detectable levels of IL-10, IL-5, but rarely IFN-γ or IL-2 in the serum after treament. In addition, the drug induces a population of CD4+IL-10+ CCR4+ cells in vivo. Preclinical data suggest that anti-CD3 MAb induces a population of regulatory T cells that can prevent or lead to reversal of Type 1 diabetes. The induction of cells with a regulatory phenotype may account for the ability of anti-CD3 MAb to induce immune regulation.
Human cytomegalovirus-specific T-cell receptor engineered for high affinity and soluble expression using mammalian cell display

T-cell receptors (TCR) have considerable potential as therapeutics and antibody-like reagents to monitor disease progression and vaccine efficacy. Whereas antibodies recognize only secreted and surface-bound proteins, TCRs recognize otherwise inaccessible disease-associated intracellular proteins when they are presented as processed peptides bound to major histocompatibility complexes (pMHC). TCRs have been primarily explored for cancer therapy applications but could also target infectious diseases such as cytomegalovirus (CMV). However, TCRs are more difficult to express and engineer than antibodies, and advanced methods are needed to enable their widespread use. Here, we engineered the human CMV–specific TCR RA14 for high-affinity and robust soluble expression. To achieve this, we adapted our previously reported mammalian display system to present TCR extracellular domains and used this to screen CDR3 libraries for clones with increased pMHC affinity. After three rounds of selection, characterized clones retained peptide specificity and activation when expressed on the surface of human Jurkat T cells. We obtained high yields of soluble, monomeric protein by fusing the TCR extracellular domains to antibody hinge and Fc constant regions, adding a stabilizing disulfide bond between the constant domains and disrupting predicted glycosylation sites. One variant exhibited 50 nm affinity for its cognate pMHC, as measured by surface plasmon resonance, and specifically stained cells presenting this pMHC. Our work has identified a human TCR with high affinity for the immunodominant CMV peptide and offers a new strategy to rapidly engineer soluble TCRs for biomedical applications.
Management of mobile species with spatial property rights: Challenges and opportunities

Abstract Territorial Use Rights for Fisheries (TURFs) offer a promising strategy to address overfishing problems faced by many small-scale fisheries. TURFs allocate property rights over fisheries resources to a group of fishers to incentivize optimal resource management. However, a challenge remains when using this strategy to manage mobile species and in locations with high human population densities. In such situations, a single TURF cannot be designed to encompass natural scales of movement while also being small enough to maintain favorable conditions for collective action. A bioeconomic model is used to investigate whether TURF networks have the potential to address this challenge. We explore cooperation incentives faced by TURFs within a network for various resource mobility rates, and investigate how offering a price premium for cooperating TURFs can improve system-wide outcomes. We find that without a market intervention, TURFs that are competing for the same resource have profit incentives to harvest above optimal levels for the entire system (i.e., non-cooperative behavior). We predict that incentives within TURFs will lead to non-cooperative behavior above a certain species mobility rate. However, offering a price premium for cooperating TURFs has the potential to provide the incentives needed to achieve full cooperation. The price premium required to achieve optimal economic outcomes depends on the mobility characteristics of the species being managed, but at maximum is 26% for highly mobile species. Finally, we explore how such market-based initiatives can be implemented and provide some insights on the local conditions that would best support this strategy.
Machine learning for avoiding stagnation in image-based wavefront sensing

Image-based wavefront sensing uses a physical model of an aberrated pupil to simulate a point-spread function (PSF) that attempts to match measured data. Nonlinear optimization is used to update parameters corresponding to the wavefront. If the starting guess for the wavefront is too far from the true solution, these nonlinear optimization techniques are unlikely to converge. We trained a convolutional neural network (CNN) based on Google's Inception v3 architecture to predict Zernike coefficients from simulated images of PSFs with simulated noise added. These coefficients were used as starting guesses for nonlinear optimization techniques. We performed Monte Carlo analysis to compare these predicted coefficients to 30 random starting guesses for total root-mean-square (RMS) wavefront errors (WFE) ranging from 0.25 waves to 4.0 waves. We found that our CNN's predictions were more likely to converge than 30 random starting guesses for RMS WFE larger than 0.5 waves.
Learning and Fun with Geometry Games.

games similar to those illustrated in this article. In general, games can help to improve mathematics achievement (cf., Bright, Harvey, and Wheeler 1985), although any particular game cannot guarantee achievement. Geometry games to be used by elementary and middle school students must be carefully chosen since (a) the geometry backgrounds of these students are often uneven and (b) it is important that the level of the game be consistent with what students know and can do