cssi/SciSciGPT-SciSciNet huggingface dataset:
A Wavelet Packet and Mel-Frequency Cepstral Coefficients-Based Feature Extraction Method for Speaker Identification☆

Abstract One of the most widely used approaches for feature extraction in speaker recognition is the filter bank-based Mel Frequency Cepstral Coefficients (MFCC) approach. The main goal of feature extraction in this context is to extract features from raw speech that captures the unique characteristics of a particular individual. During the feature extraction process, the discrete Fourier transform (DFT) is typically employed to compute the spectrum of the speech waveform. However, over the past few years, the discrete wavelet transform (DWT) has gained remarkable attention, and has been favored over the DFT in a wide variety of applications. The wavelet packet transform (WPT) is an extension of the DWT that adds more flexibility to the decomposition process. This work is a study of the impact on performance, with respect to accuracy and efficiency, when the WPT is used as a substitute for the DFT in the MFCC method. The novelty of our approach lies in its concentration on the wavelet and the decomposition level as the parameters influencing the performance. We compare the performance of the DFT with the WPT, as well as with our previous work using the DWT. It is shown that the WPT results in significantly lower order for the Gaussian Mixture Model (GMM) used to model speech, and marginal improvement in accuracy with respect to the DFT. WPT mirrors DWT in terms of the order of GMM and can perform as well as the DWT under certain conditions.
A Genetic Algorithm Approach to Cluster Analysis

A common problem in the social and agricultural sciences is to find clusters in experimental data; the standard attack is a deterministic search terminating in a locally optimal clustering. We propose here a genetic algorithm (GA) for performing cluster analysis. GAs have been used profitably in a variety of contexts in which it is either impractical or impossible to directly solve for a globally optimal solution to complex numerical problems. In the present case, our GA clustering technique attempted to maximize a variance-ratio (VR) based goodness-of-fit criterion defined in terms of external cluster isolation and internal cluster homogeneity. Although our GA-based clustering algorithm cannot guarantee to recover the cluster solution that exhibits the global maximum of this fitness function, it does explicitly work toward this goal (in marked contrast to existing clustering algorithms, especially hierarchial agglomerative ones such as Ward''s method). Using both constrained and unconstrained simulated datasets, Monte Carlo results showed that in some conditions the genetic clustering algorithm did indeed surpass the performance of conventional clustering techniques (Ward''s and K-means) in terms of an internal (VR) criterion. Suggestions for future refinement and study are offered.
Willard Beatty and Progressive Indian Education

Our real measure of success is what happens to the children. If the children are happy, if they are making spontaneous use of English and enjoy doing so; if they are learning to read and enjoy work with books; if they can count easily and are acquiring automatic recall of number combinations, the teacher is doing a good job whatever methods he is using, or by whatever phrases he describes his educational philosophy. —Willard W. Beatty, Education for Action, 1944
Optical theorem detectors for active scatterers

We develop a new theory of the optical theorem for scalar fields in nonhomogeneous media which can be bounded or unbounded. It applies to arbitrary lossless backgrounds and quite general probing fields. The derived formulation holds for arbitrary passive scatterers, which can be dissipative, as well as for the more general class of active scatterers which are composed of a (passive) scatterer component and an active, radiating (antenna) component. The generalization of the optical theorem to active scatterers is relevant to many applications such as surveillance of active targets including certain cloaks and invisible scatterers and wireless communications. The derived theoretical framework includes the familiar real power optical theorem describing power extinction due to both dissipation and scattering as well as a novel reactive optical theorem related to the reactive power changes. The developed approach naturally leads to three optical theorem indicators or statistics which can be used to detect chan...
Grass and Forest Potential Evapotranspiration Comparison Using Five Methods in the Atlantic Coastal Plain

AbstractStudies examining potential evapotranspiration (PET) for a mature forest reference compared with standard grass are limited in the current literature. Data from three long-term weather stations located within 10 km of each other in the USDA Forest Service Santee Experimental Forest (SEF) in coastal South Carolina were used to (1) evaluate monthly and annual PET estimates from five different methods with varying complexities [Penman-Monteith (P-M), Turc, Thornthwaite (Thorn), Priestley-Taylor (P-T), and Hargreaves-Samani (H-S)] at two grass reference sites; and (2) compare results for the grass sites with PET estimated using the P-M method for a forest reference site using measured daily climatic data for the 2011–2014 period. The grass reference sites are located at the SEF headquarters (SHQ) and in the Turkey Creek watershed (TC). The forest reference station is on a 27-m-tall tower above the canopy of a pine/mixed hardwood forest in watershed WS80 in the SEF. At the WS80 forest site, the highest...
Assessment of WENO Methods with Shock-Confining Filtering for LES of Compressible Turbulence

Large-eddy simulations (LES) rely on a spatial lter to separate turbulent scales into resolved scales and scales to be modeled, and the majority of modern closure models themselves involve ltering operations. The uniform application of discrete linear lters can create new extrema in the vicinity of o w discontinuities. These new extrema can lead to spurious oscillations and to antiphysical features such as negative pressures. This is similar to the dicult y encountered when using a high-order-accurate linear nite dierence scheme for convective terms in a shock-containing o w. In the case of the convective terms, many shock-capturing methods have been devised to provide physically correct solutions free from spurious oscillations. For example, weighted essentially non-oscillatory (WENO) schemes adapt their numerical stencils in the vicinity of a shock to avoid interpolation across it. In this paper, we propose a \shock-conning" lter (SCF) that adapts to avoid ltering across discontinuities. We present a method for constructing an SCF from a general linear lter and assess its performance both in traditional LES models, as exemplied by the dynamic mixed model (DMM), and in mathematical models, as exemplied by the approximate deconvolution model (ADM). Numerical studies of the shocktube problem show that the SCF greatly improves the behavior of the ADM by eliminating spurious oscillations near discontinuities. Simulations of decaying compressible isotropic turbulence show that the SCF gives behavior for the DMM and ADM that is at least comparable to, and in some way better than, the behavior of DMM with linear ltering. Although the best results for the decaying turbulence come from the ADM with relaxation, we do not consider this to be a signican t drawback to the SCF because the SCF enables the ADM to behave qualitatively correctly in o ws where the ADM solution would otherwise exhibit large antiphysical oscillations. Shock-conning ltering in conjunction with ADM improves the prediction of gasdynamics eects without signican tly altering the prediction of turbulence; therefore, we conclude that it holds promise for LES of shock/turbulence interaction problems.
Scaling of Spontaneous Emission and Intermolecular Interactions in a Dielectric Medium Using Polaritons

The theoretical description of the excited state dynamics of molecules embedded in a condensed phase is of great interest in view of the numerous optical experiments that are currently carried out on, for instance, mixed crystals, glasses and solutions. The excited state evolution of the molecules studied is affected by the host medium. Not only does the medium induce dephasing processes, also properties which seem to be intrinsic to the molecules may be altered by the environment. For example, the spontaneous decay rate of an excited molecule embedded in a dielectric differs from the rate for the same molecule in vacuum.[1-3] This phenomenon ties to a much more general current field of interest, in which the problem is addressed how the spontaneous emission of a molecule is affected by both the nature and the geometry of the surrounding space. Systems which draw considerable experimental and theoretical attention within this framework are molecules (dipoles) near dielectric or metallic surfaces,[4] in high Q cavities,[5] in or near small dielectric particles,[6,7] or in an artificial superlattice with a spatial periodicity in the dielectric constant.[8] The common principle underlying all these cases is that the density of states of the eigenmodes of the radiation field depends on the nature and the geometry of the medium considered, and that this density of states is one of the important factors in the Fermi golden rule for the radiative decay rate: $$\gamma = \frac{{2\pi }}{\kappa }{\left| {coupling} \right|^2} \times density{\text{ }}of{\text{ }}states.$$ (1)
G350(P) HASTE: Handover audit of safety, timeliness and efficiency

Background and aims Handover of patients between shifts is an important process, to ensure continuity of care and that important information is communicated to the appropriate personnel. It should be completed in a timely and efficient manner. Interruptions should only be for emergencies or essential clarification. In a large teaching hospital information regarding up to 80 patients needs to be communicated in a half an hour window every morning to a number of subspecialities. Late arrivals delay the start of this process and prolong the duration. Frequent interruptions may disrupt the process. We aimed to evaluate the start time, duration, personnel present and interruptions of morning handover in a tertiary centre. Methods 10 days August to October 2015 were selected and analysed looking at start time and duration of handover, personnel present, whether or not safety briefing was performed and any late attendences, interruptions and non urgent phone calls. The standard was that the safety briefing should be completed 100% of the time and that handover should start on time and there should be no late arrivals. Results Handover on average started 5 min late each morning and 8/10 times the safety briefing was not performed. An average of 3 people were late to handover each morning and on average 2 non urgent phone calls were received each handover. Late attendance and interruptions positively correlated with length of handover with values of 0.48 and 0.45 respectively. Conclusions We concluded that there are too many interruptions which are frequently non urgent. Phone calls from nursing staff about routine tasks were frequent. The delay in starting handover and the duration impacted on the ability of teams to commence ward rounds in a timely manner. Following this audit, we have implemented a reminder about handover etiquette including 10 rules and have provided nursing staff with up to date information about handover timings and the appropriateness of phone calls. Following this intervention a re-audit is underway.
Pulmonary function after laparoscopic cholecystectomy

Background. The purpose of this study was to prospectively compare the effect of laparoscopic cholecystectomy (LC) versus open cholecystectomy (OC) on postoperative pulmonary function. Methods. Forty consecutive patients (20 in each group) who were evenly matched in terms of pulmonary risk factors were assigned to either elective LC or OC. Pulmonary function studies, oxygen saturation, and chest radiography were performed on both groups before and after the operation until baseline levels were reached. Narcotic requirements and pulmonary complications were compared. The t test, ANOVA, and chi-squared analysis were used
Appendicular lean mass and mortality among prefrail and frail older adults

Prefrail and frail older adults are a heterogeneous population. The measurement of appendicular lean mass (ALM) may distinguish those at higher versus lower risk of poor outcomes. We examined the relationship between ALM and mortality among prefrail and frail older adults. This was a population-based cohort study. The Third National Health and Nutrition Survey (NHANES III; 1988-1994). Older adults (age ≥65 years) with pre-frailty or frailty defined using the Fried criteria. ALM was quantified using bioimpedance analysis. Multivariable-adjusted Cox regression analysis examined the relationship between ALM and mortality. Logistic regression analysis was used to determine if ALM added to age and sex improved the predictive discrimination of five-year and ten-year mortality. At baseline, the average age was 74.9 years, 66.7% were female, 86.3% and 13.7% were prefrail and frail, respectively. The mean ALM was 18.9 kg [standard deviation (SD): 5.5]. During a median 8.9 years of follow-up, 1,307 of 1,487 study participants died (87.9%). Higher ALM was associated with a lower risk of mortality. In a multivariable-adjusted regression model that accounted for demographic, behavioral, clinical, physical function, and frailty characteristics, each SD increase in ALM was associated with an 50% lower risk of mortality [Hazard Ratio: 0.50 (95% CI: 0.27-0.92); P=0.026]. The addition of ALM to age and sex improved the predictive discrimination of five-year (P=0.027) and ten-year (P=0.016) mortality. ALM distinguishes the risk of mortality among prefrail and frail older adults. Additional research examining ALM as a therapeutic target is warranted.
Heparan Sulfate Binding Promotes Accumulation of Intravitreally Delivered Adeno-associated Viral Vectors at the Retina for Enhanced Transduction but Weakly Influences Tropism

ABSTRACT Many adeno-associated virus (AAV) serotypes efficiently transduce the retina when delivered to the subretinal space but show limited success when delivered to the vitreous due to the inner limiting membrane (ILM). Subretinal delivery of AAV serotype 2 (AAV2) and its heparan sulfate (HS)-binding-deficient capsid led to similar expression, indicating transduction of the outer retina occurred by HS-independent mechanisms. However, intravitreal delivery of HS-ablated recombinant AAV2 (rAAV2) led to a 300-fold decrease in transduction compared to AAV2. Fluorescence in situ hybridization of AAV transgenes was used to identify differences in retinal trafficking and revealed that HS binding was responsible for AAV2 accumulation at the ILM. This mechanism was tested on human ex vivo retinas and showed similar accumulation with HS-binding AAV2 capsid only. To evaluate if HS binding could be applied to other AAV serotypes to enhance their transduction, AAV1 and AAV8 were modified to bind HS with a single-amino-acid mutation and tested in mice. Both HS-binding mutants of AAV1 and AAV8 had higher intravitreal transduction than their non-HS-binding parent capsid due to increased retinal accumulation. To understand the influence that HS binding has on tropism, chimeric AAV2 capsids with dual-glycan usage were tested intravitreally in mice. Compared to HS binding alone, these chimeric capsids displayed enhanced transduction that was correlated with a change in tropism. Taken together, these data indicate that HS binding serves to sequester AAV capsids from the vitreous to the ILM but does not influence retinal tropism. The enhanced retinal transduction of HS-binding capsids provides a rational design strategy for engineering capsids for intravitreal delivery. IMPORTANCE Adeno-associated virus (AAV) has become the vector of choice for viral gene transfer and has shown great promise in clinical trials. The need for development of an easy, less invasive injection route for ocular gene therapy is met by intravitreal delivery, but delivery of AAV by this route results in poor transduction outcomes. The inner limiting membrane (ILM) creates a barrier separating the vitreous and the retina. Binding of AAV to heparan sulfate proteoglycan (HSPG) at the ILM may allow the virus to traverse this barrier for better retinal transduction. We show that HSPG binding is correlated with greater accumulation and penetration of AAV in the retina. We demonstrated that this accumulation is conserved across mouse and human retinas and that the addition of HSPG binding to other AAV capsids can increase the number of vectors accumulating at the ILM without dictating tropism.
(Un)becoming the I: A Duoethnography of Displacement

We frame this chapter around personal narratives dealing with issues of displacement as curriculum. This duoethnography examines our stories of becoming and unbecoming as we vacillate within entrenched/marginalized, insider/outsider, I/thou, and privileged/oppressed relationships intrinsic to teaching and learning. In this journey, we imagine the curricular and pedagogical possibilities of becoming co-creators within, and of, learning communities in which members generatively engage one another from distinct perspectives. Our personal stories illustrate issues of sociocultural dissensus along racial, religious, epistemological, and political lines.
Feasibility of baseline neurocognitive assessment using Cogstate during the first month of therapy for childhood leukemia.

Purpose Neurocognitive impairment is frequently observed among acute lymphoblastic leukemia (ALL) survivors within the domains of intelligence, attention, processing speed, working memory, learning, and memory. However, few have investigated treatment-induced changes in neurocognitive function during the first months of treatment. Additionally, dysfunction during treatment may be preceded by changes in biomarkers measured within cerebrospinal fluid (CSF). Identification of acute declines in neurocognitive function, as well as predictive genotypes or biomarkers, could guide therapeutic trials of protective interventions.
Analyzing AVHRR thermal calibration using Sensor Stability for SST (3S) system

Recently, the National Oceanic and Atmospheric Administration (NOAA) performed sea surface temperature (SST) reanalysis (RAN1) from seven AVHRR/3s onboard NOAA-15 to -19 and Metop-A and -B, from 2002-present using operational L1b input. The time series of clear-sky ocean brightness temperatures (BTs) and derived SSTs were found to be unstable. While the SSTs were empirically stabilized against in situ SSTs, the measured BTs were left intact. To better understand the AVHRR calibration and stabilize its BTs, the Sensor Stability for SST (3S) system was established at NOAA, which monitors orbital statistics of the sensor measured blackbody temperatures (BBTs), blackbody counts (BCs), and the space counts (SCs), along with the derived calibration gains and offsets. Other factors affecting the calibration are also monitored, including the Sun and Moon position relative to the sensor, local equator crossing time, and duration of the satellite night. All AVHRRs show long-term and band-specific smooth changes in the calibration gains and offsets, which are occasionally perturbed by spurious non-monotonic anomalies. We argue that the operational quality control (QC) and calibration procedures are suboptimal and should be improved. More stringent QC should be applied, and scan lines with bad calibration should be filled in by interpolation from the best parts of orbit or satellite lifetime. Work is underway to redesign the AVHRR QC and calibration algorithms, reprocess L1b, and use in the subsequent ACSPO SST RANs.
Consumptive Water Use Analysis of Upper Rio Grande Basin in Southern Colorado.

Water resource management and governance at the river basin scale is critical for the sustainable development of rural agrarian regions in the West. This research applies a consumptive water use analysis, inspired by the Water Footprint methodology, to the Upper Rio Grande Basin (RGB) in south central Colorado. The region is characterized by water stress, high dessert conditions, declining land health, and a depleting water table. We utilize region specific data and models to analyze the consumptive water use of RGB. The study reveals that, on an average, RGB experiences three months of water shortage per year due to the unsustainable extraction of groundwater (GW). Our results show that agriculture accounts for 77% of overall water consumption and it relies heavily on an aquifer (about 50% of agricultural consumption) that is being depleted over time. We find that, even though potato cultivation provides the most efficient conversion of groundwater resources into economic value (m3 GW/$) in this region, ...
Evaluation of a Novel Renewable Hepatic Cell Model for Prediction of Clinical CYP3A4 Induction Using a Correlation-Based Relative Induction Score Approach

Metabolism enzyme induction-mediated drug-drug interactions need to be carefully characterized in vitro for drug candidates to predict in vivo safety risk and therapeutic efficiency. Currently, both the Food and Drug Administration and European Medicines Agency recommend using primary human hepatocytes as the gold standard in vitro test system for studying the induction potential of candidate drugs on cytochrome P450 (CYP), CYP3A4, CYP1A2, and CYP2B6. However, primary human hepatocytes are known to bear inherent limitations such as limited supply and large lot-to-lot variations, which result in an experimental burden to qualify new lots. To overcome these shortcomings, a renewable source of human hepatocytes (i.e., Corning HepatoCells) was developed from primary human hepatocytes and was evaluated for in vitro CYP3A4 induction using methods well established by the pharmaceutical industry. HepatoCells have shown mature hepatocyte-like morphology and demonstrated primary hepatocyte-like response to prototypical inducers of all three CYP enzymes with excellent consistency. Importantly, HepatoCells retain a phenobarbital-responsive nuclear translocation of human constitutive androstane receptor from the cytoplasm, characteristic to primary hepatocytes. To validate HepatoCells as a useful tool to predict potential clinical relevant CYP3A4 induction, we tested three different lots of HepatoCells with a group of clinical strong, moderate/weak CYP3A4 inducers, and noninducers. A relative induction score calibration curve-based approach was used for prediction. HepatoCells showed accurate prediction comparable to primary human hepatocytes. Together, these results demonstrate that Corning HepatoCells is a reliable in vitro model for drug-drug interaction studies during the early phase of drug testing.
What Happened to the Complication? The Importance of ACS NSQIP Pediatric in Optimizing Quality Improvement Initiatives for Resident Education

Objective Morbidity and Mortality (M&M) conference is considered the golden hour of surgical education. Most training programs lack standardized methods to evaluate self-reported outcomes and contributions to resident education. The purpose of this study was to determine whether residents underreport pediatric postoperative complications thereby limiting a comprehensive educational opportunity and the ability to adequately perform quality improvement during M&M conference. Design A retrospective analysis of resident reports submitted to the M&M committee at an academic medical center was conducted over 1 year. All complications were compared to the American College of Surgeons (ACS) Pediatric National Surgical Quality Improvement Program (NSQIP) data abstracted over the same period. A descriptive analysis of perioperative events was performed. Setting This study was conducted at the Medical University of South Carolina Medical Center and MUSC Children's Hospital, an academic tertiary care center located in Charleston, South Carolina. Results Overall, 81 complications were captured. Resident and NSQIP databases captured 27 (33%) and 68 (84%) complications, respectively. Residents were more likely to report major complications. More common sources of postoperative morbidity, including surgical site infection and transfusion, were underreported at 20% and 5%, respectively. Conclusions Resident reporting inadequately captures the full complement of pediatric perioperative complications. NSQIP-abstracted data serve as a useful adjunct to traditional M&M reporting in capturing complications underreported by trainees.
Human Resource Management in State and Local Government in the United States: Avoiding Liability for Discrimination Under Title 42 U.S.C. § 1983

Abstract The purpose of this review is to summarize Title 42 U.S.C. §1983, sometimes known as the “other” or “original” federal discrimination law in the United States that applies to elected officials, their appointed public administrators, and other employees in state and local governments. This federal statute provides a procedural process that allows a person to bring a private right of action to seek redress when just laws and policies are administered unjustly by state and local governmental entities. A hypothetical set of facts from a municipal setting is used to explore a typical Title 42 U.S.C. § 1983 proceeding. Included in the review are typical defenses and immunities that make these proceedings for both the complaining party and the political entity complex, if not paradoxical. Strategies to prevent such claims are also discussed. Key words :Title 42 U.S.C. §1983, state and local government, employment discrimination, defenses and immunities.
On the Equality of a Lane Integral and a Stieltjes Mean Sigma Integral

We deal in this paper with an integral which was defined by R. E. Lane [2] and which is an extension of the Stieltjes mean sigma integral introduced by H. L. Smith [3].
Temperature-driven structural identification of a steel girder bridge with an integral abutment

Abstract The Tennessee Department of Transportation (TDOT) visually detected recurring structural damage with one of their steel girder bridges in eastern Tennessee, USA. These issues prompted an investigation into the source of the damage. TDOT approached the structural research team in Tennessee Tech University’s Civil and Environmental Engineering Department with what presented as damage related to thermal effects acting on the Anderson County Route 61 Bridge. In the presented study, temperature-driven structural identification is employed on the Route 61 Bridge to assess the structural damage and determine potential causes of such deterioration. An element-level, finite element model is created to provide insight regarding the bridge behavior. The bridge is field instrumented with monitoring equipment to quantify the bridge responses to daily thermal loads. The quantitative results are then used to calibrate the model and represent the bridge in its current condition. The root cause of the damage is identified through multiple numerical simulations and recommendations are provided for the long-term rehabilitation and preservation of the structure. Overall, the study contributes knowledge regarding the thermal behavior of steel girder integral abutment bridges including expansion/contraction movement, built-up strains/stresses, and potential damage produced by thermal loads. This study also provides illustration of an effective temperature-driven structural identification approach for evaluation of these types of structures.
Landscape of ABO-Incompatible Live Donor Kidney Transplantation in the US.

Background Widespread implementation of ABO-incompatible (ABOi) living donor kidney transplantation (LDKT) has been proposed as a means to partially ameliorate the national shortage of deceased donor kidneys. Acceptance of this practice has been encouraged by reports from experienced centers demonstrating acute rejection (AR) rates similar to those obtained with ABO-compatible (ABOc) LDKT. Acute rejection rate and graft survival after ABOi LDKT on a national level have yet to be fully determined. Study design We studied adult (>18 years) LDKT recipients, from 2000 to 2015, reported to the Scientific Registry of Transplant Recipients. Acute rejection rates in the first post-transplant year (modified Poisson regression) and graft survival (Cox proportional hazards) were assessed by ABO compatibility status (ABOi: 930; ABOc: 89,713). Results Patients undergoing ABOi LDKT had an AR rate of 19.4% compared with 10.5% for ABOc recipients (p Conclusions Based on these findings, the low rates of AR and excellent short-term graft survival presented in single center series may not be sustainable on a national level. These findings highlight the potential utility for identification of centers of excellence and regionalization of ABOi LDKT.
Incident Reporting to Improve Patient Safety: The Effects of Process Variance on Pediatric Patient Safety in the Emergency Department.

ObjectiveMedical errors threaten patient safety, especially in the pediatric emergency department (ED) where overcrowding, multiple handoffs, and workflow interruptions are common. Errors related to process variance involve situations that are not consistent with standard ED operations or routine pa
Aspects of Nonlinearity and Selforganisation in Plastic Deformation

Even though there is strong evidence of multiplicity, nonlinearity and selforganization in plasticity, there is not a general consensus or systematic effort to utilize recent methods of nonlinear physics for understanding bifurcation and patterings of deformation phenomena. An approach recently advocated by the author and his co-workers is briefly outlined here. Emphasis is put on illustrating the origin of plastic instabilities at various levels of observation. Details are given on the problem of the persistent slip bands noted, for example, during cyclic deformation of Cumonocrystals, and of the Portevin-Le Chatelier bands noted, for example, during monotonic deformation of Al-5% Mg polycrystals.
Clinical and blood bank factors in the management of platelet refractoriness and alloimmunization

Numerous independent and interdependent factors are involved in the posttransfusion platelet response. Factors such as ABO match and platelet age are related to circumstances potentially under the control of the blood bank physician and therefore may permit circumvention by an active transfusion service. On the other hand, factors such as fever or sepsis may be unavoidable, being related more to the individual patient or clinical condition. To evaluate which factors could be circumvented, we prospectively followed the 1-hour corrected count increments (CCIs) for 962 single-donor apheresis platelet transfusions to 71 refractory hematologic oncology inpatients, with concomitant recording of implicated factors. Stepwise regression analysis allowed for determination of which concurrent and confounding clinical-, patient-, and blood bank-related factors significantly affected the CCIs. Although many implicated factors proved to be independently associated with an increased or decreased CCI, we found that no single variable consistently explained the CCI variation across the patient population. Each patient appeared sensitive to one or a few particular factors, but because of marked intraindividual variation, it was not possible to identify a priori which factors were important for a given patient. The single exception was a solid-phase red blood cell adherence assay used to cross-match platelets, but only for alloimmunized patients. We also evaluated the utility of requesting HLA-matched platelets from the local suppliers and maintained a clear distinction between platelets simply ordered as HLA matched and actually HLA-identical platelets. Accounting for the confounding clinical-, patient-, and blood bank-related factors, the cross-match assay was a better predictor of an adequate CCI than ordering platelets as HLA matched.
Assessment and intervention for attention-deficit/hyperactivity disorder in the schools. Lessons from the MTA study.

The MTA experience provides several lessons that may have clinical relevance. First, the MTA study identified six key instruments (see Table 1) that clinicians may want to use, but even on these instruments discrepancies in parent and teacher sources should be expected. We believe that unnoticed or unresolved discrepancies may be important factors contributing to the "disconnect" identified by the Consensus Conference Panel. Based on the MTA experience, we recommend a telephone call to the child's teacher, specifically to inquire about any discrepancy in the "source by domain" summary, as an efficient way to make a meaningful connection "... between developmental or educational (school-based) assessments and health-related (medical practice-based) services" for children with ADHD. Second, evaluation of pharmacologic intervention in the MTA study confirmed that teachers' reports are crucial for documenting efficacy, whereas parent reports are crucial for documenting side effects. Based on the MTA experience, we recommend frequent telephone contact with the teacher specifically to inquire about the peak effects and dissipation of effects of medication that are expected to occur during the school hours as a way to improve "... communication between diagnosticians and those who implement and monitor treatment in the schools."
Processes Contributing to the Rapid Development of Extratropical Cyclones

The study of extratropical cyclones has provided the basis for vigorous scientific debates within the meteorological community for at least the past 150 years. In her monograph entitled The Thermal Theory of Cyclones: A History of Meteorological Thought in the Nineteenth Century, Kutzbach (1979) documents the interest of the leading European and American meteorologists of the 19th and early 20th centuries in providing a description of the weather and airflow associated with cyclones and identifying the physical processes that contribute to their development. In the 19th century, the emergence of the so-called “thermal theory of cyclones” (see Fig. 6.1) was based, to a large degree, on the work of Espy, who believed that the decrease of surface pressure in storms is related primarily to the release of latent heat in the ascending air near the storm center. By the early 20th century, the theoretical work of Margules and V. Bjerknes and the observational studies by Dines (which indicated extratropical cyclones were cold core systems) led to a more dynamically based perspective on cyclogenesis. The energy conversions and low-level convergence associated with instabilities in regions marked by significant temperature gradients (especially in the lower troposphere) were recognized as important contributing factors in the development of extra tropical storms.
Factors associated with conjunctival erosions after ahmed glaucoma valve implantation

Purpose: To investigate the frequency of conjunctival erosions in a series of patients who underwent Ahmed valve implantation in a tertiary referral center and to study risk factors associated with the conjunctival erosions. Methods: This is a single-center, retrospective case-control study of all patients who underwent Ahmed valve implantation between October 2006 and July 2016 at the Kresge Eye Institute in Detroit, Michigan. The series consisted of 306 eyes (277 patients) that underwent Ahmed valve implantation. The rate of conjunctival erosions was determined. Univariate, bivariate, and Cox-proportional hazard analyses were performed to identify factors associated with conjunctival erosions. Results: During the study period, 23 erosions occurred in 306 eyes (7.52%). Aphakia was significantly more common in eyes with erosions (P Conclusions: The overall erosion rate was 7.52% in our series. Uveitic glaucoma, aphakia, and longer post-operative use of topical steroids were significantly associated with conjunctival erosions.
Improved long-term patient-reported health and well-being outcomes of early-stage breast cancer treated with partial breast proton therapy.

BACKGROUND Because early-stage breast cancer can be treated successfully by a variety of breast-conservation approaches, long-term quality of life (QoL) is an important consideration in assessing treatment outcomes for these patients. This study compares patient-reported QoL outcomes among women with stage 0-2 disease treated via lumpectomy followed by whole breast irradiation (WBI) or partial breast proton irradiation (PBPT). METHODS In this cross-sectional study, 129 participants evaluated QoL several years post-treatment by responding to subjective instruments, including established scalar questionnaires and self-report measures. Responses were averaged between the two groups. RESULTS At 6.5 years (median) postdiagnosis, participants' demographic, and clinical characteristics were similar. Patient-reported outcomes were reported as mean scale scores for the two groups, all displaying significant differences favoring PBPT, including: cosmetic breast cancer treatment outcome scale (BCTOS) (PBPT mean 1.45, WBI mean 1.88, P < 0.001); breast pain (PBPT mean 1.30, WBI mean 1.67, P < 0.05); breast texture (BPT mean 1.44, WBI mean 1.91, P < 0.001); clothing fit (PBPT mean 1.06, WBI 1.46, P < 0.001); fatigue (PBPT mean 2.24, WBI mean 3.77, P < 0.002); impact of daily life fatigue on personal relations (OBPT mean 0.83, WBI mean 2.15, P < 0.001); and self-consciousness (appearance dissatisfaction) (PBPT mean 1.38, WBI mean 1.77, P < 0.004). CONCLUSION Patients' responses suggest that PBPT is associated with improved overall QoL compared to standard whole breast treatment. These self-perceptions are reported by patients who are 5-10 years post-treatment, and that PBPT may enhance QoL in a multitude of interrelated ways.
Development of an entirely remote, non-physician led hypertension management program.

BACKGROUND Hypertension remains poorly controlled on the population level. National rates of control, even when defined leniently by BP < 140/90 mm Hg, are only ~50%. As growing healthcare costs coincide with tighter blood pressure (BP) targets, innovative management programs are needed to maximize efficiency of care delivery and optimize control. HYPOTHESIS We aimed to develop a remote, navigator-led hypertension innovation program that would leverage algorithmic care pathways, home BP measurements and patient coaching to allow rapid and complete medication titration. METHODS A multidisciplinary group of clinical experts from subspecialties and primary care collaborated to develop an evidence-based clinical algorithm, designed to be automated and administered by non-licensed patient navigators. In the development stage, a prospective pilot cohort of 130 patients was managed by nurse practitioners and pharmacists to ensure efficacy and safety. Patients with clinic BP ≥ 140/90 mm Hg were enrolled and given a Bluetooth-enabled BP device. Home BPs were transmitted automatically into the electronic medical record. Medication titrations were performed by phone at biweekly intervals, based upon weekly average BP, until home BP was controlled at <135/85 mm Hg. RESULTS Eighty-one percent of all enrolled, and 91% of those patients who regularly measured home BP achieved goal, in an average of 7 weeks. Control was reached similarly across races, genders, and ages. CONCLUSIONS A home-based BP control program run by non-physicians can provide efficient, effective and rapid control, suggesting an innovative paradigm for hypertension management. This program is effective, sustainable, adaptable, and scalable to fit current and emerging national systems of healthcare.
Tumour lysis syndrome following eribulin for metastatic uterine leiomyosarcoma.

A middle-aged woman with a history of leiomyosarcoma of the uterus treated with surgery and adjuvant chemotherapy suffered a bulky metastatic recurrence 1 year later. She elected treatment with palliative eribulin, presenting with acute renal failure and electrolyte abnormalities consistent with tumour lysis syndrome on cycle 1 day 8. Despite aggressive supportive care and treatment including intravenous hydration, bicarbonate and rasburicase, she continued to decline, ultimately foregoing haemodialysis in favour of palliative care and passed away in the hospital.
Barriers to creating the next-generation cancer registry.

e17682 Background: The IOM report Delivering High-Quality Cancer Care highlights the need to improve the cancer care system. One idea is to convert current, passive, retrospective cancer registries...
DUCHENNE AND BECKER MUSCULAR DYSTROPHY CARRIERS: EVIDENCE OF CARDIOMYOPATHY BY EXERCISE AND CARDIAC MAGNETIC RESONANCE IMAGING

Lack of defined parameters and varied detection methods have resulted in a broad range of predictions on the prevalence of cardiac disease in carriers of Duchenne and Becker muscular dystrophy (DMD and BMD). Prior studies have been small retrospective samples without genotype confirmation. No study
Neighbourhood disparities in the price of the cheapest cigarettes in the USA

Background There is evidence that the cheapest cigarettes cost even less in neighbourhoods with higher proportions of youth, racial/ethnic minorities and low-income residents. This study examined the relationship between the price of the cheapest cigarette pack and neighbourhood demographics in a representative sample of tobacco retailers in the USA. Methods Data collectors recorded the price of the cheapest cigarette pack (regardless of brand) in 2069 retailers in 2015. Multilevel linear modelling examined the relationship between price and store neighbourhood (census tract) characteristics, specifically median household income and percentage of youth, Black, Asian/Pacific Islander and Hispanic residents. Results Average price for the cheapest pack was $5.17 (SD=1.73) and it was discounted in 19.7% of stores. The price was $0.04 less for each SD increase in the percentage of youth and $0.22 less in neighbourhoods with the lowest as compared with the highest median household incomes. Excluding excise taxes, the average price was $2.48 (SD=0.85), and associations with neighbourhood demographics were similar. Conclusion The cheapest cigarettes cost significantly less in neighbourhoods with a greater percentage of youth and lower median household income. Non-tax mechanisms to increase price, such as minimum price laws and restrictions on discounts/coupons, may increase cheap cigarette prices.
Integrated single cell and bulk multi-omics reveals heterogeneity and early changes in pathways associated with cetuximab resistance in HNSCC sensitive cell lines

Identifying potential mechanisms of resistance while tumor cells still respond to therapy is critical to delay acquired resistance. We generated the first comprehensive multi-omics, bulk and single cell data in sensitive head and neck squamous cell carcinoma (HNSCC) cells to identify immediate responses to cetuximab. Two pathways potentially associated with resistance were focus of the study: regulation of receptor tyrosine kinases through the transcription factor TFAP2A, and epithelial-to-mesenchymal transition (EMT) process. Single cell RNA-seq demonstrates heterogeneity, with cell specific TFAP2A and VIM expression profiles in response to treatment. RNA-seq and ATAC-seq reveal global changes within five days of cetuximab therapy, suggesting early onset of mechanisms of resistance; and corroborates cell line heterogeneity, with different TFAP2A targets or EMT markers affected by therapy. Lack of TFAP2A reduces HNSCC growth and is enhanced by cetuximab and JQ1. Regarding the EMT process, short term cetuximab therapy has the strongest effect on inhibiting migration. TFAP2A silencing does not affect cell migration, supporting an independent role for both mechanisms in resistance. Overall, we show that immediate adaptive transcriptional and epigenetic changes induced by cetuximab are heterogeneous and cell type dependent; and independent mechanisms of resistance arise while tumor cells are still sensitive to therapy.
Gene expression of four targets in situ of the first trimester maternal-fetoplacental interface.

Abstract EPAS1, FSTL3, IGFBP1, and SEMA3C were localized to determine whether expression is decidual, trophoblastic, or both in the human first trimester maternal-fetoplacental interface. Identified on global genome-wide microarray analysis of chorionic villus sampling tissues in preclinical preeclampsia, these targets were predicted to interact by bioinformatics pathways analysis. In situ hybridization (ISH) with mRNA of each gene was conducted in 10 cases of archived first trimester termination tissues. Randomly selected areas of cells by tissue type yielded the relative proportion of cells expressing mRNA signal in decidual and fetoplacental sites. Data were analyzed using Shapiro-Wilk and Kruskal-Wallis tests (p ≤ .05). The average gestational age was 10.2 weeks. Expression signal for each gene differed by cell type (p
Review: Flintstone Modernism, or The Crisis in Postwar American Culture, by Jeffrey Lieber

Jeffrey Lieber Flintstone Modernism, or The Crisis in Postwar American Culture Cambridge, Mass.: MIT Press, 2018, 296 pp., 21 color and 19 b/w illus. $34.95 (cloth), ISBN 9780262037495 Anxiety stimulates creativity. In his new book Flintstone Modernism , Jeffrey Lieber explains how mid-twentieth-century anxiety over a perceived cultural crisis shaped modernist architecture in the United States. Lieber ingeniously relates buildings to fashion photography, advertising, and Hollywood's “sword-and-sandal” epics about the ancient world. He draws upon all of these to analyze International Style structures and the more decorative, historicist buildings of the late 1950s and early 1960s by Eero Saarinen, Edward Durrell Stone, and others. Until recently, these works—the latter in particular—were often dismissed or castigated as retreats from modernism's core values and aesthetics, or as more troubling symptoms of a larger cultural crisis. Lieber frames his narrative with Hannah Arendt's warning about the perceived cultural crisis in her 1958 book The Human Condition .1 Arendt deplored the rise of a technology-obsessed society that masked its totalitarian tendencies with a thin veneer of humanism, resulting in a debased “mass culture.” Lieber asks, “What are some expressions of the crisis in culture?” (2). He finds the answers in buildings, movies, and other related media, though he is not fully clear about the contradiction at the heart of his project. What Arendt saw as expressions of the cultural crisis were actually the solutions offered by government, business, and media to the same problem she saw. Like Arendt, many in these sectors believed their culture was in crisis. To help solve the dilemma, they formulated an architecture that crossed modernism with ancient-world precedents, calling it a new humanism (a goal of many postwar architecture cultures). For example, Rome's Colosseum inspired Stone's United States Pavilion for the 1958 Brussels World's Fair. Such enthusiasm for the ancient world extended far beyond architecture: Cecil B. DeMille's 1956 film The Ten Commandments , for instance, told a …