cssi/SciSciGPT-SciSciNet huggingface dataset:
Foodservice Forecasting: A Comparative Study of Exponential Smoothing and Expert System Models

Abstract The forecast is one of the most critical decisions in the foodservice industry because it is reflected in the material costs, labor costs, labor schedule, and overhead costs. The purpose of this study was to compare the purchasing forecasts using an expert system (knowledge base system) and an exponential smoothing model to the actual usage data in order to determine which one is best for the operation of a university dining center. This university dining center utilized a food court concept. Three of the four service lines were forecast, these lines included mexican, italian, classic, and deli menu options. An expert system previously developed was used. The expert system contained more than 1000 rules that replicate the expertise of the manager of the foodservice operation in forecasting. Data from the fall semester 1993 were used to forecast spring semester 1994 using the exponential smoothing. Different alpha values were tested to find the forecast value with the minimum mean squared error (MSB). The optimum value was α = 0.45. Results showed that in forecasting the classic and mexican lines the expert system model outperformed the exponential smoothing model because it had the lowest mean absolute deviation and mean squared error. However, for the italian line, the exponential smoothing forecast outperformed the expert system.
Illinois-LH: A Denotational and Distributional Approach to Semantics

This paper describes and analyzes our SemEval 2014 Task 1 system. Its features are based on distributional and denotational similarities; word alignment; negation; and hypernym/hyponym, synonym, and antonym relations.
Gram's Stain Does Not Cross the Bacterial Cytoplasmic Membrane.

For well over a century, Hans Christian Gram’s famous staining protocol has been the standard go-to diagnostic for characterizing unknown bacteria. Despite continuous and ubiquitous use, we now demonstrate that the current understanding of the molecular mechanism for this differential stain is largely incorrect. Using the fully complementary time-resolved methods: second-harmonic light-scattering and bright-field transmission microscopy, we present a real-time and membrane specific quantitative characterization of the bacterial uptake of crystal-violet (CV), the dye used in Gram’s protocol. Our observations contradict the currently accepted mechanism which depicts that, for both Gram-negative and Gram-positive bacteria, CV readily traverses the peptidoglycan mesh (PM) and cytoplasmic membrane (CM) before equilibrating within the cytosol. We find that not only is CV unable to traverse the CM but, on the time-scale of the Gram-stain procedure, CV is kinetically trapped within the PM. Our results indicate th...
Rate of Molecular Exchange through the Membranes of Ionic Liquid Filled Polymersomes Dispersed in Water

The permeation of 1-ethyl-3-methylimidazolium ([EMIM]), 1-butyl-3-methylimidazolium ([BMIM]), and 1-butylimidazole through the bilayer membranes of nanoemulsion-like polymersomes was investigated by nuclear magnetic resonance spectroscopy (NMR) techniques. 1,2-Polybutadiene-b-poly(ethylene oxide) (PB–PEO) polymersomes in the ionic liquid (IL) 1-ethyl-3-methylimidazolium bis(trifluoromethylsulfonyl)imide ([EMIM][TFSI]) were prepared by a cosolvent method and then migrated to the aqueous phase, which is not miscible with the IL, at room temperature. In this way stable, nanoscopic domains of the IL (average diameter ca. 200 nm) were dispersed in water. Two similarly sized molecules, charged [EMIM] and neutral 1-butylimidazole, were employed as tracer molecules, and proton NMR (1H NMR) and pulsed-field-gradient NMR (PFG-NMR) experiments were conducted. Furthermore, transient 1H NMR was used with [BMIM] to estimate how rapidly the charged molecules can go through the hydrophobic membrane into the polymersome i...
What to Expect in a Game of Memory

The game of memory is played with a deck of n pairs of cards. The cards in each pair are identical. The deck is shuffled and the cards laid face down. A move consists of flipping over first one car...
XIII. Sausages and luncheon meats. Comprehensive evaluation of fatty acids in foods.

Here are further data in the series on fatty acids in foods. A number of the items listed are applicable to ethnic groups, particularly.
“The More to Draw His Love”: Paradise Lost and the Critique of Misogyny

Earlier critics of Milton’s gender politics generally split into two groups.1 The first denounces the poem as a monument to oppressive patriarchy (as Sandra Gilbert, Mary Nyquist, and Christine Froula have done2), while the second argues that Milton defends Eve, notwithstanding her subordinate position (Barbara Lewalski, Joan Webber, and Diane McColley best represent this position3). As McColley puts it, “we need to observe that in Paradise Lost subordination is not inferiority, and that Milton’s Eve is equal to Adam in sanctitude while remaining, as the Vulgate has it, adjutorium—one who by helping gives delight—in allegiance.”4 The impulse, as always in Milton criticism, is to resolve the matter one way or another, to define Milton as either an unreconstructed misogynist (Nyquist calls Milton “English literature’s paradigmatic patriarch”5) or a prophet of gender equality.6 More recently, such critics as Karen Edwards, Lee Morrissey, and Elisabeth Liebert7 have expressed dismay with the “pendulum swing of blaming or excusing,”8 as Edwards puts it, and have tried to argue for a third way, but in trying to find a way to resolve or go beyond the poem’s antimonies, they too seek to find certainty in Milton’s treatment of gender.9
An Institutional Change in Continuous Renal Replacement Therapy

Background: Critically ill patients with acute kidney injury may require parenteral nutrition (PN) and continuous renal replacement therapy (CRRT). Introduction of a phosphate-free premixed renal replacement fluid without system-wide education in May 2011 resulted in increased incidence of hypophosphatemia, necessitating change in practice. Changes included (1) maximizing phosphate in PN, (2) modifying the CRRT order set, and (3) developing a CRRT competency evaluation for nutrition support team members. This study evaluates the effect of these changes on the incidence of hypophosphatemia. Methods: Phosphate levels and predicated probability of hypophosphatemia were evaluated for patients receiving PN and CRRT over 3 time periods: prior to implementing the changes (preimplementation), during change implementation (intermediate), and following implementation (postimplementation). Hypophosphatemia was defined as a serum phosphate level <2.5 mg/dL. Generalized linear mixed models were applied for statistical...
An Analysis of Urinary Prostate Specific Antigen Before and After Radical Prostatectomy: Evidence for Secretion of Prostate Specific Antigen by the Periurethral Glands

AbstractWe investigated whether urinary prostate specific antigen (PSA) might be a useful marker to detect locally recurrent tumor after radical prostatectomy. We also investigated whether PSA in the first 1 to 5 cc of voided urine is a more useful indicator of urinary PSA levels than the midstream urine PSA, since the first portion of the voided urine contains the highest concentration of prostatic and urethral secretions. To determine the response of urinary PSA to radical prostatectomy, we obtained first voided and midstream urine PSA levels in 18 patients with adenocarcinoma of the prostate before and after surgery. Mean first voided urine PSA levels decreased from 915.1ng./ml. (range 21 to 2,853) preoperatively to 21.4ng./ml (range 0.9 to 88) postoperatively, while mean midstream urine PSA levels decreased from 245.9ng./ml. (range 5 to 1,312) preoperatively to 1.8ng./ml. (range 0 to 20.4) postoperatively.We also obtained postoperative first voided and midstream urine PSA levels in 9 prostate cancer p...
Extended interaction klystrons for submillimeter applications

The extended interaction klystron is one of the few available devices, which are capable of providing the required performance. This presentation describes the extended interaction klystron technology and presents improvements and design modifications in order to extend the operating frequency in to the sub-millimeter region.
Interactive teaching strategies for agent training

Agents learning how to act in new environments can benefit from input from more experienced agents or humans. This paper studies interactive teaching strategies for identifying when a student can benefit from teacher-advice in a reinforcement learning framework. In student-teacher learning, a teacher agent can advise the student on which action to take. Prior work has considered heuristics for the teacher to choose advising opportunities. While these approaches effectively accelerate agent training, they assume that the teacher constantly monitors the student. This assumption may not be satisfied with human teachers, as people incur cognitive costs of monitoring and might not always pay attention. We propose strategies for a teacher and a student to jointly identify advising opportunities so that the teacher is not required to constantly monitor the student. Experimental results show that these approaches reduce the amount of attention required from the teacher compared to teacher-initiated strategies, while maintaining similar learning gains. The empirical evaluation also investigates the effect of the information communicated to the teacher and the quality of the student's initial policy on teaching outcomes.
Differential role of base excision repair proteins in mediating cisplatin cytotoxicity

Interstrand crosslinks (ICLs) are covalent lesions formed by cisplatin. The mechanism for the processing and removal of ICLs by DNA repair proteins involves nucleotide excision repair (NER), homologous recombination (HR) and fanconi anemia (FA) pathways. In this report, we monitored the processing of a flanking uracil adjacent to a cisplatin ICL by the proteins involved in the base excision repair (BER) pathway. Using a combination of extracts, purified proteins, inhibitors, functional assays and cell culture studies, we determined the specific BER proteins required for processing a DNA substrate with a uracil adjacent to a cisplatin ICL. Uracil DNA glycosylase (UNG) is the primary glycosylase responsible for the removal of uracils adjacent to cisplatin ICLs, whereas other uracil glycosylases can process uracils in the context of undamaged DNA. Repair of the uracil adjacent to cisplatin ICLs proceeds through the classical BER pathway, highlighting the importance of specific proteins in this redundant pathway. Removal of uracil is followed by the generation of an abasic site and subsequent cleavage by AP endonuclease 1 (APE1). Inhibition of either the repair or redox domain of APE1 gives rise to cisplatin resistance. Inhibition of the lyase domain of Polymerase β (Polβ) does not influence cisplatin cytotoxicity. In addition, lack of XRCC1 leads to increased DNA damage and results in increased cisplatin cytotoxicity. Our results indicate that BER activation at cisplatin ICLs influences crosslink repair and modulates cisplatin cytotoxicity via specific UNG, APE1 and Polβ polymerase functions.
Shock-structure interaction using background oriented schlieren and digital image correlation

Flight-critical structures can be subjected to blast or shock loadings, e.g., during conflict situations or during supersonic flight operations. It is therefore necessary that structural behavior of the materials used be well understood in such extreme environments. The Background Oriented Schlieren (BOS) technique is applied to study the reflection of shockwave over an inclined aluminum plate in tandem with the 3D DIC technique to study the full field deformation of the back face of the aluminum plates. The mathematical formulation of the BOS technique is used to observe pressure and shock wave fronts. Back face DIC of the aluminum plates can be correlated to the BOS data at the same time and hence providing a more comprehensive way to study fluid structure interaction during a shock wave reflection.
Equivalence of internal and external mixture schemes of single scattering properties in vector radiative transfer

Polarized radiation fields in a turbid medium are influenced by single-scattering properties of scatterers. It is common that media contain two or more types of scatterers, which makes it essential to properly mix single-scattering properties of different types of scatterers in the vector radiative transfer theory. The vector radiative transfer solvers can be divided into two basic categories: the stochastic and deterministic methods. The stochastic method is basically the Monte Carlo method, which can handle scatterers with different scattering properties explicitly. This mixture scheme is called the external mixture scheme in this paper. The deterministic methods, however, can only deal with a single set of scattering properties in the smallest discretized spatial volume. The single-scattering properties of different types of scatterers have to be averaged before they are input to deterministic solvers. This second scheme is called the internal mixture scheme. The equivalence of these two different mixture schemes of scattering properties has not been demonstrated so far. In this paper, polarized radiation fields for several scattering media are solved using the Monte Carlo and successive order of scattering (SOS) methods and scattering media contain two types of scatterers: Rayleigh scatterers (molecules) and Mie scatterers (aerosols). The Monte Carlo and SOS methods employ external and internal mixture schemes of scatterers, respectively. It is found that the percentage differences between radiances solved by these two methods with different mixture schemes are of the order of 0.1%. The differences of Q/I, U/I, and V/I are of the order of 10-5∼10-4, where I, Q, U, and V are the Stokes parameters. Therefore, the equivalence between these two mixture schemes is confirmed to the accuracy level of the radiative transfer numerical benchmarks. This result provides important guidelines for many radiative transfer applications that involve the mixture of different scattering and absorptive particles.
A Three-Dimensional Computational Human Head Model That Captures Live Human Brain Dynamics.

Abstract Diffuse axonal injury (DAI) is a debilitating consequence of traumatic brain injury (TBI) attributed to abnormal stretching of axons caused by blunt head trauma or acceleration of the head. We developed an anatomically accurate, subject-specific, three-dimensional (3D) computational model of the human brain, and used it to study the dynamic deformations in the substructures of the brain when the head is subjected to rotational accelerations. The computational head models use anatomy and morphology of the white matter fibers obtained using MRI. Subject-specific full-field shearing motions in live human brains obtained through a recently developed tagged MRI imaging technique are then used to validate the models by comparing the measured and predicted heterogeneous dynamic mechanical response of the brain. These results are used to elucidate the dynamics of local shearing deformations in the brain substructures caused by rotational acceleration of the head. Our work demonstrates that the rotational...
Multi-Layer Interaction Graph for Analysis and Mitigation of Cascading Outages

This paper proposes a multi-layer interaction graph on cascading outages of power systems as an extension of a single-layer interaction network proposed previously. This multi-layer interaction graph provides a practical framework for the prediction of outage propagation and decision making on mitigation actions. It has multiple layers to, respectively, identify key intra-layer links and components within each layer and key inter-layer links and components between layers, which contribute the most to outage propagation. Each layer focuses on one of several aspects that are critical for system operators’ decision support, such as the number of line outages, the amount of load shedding, and the electrical distance of outage propagation. Besides, the proposed integrated mitigation strategies can limit the propagation of cascading outages by weakening key intra-layer links. All layers are constructed offline from a database of simulated cascades and then used online. A three-layer interaction graph is presented in detail and demonstrated on the Northeastern Power Coordinating Council 48-machine 140-bus system. The key intra- and inter-layer links and key components revealed by the multi-layer interaction graph provide useful insights on the mechanism and mitigation of cascading outages, which cannot be obtained from any single-layer.
Effective conductivity of materials with continuous curved fibers

Abstract Overall conductivity of composites reinforced with in-phase continuous sinusoidal fibers of circular cross-sections is investigated. The effects of the fiber/matrix conductivity contrast, crimp ratio and relative fiber radius are studied. Two approaches are employed for the analysis: direct finite element analysis based on curvilinear periodic unit cells, and micromechanical homogenization based on the conductivity contribution tensor combined with the non-interaction and Mori-Tanaka schemes. In addition, an approach to approximation of the conductivity contribution tensor of a single fiber using an equivalent set of ellipsoids is presented. Comparison of the direct numerical analysis results with micromechanical homogenization shows that the latter approach can be used to estimate all components of the effective conductivity tensor of the considered composite material system with good accuracy. However, the results also indicate that the choice of the micromechanical homogenization scheme for this type of reinforcement depends on the conductivity component being approximated and the fiber/matrix conductivity contrast.
Vigilantismus, Demokratisierung und die Rolle der Polizei

Im Mittelpunkt der folgenden Skizze stehen illegale oder am Rande der Legalitat angesiedelte Gewaltpraktiken der lateinamerikanischen Polizei. Freilich ist das brutale Vorgehen der Polizei keine isolierte Erscheinung, sondern eingebettet in einen allgemeinen Strom von Gewalttaten zur Aufrechterhaltung von Ordnung und Sicherheit, fur den sich im angelsachsischen wissenschaftlichen Sprachgebrauch der Terminus Vigilantismus eingeburgert hat. Vigilantismus meint eine Form der Gewaltanwendung, deren Hauptmerkmale a) ihre Illegalitat und b) die Ziele der Erhaltung und Verteidigung der bestehenden gesellschaftlichen und politischen Verhaltnisse sind. „Man verteidigt eine Ordnung, indem man die Gesetze, auf denen diese Ordnung beruht, bricht“, so konnte man mit einer paradoxen Formulierung die Handlungslogik vigilantistischer Gruppen charakterisieren, andere sprechen kurzerhand von „Establishment-Gewalt“ (Rosenbaum/Sederberg 1976:40. Im folgenden wird zunachst ein allgemeiner Uberblick uber die wichtigsten Formen des Vigilantismus in Lateinamerika gegeben. In einem weiteren Abschnitt wenden wir uns dann der lateinamerikanischen Polizei zu, deren illegale Zwangsmethoden kurz beschrieben und interpretiert werden.
7 – Overview of Volume Rendering

Volume visualization is a method of extracting meaningful information from volumetric data using interactive graphics and imaging. It is concerned with volume data representation, modeling, manipulation, and rendering. Volume data are 3D (possibly time-varying) entities that may have information inside them, may not consist of tangible surfaces and edges, or may be too voluminous to be represented geometrically. They are obtained by sampling, simulation, or modeling techniques. When volumetric data are visualized using a surface-rendering technique, a dimension of information is essentially lost. In response to this, volume rendering techniques were developed that attempt to capture the entire 3D data in a single 2D image. Volume rendering conveys more information than surface-rendered images but at the cost of increased algorithm complexity and consequently increased rendering times. To improve interactivity in volume rendering, many optimization methods both for software and graphics-accelerator implementations as well as several special-purpose volume rendering machines have been developed.
Pricing Retail Electricity: Making Money Selling a Commodity

This paper draws from observations of other deregulated industries to describe the likely transition to competitive retail electricity markets. The paper describes risk-differentiated products and lays out the principles for risk-based pricing. The paper also addresses the strategy of bundling value-added services with retail electricity. Finally, the paper presents conclusions of how successful energy service providers might be able to differentiate their products and avoid the “commodity trap” of price wars and low profit margins.
Rational management approach to pure red cell aplasia

Pure red cell aplasia is an orphan disease, and as such lacks rationally established standard therapies. Most cases are idiopathic; a subset is antibody-mediated. There is overlap between idiopathic cases and those with T-cell large granular lymphocytic leukemia, hypogammaglobulinemia, and low-grade lymphomas. In each of the aforementioned, the pathogenetic mechanisms may involve autoreactive cytotoxic responses. We selected 62 uniformly diagnosed pure red cell aplasia patients and analyzed their pathophysiologic features and responsiveness to rationally applied first-line and salvage therapies in order to propose diagnostic and therapeutic algorithms that may be helpful in guiding the management of prospective patients, 52% of whom were idiopathic, while the others involved large granular lymphocytic leukemia, thymoma, and B-cell dyscrasia. T-cell-mediated responses ranged between a continuum from polyclonal to monoclonal (as seen in large granular lymphocytic leukemia). During a median observation period of 40 months, patients received a median of two different therapies to achieve remission. Frequently used therapy included calcineurin-inhibitors with a steroid taper yielding a first-line overall response rate of 76% (53/70). Oral cyclophosphamide showed activity, albeit lower than that produced by cyclosporine. Intravenous immunoglobulins were effective both in parvovirus patients and in hypogammaglobulinemia cases. In salvage settings, alemtuzumab is active, particularly in large granular lymphocytic leukemia-associated cases. Other potentially useful salvage options include rituximab, anti-thymocyte globulin and bortezomib. The workup of acquired pure red cell aplasia should include investigations of common pathological associations. Most effective therapies are directed against T-cell-mediated immunity, and therapeutic choices need to account for associated conditions that may help in choosing alternative salvage agents, such as intravenous immunoglobulin, alemtuzumab and bortezomib.
Epidermotropic presentation by splenic B‐cell lymphoma: The importance of clinical‐pathologic correlation

There are exceedingly rare reports of patients with epidermotropic B-cell lymphomas. A subset presented with intermittent, variably pruritic papular eruptions and involvement of their spleens, peripheral blood and bone marrow at the time of diagnosis. Furthermore, some experienced an indolent course despite dissemination of their lymphomas. We report a 66-year-old woman with a 12-year history of intermittent eruptions of non-pruritic, salmon-colored papules on her torso and proximal extremities that occurred in winter and resolved with outdoor activity in spring. Skin biopsy revealed an epidermotropic B-cell lymphoma with a non-specific B-cell phenotype and heavy chain class switching with IgG expression. On workup, our patient exhibited mild splenomegaly and low-level involvement of her peripheral blood and bone marrow by a kappa-restricted B-cell population. A splenic B-cell lymphoma was diagnosed. Considering her longstanding history and absences of cytopenias, our patient has been followed without splenectomy or systemic therapy. Furthermore, the papules have responded dramatically to narrowband UVB. Our case and a review of similar rare reports aim to raise awareness among dermatopathologists and dermatologists of a clinically distinct and indolent subset of epidermotropic splenic lymphomas with characteristic clinical and histologic findings.
Multimodality Study of a Twin Pregnancy Within a Rudimentary Horn

Pregnancies within rudimentary horns of unicornuate uteri are extremely rare. These pregnancies account for approximately 1 in 76 000 to 1 in 140 000 worldwide, with uterine rupture being the most ...
What "likes" have got to do with it: Exposure to peers' alcohol-related posts and perceptions of injunctive drinking norms.

ABSTRACTObjective: Examine 1) whether observed social reinforcements (i.e., “likes”) received by peers' alcohol-related social media posts are related to first-year college students' perceptions of peer approval for risky drinking behaviors; and 2) whether associations are moderated by students' alcohol use status. Participants: First-year university students (N = 296) completed an online survey in September, 2014. Method: Participants reported their own alcohol use, friends' alcohol use, perceptions of the typical student's approval for risky drinking, and ranked 10 types of social media posts in terms of the relative numbers of “likes” received when posted by peers. Results: Observed social reinforcement (i.e., “likes”) for peers' alcohol-related posts predicted perceptions of peer approval for risky drinking behaviors among non-drinking students, but not drinking students. Conclusions: For first-year college students who have not yet initiated drinking, observing peers' alcohol-related posts to receive...
The World of Gravity According to Rapp

A former advisee, student, apprentice, and now colleague gives a historical account of Richard H. Rapp’s contributions to our knowledge of the Earth’s gravity field. Clearly, his most prominent products are the spherical harmonic degree models that have emphasized theoretical rigor, wide geodetic applicability, and computational economy, and that are used by scientists and professionals throughout the world. Though the study and development of these models occupied the center of Richard Rapp’s attention over most of his career, he contributed much to related endeavors, including gravity estimation techniques, geoid determination, satellite altimetry data processing, ellipsoidal parameter determination, world height datum definition, sea surface topography, and ocean circulation models. Richard Rapp’s forte and credo are the numerics of data, always with a keen understanding of the underlying theory that they ought to support. His proven methods, organization, and enthusiasm were inculcated in many of his students who now also practice what he (still) preaches.
Cerebral infarcts complicating neonatal leptomeningitis. Acute and residual lesions.

Cerebral infarcts are a complication of neonatal leptomeningitis found in approximately 30% of the autopsy cases. Observations in 9 cases are presented, six acute and three with subacute or residual lesions. Infarction was due to the formation of fibrinous thrombi in leptomeningeal, cortical and subependymal veins during the acute phase of the disease. Involvement of the intracranial sinus was not typical. Endarteriitic changes were present, but neither complete obliteration nor formation of arterial thrombi was observed. Infarcts were located in cortex and underlying white matter, or deep in the periventricular white matter and basal ganglia; the latter localizations appear to be a consequence of ventriculitis. With longer survival the infarcts form multiple large cystic cavities, or abscesses by superinfection. Three cases with longer survival showed a characteristic clustering of multiloculated cavities in the central portion of the hemispheres obliterating fornices and corpus callosum, some communicating with a loculated distended ventricular system.
On the computation of hybrid modes in planar layered waveguides with multiple anisotropic conductive sheets

A reliable method is presented for the computation of the propagation constants and the corresponding hybrid modal fields in multilayered planar dielectric stacks comprising multiple anisotropic co...
The contribution of endogenous glutamatergic input in the ventral respiratory column to respiratory rhythm.

Glutamate is the predominant excitatory neurotransmitter in the ventral respiratory column; however, the contribution of glutamatergic excitation in the individual subregions to respiratory rhythm generation has not been fully delineated. In an adult, in vivo, decerebrate rabbit model during conditions of mild hyperoxic hypercapnia we blocked glutamatergic excitation using the receptor antagonists 2,3-dihydroxy-6-nitro-7-sulfamoyl-benzo[f]quinoxaline-2,3-dione (NBQX) and d(-)-2-amino-5-phosphonopentanoic acid (AP5). Disfacilitation of the preBotzinger Complex caused a decrease in inspiratory and expiratory duration as well as peak phrenic amplitude and ultimately apnea. Disfacilitation of the Botzinger Complex caused a decrease in inspiratory and expiratory duration; subsequent disfacilitation of the preBotzinger Complex resulted in complete loss of the respiratory pattern but maintained tonic inspiratory activity. We conclude that glutamatergic drive to the preBotzinger Complex is essential for respiratory rhythm generation. Glutamatergic drive to the Botzinger Complex significantly affects inspiratory and expiratory phase duration. Botzinger Complex neurons are responsible for maintaining the silent expiratory phase of the phrenic neurogram.
Comparing Diagnostic Evaluations for Rectal Bleeding and Breast Lumps in Primary Care: a Retrospective Cohort Study.

Inadequate diagnostic evaluations of breast lumps and rectal bleeding in primary care are an important source of medical errors. Delays appear particularly common in evaluation of rectal bleeding. Comparing pursuit and completion of diagnostic testing for these two conditions within the same practice settings could help highlight barriers and inform interventions. To examine processes undertaken for diagnostic evaluations of breast lumps and rectal bleeding within the same practices and to compare them with regard to (a) the likelihood that diagnostic tests are ordered according to guidelines and (b) the timeliness of order placement and completion. A retrospective cohort study using explicit chart abstraction methods. Three hundred women aged 30–80 presenting with breast lumps and 300 men and women aged 40–80 years presenting with rectal bleeding to 15 academically affiliated primary care practices, 2012–2016. Rates and timing of test ordering and completion and patterns of visits and communications. At initial presentation, physicians ordered recommended imaging or procedures at higher rates for patients with breast lumps compared to those with rectal bleeding (97% vs. 86% of patients recommended to receive imaging or endoscopy; p < 0.01). Most (90%) patients with breast lumps completed recommended diagnostic testing within 1 month, versus 31% of patients with rectal bleeding (p < 0.01). By 1 year, 7% of patients with breast lumps had not completed indicated imaging, versus 27% of those with rectal bleeding. Patients with breast lumps had fewer subsequent primary care visits related or unrelated to their symptom and had fewer related communications with specialists. The study relied on documented care, and findings may be most generalizable to academically affiliated institutions. Diagnostic processes for rectal bleeding were less frequently guideline-concordant and timely than those for breast lumps. The largest discrepancies occurred in initial ordering of indicated tests and the timeliness of test completion.
Students' Experiences With Death and Dying Prior to Medical School: A Content Analysis of Students' Written Reflections.

Background:Personal experiences with death and dying are common among medical students, but little is known about student attitudes and emotional responses to these experiences. Our objectives were...
Development and Assessment of a Crosswalk Between ICD-9-CM and ICD-10-CM to Identify Patients with Common Pain Conditions

Effective management of patients with pain requires accurate information about the prevalence, outcomes, and co-occurrence of common pain conditions. However, the transition from ICD-9-CM to ICD-10-CM diagnostic coding in 2015 left researchers without methods for comparing the prevalence of pain conditions before and after the transition. In this study, we developed and assessed a diagnostic framework to serve as a crosswalk between ICD-9-CM and ICD-10-CM diagnosis codes for common pain-related health conditions. We refined existing ICD-9-CM definitions for diagnostic clusters of common pain conditions consistent with the US National Pain Strategy and developed corresponding ICD-10-CM definitions. We then assessed the stability of prevalence estimates and associated patient socio-demographic features of each diagnostic cluster during 1-year periods before and after the transition to ICD-10-CM in 3 US health care systems using electronic health records data for in-person encounters. Prevalence estimates and socio-demographic characteristics were similar before and after the transition. The Pain Condition ICD-9-CM to ICD-10-CM Crosswalk includes a full spectrum of common pain conditions to enable prevalence estimates of multiple and chronic overlapping pain conditions. This allows the tool to serve as a foundation for a broad array of pain-related health services research utilizing electronic databases. PERSPECTIVE: This article details the development and assessment of the Pain Condition ICD-9-CM to ICD-10-CM Crosswalk, a diagnostic framework for assessing pain condition prevalence across the ICD-9-CM to ICD-10-CM transition. This framework can serve as a standardized tool for research on pain conditions, including health services and epidemiologic research.
Color and local heritage in gemstone branding: A comparative study of blue zoisite (Tanzanite) and color-change diaspore (Zultanite/Csarite)

Abstract Gemstone value is often associated with origin, as the color, clarity, carat weight, cut, and other attributes of interest to consumers are often associated with the geological location of the stone. In this paper, we consider how the provenance of gemstones is harnessed through the ‘4P’ framework of product, price, promotion, and place. Both tanzanite and Zultanite/Csarite are currently each mined commercially in only one location in the world. Tanzanite is mined in Mererani, near Arusha, Tanzania, and Zultanite/Csarite is mined in Milas, near Mugla, Turkey. While this rarity and other attributes were successfully leveraged so that tanzanite attained global recognition, Zultanite/Csarite has remained largely unknown. Our study examines the potential reasons why tanzanite and Zultanite/Csarite have experienced such different degrees of success on the global gemstone market. Our main findings suggest that rarity and single-origin are not adequate determinants of value, and that consumer preferences for color need to be carefully marketed with a powerful storyline and linked to unique aspects of their place of origin, such as tourism and local culture.
A framework for spatial normalization and voxelwise analysis of diffusion propagators in multiple MAP-MRI data sets

We describe a pipeline for constructing a study-specific template of diffusion propagators measured with mean apparent propagator (MAP) MRI that supports direct voxelwise analysis of differences between propagators across multiple data sets. The pipeline leverages the fact that MAP-MRI is a generalization of diffusion tensor imaging (DTI) and combines simple and robust processing steps from existing tensor-based image registration methods. First, we compute a DTI study template which provides the reference frame and scaling parameters needed to construct a standardized set of MAP-MRI basis functions at each voxel in template space. Next, we transform each diffusion data set, including diffusion weighted images (DWIs) and gradient directions, from native to template space using the corresponding tensor-based deformation fields. Finally, we fit MAP coefficients in template space to the transformed DWIs of each subject using the standardized template of MAP basis functions. The consistency of MAP basis functions across all data sets in template space allows us to: 1. compute a template of propagators by directly averaging MAP coefficients and 2. quantify voxelwise differences between co-registered propagators using the angular dissimilarity, or a probability distance metric, such as the Jensen-Shannon Divergence. We illustrate the application of this method by generating a template of MAP propagators for a cohort of healthy volunteers and show a proof-of-principle example of how this pipeline may be used to detect subtle differences between propagators in a single-subject longitudinal clinical data set. The ability to standardize and analyze multiple clinical MAP-MRI data sets could improve assessments in cross-sectional and single-subject longitudinal clinical studies seeking to detect subtle microstructural changes, such as those occurring in mild traumatic brain injury (mTBI), or during the early stages of neurodegenerative diseases, or cancer.
Close relationships as a contributor to chronic pain pathogenesis: Predicting pain etiology and persistence.

Abstract Rationale. Chronic stress contributes to the pathogenesis of chronic pain. Yet, the role of close relationship stress in these pathways to pain is not fully understood. Objective. To delineate specific psychosocial pathways associated with chronic pain, specifically emphasizing close relationships for midlife adults. We tested whether relationship strain, relationship support, social integration, depression, anxiety, and pain severity predict chronic pain etiology and persistence over 10 years, highlighting specific associations for acute versus chronic pain. Method. Using data from the National Survey of Midlife in the U.S. (MIDUS 2 and 3, collected in 2004–2006 and 2013–2014, respectively), we used logistic regression to test the etiology of new chronic pain (n = 1591) and persistence of pain for adults with acute (n = 352) and chronic pain (n = 367) conditions at baseline. Results. Of participants who reported they did not have chronic pain at baseline, the development of chronic pain 10 years later was significantly associated with baseline family strain (OR = 1.38, p
Assembling seed dormancy genes into a system identified their effects on seedbank longevity in weedy rice.

Seed dormancy (SD) and longevity (SL) may share developmental and genetic mechanisms, as both traits are developed in the same maternal environment and evolved to coordinate the timing of germination and the life span of seedbanks. To test the hypothesis, allelic variants at the SD1-2, 7-1, 7-2, and 12 loci from weedy and cultivated rice (Oryza sativa) were assembled into the same genetic background, and 16 homozygous lines selected as a tetragenic system. These lines were evaluated for SD measured by germination at 7, 21, 35, and 150 days of after-ripening (DAR), and for SL measured by the seed decay rate and survivability in the soil of a rice field for 7 months. Pyramiding the alleles from weedy rice lengthened the dormancy duration, and seeds survived in the soil remained dormant at the excavation. Germination levels at 7 to 150 DAR were correlated positively with the seed decay rate (r = 0.41–0.53) and negatively with the survivability (r = −0.45 to −0.28) in the tetragenic system. All four loci contributed to genotypic variation for each of the SD and SL measurements through main and/or epistatic (two- to four-order interactions) effects. SD7-1 (identical to the pericarp color gene Rc) played a major role in regulating seedbank longevity when interacted with the other SD gene(s). This research provided evidence that natural genes controlling SD are involved in regulation of soil seedbank longevity. Thus, accumulation of SD genes in a population could result in persistence of wild plants and weeds in conventional tillage systems.
Two Ships Passing in the Night—But Shooting Up Flairs From Time to Time!:

Although this article’s author and Ellen Winner completed their graduate training at Harvard’s now extinct Department of Psychology and Social Relations in the 1970s, they pursued divergent paths t...
Renal ultrasound to evaluate for blunt renal trauma in children: A retrospective comparison to contrast enhanced CT imaging.

Summary Introduction The standard imaging modality for hemodynamically stable blunt abdominal trauma patients is a contrast enhanced CT scan, which is reflected in the current AUA urotrauma guidelines. This comes, however, with radiation exposure and the potential sequalae of IV contrast administration in the pediatric patient. Objective We hypothesize that ultrasound imaging would be able to diagnose and rule out clinically significant renal injuries when compared to the gold standard of CT scan in the setting of pediatric blunt abdominal trauma. Study design All children Results There were 76 patients identified, 24 of which had a renal injury (1 bilateral) diagnosed by CT scan for a total of 25 injuries in 152 renal units. There were six grade I-II injuries and 19 grade III-V injuries. The sensitivity of the four blinded reviewers by ultrasound alone to detect the 19 grade III-V injuries ranged from 79 to 100% with NPV between 97 and 100%. Three of the four reviewers identified all 19 grade III-V injuries by ultrasound. When combined with significant hematuria, all 19 grade III-IV injuries were identified. Of note, all patients with a grade III-V injury of the kidney had significant hematuria. Of the grade I-II renal injuries, all reviewers identified 1/5 or 2/5 by ultrasound alone. Discussion The limitations of this study include: its retrospective nature, limited number of patients and reviewers, quality of the ultrasound machine. and experience of technologist, radiologist and urologist. A major limitation is the inability to assess other solid organ injuries during this initial study. Conclusions When compared to a CT scan as the gold standard, kidney ultrasound images had a sensitivity of 79–100% to detect grade III-V injuries and NPV of 97–100% by four blinded reviewers. All grade III-V injuries had either an episode of gross hematuria or microscopic hematuria >50 RBC/hpf. A prospective study that includes full abdominal imaging is needed to confirm that ultrasound can safely be used in place of CT scan for evaluation of hemodynamically stable blunt trauma patients. Summary Table . Patient Characteristics (N = 76) Female 30 (39%) Age in years (median, IQR) 9.4 (6.1–13.5) Number of renal injuries 25 AAST Grade I-II 6 AAST Grade III-V 19 Gross hematuria or >50 RBC/hpf 32 (42%) Diagnostic test performance for ultrasound to diagnose and rule out renal trauma for blinded reviewers All renal trauma Sensitivity NPV Reviewer 1 20/25 (80%) 121/126 (96%) Reviewer 2 20/25 (80%) 125/130 (96%) Reviewer 3 16/25 (64%) 119/127 (93%) Reviewer 4 21/25 (84%) 119/123 (97%) Grade III-V renal trauma Sensitivity NPV Reviewer 1 19/19 (100%) 126/126 (100%) Reviewer 2 19/19 (100%) 130/130 (100%) Reviewer 3 15/19 (79%) 124/128 (97%) Reviewer 4 19/19 (100%) 123/123 (100%) IQR = interquartile range; AAST = American Association for the Surgery of Trauma; RBC = red blood cells; hpf = high power field; NPV = negative predictive value; PPV = positive predictive value; ROC AUC = receiver operating characteristic area under curve
Digital Machine Learning Circuit for Real-Time Stress Detection from Wearable ECG Sensor

This paper presents a digital machine learning circuit for classifying stress condition from chest ECG signal from a wearable sensor. To minimize hardware cost, we use only 5 time-domain features that have much lower area and power consumption than frequency domain or combination of time and frequency domain features as is used conventionally. We test the time-domain features on several machine learning algorithms. Random Forest classifier shows the best classification accuracy of 0.96 with the time-domain features at an estimated power consumption of only 1.16mW at 65nm CMOS process which demonstrates feasibility of embedding a machine learning classifier in a wearable ECG sensor for real-time, continuous stress detection.
Retinal degeneration-3 protein promotes photoreceptor survival by suppressing activation of guanylyl cyclase rather than accelerating GMP recycling

Retinal degeneration-3 protein (RD3) deficiency causes photoreceptor dysfunction and rapid degeneration in the rd3 mouse strain and in human Leber's congenital amaurosis, a congenital retinal dystrophy that results in early vision loss. However, the mechanisms responsible for photoreceptor death remain unclear. Here, we tested two hypothesized biochemical events that may underlie photoreceptor death: (i) the failure to prevent aberrant activation of retinal guanylyl cyclase (RetGC) by calcium-sensor proteins (GCAPs) versus (ii) the reduction of GMP phosphorylation rate, preventing its recycling to GDP/GTP. We found that GMP converts to GDP/GTP in the photoreceptor fraction of the retina ∼24-fold faster in WT mice and ∼400-fold faster in rd3 mice than GTP conversion to cGMP by RetGC. Adding purified RD3 to the retinal extracts inhibited RetGC 4-fold but did not affect GMP phosphorylation in wildtype or rd3 retinas. RD3-deficient photoreceptors rapidly degenerated in rd3 mice that were reared in constant darkness to prevent light-activated GTP consumption via RetGC and phosphodiesterase 6. In contrast, rd3 degeneration was alleviated by deletion of GCAPs. After 2.5 months, only ∼40% of photoreceptors remained in rd3/rd3 retinas. Deletion of GCAP1 or GCAP2 alone preserved 68% and 57% of photoreceptors, respectively, whereas deletion of GCAP1 and GCAP2 together preserved 86%. Taken together, our in vitro and in vivo results support the hypothesis that RD3 prevents photoreceptor death primarily by suppressing activation of RetGC by both GCAP1 and GCAP2 but do not support the hypothesis that RD3 plays a significant role in GMP recycling.
Vital Conversations: An Interactive Conflict Resolution Training Session for Fourth-Year Medical Students.

Introduction The AAMC has recognized the importance of effective teamwork and collaboration. One core Entrustable Professional Activity emphasizes creating a climate of mutual respect and trust and...
Studies on ketosteroids in urine of normal children using alumina chromatographic fractionation.

Patterns of urinary excretion of ketosteroids in eight normal children, four males and four females, ranging in age from 3 to 5 years, were determined by alumina chromatography. The method has also been applied to urines of five normal adults. The patterns of excretion in these boys and girls were alike. Comparison of patterns of excretion of children with those of normal adults reveals important differences. There is a relatively lower excretion of androsterone and etiocholanolone. The 11-oxy l7-ketosteroid excretion is percentage-wise the same in children as in adults. There is a relative increase in other unidentified ketosteroid metabolites.